First off, let me be clear. Psychiatrists and therapists are, usually, worlds apart. Psychiatrists, increasingly, are little more than medication vending machines with an arrogant, ignorant, damaging attitude. Many don’t listen to their patients and are trained, oddly, in an out-dated Freudian tradition, whereas most therapists are in the 21st century. Psychiatrists are the MDs, therapists (usually) have various other degrees. I have had much better luck with therapists who are warm and compassionate and have helped me grow and find balance.
After 21 years of terrible psychiatrists (beginning when I was 16), I finally found one who is also trained as a psychotherapist and doesn’t treat me like a sub-human. This is exceedingly rare. And “Not being treated like a subhuman” is a pretty low bar. What about a psychiatrist that would trust that I’m the expert in my own wellness, and that they are there to guide me through the complicated world of psycho-active drugs, and ultimately, (gasp), what if the goal was to be on the least amount of those drugs as possible? These psychiatrists do exist, but they are even more rare.
At this point in my life, I’m relatively comfortable with my doctor right now and fairly conservative medication plan. I’m in a productive, stable place, and I don’t want to mess with that.
This is what the journey has taught me so far.
- I pay attention to my own symptoms, and don’t put my faith in someone just because they have an “MD” after their name.
One of the worst incidences of psychiatric malpractice that I’ve experienced happened about five years ago. I was concerned about the side effects of Zyprexa, which I’d been on for years to help manage the manic side of my bipolar disorder. Not only is it sedating, it can lead to diabetes over the long term. So I asked my doctor to switch me to Seroquel. I felt less sedated for a while, and that was great. Then, I started getting sick. A lot. Like four bad colds in one month. I was exhausted all the time. My health insurance provider was Kaiser Permanente. Much could be said about their crappy practice in general, but for mental health care, they are particularly bad. They have actually been sued in this area. The only person at Kaiser who listened to me was an allergist. He ordered a blood panel and as it happened, my white blood cell count had plummeted. I had test after test, including HIV (twice) and a chest X-Ray.
Finally, after a month, someone thought it might be smart to loop my psychiatrist into the conversation. This is supposed to be the advantage of having an all in-house HMO plan–that the doctors talk to each other early and often enough to prevent suffering for patients. Took longer than it needed to in my case. Turns out when you take Seroquel and Depakote together, white blood cells die off. My psychiatrist’s sage advice? “Just stop taking the Seroquel—you’re on a ‘petite’ dose.” Petite. Like I’m in the fucking business suit section at Macy’s. Any idiot can tell you that stopping an anti-psychotic cold turkey is a bad idea. You need to taper down off that shit, at the very least, and a more conservative response would be to cross-taper back to a medication without such a problematic side effect. So, I took her advice. I stopped my “petite” dose, and two months later, suffered a full-blown manic episode due to that withdrawal and was in the hospital.
Now, I have to admit, I was in a headspace where I was angry at side effects. I felt like the medications were doing me harm, so I was happy to take advice that told me to just quit something, even though my gut told me to be more cautious. Since this incident, I have been exceedingly cautious with medication as I never want to be hospitalized again. That is a painful and traumatic experience. But I need to find the Goldilocks sweet spot of not too many meds that sedate or cause long term side effects, and not too few that cause my neurodiverse brain to backfire against itself.
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- I don’t tell parts of my story to anyone I don’t trust.
On my very first meeting with him , this fifty something white dude MD with a leather jacket does my intake. Intakes with psychiatrists are the worst. They just go over a laundry list of trauma. I mentioned I was a childhood sexual abuse survivor. When the litany was done, he threw a hand flamboyantly in the air and said, “Let’s talk about…the molest.” Like he was savoring the fucking word. I can’t even explain it. I’m not trying to be a grammarian, but I don’t even think that’s the right way to say the thing. Also, it just sounds creepy. “The molest.” He genuinely sounded excited to get into it. This is not something you dive right into the first day. This is not like hooking up jumper cables to a car whose ignition won’t start. This needs to be a gentle process or you risk triggering the traumatized person, re-wounding them.
I told him no.
But I continued to see him. It was easier than doing a second intake. He ended up leaving a few months later, anyways. Kaiser psychiatrists are constantly quitting.
- I do quit psychiatrists if they do something really out of line.
Her name was Dr. Rambo, and her approach had all the delicacy of her name. The incident was also on my dreaded intake, which because of Kaiser’s turnover, I had to do many times. To be fair, not every psychiatrist I saw at Kaiser was incompetent, indelicate, rude, or patronizing. Some were just mediocre, overworked, and did nothing to advance my healing. But Dr. Rambo managed to be all of the worst things in one blonde little package.
After a heinously arrogant intake of condescending murmurs around all my trauma, she insipidly told me she was concerned about me. She didn’t want me to be hospitalized again, she said. “Of course,” I said. “I don’t want that either.” Please know that I was in a stable place when this happened. She had just read my chart and was perhaps alarmed by something she’d seen in it. She decided it would be wise to quote back to me some of my own delusional thinking from two years prior during a manic episode (spurred on by her predecessor, see above). Like leather jacket man, she brought in trauma head-on on the first session, but this time it was psychiatric trauma, the trauma inflicted on my psyche and soul when in a state of spiritual emergency.
She shamed and stigmatized me for what she was supposed to help me with. Maybe ironically, she was trying to go above and beyond to prove how sensitive she could be. That she could study extra hard for that MCAT, I mean, my chart, and quote back to me the most shocking bit of my pain. Verbatim. I hadn’t thought about thinking that way in years.
In an eerie way, it also reminded me of the panoptic gaze of psychiatry, the one that turns our words, even ones from years ago, into thought crimes. It was alarming, unnecessary and painful. Dr. Rambo lodged a verbal bullet in me, so I extracted it carefully and never saw her again.
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- If a psychiatrist actively tries to DENY a part of my story, I run the other way.
So I did try to see a holistic psychiatrist once. Thought he would get me off the side-effect drugs and onto a regimen of supplements and good diet. Trouble was, he was an asshole. I showed up to his house high in the Berkeley hills, and he had forgotten about our appointment. Maybe that should have tipped me off. But I was eager to try a different approach.
In my intake, I told him that my first manic episode happened at the age of sixteen, spurred on by the surfacing of memories of sexual abuse. To this piece of information, he rolled his eyes.
“Sure I’ve heard that story plenty practicing in the Bay Area,” he said.
“Excuse me, are you…do you mean to say you don’t believe in repressed memories?”
What I wanted to say was “you don’t believe me? Does this make my story untrue, because this man with credentials says so?”
“No, I don’t.”
- I don’t believe in the mainstream story of psychiatric redemption.
For me, psychiatry has always been clearly about power. I was involuntarily hospitalized at sixteen. I was strapped to beds. Injected with meds in the hip. Cuckoo’s Nest, Girl, Interrupted type shit. Thankfully, I’ve never experienced Electroshock Therapy, but that still happens.
Nowadays, so often in our culture we observe in movies, books, and television these narratives:
Beginning: Character/patient experiences troubling symptoms of mental “illness”
Middle: the symptoms become more and more unmanageable. Character/patient reaches a point of crisis. Character/patient finally relents and seeks psychiatric “care.”
End: Character/patient, now medicated, is happy, managed, if a little eccentric, but that’s okay! We need these wacky people in this complicated tapestry we call late capitalism!
Then, of course, as I am a product of my culture, I have tried at some level to emulate this narrative. But it doesn’t work out so simply, largely due to the problematic framework of psychiatry itself. And simple incompetence and rudeness doesn’t help either.
It’s a life long balancing act of finding the Goldilocks sweet spot of not too many meds to damage our bodies and lives, not too few meds to make our bold brains spill their guts all over the place. It’s maddeningly difficult to find a caring doctor to help with that.
These are the lessons that are carrying me forward. I have a kind and skilled doctor now, and am immensely grateful. It might not surprise you that I had to leave Kaiser to find this. I have to trust, that after all the years of being treated like a sub-human, that a psychiatric doctor should be a compassionate partner, not a warden, an impulsive surgeon, a pill machine, or the authority on my experience.
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(Feature Image: A person outside in a cityscape, at night, in the rain. They have long dark wavy hair and is wearing a blue button-down shirt and dark jacket. Source: Andrea Portilla)