Saturday, June 4, 2016

Throw down your anchor



I have been under the care of a psychiatrist for 30 years. I am teetering somewhere between my eighth and ninth doctor currently. These may not seem like bad odds but when you do the math, this is a lot of changes over a lot of years. 


I have a few favorite doctors and up until the age of 40 I always felt well-cared for: someone had my back, someone was watching out for my mental health, someone cared.


When Dr. H.A. retired I had been seeing him for eight years and his retirement was difficult. He was a doctor that not only cared for my mental health, but checked to make sure I was getting the care I needed overall, because he seemed to understand that when the rest of my body was in good health, then good mental health was easier to maintain.


When I began seeing my new psychiatrist , I just assumed that he would care for me as well as Dr. H.A. The shock to my system was like crashing into an embankment in the night. I struggled to understand why, instead of telling me when he wanted to see me next, he asked me when I wanted to come back. When I shared struggles with him he would make suggestions of medication changes, but mostly left the decision up to me.


These changes, were, at first confusing. He was the doctor and I was the patient; why was he not telling me what to do and instead asking me what should be done? After five years, he left his practice and then came Dr. B.


At first Dr. B seemed fine, but before long I felt he was similar to Dr. V and mostly kept asking when I wanted to return and what I wanted to do.  I was critical and outspoken about the care I was receiving and know, at this point, that my anger seemed to grow over the disbelief that this is the way the system now works.


As we packed up our house to move to another area I knew I would have to find a new psychiatrist. By this time, I had learned, repeatedly, that psychiatric care in the United States had changed and that no longer could a person be expected to see a psychiatrist because they were depressed, but that if you did have the benefit of being under one’s care, this doctor was going to spend as little time as possible with you and leave any and all counseling, and/or emotional consultation, up to a counselor.


How silly of me not to realize this years ago. Of course if you are depressed it is only a chemical issue and why would a psychiatrist need to know if you are under stress or throwing breakable items at a stone wall or cutting your skin or not sleeping or not eating? Am I the only one who struggles to understand that if a psychiatrist does not understand your emotional state or how you are living from one day to the next, he or she cannot possibly prescribe the correct psychiatric medications or dosage to help you?


“This is just the way things are now, get used to it,” I have been told. 


What if you had tried a dozen different diets over 20 years and still couldn’t lose weight, scheduled an appointment with your doctor for help and he said, have you tried counting calories? What if he asked you this without giving you any opportunity to explain what you had already tried and then went on to explain that if you take in more calories than you burn you are going to get fat?


This is what happened at my most recent psychiatric appointment with a doctor to whom I had been referred with accolades. The first thing he wanted to know is if I had side effects from my medications and then went on to explain to me how these medications, antidepressants referred to as MAO inhibitors, worked. I felt my body go into flight or fight mode and stopped him mid-sentence while he continued on with his pages-long, first-year-of-med-school speech to me.


I told him I have been on these medications for 20 years and know how they work; I am not stupid. He went on without pause, discussing things that can happen when you take MAO inhibitors. 

This time my mind went numb and flight or fight would have been preferable to the utter sense of desperation I felt in that moment.

When he asked me about sleep and wondered why I get up during the night, I couldn’t remove the edge from my voice when I told him I never said I get up, just that I wake up. He continued talking until I told him that I was having problems sleeping but not anymore.


He never asked me why I was there and when I could see he was not going to address the real problem I just began telling him what it was. He then asked me if I had additional symptoms. When I told him the stress I had been under, he said, “I meant physical issues.”

Mid-sentence the female assistant sitting in the room on my right hand side said, “Dr. S, you are over time.” This was after 20 minutes. My new psychiatrist spent 20 minutes with me. 


In the movie As Good as it Gets, Jack Nicholson’s character says it best when he says: “I’m very intelligent here, if you’re going to give me hope you’re going to have to do better than you’re doing. I’m drowning here and you’re showing me the water.”


 In the same sentence, I have heard people describe the great suicide prevention initiatives moving into place, while also discussing the crisis in finding psychiatric care. Miss Clavel in the children’s book Madeline had a knack for sensing when something was not right. She would look around and with her Parisian accent, declare, “Something is not right.” I don’t think Miss Clavel’s intuition is needed to see that with the current state of psychiatric care in the United States we are headed for a tsunami. 


 In the midst of mental health professionals, I have been criticized when I don’t instill hope with my words or suggest answers to the crises I bring forth. Sorry about that. If you are someone who needs psychiatric care, throw down your anchor, demand your care, and find a life raft in the midst of ocean liners, or learn to swim, fast, uphill, in the pouring rain.

1 comment:

  1. Well this sucks shit. Now what do we do? How can I help? I guess you could ask to see the other doctor (the only other psychiatrist available to you within 100 miles). It's outrageous, 2 psychiatrists for the whole medical group. Is it too late to switch to Marshfield? Set up an internists appointment again and get another referral from a clinic that has more than two psychiatrists for thousands of patients.

    I'd be pis.sed too. Let's talk soon

    ReplyDelete