White Coats and Black Swans

A Doctor’s Descent Into Misdiagnosis and Madness

When Scott Standage, MD—a successful rehabilitation medicine physician—began experiencing persistent fatigue, brain fog, and extreme daytime sleepiness, he initially assumed the cause was stress or burnout. Instead, a sleep study revealed severe obstructive sleep apnea (OSA), a common condition that is serious if untreated but straightforwardly managed with appropriate care. Yet when he sought treatment through his healthcare network, the diagnosis was outright dismissed. Instead, doctors incorrectly labeled him with periodic limb movement disorder (PLMD)—a rare, widely disputed diagnosis that many sleep experts question as even legitimate—and prescribed powerful psychoactive medications. Predictably, his symptoms spiraled.

What followed was a devastating descent into full-blown psychosis—paranoid delusions, multiple involuntary psychiatric holds, career collapse, and nearly total social rejection. The true cause? Misdiagnosis, untreated sleep apnea, and polypharmacy. As both a doctor and a patient, Scott was uniquely positioned to understand the system’s failures—but powerless to escape them. His survival—and the consequences he still carries—along with his hard-fought legal vindication expose a profound diagnostic failure at the center of modern medicine.