Recognizing that a patient is psychotic is not the same as finding the reason why. My doctors saw the behavior and missed its cause.
If I were to search my house for spyware, I was determined to do it thoroughly. Every square inch must be considered, or I would risk missing some stealthy device. Unfortunately, what followed was the complete and utter destruction of my home.
I was a physician in my mid-50s, convinced that shadowy foreign interests had planted listening devices in my house in Menlo Park, California. My approach to being thorough was to conduct a methodical search of each room in the house, one by one, in an orderly fashion.
Regrettably, this required pulling all the drywall off the studs, removing all the fiberglass insulation (even up in the attic), and taking out the HVAC ducting. Everything got tossed out into the driveway along the side of the house.
Fortunately I had plenty of time on my hands, having recently been fired from my job at Valley Medical Center for suspected hacking — a side effect of my paranoia. Working tirelessly throughout the week, I took things a step further by removing every window. Since the window casings were metal and could conduct electrical signals, I removed them as well. I was a busy beaver, impressively industrious.
I was certain that my perseverance would soon pay off. After the windows came out, I turned my attention to the electrical wiring. Over the next couple of weeks, I removed all of it, forcing myself to rely on no more than a dim bulb in a ceiling lamp in the living room powered by my car battery.
How ironic, one dim bulb using another.
By then my distorted reasoning had taken another leap. Having recently had a mild case of sore throat, I believed my adversaries were targeting my thyroid with an electromagnetic beam, using nearby metal objects as antennas to channel its deadly energy. Removing the wiring would thwart their efforts to induce thyroid cancer. Diabolical, I thought. Clever, even. But terrifying.
When I opened the electrical panel, the line supplied by the electrical company was still coming in hot. I briefly asked myself, “What’s the worst thing that could happen?” I was about to find out.
As I unscrewed the last wire, a blinding flash resulted in a small yet impressive explosion. The blast knocked me back with considerable force and startled me greatly, though I wasn’t injured.
Silly me. This one incident could have easily been a fatal mistake.
As my house demolition approached completion, there was no sign of anything resembling spyware. I was both surprised and disappointed. I’d been certain that I’d find something.
The absence of evidence didn’t persuade me that I was wrong. It persuaded me that the spyware was exceedingly sophisticated. I moved my mattress into the backyard and slept with a large kitchen knife under my pillow. These were sensible precautions according to the terms of the reality I was then inhabiting.
My nightmare had begun months earlier when I sought care for my overwhelming daytime sleepiness. An initial sleep study confirmed severe obstructive sleep apnea, a condition in which breathing repeatedly stops during sleep. But a second specialist dismissed that evidence out of hand, diagnosed a different disorder, and prescribed Mirapex and Provigil at doses that eventually far exceeded the manufacturers’ recommended limits.
The combination of sleep deprivation and medication-induced psychosis eliminated my ability to perceive the world accurately. The world had become a very dangerous place, especially for me.
There was no question that I was profoundly disturbed. My family could see it. My doctors could see it. But what more than a dozen psychiatrists failed to identify was why. Instead, I was labeled bipolar and cycled through 18 different psychiatric medications over the course of six months.
My behavior supplied ample evidence of psychosis, but it didn’t establish that I had bipolar disorder. Yet, once that diagnosis was in my chart, my deterioration was interpreted through it. My objections to the medications became evidence that I lacked insight into my illness.
During my final hospitalization, a psychiatrist failed to continue prescribing Mirapex and Provigil. A slow return to sanity began to stir. By then, my career, finances, and relationships — along with my home — all lay in ruins. Regaining my grasp on reality didn’t give me back the life I’d lost.
For patients, families, and doctors confronting a frightening change in behavior, my experience points to three questions for which we should insist on answers from any physicians treating us:
1. What changed before the symptoms began? Write the medication names, doses, dose increases, and changes (in my case, with sleep) on a timeline. Make sure the treating doctor reviews it.
2. What other causes have been considered? Ask what supports the diagnosis and whether medications or an underlying medical condition could account for the symptoms.
3. If treatment is making me worse, why are we continuing on the same course? Ask for a diagnostic reassessment and, if necessary, a second opinion.
Dear Doctors, if your treatment isn’t working as planned, you might want to revisit your diagnosis. Doctors who fall in love with their diagnosis are just asking for trouble.
I tore apart my house because I could no longer question what I believed. My doctors, on the other hand, were entirely capable of questioning what they believed. I needed them to, and they failed at that most fundamental task.
White Coats and Black Swans by Scott Standage, MD
Scott Standage, MD, is a Stanford-trained specialist in physical medicine and rehabilitation (PM&R) with more than two decades of clinical experience in musculoskeletal and neurological rehabilitation. He’s practiced medicine at leading institutions, including Stanford and Santa Clara Valley Medical Center, and currently sees patients at an outpatient clinic in California. After being misdiagnosed and treated with powerful psychiatric medications for a sleep disorder, he endured years of medical maltreatment that cost him his career, his reputation, and nearly his life. His new book, White Coats and Black Swans: A Doctor’s Descent into Misdiagnosis and Madness (Amplify Publishing, Oct. 13, 2026), advocates for diagnostic reform, mental health accountability, and evidence-based treatment pathways. Learn more at scottstandage.com.
Disclaimer: This article is for general informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional before making decisions about your health, including changes to your diet, exercise, supplements, or medications.
