As a physician, I spent my career diagnosing and treating patients, and trusted in medicine’s scientific methods and the medical system. But when I became a patient myself, I discovered firsthand how fragile that system can be and how quickly it can turn against those it’s meant to help.
I was battling severe obstructive sleep apnea — a common condition that’s serious (and can be fatal) if untreated but readily managed with appropriate care. However, it was misdiagnosed by the Northern California Director of Sleep Medicine for Kaiser, no less. What followed was my descent into the vortex of a medical malpractice nightmare.
Over the ensuing years, the director’s serious misdiagnosis and a cascade of missteps by a dozen psychiatrists left me grappling with the aftermath of a paranoid, manic psychosis that was both substance-induced (by his prescription medications) and general medical condition-induced (by the untreated severe chronic sleep deprivation). As a result, I lost my sanity, my medical reputation, and nearly my life.
Soon after I began taking the prescribed regimen of a psychoactive medication, things went bad in a big hurry. What had previously seemed to be a full but manageable life now became overwhelming. As I got worse, I made multiple calls and emails, even as direct as “I’m a walking zombie. Do I perhaps have narcolepsy?” Almost without exception, they went unanswered.
Treatment failure is nature’s way of telling doctors that the diagnosis should be reconsidered. Yet, nearly two years after my initial visit, the director instead decided to pile on another extremely powerful psychoactive medication. It was gasoline on the fire.
My resulting substance-induced paranoia eventually drove my family to enlist a family friend to intervene. He called the police, who delivered me to a psychiatric ward. To any lucid observer, it would seem that I was finally in the right place to reverse the misdiagnosis and overly prescribed — and contraindicated — medications. Undoubtedly, doctors in a psych ward are well-versed in addressing the effects and dosage levels of psychoactive medication and would determine the cause of my severe symptoms through their diagnostic procedure. Well, we should doubt the undoubtable.
The move was a disaster: that friend scribbled a handwritten note saying that I’d previously been diagnosed as bipolar (an incurable mental illness), and posed as my cousin. Both claims were terrible fictions. It may be that he was hoping to encourage the staff to take my case seriously, but the result was that I was treated as bipolar with no investigation though I was categorically not. None of the doctors tried to confirm his identity either. Of eight psychiatric holds over the course of my psychosis, every doctor treated the story as settled fact.
This wasn’t just bad medicine. It was a medical train wreck that doomed me. Wrong diagnosis led to wrong medication, wrong medication led to side effects, new side effects led to new diagnoses. It was a chain of dominos I nearly didn’t escape from.
But through the strength of persistence, my own allies, and glimmers of hope, I eventually emerged from the nightmare. Later, I won a rare legal victory in a wide-ranging malpractice case that underscored the systemic failures in my treatment.
Here are lessons from my story I hope will be instructive for patients, their families and advocates, and the medical establishment:
1. If this could happen to a doctor, it could happen to anyone.
I understood medical terminology, knew how healthcare systems operated, and had professional relationships with other physicians. None of that protected me once an incorrect diagnosis entered my record and my behavior began to be interpreted through a psychiatric lens. Most patients have less medical knowledge, fewer resources, and less ability to challenge the system than I did.
2. A diagnosis is a hypothesis, not a verdict.
Doctors are trained to construct a well-considered differential diagnosis: a list of plausible explanations that must be investigated and ruled in or out. In my case, that basic discipline was abandoned in each and every hospitalization. Once the first doctor decided I had periodic limb movement disorder, and once the first of twelve psychiatrists decided I was bipolar, I was trapped. Clinician after clinician largely accepted the label and treated my worsening symptoms as reasons to add medication rather than reasons to question the original diagnosis.
3. Sleep disorders can produce symptoms that appear psychiatric.
Severe, untreated obstructive sleep apnea doesn’t simply make a person tired. Chronic sleep fragmentation and oxygen deprivation can impair memory, concentration, judgment, emotional regulation, and the ability to distinguish reality from delusion — particularly when stimulants and other psychoactive drugs are added. Before assigning a lifelong psychiatric diagnosis, doctors must investigate physical, neurological, sleep-related, and medication-induced causes.
4. Multiple medications can manifest as the illness it is supposed to treat.
I was prescribed multiple powerful medications, sometimes at extraordinarily high doses, with too little attention paid to their interactions, side effects, or failure to improve my underlying condition. As my health deteriorated, the response was repeatedly to add another drug. Medication can save lives, but prescribing more drugs to treat symptoms caused by existing drugs can create a medical train wreck.
5. A psychiatric label can strip a patient of credibility and control.
Once I was labeled bipolar, nearly everything I said or did was treated as further evidence of mental illness. My objections were written off as the opinions of a mentally ill patient in denial of his illness. I was repeatedly hospitalized against my will, and other people gained control over my medical and financial decisions with a conservatorship. My eventual recovery and complete legal vindication came after a years-long court battle. That won’t erase the damage done. But it does show that psychiatric patients need a far better treatment system, including psychiatrists to make a genuine commitment to a well-considered differential diagnosis, meaningful safeguards, and advocates willing to keep asking questions when the official story doesn’t add up.
What happened to me is an urgent argument for better medicine: greater diagnostic curiosity, more accountability, a commitment to follow national diagnostic guidelines, and a willingness to question, investigate, and listen when a patient’s symptoms don’t fit the label in the chart and treatment failure is evident. It’s critical that the healthcare community understand the human consequences of diagnostic shortcuts.
By Scott Standage, MD
Scott Standage, MD, is a Stanford-trained specialist in physical medicine and rehabilitation (PM&R) with 20+ years 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. He was first misdiagnosed and treated with powerful psychiatric medications for a sleep disorder, then suffered from a cascade of side effects and subsequent medical missteps that nearly cost him his relationships, his career, his home, 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.
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