Slight tangent

So, a good friend of mine, who I met back in college was reading this blog and she thought I should share with everyone where the title came from. It happens that this friend also has some experience with the mental health care system. We've even had a few misadventures in therapy together (see the upcoming post: Give me Liberty and give me death). Anyway, to the poorly concealed astonishment of her therapists, she makes a decent living as a playwright and after a particularly rough patch in her life, she turned to a therapist called Mary Spilde (spelling?) in Binghamton, NY. Her experience with this person led her to write what I consider to be her best work on a bus between Binghamton and Newburgh. It was a ten minute play that demonstrated exactly how absurd and frustrating therapy can be and it ends with the therapist screaming at and physically shaking the patient followed by an abrupt request for money. She didn't know what to call it, and I suggested "Your Moneys Worth". When I started this blog, my intent was sort of to pick up where the play left off, albeit in a much less inventive way, showing people what really happens to many of us who put ourselves into the system and giving those who share my frustration the message that they are not alone. So I took the title of the play and made the title of my blog. If you'd like to read this piece, it's available at www.notmyshoes.net, as are some other really good plays including Like Dreaming Backwards which deals with the tragedy of suicide. A real beach read. Anyway, enjoy, and if you want, let me know what you think.

The old college try

Going back to the history of Joanna in Crazyville. So, I'm mentally ill, right? So says my lovely psychiatrist back in approximately 2001. Now you've got to understand something. I was, at this point extremely excited about becoming a nurse. All I wanted to do was get that R.N. license and go to work on a hospital floor. I wanted to be part of the system. I had the utmost faith that worked and that within its' bounds, I could be a genuine caregiver. I also looked forward to being a colleague of doctors, whom I imagined were all something like Gregory House. Assholes? Yes, but medically curious assholes who wanted to find the answer and would exhaust every possible resource investigating their patients symptoms. Me and the system were gonna make people better. So when I found out that I was ill, I became the single most compliant patient you could ever imagine. I took ALL the drugs, I kept EVERY appointment. I was completely honest about everything I felt. I didn't have that suspicion which people often bring into treatment because these people were my friends. And not only that, I might have to work with them some day.

This being the case, when I went to college, I dutifully kept up my treatment, despite the fact that up till then, my treatment had had little effect. The first week I went to the counseling center and made an appointment. I was assigned a therapist named Bill Russel and I have to hand it to this guy, he tried. His approach was psychoanalytic in nature, like Freud, Jung, and Erikson. We talked at length about my family situation, about dreams I had, about what my subconscious was trying to tell me. We came up with all kinds of reasons for my sadness and lack of self worth, and all kinds of reasons why logically they shouldn't be a problem. But we never addressed head on the fact that they were a problem and we never came up with anything to actually do about it. A year into this therapy Bill referred me to the campus psychiatrist. After telling her my life story, she prescribed Lithium and Seroquel. Again, no physical investigation, no insight as to what sort of therapy might be helpful, just drugs, and bigtimes drugs at that. Lithium is a very dangerous and uncomfortable drug to be on. It's therapeutic margin is very slim and if you're not VERY careful about your sodium intake, or you get sick and vomit,(a side effect of Lithium) you can become toxic like that. Even at "safe" levels, Lithium can damage the thyroid, kidneys,heart, and liver, all organs that you pretty much need. Seroquel is an antipsychotic. The combination of lithium and an antipsychotic pretty strongly suggests a diagnosis of bipolar disorder which this doctor insisted she believed I did not have. What did I have? She didn't yet know. She never found out either. I was given the non-diagnosis of mood disorder NOS (not otherwise specified). And since then, every doctor I've seen has taken one look at these medications and gone, "Well, someone prescribed these once for some reason, so you must be bipolar." Nevermind the fact that I've never had a manic episode, or especially impulsive behavior, or even, (especially back in college) pronounced irritability or rage. The drugs said bipolar. The symptoms became irrelevent. As to their effectiveness, at first I was so hopeful that a new approach was being tried that they seemed to work. Very quickly though, I fell back into my familiar patterns of anxiety and depression. The Lithium was increased, and I became toxic. It was reduced again and then maintained as if everything were fine. As long as I wasn't suicidal they were content to let me suffer because in their minds, I shouldnt' have been suffering, after all the lithium levels were fine so clearly the drugs were working. I spent about a year and a half like that. That's when things got really desperate

Language barriers and the underpants gnomes

My original intent with this blog was to describe my experience chronologically. I'm going to interrupt that flow right now, however. Last night I was in the office with my current therapist trying to find a way to cope with feelings of panic and despair that have prevented me from working for the past three days in a row. I realized two things. One: Therapists as a community are very much like the underpants gnomes of T.V.'s South Park. They seem to lay out three phases of treatment which go something like this

Phase one: Collect underpants (Tell your therapist everything)

Phase two: ... (No one seems to have quite put their finger on it)

Phase three: Profit (Feel better)

Now, I'm not saying nobody ever benefited from what is called "supportive therapy" which seems to be based on the idea that simply talking about your feelings and circumstances will help alleviate them. In fact, it may be ideal for people just beginning therapy who are struggling to understand what is happening to them, newly diagnosed people who are just wrapping their minds around their symptoms, or even as an adjunct to other therapies for people who are in long term treatment but who have little support. However it's been my experience that staying with this type of therapy exclusively does not help you to learn to manage your feelings, and change them (or at least your response to them) so that you can live an enjoyable life. It can leave you feeling stuck, ineffective, and powerless. Unfortunately, even therapists who claim to take a more cognitive approach are often way more support based then "skills based". So the patients are left with a big whole in their treatment between talking things through and feeling some relief and no practical way of breaching it.

The second thing I realized is what a large proportion of mental health professionals in this country do not speak English particularly well. I do not pretend that this makes them any less knowledgeable or empathic, or any less valuable in a country full of different languages and cultures. Indeed, for people who do not speak English, or who are bilingual, they are probably a godsend. However, I do sort of take issue with the fact that these people are often assigned the care of monolingual Americans like me. This is a profession where diagnosis and much of responsible treatment relies solely on the ability of the two parties to communicate with each other. If one cannot make herself understood to the other, treatment becomes ineffective at best and harmful at worst. And I'm not talking about an accent here. I'm talking about my actual words being not understood. I'm talking about my therapist repeating the same non-helpful phrase over and over because she does not have the words to paraphrase. Should I broaden my horizons and learn to speak Spanish, Russian, Polish, Chinese, or Hindi? Probably. Would it make me a better, more interesting and possibly more empathic person? Again, probably. Does the fact that I have not done so mean that I forfeit the right to be helped psychologically? God, I hope not.

It all started when...

There are a number of reasons that led me to seek help from mental health professionals. Most of these came to a head when I was sixteen, the age I used in the previous story. This was the year that my alcoholic and sexually abusive father finally walked out. That actually probably would have been a good thing, except that my mom, who has mental health issues of her own began to decompensate. She had a lot of anger and no means of expressing it and became occasionally physically violent. At around the same time I contracted mononucleosis although we wouldnt' find that out till later. Finally, my boyfriend at the time expressed that he no longer shared my feelings and essentially disappeared off the face of the earth. This was really the kicker for me. I know it seems trivial, but I never really expected much of my parents in terms of support and stability. He had been the person I'd come to rely on and unfortunately when it ended, as most high-school relationships do, I had no leg to stand on. I stopped wanting to go to school. I quit my job as a groom at Claremont Riding Academy. I cried constantly, and I slept a lot. I began to long for a way out. So, I was brought to a psychiatrist. What with the circumstances I was in, no physical causes of my malaise were even considered. No physical was done, no blood tests for hypothyroidism or vitamin deficiencies even though these are terrifically common. On the basis of a one and a half hour interview I was not referred to a therapist even though it certainly seemed that circumstances and trauma played a large role in how I was feeling. Instead, I was given drugs. First Zoloft, then Effexor, then (to go in a completely different direction) Klonopin. The mono went undiagnosed for nine months, and a child who had, undoubtedly, a lot going on in her life was labled mentally ill. When the drugs had no effect, other options were not considered. The doses were increased until the side effects were intolerable and then another drug was prescribed. At no time was the possibility that my symptoms could have been the result of anything other than disordered brain chemistry entertained. The symtoms were not investigated, they were taken at absolute face value, and no real diagnosis was put forth. I was just put on drugs. That's it.

Just to give you a feel

Imagine you are sixteen. You've just been out for a run, something you always do after school. Only this time your run has left you thirsty. Not just a little dry in the throat, but parched. Every breath burns, you begin to feel light-headed, you see spots. You reach for the water fountain, but it's out of service. Up ahead, there's a starbucks. "They've gotta have some water" you think to yourself. So you drag yourself up the block, you very patiently wait in line, and when it's finally your turn, you ask for a cup of tap water. The woman behind the counter returns your question with a smile. "Why do you want water?" she asks. "Would you say that you're feeling thirsty?" You can't help but feel that that's a silly question, but you nod. The woman shakes her head sadly. "You're so young." she says. "How did you let yourself become so dehydrated?. " You have no answer. "Surely there must be a reason?" she presses. When you still have no answer she continues to ask you very detailed and personal questions both about your thirst and everything else up to and including your sex life. Now you are thinking "This must be some water." Finally the woman walks away. She returns without water or explanation. "Are you feeling better?" she asks. You reply that you still haven't had any water. The woman furrows her brow in concern. "I think maybe you need something more than water. How about some coffee? It'll make you jittery, keep you up at night, give you headaches and make you sick to your stomach, not to mention stunt your growth and hinder your brain development, but it will quench your thirst. For now." You're desperately thirtsty, so you try the coffee. After about half an hour, your thirst is back with a vengeance. You thank the woman for the coffee but say that you really feel that you need some water. "I know just the thing" she answers and again walks away. This time she returns with a bag of normal saline solution and an I.V. needle. You see the needle and flinch. "Really I just need some water" you protest. "It's too late for water. Your thirst is out of control. You really shouldn't have let it get this far," she answers, all the while coming closer and closer with the needle. You look to the other customers for help, but none of them even meet your eyes. Other employees are blocking the door. What now?

This is the best analogy I can think of for my interaction with the mental health care system, which will be the focus of this blog. I've spent eight years as a patient, and have also dabbled as a psychiatric nurse on an inpatient unit. Hopefully, this means I will have something helpful and interesting to say on the subject. I hope you enjoy