Tag Archives: doctor

Better

I’ve spent the better part of the last decade in therapy and on meds. Going to therapy, takin’ my meds. Rescheduling therapy, adjusting my meds. Adding more therapy, adding more meds, then backing off a little on both. Though I’m still a habitual marijuana self-medicator, I’ve more or less stopped drinking over the past year. I definitely stopped that shit where I pick up a 6 pack on my way home and drink alone in my living room with my guitar before the sun even goes down. A bottle of gin in my house has a way longer shelf life these days. I been good. A model prisoner of my illness (or whatever poetics you wanna stamp onto this situation).

A week or so ago in therapy, my doctor commented on how much better I was doing. I’ve been on Depakote for like 5 months. No hair loss or anything! I’ve had some kinda funky depressions and at least one pretty awesome hypomanic episode, but overall things have been less sharp and less rough. I’ve been writing a lot. I’m working on a collection of poems and I’ve been writing some essays just for shits. I feel stupid and wordless a lot. Then I don’t. Sometimes I feel proud of myself. It’s real weird.

But my doc says I’ve been doing better. She has my chart. She’s been treating me for 8 and a half years. I told her I didn’t really believe her, but that she’s the expert. So here we are. I’m better. Yikes.

Part of me is upset by this prospect: better. It makes me wanna destroy myself a little and I certainly know how, but there’s a large part of me that feels I owe it to my psychiatrist – to all the hard work she’s done and all the shit she’s put up with from me – to stay better. Why don’t I feel beholden in the same way to myself?

Couple theories: Firstly, and most obviously, if I’m doing terribly, I probably can’t get a whole lot worse. There’s nowhere to fall from rock bottom. It’s paradoxically comforting to know there are no threads left to cradle you. You get to lie all the way down.

Secondly, I’ve had more experience with depression than…almost anything else over the past decade. I know how to navigate it. Sure, it hurts like hell, but it’s a hurt I’m used to. I can change all the dressings ‘n everything. I’ve been ill as a full time job for years and years. I’m getting fired or something. Additional metaphors relating to the unknown, etc.

But I think my biggest problem is: what now? My identity is kinda shifting away from simply Bipolar Laura to _______ Laura. Not sure how to fill in that blank. I mean, I’ll always have bipolar. I didn’t get here by magic, I worked toward this. I don’t think, though, I ever really thought concretely about what I was working toward, just that I needed to keep pushing in an upward direction. Now I have more time and energy (most days) and I don’t need to use those circumstances to patch myself up the same way. I can do things!

I told my doctor that I’ve arrived at the downside of up and she said, “Yup, that’s the downside.” She recognizes that the new imperative I’m facing to do something with my life is not an easy thing to tackle. Maybe it’s even complicated by the fact that there are like a hundred things I wanna do with my life. Basically, I’m having a Sylvia Plath problem:

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The Bell Jar

‘Cept I’m starving not just because I can’t decide, I’m starving ’cause even if I do decide, I can’t rely on my own self-motivation which has been directed entirely at my mental health for so long that I don’t really know how to use it for anything else. I just haven’t really had to, and though people keep telling me to be easier on myself, I still insist that I’m awfully lazy.

So let’s not confuse “better” with “cured.” I still have to take care of my illness, but the difference is that it’s not the sole thing I have to take care of right now. I still have mood swings and panic attacks and episodes. Like, that shit’s never going away entirely. Not unless I cloister myself in completely perfect behavior and probably take some stupefying meds that I don’t want. But that’s not a life. I’ve always been scared of the future for the same reason I’m now scared of being better. I don’t know precisely how to move around in it.

That’s basically where I’m at. And don’t think that I won’t stretch my indecision and cowardice and self-doubt into months and months of soul searching or some bullshit, ’cause I definitely will. Out of fear and hesitation. I have some thinking to do. It’s probably gonna be a minute.

-LB

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You Tell ME

Ok, so I need you lovelies out there to share your opinion on this – if you have one:

I’m going to start seeing my therapist twice a week again. I have the hypothetical option of going 2 days in a row or spacing my appointments out a little so I don’t go as many days in a row without seeing my doctor. Few things to consider:

1. The benefit of going 2 days in a row is that I can keep the momentum going and pick up where we left off the day before when I’m dealing with something that can’t be dealt with entirely in 50 minutes. Doc says some of her patients find this route really beneficial – closer to having one really long appointment than 2 shorter ones…kinda.

2. On the other hand, sometimes something fucked up will happen the day of or the day after a session and I have to wait almost a whole week to talk about it, and in that time, I might forget important details or the incident altogether, so it might not get handled properly. So it might be better to, for example, meet on a Monday and a Thursday so therapy is, in a way, more frequent and my issues more up to date.

3. It’s about a 90 minute commute via public trans from my house to my doctor’s office, which probably sounds like a stupid choice on my part, but I started seeing this doctor 8 years ago, and 8 years ago, I lived in a neighborhood that was pretty close to her office, so it was fine. 90 minutes each way, two days in a row is a pain in the ass. It might be less exhausting if I had some spacing between doctor visits that take up like half of my goddamned day.

4. Regarding #3: I don’t mind long bus>train>another train commutes as much as most people probably do. I can read, I can listen to music, I can write, I can check out cute girls like a total pig. A lot of my fashion decisions are the result of things I’ve seen people wear on the train, and because my city’s so large, there’s a lot of variety.

5. Depending on what my doctor has available, this choice might be made for me, and, really, I’m not gonna suffer either way.

But I still wanna know what you think. Which option would you prefer? Why? Open to all opinions and experiences. Lemme know in the comments and thanks in advance! (Especially for factors I hadn’t considered here.)

-LB

Everybody’s Talkin’ (Except Me Because I Have Nothing To Say Right This Sec)

I am astonished by how astonished I am that I have so many covers of Harry Nilsson’s classic novelty jam, “Coconut” in my library. Right now I’m listening to one by Fred Schneider from the B-52s and it sounds EXACTLY how you think it would.

I wrote like 11 drafts of this post and deleted all but this one because the only thing I needed to say is that I have therapy today and I have nothing to talk about which is really disconcerting because my doctor will let a pause get pregnant and pregnant-er until I spill my guts about anything in the hopes it’ll circle back around to something worth talking about. It’s a really good strategy.

Everything is fine. I think I’m gonna waste the session talking about Harry Nilsson.

Harry Nilsson is one of only 3 blonde dudes I’ve ever wanted to bang. I mean, not now, obviously, ’cause he died in the 90’s, so that’d be hard to swing. But before he had 8 kids? I’d hop on that train, no hesitation.

Harry Nilsson is sometimes referred to as the 5th Beatle, which is kind of unfair because Harry Nilsson is better than the Beatles. John Lennon produced one of his later albums and it’s SO DEPRESSINGLY BAD. John Lennon ruins everything.

I wonder what Harry Nilsson thought about Soundgarden.

If I got to watch Harry Nilsson fistfight Paul Simon, there’s no way any possible outcome would leave me dissatisfied.

Nilsson Sings Newman should be rocketed into space as humanity’s ambassador to all aliens.

I don’t do hard drugs anymore, but I would to ALL the drugs with Harry Nilsson if he called me up and was like, “Laura, I have all the drugs. Let’s do all the drugs together.” Yes, Harry. Let’s.

And then my 50 minutes would be up. I mean, I guess I have some insurance stuff to discuss with my doc, but I’m not insured by Harry Nilsson, so I feel like it’d be really hard to keep me on track.

Sorry about the throwaway post (except I’m not really that sorry, but I feel like I should be). Umm…I guess I should go to therapy. Dig this in my absence:

-LB

You’re More In Charge Than You Think

I may write about this some more because I feel really strongly about it, but I want to address a specific aspect of the doctor/patient relationship. In order to get the most out of your efforts, you need to be an active participant in your healthcare. You’re not a lab rat. You’re allowed to say no to things you don’t wanna do. You’re allowed to fire your therapist if (s)he is not working out for you. When you’re prescribed a medication, do your homework. Knowing what to expect makes medication a lot less daunting. Know your body. Know your meds. I’m practically a pharmacist at this point because I won’t take a pill or a dosage adjustment before I ask every question I can think of. Your doctor might be the one with the medical license, but that doesn’t mean you have to be uninformed. You’re smart enough to understand the things you need to know to be a knowledgable and participatory patient. You also have every right to negotiate your treatment options. The only time you can’t really do this is if you’re hospitalized, but you can do it once you get out.

I’ve seen a few people who have been cowed into submission by a doctor or therapist. This is not how it’s supposed to work. You’re not a car in need of a mechanic. You have agency. Work with your doctor, not for your doctor. I got pretty lucky and found a doctor/therapist who’s honesty and leniency are at a good ratio. She tells me things I don’t wanna hear all the time, but she’s not punitive if I decided to push back.

There are a few red flags that I think are deal breakers when it comes to choosing a doctor:

1. Your doctor admonishes you for drinking or using drugs instead of non-judgmentally advising you not to do those things and then explaining how they actually affect your symptoms. My doctor knows I drink moderately (but less so lately because I’ve been having migraines more frequently for some reason) and that I use marijuana occasionally (I said “use” instead of “smoke” because I recently got kinda into edibles). She also knows that, once in a blue moon I’ll use hard drugs or hallucinogens, most likely MDMA, but this only happens a few times a year at most because hard drugs get really boring eventually. BUT: really important PSA about hallucinogens: if you’re taking lithium do not take mushrooms, LSD, DMT, Salvia (which I don’t think anybody even uses anymore, but whatever) or anything that makes you trip because if you mix hallucinogenic drugs with lithium, you’re basically asking for a seizure, even if you’ve never had one before. I found this out just in time before I went to visit my sister which is pretty much the only time I take acid. But my doctor doesn’t berate me when I come home from a Big Sis bender and tell her I was high for 4 days straight. She explains to me what the intoxicants do to my brain, how they affect mood disordered people differently and what the potential consequences are if I decide to get messed up. She’s my doctor, not my nanny. I have a friend whose doctor likes to take up valuable therapy time by chastising my friend for having a single fucking drop of alcohol. This doctor, in my opinion is overstepping her bounds partly because she assumes my friend is completely unaware of the effects of drugs/booze (which my friend is not because she’s not stupid) and partly because it’s your therapist’s job to help you learn to take care of yourself. Condescending to a mentally ill person is the worst idea ever. If your doctor doesn’t treat you like the grownup that you are, then find somebody who does because, rather than a slap on the wrist over a tallboy, your therapist should be equipping you to make healthy decisions.

2. Your doctor dismisses the side effects of the meds (s)he prescribed you. If your doctor doesn’t think that medication side effects are a quality of life issue, then (s)he is a crappy doctor. One of my older meds made me so tired that I never had the energy to go out. As a result, I was alone a lot, and being alone constantly cancelled out whatever positive effect the medication might have because being isolated – willingly or not – makes most people’s depression worse. And, speaking of quality of life issues, there is no issue too small if it’s really bugging you. I refuse to take SSRI antidepressants (see LBD: antidepressants) because when I take them, I can’t have orgasms. Maybe that’s not a big deal to some people, which is fine. But some people think it’s frivolous and it’s not. Do you wanna not be depressed or do you wanna get off? is a false dichotomy. I can come and get proper medical attention, the two are not mutually exclusive. But if you have a problem re: side effects that you think is trivial, it’s not. Tell your doctor about it and then discuss what your other options are because you’re not short on options.

3. You doctor doesn’t monitor the long term effects of your meds. Prolonged use of antipsychotic meds (see LBD: antipsychotics) can cause a condition called tardive dyskinesia which is a neurological disorder that causes involuntary, repetitive and aimless movements, mostly in the face and the hands (which are things I assume you don’t want messed with). The really scary thing about TD is that, in some cases, it’s irreversible even after you’ve stopped using the drug that caused it. TD can present as something as mild as a mouth twitch and as severe as involuntary jerking of the head and neck which is extremely noticeable. My doctor tests me for TD like twice a year. I started to show minor symptoms of it the last time she checked so we’re trying to come up with a better long term solution (together). If you’re taking lithium, you’ve probably already been warned about what lithium can do to your thyroid and kidneys. Lithium will trash your thyroid pretty thoroughly if you take it for many years so you should have blood work done roughly twice a year to make sure your organs are still doing their job. I know a couple of people who are stuck in medication limbo because their prescribing doctor is myopic. If your doctor doesn’t keep an eye out for what your meds are doing to you in the long term, find a doctor who will.

4. Your doctor talks more than you do. You didn’t go to therapy to get a weekly lecture. You went because you need to work out your problems with someone who’s trained to deal with them. Working out said problems begins with articulating them (which is way harder than most people think) so you need to be able to talk. Ask for advice when you need it, heed your therapist’s recommendations, but don’t get run over. You may have an illness that several million other people also do, but your illness is your own and it’s different from anybody else’s. Cookie cutter therapy only works if you’re a literal textbook and not a human being. You are allowed to tell your therapist to shut up. They’re not your boss and you’re paying them. A good therapist will let a pregnant pause sit until you’re ready to squeeze out a thought because, in the long run, those awkward silent moments can rouse some really important feelings that you didn’t even realize were part of the bigger picture. Everybody needs to learn to speak for themselves and that voice should not be sequestered to therapy. So say anything. You have no idea whether or not the loose thread you just tugged will unravel the whole garment. Sometimes it does and sometimes it doesn’t. But you’re not hurting yourself by babbling. In the long run, you’ll get better at dealing with the bad shit on your own, which is pretty much the entire point of therapy.

All said, I’m not bitching about doctors in general. Doctors are great (a lot of the time). You should not cavalierly ignore a doctor’s advice just because it sounds like no fun. Much of the time it is no fun. But you decided to get help from a professional because you probably realized you couldn’t do some things on your own. But it’s your life. You’re not too stupid to wrap your head around your situation and you’re not too stupid to understand the process of dealing with that situation. Bipolar disorder can make it really hard to feel like you’re in charge of anything. Depression can too. But you are in charge. Do your homework, ask every question you need to and remember that nothing – not meds, not doctors, not therapists – is indelible. You’re the boss, so act like it.

-LB

Your Time Vs. My Money

Without getting too into my mommy issues at the moment (which I will plumb deeply at some point in the future, probably when I’m pissed), I spoke with my psychiatrist/therapist yesterday about how I feel that my mom has a defeatist outlook when it comes to changing her attitudes. For context: my mom is 66 years old. She’s a really smart lady who has a very successful career and some pretty powerful connections. She’s a bulldog in negotiations, she’s the last enemy you want to make as a professional, she’s business savvy and law savvy and media savvy. She’s spent her whole life adapting to changing corporate atmospheres and, now, as a senior citizen, she’s still probably the first person you want in your rolodex if you work in X field. That being said, she’s so completely set in her ways, it’s infuriating. She’s the kind of person social conventions were made for. She flourishes within rigid structures and, despite being demonstrably adaptable, she’s simultaneously an old dog who refuses to learn new tricks. I have a lot of theories about this part of her personality but I don’t want to talk about them now because I have therapy again tomorrow and there’s very little that’s more disconcerting than going to therapy and having nothing to say.

My mother is also a micromanager. When she wants to help you, she tells you she’s going to help you. She does not ask if you need her help (you probably do, though). As a result, I feel less surefooted when it comes to making decisions and I feel like less of an adult because mommy swoops in before I can learn from my mistakes or work out problems on my own. So for the last year or so – maybe even longer – I’ve been having conversations akin to this:

Mom: You have your wedding dress, right?

Me: Yeah, of course, it’s in my closet.

Mom: Ok, next time your out by me, bring it with you and I’ll take it to the dry cleaners to have it preserved.

Me: Mom, I can find a dry cleaners out here.

Mom: Well they don’t all know how to preserve a wedding dress properly, the people in at [dry cleaners] in [hometown] are the best at it, just bring it here, I’ll hang on to it for you so you don’t have to worry about it.

Me: Ok, look, I realize that you’re trying to help and I appreciate it because hauling my wedding dress around is a pain in the ass, but I really would have preferred it if you’d have asked me if I needed your help here instead of telling me that you were gonna take care of it. I think this is one of those grownup things I’d like to do for myself. I think it would be good for my self-esteem to take responsibility for something important. From now on, can you just say, “Laura, would you like my help with X?” rather than “Laura, I’m going to do X for you?”

Mom: WHY IS IT ALWAYS ABOUT WORDING WITH YOU?? YOU NITPICK THE WAY I SAY EVERYTHING! (she’s a screamer)

Me: Because when you don’t give me the option to take care of things for myself, it makes me feel like an overgrown child. I feel inadequate and incapable and it bruises my sense of self worth and independence. I’m 27. Please, just ask instead of tell from now on, that’s all I want.

Mom: Fine. But you know, I’m old and I can’t change and I’ve been this way forever and…(Laura puts down the phone, goes to take a pee, pets one of the cats, returns to mom’s rambling bullshit, waits for her to shut up)

Me: Mom, I’m late for something we’ll talk about this later. Bye.

This is an issue that incenses me pretty consistently and it comes up in therapy a lot. Yesterday, to illustrate this problem to my doctor yet again I discussed how my mom claims that she’s incompetent when it comes to technology (untrue) and that, when presented with a task she’s never done before that involves something technical, she decides she can’t do it before she even tries.

Ok, so it’s taken me about 700 words to get to the actual point of this post and I know I said I wasn’t gonna talk about my mommy issues a lot (and, honestly, I haven’t because this is just the tip of the iceberg), but at this juncture in my session, my doc said to me: “Here’s something you have to understand about people in their 60’s: People your mom’s age and my age didn’t grow up around technology the way people your age did so it is actually a little bit more difficult for us to learn new things. I’m not saying your mom’s attitude is right here, but I do think you should keep that in mind.” (The irony here is that I still don’t own a smart phone and both my mom and my doctor do.)

But she mentioned her age(ish). I’ve placed my doctor’s age (currently) at somewhere between 55 and 65, but she’s pretty youthful looking and and a fairly stylish dresser so I was always thrown off a little by those factors. Either way, I never really thought about it much. The reason I never really thought about it much is because I didn’t seek out a psychiatrist and agree to pay [insane amount of] dollars each week so I could make a new friend. I’m pretty good at making friends for free; I am not pretty good at resolving deep-seated psychological problems without the aid of a professional (gettin’ better though, dollars at work). So in the 7 and a half years I’ve been seeing her, I don’t think I’ve ever once asked my psychiatrist a personal question. I guess another reason, and the prompt for my question is: I don’t understand the etiquette of asking my doctor about her personal life. I don’t know if she’s married, has kids, is queer, is straight, is from the South, votes Democrat, jogs after work, hates Japanese food, has a dog, is an atheist, listens to Fleetwood Mac, or (and this is probably the only thing I’ve really wondered about) has a mental illness herself. It really doesn’t bother me that she knows pretty much everything about me and I know almost nothing about her. So yesterday I found out that she’s probably in her 60’s. I think after so much time has passed, it might be uncomfortable for both of us if I started asking my doc about her private life now. I also don’t know if I was ever supposed to.

So my question(s) for you reading this: Do you ask your therapist personal questions? Was it at all helpful to your treatment or was it just one of those countless tangents that exist in the space of psychotherapy? If you’ve asked, has your therapist ever declined to answer? Do you think it’s rude to ask? Do you think it’s pointless to ask? Does it feel intuitive to ask at least a few questions/is my doctor likely to think I’m inconsiderate for never even inquiring if she has a family life?

I’m not gonna go to any lengths to change up the social dynamic of my doctor-patient relationship at this point. Focusing solely on my shit has been working out pretty well thus far. Therapy time is Laura time. I know why I’m there and it’s not as if we’re going to spend the whole session rehashing my doctor’s life story if I ask one probing question. I’m just really curious to know if other people have cultivated a two-way street kind of relationship with their therapist (and why and what it’s like).

So lemme know what your experience is. This thought has occurred to me before, but never so acutely as when my doc indicated her relative age to me yesterday. So please share! I super wanna know.

-LB