RealMental

My post about my first appointment with my (psycho) psychiatrist made a couple of waves in the mental health blogging world. Phil from Furious Seasons did a huge post on it, and told me it was one of the “worst stories I’ve ever heard,” which, coming from a dude who blogs exclusively on mental health injustices, is pretty bad. Liz Spikol from The Trouble with Spikol also picked it up, with the title, “This is why people don’t trust doctors,” calling the experience “bizarre” and stating, “I have heard of similar experiences, but only with cults.”

It was nice to have others recognize how horrible this situation was. Unfortunately, it didn’t really change my situation.

After that first appointment, I vowed I would never go back to psycho psychiatrist again. I went to my family doctor and told her what happened, (she was horrified and said, “Maybe she was hypomanic that day!”) and she agreed to refer me to another psychiatrist.

The problem is this is a small city with a limited number of psychiatrists, and the majority of them work in the same clinic downtown. I made sure that she referred me to a psychiatrist who had a private clinic so there wouldn’t be any problems.

A few weeks later, I got a call back from my doctor’s office saying that the psychiatrist’s office had rejected my referral, stating that it’s his policy not to accept any patients who have already been seen by another psychiatrist in the city.

My doctor tried to refer me to another psychiatrist, again in a private clinic, and his office also rejected my referral, based on a “conflict of interest” because I had already seen another psychiatrist.

[And may I also mention that before I even went to psycho psychiatrist, I tried to get in with my mom’s psychiatrist, and he also refused to see me because he felt it was a “conflict of interest” to see two members of the same family.]

So, not only is it really difficult to get in with a psychiatrist in the first place, once you get in, you’re stuck with her no matter what, because everyone else will refuse to see you because they don’t want to get involved in any drama that may be going on between other psychiatrists and their patients.

Aaaaaaaaaaghhhh!

I didn’t feel like I had much of a choice, because I strongly felt I needed a psychiatrist to monitor me because of my family history. Unless I wanted to try and get referred to a psychiatrist in one of the neighbouring cities, wait another six months to get in with him/her and then take time off work to drive a few hours to my appointments, I was stuck.

So, I did what any semi-sane person would do: I went back.

But I went back armed with six months of mood charts, a list of supplements and drugs I’m taking and a very guarded attitude.

It was six months after the first appointment. And the weirdest thing happened.

She was nice.

She smiled, she laughed, she was friendly and helpful.

It was like she had switched personalities since the last time I saw her. This was the woman my doctor had described when she first referred me to a psychiatrist. This is the woman I wish I had had during my first psych appointment when I was scared and vulnerable.

Maybe she has some kind of personality disorder?

I think I’ve also learned how to deal with her. One of the first things I did was hand her a piece of paper with all my supplements and drugs listed, along with the doses. She exclaimed, “Oh, I wish all my patients did this. This is so helpful!”

I then said things like, “I took your advice and started taking fish oil supplements, and I noticed a real difference.”

“I took your advice and went off the Wellbutrin, and I’m really glad I did because I don’t think it was a good drug for me. I feel much better now just on the Celexa, as you suggested.”

“I took your advice and kept a daily mood log, and I’ve brought a graph of all my moods for the past six months here with me for you to look at.”

She was really pleased. “You’re doing everything right! You’re doing so well!”

Of course I was: I had followed all her advice and made sure she knew it.

We looked at my mood graph together and she agreed that there was no hypomania there. I reminded her that the only time in my life that I’ve ever felt hypomanic was when the Effexor made me wonky and again with a high dose of Wellbutrin.

She hasn’t deviated from the initial diagnosis as far as I can tell, but she was much better to deal with this time, and didn’t push any additional drugs on me. She just said we’d monitor it and only respond if something changes. She didn’t try to get me to go off the Celexa either.

So, while the situation isn’t ideal, I think I can work with this woman, particularly if I only have to see her once every six months.

I don’t think I can ever fully trust her, though, because I will never forget the things she said/did during the first appointment and the horrible way she made me feel.

The main problem with this psychiatrist, as far as I can tell, is that she needs to be the authority figure. She doesn’t know what to do with an educated, intelligent women who has done her research and who knows her mind/body/mood well.

During my first appointment, my psychiatrist was very defensive and aggressive, and it seemed as though she was threatened by me asserting myself and not agreeing with everything she said. If I had to guess, it was that dynamic that led to the weird behaviour/accusations on her part.

I was able to diffuse that dynamic by appeasing her in the second appointment, but I did notice that anytime I spoke too much, inserted my opinion, or let my guard down and tried to crack a joke, she would cut me off and dismiss me.

So, it’s all about walking that fine line with her. Acting the part of the patient and choosing my battles in order to get the care that I need in the very weird system we’ve got going on here.

My next appointment is in December. Hopefully, I’ll get her nice personality again. Wish me luck.

In geography class, we learned that a plateau is a geologic formation, with a flat top and often, sheer or highly-angled slopes supporting it.  It’s easy to recognize when you’re looking at pictures, or approaching one on a hike through the desert.

In psychiatry’s life class, I learned that it’s what they call it when you’ve reached your maximum efficacy on the dosage you’re taking, and it’s time to go up.  The problem is that psychiatric plateaus are not obvious.  You know the lift from the desert of depression to the top, the stable flat line you can walk for a while, not tripping and stumbling as on your climb to the top.  You don’t realize you’ve reached the end, until you start sliding down the psychiatric plateau’s more gently sloped sides, until you’re halfway down, and then you have to stop yourself, skidding on the rocks and dirt, before flipping yourself over, and climb your way back up, sometimes on hands and knees.

I’ve been climbing my way back to the top, hands and knees scratched and bloody, head pounding and breath shaky from the screeching halt I’ve pulled myself to, and the flat top is once again in sight.  But I’m tired of sliding, and each time I slide I berate myself for not learning, yet, my internal geography, for not knowing the edges of my equilibrium, my flat surfaces, and for not knowing that the plateau doesn’t go on forever in my head, as it does not in nature.  Those mental plateaus, they surprise you, in a way the physical ones don’t.

The art historians call it a Dutch Heaven, for its prevalence in the land and seascapes of the old Dutch and Flemish master painters. You’ve seen it, even if you didn’t know what it was called. Those tall, puffy clouds in a deep, blue sky, flattened and slightly grey at the bottom, teased, white, and cottony at the top– the kind of cloud that can dissipate into wisps in a completely sunny sky, or roll into thunderheads letting loose torrents in a moment’s notice. The sun shines through or on top of those clouds, and the depth of the blue sky is heightened by the contrast of the sun and the grey and silver and white clouds, the beauty of the sun more poignant for the threat of rain.

Even well medicated, the threat of mercurial moods shines through. The introspection that is necessary to maintaining a healthy balance, of not letting the natural mood cycles extend beyond “merely” moody and happy, can cause me to call into question whether the sunshine is actually about to turn into parching desert sun, or whether the rainclouds are presaging a hurricane.

Sometimes, though, a mood is just a mood, and a partly cloudy, partly sunny sky is just a Dutch Heaven. Mine, too.

I’ve been musing on how the adult child thing can rear its head in good times as well as bad– particularly the feeling inadequate thing. I had the extreme blessing of being able to go to BlogHer08 this weekend. All around, I met women whose blogs I’d admired from afar, and others whose blogs I’d not yet encountered. I got to meet bloggy friends, and I met people who’d read my site. All around, everyone was being affirming, interested, curious about one anothers’ experiences, motivations, and writing.

Having some of that positive stuff directed at me ended up being really hard to handle, even as I was meeting people who I wanted to meet, to hug, to praise. I have no problem praising others. I want to, it feels important, it’s a part of what I’d like to see the world become– affirming, supportive, other-centered. But getting praise? Being the object of interest? That’s another story.

My adult-childness developed not in the scenario of overt abuse, neglect, etcetera– really, I know, it could have been so much worse. But even as the adult child of “merely” divorced parents who were preoccupied with their own (admittedly real) shit, the fact remains that I was forced to step forward to care for myself, to try to care for my brother. Whether or not I succeeded is beside the point– the fact is, I was made to try. I was never told, “this is something you shouldn’t have to take on.” Rather, it was a relief to them, that I was able to take care of myself.

Suffice it to say that having grown up not receiving praise for extraordinary efforts, having had success expected of me as a matter of course, and having no attention paid me should I fall short of whatever their mark happened to be, being on the receiving end of positive attention is . . . anxiety-inducing. It skews my perception of what’s ordinary, where the expectations lie. I keep thinking, “it’s not hard,” or “if they really knew,” or worse yet, “what’s the catch?” Except, of course, this is BlogHer. They do really know, it is hard sometimes, and there is no catch– these women bare their own wounds, and by their support and praise clean and bind those wounds I voluntarily bare for exploration. And yet, I still find it hard to believe– as much as I put my content out there for catharsis and on the off chance that it might be helpful to someone else, spare them the misery I’ve felt, I nonetheless doubt I have something important to say.

It got to the point where I had a little bit of a meltdown Saturday night, and had to get out, go have dinner with my husband while I didn’t really talk. (He’s very patient with my semi-catatonic states like that.) There was so much to take in, and overwhelming is still overwhelming, even if the stuff you’re being overwhelmed with is good. I missed most of the closing party because I just needed to be quiet and have no more input for a bit– which makes me sad, because there were lots of “old” and “new” friends I wanted to talk to. But I couldn’t do it, without a time out to put my game face on. I did get back in time to catch up with some of the folks I wanted to see– but now I’ve some regrets for others with whom I didn’t get to spend more time. Great– now I’ve got self-inflicted wounds, too.

In high school, I had a friend who was perpetually insecure, who was actually great, fabulous, wonderful. It came to be a joke between us when I would reassure her or praise her about something, that if she couldn’t believe herself, she should at least believe me, because as everyone knew, I was always right. The tag line was, “because I said so.” So that’s my resolution (among other things) coming out of BH: even as I am trying to put my “because I said so” out into the blogoverse, I am going to try to remember that my own stuff is interesting, “because they said so.” Thanks, they.

Liz Spikol posted a very awesome video about depression advice over at her blog yesterday. It makes light of that oh-too-familiar advice that we get from well-meaning people who have no clue what it’s like to be depressed.

If only laughter really were the best medicine. For now, I’m sticking with my Celexa.

I’ve been told to “snap out of it”, to turn up some music and dance around my living room, and to quit taking things so seriously by people who couldn’t understand why I was debilitatingly depressed or anxious.

They meant well, but they had no idea what they were dealing with because they have never experienced it. Their advice only served to make me feel like more of a failure because I was unable to control something they thought was so easy to solve. It made the gulf between me and what was “normal” even wider.

What’s the worst, most ignorant, or most insulting advice you’ve ever gotten from someone in regards to your mental illness?

At the end of September, when the antidepressant I was on made me go wonky, I asked my doctor to refer me to a psychiatrist.

 And then I waited.

 And waited.

 And waited some more.

 Because, while I usually have nothing but praises to sing about the Canadian health care system, when it comes to mental health care, if you don’t have a knife to your throat, you’re shit out of luck. If you want to get in with a psychiatrist for the first time, you have to wait three to six months, no matter how bad you are doing. As long as you’re not actively suicidal or homicidal, you wait.

 I waited five months. By the time my appointment came up, I was feeling fine. My drugs were working and I wondered if I even needed a psychiatrist after all. But, given my family history, I decided to go anyway. It couldn’t hurt, right?

 Wrong. Oh, so very wrong.

 The psychiatrist, whom I shall call Dr. R, came very highly recommended from my family doctor. I had told her, “I want someone who will allow me to be an active participant in my own care, who will listen to me.” She said this woman is fantastic and very compassionate. I adore my family doctor and we get along quite well, so I trusted her opinion.

 My appointment was three weeks after I had major jaw surgery, and only one week after I had my jaw unwired, so I was still on some painkillers and having problems getting enough calories into my body. That didn’t really help my emotional state going into the appointment.

 However, I was determined to have a positive attitude and to be open-minded. Sitting in that waiting room, I tried not to be nervous and instead psyched myself up (hah), telling myself: this is something I’m doing to make my life better and ensure I am going to be healthy long into the future.

 I quickly figured out that this appointment wasn’t what I was hoping it would be, no matter how much positive energy I tried to throw at it. The moment I told Dr. R my family history and the adverse reactions I had to the Effexor and Wellbutrin, she decided I was Bipolar II and tried to fit everything I said into that diagnosis.

 I’m not disputing the diagnosis itself; it’s a fair hypothesis, and one that I have considered myself. However, I have a huge problem with a doctor diagnosing a patient within five minutes and then “accusing” her of all kinds of behaviour that doesn’t exist.

As the “interview” (or interrogation, as it became) went on, the two of us got more and more frustrated, and the conversation grew heated. She was frustrated because I refused to just accept what she was telling me about myself, and I was frustrated because she wasn’t listening to me or considering my explanations for my decisions or behaviours.

 And then it just got plain weird.

 Dr. R: Do you ever spend large amounts of money?

Savia: Sure. I have a house. I’m doing home renovations right now.

Dr. R: How are you paying for that?

Savia: A line of credit.

Dr. R: That’s hypomanic, irresponsible financial behaviour.

Savia: But I’m making an investment in my home, and my house value has quadrupled in the past seven years.

Dr. R: Going into debt for any reason is hypomanic.

Savia: What? But it’s not just any debt. It’s good debt.

Dr. R: There is no such thing as good debt.

Savia: But… [about to explain how her sewer blew up and also how the energy efficient renovations were eligible for a $3,000 government grant, which would pretty much pay for them, not to mention the savings on the monthly energy bills.]

Dr. R: [Cuts me off] The only way it would be acceptable for you to go into debt for home renovations is if you were selling your house and would get the money back right away.

Savia: [looks at her like she’s on smack] I guess we’ll have to agree to disagree on that one.

 Note how she didn’t even ask how much money I make or how much the home renovations cost or any other details that would have explained why I was going into debt for this project? It was all about absolutes. And let me just say, if going into debt for any reason makes a person bipolar, I guess the majority of North Americans have this disorder. Maybe that’s why it’s so hard to get in with a psychiatrist?

 After that, it quickly went downhill. She snapped her questions at me and cut off my answers. Any time I tried to explain or elaborate on one of my answers, she said, “You’re rationalizing your behaviour.”

Um…no…I’m just trying to give context – the grey answer to a question that she tried to make black and white. Because life isn’t like that – it’s all about the shades of grey.

 At the beginning of the appointment, I was quite succinct in my answers. But then, she would jump in and fire several more at me, obviously looking for more context. So, I started giving more thorough answers. She never smiled and she cut me off a lot, which made me really nervous and uncomfortable. I started talking faster and being less concise. At one point, she stopped, tilted her head, smirked at me and said:

 Dr. R: You’re talking fast and circumventing the question. That’s hypomanic.

Savia: I’m nervous!

Dr. R: [cutting me off] There you go, rationalizing your behaviour again.

 I’ve lost count of how many arguments we got into in that hour and a half. Our personalities clearly do not mesh, and I could tell that she didn’t appreciate me challenging some of the things she was saying or asking questions to help me understand where she was coming from. We both ended the session thoroughly pissed off.

I was so angry and upset, not about the diagnosis (though that did scare me quite a bit, because I don’t want to have this disorder and I don’t want to have to take mood stabilizers, ever), but about the way she treated me. Her cruelty to someone so vulnerable cut very deep.

 I didn’t sleep at all that night, and then I cried for two days straight and fell into a depression. What if she was right, and all of these things that I consider as part of my personality are just a disease? I thought I knew myself really well, but if this is the case, who the hell am I, then?

 I talked to a few friends who’ve known me through all of the ups and downs, and they said the same thing, “You’re always Savia. No matter if you’re depressed or anxious, there’s still something about you that’s always there and doesn’t change.”

 And they were right. I tried to put Dr. R’s harsh words behind me and take the good out of the appointment. A few things that she said did ring true.

 For instance, when I told her that I don’t have hypomanic or manic episodes, she said that for me, hypomania may manifest itself as anxiety. I found that interesting, and it would fit with what’s been happening to me. She also gave me the signs of hypomania and told me to keep a mood chart for the next three months so I would have a record of my patterns.

 Dr. R said that the current drug mix I was on (Celexa and Wellbutrin together, in low doses) could put me at a higher risk for hypomania and that it would be better for me to be on just one of those drugs, or off them entirely and on a mood stabilizer, my reaction to which would serve as a diagnostic tool.

 She also told me to take Omega 3 fatty acids, which she said is the one thing that has been clinically proven to help with depression and mood disorders.

 So, I did take the good advice she had and used it to my advantage. I went off the Wellbutrin at the end of April and found that just being on the Celexa was much better for me. I started taking Omega 3s, along with a daily arsenal of B complex and Vitamin C, and am amazed at what a difference that makes in stabilizing my mood.

And last, but certainly not least, I am keeping a daily mood blog where I quickly jot my mood, appetite, sleep, spending, menstrual cycle, drugs and sexual interest levels. It takes me two minutes a day, but it has made me aware of some of the factors that affect my mood, which gives me the opportunity to deal with things before they get out of hand.

 And the best thing about the mood chart is that the next time I go to a psychiatrist (in six months, if I can get in with someone else, that is), I will have that record to show him/her. And, hopefully, I can avoid any further nastiness.

Because going to the psychiatrist is stressful enough without having to prepare yourself for a knock-down, drag-out fight with the person who is supposed to be helping you.

Migraines?  Excedrin alone will sometimes work, but I’ve got other pills in my arsenal if I need them.  Arthritis bugging me?  Allergies? Same thing.  There’s almost a pill for each everyday physical ill, or something that works in a matter of days.  Non-medicinal remedies too– more water, less sugar, more walking, less gluten.  The lag time between applying the cure and the end of what ails me is short, and the resolution is tangible.  Hour by hour, I can feel myself getting better– and if it’s not a cure, then at least there are palliatives that can be repeatedly applied to assuage the feelings of not-rightness.

Not so with mood.  Taking your meds, getting enough sleep, watching my carb intake, trying to get out in the sun and to move around some more only help so much.  Positive self-talk, journaling, talk therapy, too.  The distance between what I know and what I feel?  Sometimes it’s a short reach across a small crack, and I can grab hold, strongly, to join the brain and the heart for days, weeks, months.  Other times, that crack is a chasm, miles wide and deeper than imagining, and there’s nothing to be done but hunker down with my darkened heart, and hope that in the meantime, the brain on the other side of the chasm will kick in and figure out how to bridge the crossing.  Right now, the gap is narrowing, something my brain side knows and something my heart side hopes, and my heart side is reaching out, but my heart and my brain are still fingertips away, swiping at each other– I know it’s close, but any contact now is tentative, fleeting, too weak to get me across without making a lunge that I know, from experience, may not get me across.  There’s no quick fix– just a waiting game.