My other psychiatrist

I don’t know if it’s clear or not that I have two psychiatrists. The one that’s a four hour drive from here who I wrote about the other day. She is orthomolecular and treats by natural means. Strangely enough her manner is that of a typical un-empathetic, arrogant traditional psychiatrist. She was not willing to take over my case as a primary doctor because she didn’t want to deal with my disability claims. Once her true colors showed I was glad I did not have the opportunity to make a complete switch before knowing her. I intend to use her only as long as I absolutely need her for her expertise.

Then I have my local prescribing traditional doctor who has been nothing but cooperative, even if ignorant, in my process of coming off of meds. He is gentle, kind and warm. He listens to what I’ve learned about how drugs mess you up and he respects my opinion and he prescribes what I ask him to prescribe. Ever smaller doses of drugs, multiple different doses of drugs and liquids, all to make the tapering process easier. I understand how lucky I am to have him in my life. So many of the people I communicate with in the community of people I know who have withdrawn or are in the process of withdrawing don’t have their doctor’s cooperation–many make it near impossible for someone to withdraw successfully.

My doctor supports me and yet I still have a terror of him. It is not rational and perhaps it’s paranoid. It does not always color my perception of him but I often am scared of him nonetheless.

A funny story to illustrate how he is really a kind man and I actually do like him a lot follows: I early on told him that he did not have to ignore me in public. As most of you know, it is the general practice of all mental health professionals to pretend they don’t know you if they see you outside the office. I find this humiliating. So early on I told him, as I’ve told all my care providers, that they do not need to ignore me if they see me. I am not ashamed of my association with them and I don’t like being ignored. I’ve seen him out and about a number of times now. The last time I was in “Bed, Bath and Beyond,” I walked into the store and zeroed in a display of place mats right as I entered. I was ultra focused on those place mats! I heard my husband say, “Gianna!” I looked up and there was my psychiatrist peering at me with a devious smile, “Hello, Gianna.” he sang, rousing me from my focused stupor on the mats. I laughed and said “Hi, Dr. __,” and then I threw my arms around him in a hug which he happily returned to me. That is how I feel about him when my old paranoia based on passed experience is not haunting me. He elicits good feeling.

Nonetheless, before going to see him yesterday I was filled with fear and dread. I am, after all, doing something with him that he has never done before and he IS a psychiatrist. He is, in all other instances, doling out the drugs that people get hooked on for the rest of their lives. I can’t help but group him into the “enemy camp” in some ways. I fear he will push drugs on me again if I have a difficult time or if I challenge him too much. I’ve been bullied so much by psychiatrists and other mental health professionals. Yesterday I was afraid of telling him about my new psychiatrist. I thought he might feel threatened or say I couldn’t see both of them. (there are many doctors who take this approach.) Again, I don’t have reason to fear this as I’ve consulted (through email correspondence) with a doctor who wrote one of my favorite scathing indictments against drugs and she had a conversation with him for me. He liked her and appreciated her expertise.

Nonetheless I always feel a little at odds with him. Our relationship has evolved over time. When I first got the idea of coming off some of my meds 3 and a half years ago, my goal was modest. My neuro-psychologist who was doing my neuro-feedback said I might be able to withdraw some and perhaps become a little less sedated. I thought this sounded good. He even said he’d gotten lots of people off drugs, but cautioned that he had never worked with someone on as many meds as I was on and that I might not be able to reach full withdrawal. My goals were modest at that point, but in the back of my head I entertained what I thought was just a fantasy at the time– that I might be able to live without any meds. My psychiatrist tentatively got on board, but at that point insisted I needed to stay on the Lamictal, my mood stabilizer. For the most part he felt comfortable with my getting off the rest of it, though he was much more conservative in his hopes for me which left me feeling uncomfortable and challenged (again probably without good reason.)

Eleven months ago, I had my epiphany. I had started my research and I came to the conclusion that drugs were the cause of my problems. That they were doing nothing for me and actually hindering me. I approached my neuro-psychologist who embraced my new found confidence and commitment to come off of everything. My psychiatrist was more hesitant, though not opposed. He makes statements from time to time that raise my shackles–they are subtle pro-drug messages, but he’s never tried to convince me to do other than what I’m doing, it’s just that he clings to what he does and I do think I vaguely threaten his belief system and every time he makes a pro-drug statement, or even when it’s simply not anti-drug, (how can I expect otherwise from a traditional practicing psychiatrist) I become fearful. I have suffered at the hands of so many people in psychiatry that I can not help but feel paranoia that he will betray me and abandon me. Betray me in that he will insist I need to take something, abandon me if I refuse and then I won’t have doctor for my disability claim. I feel dependent on him and it never feels good to feel dependent on anyone and he does quite literally hold the keys to my income and therefore my livelihood.

To once again demonstrate how he is unusual; he teaches western psychiatry at a Chinese medical school. Last year, two months into my withdrawal experience, he asked me to come to his class to allow a student to take my psychiatric “history” as an exercise. I hesitated and then said, “you know I’m not going to support psychiatry if you have me do that.” He said that was fine–the students should be aware of all kinds of ideas. I agreed to go. I said nothing positive about my experience with psychiatry, though I laid blame on my old psychiatrists and not this one. I had an interesting moment in which the young woman interviewing me mentioned, as a matter of fact, what my doctor had told them– how sometimes anti-depressants reveal bipolar disorder. I shot back with, “no they do not reveal bipolar disorder, the mania is a adverse effect to the anti-depressant, all one has to do is get off the anti-depressant and they will heal–I know many people for whom this was the case, and unfortunately I know many people for whom this was the gateway into a life of drugs and disability.” The student seemed a bit taken aback and continued with the interview.

When it was all over my doctor thanked me and said I had done very well.

So why, why, why am I still terrified of this man? Yesterday I brought my husband to the appointment with me. I wanted back up. I was ready for battle and I had no confidence in my being able to win. My doctor, not surprisingly, had no issue in my seeing the orthomolecular psychiatrist and showed some interest in the results of my blood work.

I did have a couple of uncomfortable moments with him. I used the half hour to educate him, as usual these days. I told him how I was doing and how my symptoms seem to be primarily withdrawal related, citing information I’ve learned mostly anecdotally in all my internet activities. I also told him of the normal grief I’m dealing with. It’s been four months since I’m seen him and I’ve cut out an additional 1/4 mg of Risperdal and 175 mg of Lamictal.

He made me bristle when he said, “now I’m hoping you will be flexible if you start having problems once your Lamictal dose goes below 200 mg.” Not such a terrible thing for a psychiatrist to say, but I heard, “You will be forced to go back on your Lamictal if you have so much as a tiny mood fluctuation once reducing it.” I controlled myself and said something like, “Dr. ___, people do recover. I’m doing so much to stabilize myself, I don’t imagine it will be a problem.” He came back with what I now see (with the help of my objective husband who I had in tow) was a concern for my psychological well-being. “I don’t want you to feel like you’ve failed if you can’t manage it,” he said. I again heard, “You won’t be able to do it.” I told him, honestly, “I don’t know what I would do if I was confronted with the possibility of feeling like I might have to take Lamictal indefinitely. I’ll cross that bridge if I get there.”

In another instance I was telling him about my acute sensitivity to stress. How it is sometimes impossible for me to deal with ordinary stressors. I told him my theory that, from what I’ve read, it’s become pretty clear to me that my deterioration in this regard is due to benzo use. I again cited anecdotes of people who were prescribed benzo’s for reasons other than mental anxiety–for muscle relaxation, for example, who later began to deteriorate mentally. I said, “Benzodiazepines are horrible, horrible drugs.” Now I truly believe I picked up defensiveness in his response. He said, “No, when needed benzodiazepines are wonderful drugs.” I repeated how they made people sick, made them into anxious messes. He, showing that he had not listened carefully, said, “that is why they were put on them.” I repeated, “no, some of these people were not given them for non-mental health problems and they still deteriorated mentally over time as a result of the benzo use.” It had become uncomfortable. We dropped that topic.

I then told him I would be happy to do the interview for the medical students again. I had told him at the time of the first interview that I had found it traumatic and didn’t want to do it again. (It was rough being asked details about my psychosis in front of a class of about 20 young aspiring Chinese medicine doctors.) I said that I had rethought the situation and that I thought I had something important to share. He said he was quite pleased and said that I was his “cover girl,” (did he mean poster-child) no one else had ever done what I was doing and he was learning a lot! Ahhh! Eureka! That made it all feel good.

I left feeling like I had done battle and still very insecure about the future of my relationship with him. Poor man. He doesn’t deserve my distrust. My husband disagreed with me that he had become defensive about the benzos. He thought that as a psychiatrist he had probably seen cases in which benzos were a good thing when they were not abused. I could only partially take in my husband’s perspective. I can only see how terribly dangerous they are, much like crack, in my opinion. But my husband, I know is right in some universe–just not mine.

About Monica Cassani

Author/Editor Beyond Meds: Everything Matters

9 Responses

  1. thememoryartist

    “He said, “No, when needed benzodiazepines are wonderful drugs.” I repeated how they made people sick, made them into anxious messes. He, showing that he had not listened carefully, said, “that is why they were put on them.”

    That did sound defensive to me. I think it must be hard for the psychiatrist to be faced with the growing evidence of the possibility that what he does may be less than helpful and often harmful for patients.Your statement about the benzos was probably too much for him to take in.As nice as he is, there are things he’s just not getting.

    I don’t think your concerns about him are paranoid.He’s a nice psychiatrist, but he is a psychiatrist. He obviously can’t force you to take the Lamictal, but I do find it irksome that he’s seems to be trying to prepare you for failure.I hope you do the same for him. He’s more likely to be the one who continues to be surprised.I think your answer to him on that one was perfect.

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  2. Sara

    You are doing a great job and it’s not surprising that you feel the way you do because even though he’s cooperating with you he’s still handing out the drugs to others. I also saw a psychiatrist who I knew was doing this but who also listened attentively to my views and was supportive. It’s a difficult spot for the patient and I think as you get better this will interfere more and more with your relationship — anyway that’s what happened to me. I could no longer stand to see the patients who looked so heavily medicated stumbling into her office after me. Even though she was good to me I didn’t believe I was fundamentally changing her value system and that could be why you feel the way you do. These are kind people but ultimately we probably need to be with people who really share our values about this kind of treatment. But don’t rock the boat now and maybe you will make a huge difference ultimately in the way this guy practices medicine. It sounds like you are on the way to doing that.

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  3. Gianna

    thanks for the comments tma and Sara,
    they are both reassuring and validating.

    tma,
    I think you’re right that he was being defensive as my first instinct suggested. It was truly an awkward moment and I knew I had to drop it. He was challenging me and I have no desire to fight, in spite of what I said about feeling like I was in a battle.

    I lean towards being a bit more generous towards him about the Lamictal part of the story–I do think his concern was for my well-being, misplaced as it might be. But I too, certainly found it irksome and threatening. Taking this on mostly alone is scary. I would rather work with someone who assumes I will recover rather than someone who makes contingency plans prematurely.

    My husband made a great comment when the psychiatrist called me his “cover girl.” He said, “no, she is you re-covery girl!

    many brownie points for the hubby on that one.

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  4. thememoryartist

    Hey,
    Recovery Girl would be a great name for a new blog.

    I’ll tell you what.My relationships with the MHPs at the clinic I went to for nine years, only got difficult and punitive as I began to get well, and that’s even when I was still taking all of their drugs. All the years I shuffled in over-medicated, took their scripts, swallowed their pills, unquestioning and did everything they told me to do- they were sweet as pie to me. But as soon as I became the least bit assertive, set goals, took steps towards them and questioned their practices, all hell broke loose, but now so have I.

    A certain amount of “paranoia” is healthy. I’d say you should keep your guard up to some degree.I can’t be as generous as you are about the Lamictal thing though. My last psychiatrist was a wonderful person too, and willing to work with me not being on meds,but to try to see if he could find something to at least help me sleep.He gave me Ambien, and it made me hallucinate.I didn’t take it again. But in the midst of a family crisis, where there were truly legitimate reasons for my distress, he assumed the real problem was my “bipolar disorder” acting up without medication and happily sent me off with a prescription for Abilify.
    I regret trying even the one pill that I took. It made me absolutely insane for almost 24 hours. I’d forgotten what the meds can do. I fired his ass right then.
    You may have problems after going off the Lamictal, but life is full of ups and downs, and not all of it bipolar disorder.He’ll be looking for bipolar disorder in any kind of “symptoms” that come your way.So, yes, keep your guard up and pay close attention to your own feelings.

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  5. Rose

    This was hard for me to read (which is certainly not YOUR fault).

    I’m prescribed three milligrams of Klonapin a day. Typically, I take two, but that’s still lots of Klonapin. It seems to be helpful in dealing with relentless symptoms of PTSD, and keeping anxiety at a manageable level (not hyperventilating by the door when I want to go downstairs and get the mail).

    “My” psychiatrist is a very kind man, whom I’ve known for over a decade. He’s almost the only psychiatrist, in eleven years of dealing with a variety of them, who has listened to me about my experience of my life, and what *I* think is happening, is real, is going on, when things go well or not-so-well.

    But he is VERY much an advocate of psychotropics (especially in the absence of any therapy). I’m on 900 mg daily of Seroquel, now, and not only does it kick my ass and force a daily nap into my routine, I’m scared to death of the unknown side-effects of long-term use, especially at such a high dosage. When I saw him in June, I initiated conversation about this, and he spent some time reassuring me that it is a good thing, that my actual physical brain is not right and that the medication is changing it, healing it.

    He sounded like a pharma rep. And I’m still scared.

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  6. Anonymous

    You go girl!!!

    You can do it.

    The best counseling I every got was from people who beleived in me.

    I am off all meds. I am doing great. I eat organic, take supplements and remember that I AM OKAY>

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  7. Jayme

    You’re both right, in my opinion, when it comes to benzos. They truly helped me, but I only took them on occasion. One prescription would last months. And when I took them, they really, really helped. If only psychiatrists got it through their THICK heads that TEMPRORARY use of any meds could be helpful to some patients in some instances, I think that would change so much about this corrupt mental health system. I share your paranoia. No matter how nice someone is (and all my psychiatrists have been wonderful people), they are still psychiatrists, and they are still programmed to practice in ways that are potentially harmful to their patients.

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  8. Marissa Miller

    Gianna,

    Your husband sounds like an awesome guy. It’s so great to have someone with you who can give an objective opinion. Sometimes we interpret things the way WE want to hear them depending on our feelings. I’m glad you can bring him along.

    It does seem as if your psychiatrist is invested in your well-being. You should be thankful that he is open to you and is willing to work with you on your withdrawal process. I am not comfortable with my psychiatrist at all and would prefer to have a different one if possible. It is my hope that you can begin to let go of some of your reservations about a man – who through your description – sounds like a wonderful doctor.

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