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.