PSYCHIATRISTS
When
you mention mental health services the first provider that usually
comes to mind is a psychiatrist (pdocs for us in the know, “shrinks”
for those over 60). My experience with this profession is decidedly
mixed.
No couches or ink blots
First
things first, get the traditional image of a psychiatrist out of your
head. There are no couches or notepads or ink blots or even a cigar
for that matter. They make it very clear on your first visit that
they are primarily phamacologists. Their specialty is medication not
therapy. I have often heard complaints from other patients that
psychiatrists are only interested in pushing pills. I admit when I
first started on this journey I said the same thing. I have since
come to realize, at least from my experience, that that is what they
are suppose to do. Complaining about a psychiatrist always
prescribing pills is like complaining about a dentist who only cares
about your teeth. Psychiatrists are what they are.
If
you're looking for therapy and not medication, then you have to see a
therapist. A psychiatric appointment does not typically allow for
deep discussion. I saw one pdoc who started our first session by
saying “I only have 15 minutes so don't go into too much detail.”
She wanted the current problem with no backstory, pronto. Another
psychiatrist kept answering his pager during our session. Clearly
there is a shortage of psychiatrists but that doesn't change the fact
that he made me feel entirely unnecessary. It was as if he already
knew which medications he would prescribe from me even before I sat
down. He already knew “the story.” He didn't need any details.
Pharmacologists
Psychiatrists
are primarily interested in compiling a list of acute symptoms which
they can then use to select the most appropriate medications. Follow
up visits then focus on the side effects and the benefits of the
chosen drug and whether or not there is a need for a dosage change or
a different medication altogether.
I
respect psychiatrists for what they are and I know that without my
current medications I would not be able to write this book. That
said, there does seem to be a bit of alchemy involved in the
prescription process. No one really knows how psychiatric
pharmaceuticals work and so selecting the right medication for a
patient is not as simple as prescribing antibiotics. I have had
experience with a number of psychiatrists. In fact I have seen a
total of seven different pdocs in the past year. This was not by
choice. My hospital visits availed me of such variety.
What
I found troubling was that each doctor seemed to have their own drug
preferences. In fact I often had to sit and listen as one
psychiatrist would tell me why another psychiatrist's prescription
was wrong. One doctor, for example, saw no sense in breaking pills in
half. His attitude was to go up a full dosage no matter what. He also
guffawed when he heard I was on lithium. He told me it was little
more than a vitamin at low dosage and I was promptly taken off of it.
I remember how he stroked his beard with a satisfied confidence when
he revealed which “flavour” of medication he thought was
best.
The very next day I saw another psychiatrist who
proceeded to prescribe a different drug altogether. The most bizarre
pdoc interaction I ever had was when one psychiatrist actually asked
me what drugs I wanted. How would I know? Did I look like an
experienced brain med user? I just shrugged my shoulders and said “I
don't know.”
No follow up
What
was even more frustrating than the variety of medications was the
lack of follow-up. I was monitored for benefits and side effects in
the hospital but once I was discharged that was it. Unlike my wife,
who was given a very specific three-year appointment schedule for
follow up after her cancer surgery, I was discharged with a bottle of
pills and no appointments. I was instructed to see my family doctor
who readily admitted she didn't have a strong knowledge of all the
psychiatric drugs available and was uncomfortable making changes to
my medications. I felt as if I had been pushed out the door and the
door was locked behind me.
I
didn't get any follow-up treatment until I was accepted into the mood
disorder clinic. At my first visit there I saw two psychiatrists who
independently confirmed my Major Depressive Disorder diagnosis. After
that I saw one of them regularly. Only then did my medications became
consistent and effective. What I found particularly reassuring was
that if a medication had a side effect I thought was too severe, we
immediately changed the it. The psychiatrist didn't have a favourite
drug, rather he was interested in finding which one worked best for
me.
I
should pause here for a moment to clarify that my perspective on
psychiatrists is limited to those I could access free of charge. My
family doctor tried to find me a psychiatrist in private practice but
either the waiting lists were ridiculously long (years in length) or
they outright declined my case. Apparently being suicidal was deemed
too needy and so I was turned away by one doctor, sight unseen.
My
advice to those who want to access a psychiatrist is to have your
family doctor put you on every waiting list available, whether that
be urgent care, a mood disorder clinic or a psychiatrist in private
practice. If you want to see a psychiatrist immediately, the hospital
ER is your only option.
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