A heart of ice

ice formation

A few nights ago, there was an accident in the Canadian province of Saskatchewan involving a bus carrying members of a junior hockey team and their coaches.  Fifteen people died, the majority of them ages 18-20.  This tragedy has dominated the news since then.

And I can’t seem to make myself care.  I watch the news, because that’s part of my routine, and I think move on, you’ve talked about this enough already.  This evening, the news anchor’s voice broke as she read out the names of the deceased, and she was clearly fighting back tears.  Her job is to be cool as a cucumber and she struggles to maintain her composure, while I feel like an ice queen.

This isn’t new.  Depression does this.  It hardens my heart to anyone’s pain but my own.  I recognize that this isn’t who I am, but right now it’s how I experience the world.  I don’t blame myself per se, but I’m the only one accountable for my emotions.

Jumping off on a bit of a tangent, my brother’s wedding is coming up this summer.  And I don’t care.  I have no interest in going to the wedding, although I will go because that’s what’s expected of me.  I won’t feel happy for him, because my ice heart doesn’t do that.

Maybe global warming will melt my heart of ice.  Or maybe I will sink the Titanic all over again.  But now I’m just rambling.

 

Image credit: Ezra Jeffrey on Unsplash

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TED Talks on depression and suicide

TED Talks logo

Somehow, the folks at TED manage to gather amazing individuals with powerful voices to speak up about difficult topics.  Here are some talks related to depression that grabbed me.

 

Nikki Webber Allen: Don’t Suffer Your Depression in Silence

When  Nikki Webber Allen was first diagnosed with depression, she didn’t tell anyone, because “I didn’t think I had the right to be depressed.”  She attempted to self-medicate through high achievement.  It wasn’t until her nephew, who she hadn’t known was depressed, died by suicide that she decided to share her story.

 

Andrew Solomon: Depression, The Secret We Share

Andrew Solomon described depression as something “braided so deep into us there was no separating it from our character or personality”.  He observed that depression makes it seem like a veil of happiness has been removed from the world so that the depressing truth is made visible.  He described the current state of treatment as “appalling”.

 

Kevin Breel: Confessions of a Depressed Comic

Kevin Breel points out that depression often happens to people who don’t seem like they should be depressed.  He spoke passionately about the silencing effect of stigma, and the need to shatter that silence.  He described depression as society’s deep cut that we simply slap a bandaid on.

 

Sherwin Nuland: How Electroshock Therapy Changed My Life

Sherwin Nuland shared how his life was saved by ECT in the 1970’s.  At that time, most of his doctors had identified a lobotomy as the only option, and it was a medical resident that actually pushed for ECT.  After 20 treatments he’d experienced a significant response and finally was able to feel hope.  He came up with safe words to manage obsessive thoughts, and I think they’re just perfect: “Ah, fuck it”.

 

Kevin Briggs: The Bridge Between Suicide and Life

Kevin Briggs worked for many years for California Highway Patrol, and was often called to suicide attempters on the Golden Gate Bridge.  He was struck by how well people responded to being listened to.  He sends a strong message that there is hope, and suicide is preventable.

 

JD Schramm: Break the Silence For Suicide Attempt Survivors

In this short talk, JD Schramm addresses the taboos around suicide that silence and isolate people.  He brings up some disturbing statistics, and issues a call to speak up about suicide and provide resources to those who have survived suicide attempts.

 

Have you seen any TED Talks that you would consider must-see?

Botox update

Forehead frown lines

Around 5 weeks ago, I blogged about deciding to get Botox injections in my forehead to hopefully help in the management of my depression.  I got the first injections at that time, and then got round two a couple of weeks later, for a total dose of 29 units, which was the amount used in the research studies that shown that Botox can have a beneficial effect on depressive symptoms.  The Botox was injected into the frown line areas, and the idea is to block the feedback loop of frowning reinforcing negative mood.  For anyone who’s curious, botulinum toxin comes from the Clostridium botulinum bacteria and acts at the neuromuscular junction to cause muscle paralysis.  Besides cosmetic use, it’s used for a number of different muscular disorders, hyperhidrosis (excessive sweating), and the in the prevention of migraine headaches.  Effects are expected to last 3-4 months, although in the studies for depression the beneficial effect was found to last even longer.

It takes about 2 days to start noticing the effects of Botox injections, and 2 weeks to get the full effect.  I would describe the feeling as numb but not numb.  It feels numb much the same way as if your mouth was numb after going to the dentist and you couldn’t move the area.  When I try to move the muscles in my forehead, I get that same sort of numb feeling.  It’s not numb to sensory input, though, so I still feel touch, pressure, temperature, and other sensations.

What I’ve really noticed is how often I was frowning before.  Because I get that numb sort of feeling when I try to move my forehead, I notice when my face is trying to frown. And it happens often, far more often than I would have guessed.  In terms of outward appearance, when I try frown there are some little crinkles visible above the outer half of each eyebrow, but that’s it.  When I raise my eyebrows in a surprised sort of expression, there’s limited movement, but one eyebrow raises more than the other one, a fun little quirk that my naturopathic doctors said she could fix but I actually kind of like.

So, is it helping with my mood?  I’ll say a cautious maybe.  I’m still having bad days and I have no resilience when it comes to situational stressors, but looking at my mood tracking app there has been a bit of an improvement over the last couple of weeks.  It’s always hard to know what’s causing what, and there are probably other things that are helping, like the approach of spring probably and some more positive interpersonal interactions.

I’ll probably never really know for sure what effect if any the Botox is having, but I do like the idea that it’s getting in the way all the frowning I was apparently doing before.  And at this point I’m willing to do pretty much anything, even if it’s only having a small impact.

 

Images from Botox Cosmetic

Book review: Mindfulness For Bipolar Disorder

MindfulnessForBipolar

Mindfulness for Bipolar Disorder: How Mindfulness and Neuroscience Can Help You Manage Your Bipolar Symptoms by Dr. William R. Marchand lays out specific areas for mindfulness practices that be useful in managing bipolar disorder symptoms (and most if the book is also applicable to other mood disorders).  I believe mindfulness can be a really helpful thing to incorporate into one’s life, so I had originally intended to write this as a summary of the book’s suggestions rather than as a review of the book.  However, along with the good stuff I found a fair bit in the book that bugged me as well, so I didn’t think I should leave that out.

A note on language:  The author talks about things like “your everyday bipolar life”, “your bipolar self”, and “being bipolar”.  If people who have bipolar disorder want to talk about “being bipolar” because that’s how they conceptualize their self and their illness, that’s totally fine, but when people who don’t have a mental illness start talking about “being” bipolar/depressive/schizophrenic/anxious/personality disordered, it grates on me.  It bugs me because it sounds like they’re telling us that we are our illnesses, even though it’s not up to them to define us, our identities, and where our illnesses fit in.

Ok, time to delve into the practices the book suggests.

Daily meditation practice:

This meditation is focused on breathing, and bringing the focus back to the breath any time the mind wanders.  This noticing and refocusing is an important part of the practice.  The breath serves as an anchor for all of the other meditations described in the book.

Targeting bipolar depression:

This chapter looks at recognizing and moving out of autopilot thinking patterns, which often serve the purpose of trying to avoid emotional discomfort.  Instead, the aim is to accept the reality of the moment, unobscured by our own beliefs.  By mindfully accepting depressive symptoms rather than fighting them, they are more likely to fade away on their own.

The mindful minute meditation is suggested as a regular practice three times a day plus more often as needed.  It involves taking an inventory of the body, autopilot scripts that are playing, and mood, and then finding acknowledgement, acceptance, and presence.

Calming bipolar anxiety

The book talks about confronting one’s fears of impermanence.  “Being present with impermanence is the toll-free expressway to freedom from suffering.  This path leads to the solution to the bipolar puzzle and the solution to the puzzle of all our lives.”  In my own experience, when I’m depressed, I’m not experiencing fear about impermanence.  Quite the opposite, actually; ideas of permanence get me bogged down in hopelessness.  Maybe there’s a freight train blocking my toll-free expressway.

Avoidance is described as a cause of suffering, and the suggested meditation practice involves sitting with an anxiety-provoking idea.  This sounds similar to imaginal exposure work.  The steps in the meditation are:

  1. Focus on breath as an anchor for around 5 minutes.
  2. Bring into awareness a moderately anxiety-provoking situation.
  3. Observe what happens, including thoughts and bodily sensations.  Notice when shifts to autopilot occur and then refocus.
  4. Watch anxiety begin to fade.  However, don’t hold onto a preference for it to go away.

Observing your thinking pattern

This chapter focuses on autopilot, an idea that’s similar to negative automatic thoughts in cognitive behavioural therapy.  Autopilot learns from our past experiences, and one of its jobs is to protect us from getting hurt.  While this can be useful at times, it can prevent us from taking risks and lead to us getting stuck.  It’s useful to recognize how much we’re driven by autopilot, and see autopilots as just thoughts that are neither good nor bad.  Rather than suppressing them, we should try to be fully present.

The steps of the recommended meditation are:

  1. Focus on the breath.
  2. Expand awareness to physical sensations and then sensory input.
  3. Watch your thoughts like clouds in the sky.
  4. Relax in mindful awareness.

Working with mania and desire

While desire is a major source of motivation, it can also underlie discontent and dissatisfaction.  Autopilot scripts are often aimed at wanting to be different, and satisfaction doesn’t last long after desires are fulfilled.  Mindfulness allows desire to be seen as empty of substance; satisfying it doesn’t lead to true happiness.

The recommended meditation involves the same first 2 steps as in the previous chapter.  Then you bring a desire-provoking situation to mind, imagine an open space in your awareness where it can be present, and notice what arises in you.

Managing irritability and anger

In this chapter, thoughts and emotions related to desire and aversion are identified as causing the most problems in bipolar disorder.  It’s important to learn to be present with these emotions rather than try to suppress them, and recognize that thoughts and emotions don’t define who we are as people.

Mindfulness is presented as a way to find freedom from fearing your symptoms; it is this fear that tends to trigger autopilot.  The author goes so far as to suggest welcoming your symptoms, since they’re present anyway, and this will make it more likely that they will move along.  I’m uncomfortable with this choice of words, as I see a considerable difference between accepting what is and actively welcoming it to come and join the party.

Rethinking your bipolar self

Mindfulness gives distance from thoughts about self, which can fluctuate and often become more frequent with depression and mania; instead, these thoughts are allowed to just run in the background.  Mindfulness can allow you to be less attached to your own viewpoint, moving from an egocentric to a wider perspective.

The author explains that, “The answer to suffering is to move into mindful awareness, where you can be fully present with reality without needing to fix or change it.”  I think this is overly simplistic, and based on some of the other books I’ve read recently (A Fearless Heart and The Book of Joy), compassion is a major piece that’s missing here.

Furthermore, mindfulness “means experiencing at a deep level that, in each moment, the universe and everything in it – including you – is perfect as it is.”  From where I stand this is a load of crap.  It’s quite a large leap from acceptance to perfection.  If you consider the Buddhist idea that compassion is a wish for others and the self to be free from suffering, to see everything as perfect in the moment appears to deny the suffering of others and thus is an uncompassionate stance.

Being bipolar and happy

In this chapter, Dr. Marchand writes that ,“Mindfulness can teach you to view your illness as a gift.”  While it seems that what he’s trying to say is that there are things we gain from our illness experience, in my mind calling it a gift makes light of the very real pain and suffering people with mental illness and their loved ones experience.  Acceptance of the illness can be a powerful thing, and can allow us to see that there are things we gain from our illness, but that is very different from framing it as a gift.

Happiness is presented as something that “is always available to you right here and now…  From the viewpoint of mindful awareness you can be happy and joyful in this very moment…  That is the gift of mindfulness.”  I’ve ranted before about the idea that happiness is a choice.  I’m not saying that mindfulness can’t make it easier to find happiness, but I strongly disagree with the assertion that happiness is always available to everyone at any given moment if you only think in the right way.  According to Dr. Marchand, this is as simple as doing a meditation that begins with the breath, then expands the awareness, and “now allow happiness and joy to arise”.  The ad slogan “thanks, Captain Obvious” jumps to mind.  How remarkably unhelpful.

So in the end, for me the irksome in this book tended to drown out the good, but I still believe in the benefits of mindfulness, and I’m going to continue to work on incorporating it into my life.

 

You can find my other book reviews in my blog index.

 

 

Is oversimplification of mental illness useful?

brain depicted as puzzle pieces

We’ve all heard of the “chemical imbalance” explanation for mental illness.  This terminology has served a purpose in making the argument that mental illness is actually an illness.  However, it is a gross simplification of what’s actually going on in the brain.  Lately I’ve read criticism of the chemical imbalance idea as being inaccurate, which makes me wonder if it’s terminology that’s no longer serving us.  I’m going to focus on depression, as it’s probably the condition for which I’ve seen  the chemical imbalance idea challenged the most.

This chemical imbalance theory arose in the 1960’s, when it was hypothesized that a deficit in serotonin caused depression.  According to Wikipedia, it began with observations with the drugs reserpine and isoniazid, and the way they affected monoamine neurotransmitters (the monoamines include serotonin, norepinephrine, and dopamine).  The serotonin hypothesis fuelled further research and the development of new serotonergic drugs.  These drugs proved to be effective, which reinforced the hypothesis. “Chemical imbalance” certainly captures the state of scientific understanding 50 years ago, but we’ve come a long way since then.

Now it’s generally recognized that the etiology of depression is complex and multi-factorial, and the idea of a simple serotonin deficit is inaccurate.  In many ways, the more the science has progressed the more we realize just how much we don’t know.  A few of the biological factors that have been implicated are:

  • Signalling between neurons via monoamine neurotransmitters (serotonin, norepinephrine, and dopamine): This is much more complex than absolute amounts of these neurotransmitters.  Regulation of neurotransmitter receptors and transporters on nerve cell membranes has a major impact on signal conduction.  It’s been suggested that the delayed onset of action of antidepressants may be related to the time it takes to adapt the regulation of these receptors via changes in the expression of genes encoding for them.
  • Glutamate:  It is thought that the neurotransmitter glutamate can cause what’s referred to as “excitotoxicity”.  Inflammation is one of the factors suspected to play a role in promoting glutamate excitotoxicity, mediated by various factors including microglial cells.   Ketamine affects the glutamate signalling system via its effect on NMDA receptors.
  • Genetic factors: Genetic variants affecting such things as serotonin transporters and methylation processes are thought to potentially play a role.  Variants in the SERT (serotonin transporter) gene are associated with different patterns of response to treatment than those with the “normal” SERT gene.  Significantly more research is needed in this area to gain a greater understanding of the role of genetics.
  • Epigenetic changes:  Epigenetics refers to when and how often our genes are translated into the proteins that they code for.  A wide variety of environmental factors are thought to affect this, and this is where adverse childhood experiences can have a huge impact.  There is still much, much more to be learned in this area.

Sometimes people will argue that depression is not biologically caused, but instead is caused by psychosocial factors including trauma.  I guess the problem I have with this is that it strikes me as another oversimplification.  David Karp is a remarkable author and sociologist who has written about his own experiences with depression.  He argues that purely social determinism is just as problematic as biological determinism when it comes to depression.

I’m inclined to think that at this stage of the game “chemical imbalance” has outlived its usefulness.  In a time when it’s so easy for people to look things up, if we’re using terminology that oversimplifies to the point that it’s not really accurate, we may just be shooting ourselves in the foot by hanging onto this kind of language.  I’m not sure what would work better.  I could suggest “complex, multifactorial, biopsychosocial illness” but that’s rather long-winded.

What do you think is the best way to characterize mental illness?

 

Note: There are a couple of good papers by Albert and Benkelfat looking at where things stand now in relation to the serotonin deficit hypothesis; these are available from the National Institutes of Health here and here.

Image credit: GDJ / 2536 images on Pixabay

Falling down the rabbit hole

whirlpool fractal image

Sometimes I think that I’m making progress and the shit from the past has settled down and resumed its rightful place in the past.  Maybe I am making progress or maybe I’m not, but every once in a while some of that shit makes an explosive reemergence.  It only takes one little nudge in that direction to make things fall apart.  There are many metaphors I could use.  What originally popped into my head as a title for this post was scratching the surface and breaking the ice.  But the straw that broke the camel’s back also seems appropriate, as does getting nudged and falling down the rabbit hole into a depressive whirlpool.  I feel like I’m rambling and not making a lot of sense.

I’m in this place of not making sense in my head after something someone said that was not in any way meant to be hurtful.  But that slight nudge pointed me in the direction of this particular rabbit hole, and in I plunged headfirst.  I had a freeze response, and remember focusing my gaze on my hand suspended in the air.  Then the tears began as emotional memories swirled around my head.  Those memories had to do with having my fragile self torn to shreds by my manager at one of my jobs, a psychological shit-kicking that is the reason I now refuse to work any shift other than graveyard.

This whole mess happened while I was working a night shift at said job, and I hate when I lose my composure at work.  The clients were all asleep, so it was just my coworker around.  He was the one that unknowingly triggered my journey down the rabbit hole and then probably wondered what the hell was wrong with me.  This particular individual has been subjected to my own personal brand of crazy more than once now, and I would imagine he’s a bit tired of it at this point.

I’m writing this maybe 3 hours after the incident happened.  I’ve finally got my composure back, but I feel mentally exhausted.  Physically, I’m feeling dizzy and I’m freezing cold.  I feel somewhat embarrassed in the sense that I wish my coworker didn’t have to see that, but I recognize it’s not as thought I deliberately chose my reaction.  Clearly there’s stuff that hasn’t been dealt with, even though I haven’t thought about it for a while.

I could come back and edit this later before I publish it, but I think I’ll leave it as is.  My brain feels like a scrambled mess.  Down the rabbit hole and shit out the other end.  I think I need to keep my stupid mouth shut at work.

 

Image credit: Alpac1t on Pixabay

Stigma and the pathologization of normal

Health spelled out in tablets

Mental illness stigma comes from many places and in many forms.  Stigma often invalidates the experience of those of us with mental illness, and one of the ways this can happen is through pathologizing normalcy.  By this I mean inflating the significance of “normal” emotions and minimizing the significance of mental illness to make it seems as though they’re on par with each other.  Some of this comes from the language we use.  “Anxiety” and “depression” are often used to describe “normal” human emotions, but the same words are also used to describe psychiatric disorders.  This distinction is not always apparent to people with limited knowledge about mental illness, which is where misinterpretations come in.  People may think that because they feel “anxious” or “depressed” emotionally and those feelings are uncomfortable, then they likely have a mental health disorder.  Conversely, people with an anxiety disorder or a depressive disorder may be dismissed as just overinflating “normal” emotions.

I got thinking about this issue after watching  a documentary called The Age of Anxiety, which was aired on Doc Zone on CBC, Canada’s public broadcaster (it can be viewed online here, but only in Canada unfortunately).  According to the producer, “The medical definition of what constitutes an anxiety disorder is expanding to include so many aspects of normal human behaviour that we’re in danger of turning half the population into psychiatric patients.”

One woman featured in the documentary appeared to have high levels of neuroticism (I use that in a psychological rather than a pejorative sense).  She was shown hosting some friends for what was essentially a DSM self-diagnosis dinner party.  At the end of their discussion, they concluded that all of them, and probably most people in general, “meet the threshold” for an anxiety disorder.

The DSM, the “bible” of psychiatry, was never intended to be a paint-by-numbers self-diagnosis tool.  Someone might think check, check, check, I meet all the criteria for this disorder, but there’s an important piece that’s very easy to overlook.  In the DSM-5, criterion D for diagnosing generalized anxiety disorder is: “The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.”  That “clinically significant distress” is where clinical judgment is called on to distinguish between “normal” and “disorder” when it comes to things like anxiety and depression.

That boundary between normal and disorder can appear murky or even non-existant if people don’t have good information and haven’t seen the devastation that mental illness can cause.  Without a frame of reference, it’s easy to start making uneducated guesses about what constitutes a disorder.  A medical historian interviewed for the documentary suggested that if your problem can be corrected by a new boyfriend or a cheque for $5000, you probably don’t have a psychiatric disorder.  Simplistic, yes, but still a good point.  What is not helpful is when medical professionals contribute to the blurring of boundaries.  A psychiatrist interviewed for the film speculated that “by age 32, 50% of the population might qualify for an anxiety disorder”.  If it’s uninformed people doing the diagnosing, perhaps, but not if it’s a skilled clinician.

The documentary described the ethically questionable marketing campaign run by the pharmaceutical giant GlaxoSmithKline promoting social anxiety disorder as a common problem that could be managed with Paxil.  This led the filmmakers to conclude that social anxiety is essentially a made-up condition for the purpose of selling drugs.  Just because a drug company is pathologizing “normal” levels of “anxiety” in social situations does not in any way mean there aren’t people who truly have crippling social anxiety disorder, and I think it’s irresponsible when people suggest that this is the case.

The DSM has been a frequent target for criticism when it comes to pathologizing normalcy.  In some cases this has very much been warranted, with homosexuality being a prime example of this.  But that’s not always as much of an issue as it might appear.  One of the concerns often expressed when the DSM-5 came out was the removal of grief as an exclusion criteria for diagnosing a major depressive episode, as some thought that this would end up pathologizing “normal” grieving.  Yet the DSM-5 specifically addresses and cautions against this, stating that the purpose of the change was not to diagnose grief as depression, but rather to recognize that for some people grief may precipitate a major depressive episode.  Again we run into the problem that if depression is thought to be a sham diagnosis for grieving, this is likely to contribute to stigma that invalidates the experience of people who genuinely have a mood disorder.

If people are in fact being overdiagnosed with anxiety and depression, I suspect a major contributing factor is how doctors get paid for their time.  Billing is typically done using diagnostic codes.  General practitioners don’t get paid to do a lengthy psychiatric assessment, so they’re often not getting the history needed to make a solid diagnosis.

The documentary observed that more and more people are turning to medications to manage “anxiety” over everyday issues, and general practitioners are handing them out like candy.  I think insurance coverage has something to do with this; many people are more likely to have coverage for medications than psychotherapy.  I find it really interesting that within the mental illness community there are a fair number of people who are really uncomfortable with medication, but among the “worried well” it seems that medications may be seen as a quick and easy fix.

A pharmacy technician who was interviewed speculated that “about 3/4 of what we have [in the pharmacy] is for anxiety”, and the pharmacist working with her added “these things are all for situational anxiety, situational depression”.  I’m glad I don’t go to that pharmacy!  If society gets the idea that anti-anxiety and antidepressant medications are doled out like candy, how likely are they to take it seriously when some of us truly need medication to manage our illnesses?

There’s a lot of work still to be done in the fight against stigma, and education is a huge part of that, which means that it’s important for us to keep writing, raising our voices, and sharing our stories.

 

Image credit:

Padrinan on Pixabay

Profiles in Tremendousness

screen shot - the Daily Show with Trevor Noah

Profiles in Tremendousness is a segment on the Daily Show with Trevor Noah that pokes fun at the competency (and lack thereof) of various characters in the Trump White House.  I’m going to borrow that idea to take a look at the less than stellar characters I’ve come across in my mental health journey.

My first hospitalization was a sh*tstorm of incompetence all around as far as I was concerned, and years later I found out a little tidbit that gave at least some objective confirmation of that.  One of my discharge diagnoses was borderline personality traits.  There’s nothing wrong with that diagnosis if it’s accurate, but unfortunately sometimes it says more about a practitioner’s stigmatized views than anything else, and is applied as a euphemism for “difficult patient”.  Any competent psychiatrist would know that a diagnosis of personality traits/disorder can’t be made cross-sectionally (i.e. just looking at a specific point in time), particularly when someone is acutely ill; it needs to be made based on patterns that are relatively consistent throughout the person’s life.  The hospital psychiatrist seemed to  have skipped this lecture in med school, and instead decided to ignore taking any sort of social history or gathering any collateral information and instead just slap a label on because I fought the treatment team tooth and nail while I was in hospital.  Not only does this leave me with a diagnosis that doesn’t accurately reflect my experience, but it minimizes the significance of the challenges that people with BPD often face every single day.

I used to go to a medical clinic associated with the local university’s medical school, and I would get seen by whatever medical resident happened to be on for that day.  The discharge summary and who knows what else from my first hospitalization were in my chart at the clinic, and I think a lot of the residents were scared because I was the crazy girl who had tried to kill herself and they didn’t know how to deal with that.  When I went in for pap tests, they would always insist on doing a PHQ-9 (a depression screening test).  One day I went in asking for a lab requisition to get routine blood sugar and cholesterol  checks.  I was stuck there for an hour because, even though my illness was in full remission at the time and I had a psychiatrist who I was seeing regularly, the resident had a very hard time believing I wasn’t going to jump in front of a bus the moment I left the clinic.

The first time I tried therapy was okay but not particularly productive.  I decided to try again when I became depressed a few years later, and made an appointment through my Employee Assistance Program.  I wasn’t thrilled with the therapist’s interviewing style, but the real treat came as we were wrapping up the session.  Her advice was that I would feel better if I started dating.  Seriously?  That was the end of that.  And to top it off, when I emailed her to say that I wouldn’t be seeing her again and explained the reason, she thought it was peculiar that I would have chosen to fixate on that particular statement.  Um, perhaps because it represents incompetence?

That theme came up again more than once.  I clearly remember a nurse in hospital who observed that I must be depressed because I was single, and that must have been why I attempted suicide.  Between her and the nurse who was convinced that I must have attempted suicide because I was angry about something, it was a sad state of affairs.  But the stellar lack of competence didn’t end there.

freudThe hospital psychiatrist who initially treated me on the inpatient unit knew I didn’t like him (I guess the screaming and swearing was a pretty strong hint), so he decided to transfer my care to a different doctor.  This character was very much of the psychoanalytic/psychodynamic therapy persuasion, and as far as I could tell he was even more of a nutbar than I was.  My first meeting with him was all very Freudian, with a focus on sex and early childhood.  How old was I when I lost my virginity?  Did I like sex?  Did I remember how I felt when my brother was born when I was 3 years old?  He told me that the ONLY way for me to get better was to get psychoanalytic therapy, and I should only be on meds for a couple of months and then come off them.  Wowza.  But I wanted to get discharged, so I said the things he wanted to hear.  Later, my community psychiatrist commented that he wasn’t sure who that discharge summary was written about, but it definitely didn’t sound like me.

A couple of years ago, things started falling apart.  A very close friend died unexpectedly. I was bullied at work and ended up quitting because of it.  I was worried about getting sick, but I held it together.  And then I found out that my ex-manager was doing his best to destroy my career (in very much a reality-based sense, not a cognitive distortion sense), and the sh*t really hit the fan.  When I went in to see my psychiatrist, I was so slowed down that I moved from the waiting room to his office at a snail’s pace, and had a hard time even stringing a sentence together.  He knew about all the other stuff I’d made it through, but the best he could come up with was that I needed therapy to learn better coping skills so I wouldn’t get depressed when things like this happened.  I’m not sure why he thought that was the appropriate response and the appropriate time, but that was the last time I ever saw him.  Once trust is broken, I’m done.  So I decided to go see my new GP, who didn’t know me from a hole in the ground.  And what did she have to say after I told her the reason I’d decided to stop seeing my psychiatrist?  “Don’t you think you do need better coping  skills?”  Are we passing around stupid pills?

Don’t get me wrong, there are some great mental health professionals out there; I know because I’ve worked with some of them.  Unfortunately there are also some real duds, and in the next edition of Profiles in Tremendousness I’ll cover some of the specimens that I’ve worked with.  It would be nice if this wasn’t an issue we faced when trying to access mental health care, but sadly it’s far too often the reality.

What have been some of your worst experiences?

 

Image credits:

The Daily Show with Trevor Noah

Skeeze on Pixabay