Across and Inside my Universe

What's My Problem?

Why am I so upset about the group therapy?

It's not the end of the world if I'm faced with something unpleasant about myself, however awful it feels or seems.

It's not the end of the world if I feel as though I was manipulated by the psychiatrist.  Would it have been better if she hadn't done so? (If she actually, intentionally did; manipulation is in the intent.)

Sure.

Is it any surprise to me that she's insensitive, dominant, strong in her opinions, outspoken about them, and has a definite idea of what she feels is best?

Put that way, no, no it's not.

It's never fun to be receiving such things, from a doctor no less, and even more difficult to bear, from a psychiatrist.

Still, I can discount some of her "authority" by thinking of the above things that should not surprise me anymore.  Why would I put alot of weight on what someone like that says, if it's not specifically medically related?  Ie, if it's not medical advice she's giving me but therapeutic (both are medical in their way but I think you know what I mean).

So regardless of how she was, as I discussed in my last post, I can follow the chain of thoughts that led me to a very bad place, to a very . . . difficult view of myself to approach, let alone investigate.  That makes it hard for me to discount anything, and so leaves me with a feeling similar to the picture up above.

I feel kind of like it would be healthiest for me to set aside this difficult, painful view of self for awhile and just keep on plugging away, step by step, at improving.  It's hard though because this thing wants to pull out the rug from under me and just bring everything crashing down.

Perhaps I'll gain some more perspective and/or distance from it in therapy tomorrow.  I feel like I've already gotten a little, as I'm not flailing around emotionally, as much as I was.

Still, I really do not need another really bad thing to think about myself, when I get suicidal, to pile on top of the other really bad things I think about myself.

Life however doesn't care how many bad things come your way, it just goes on.  So I need to as well, hopefully putting this in a better place.

I Herd You

I went to what I thought was a support group that my psychiatrist runs, for adults with AD(H)D.   It turned out to be group therapy.

She had an agenda, that she guided and directed the group through and towards.  She lectured from time to time; she drew conclusions and presented them as "the" way to feel & think about things.

In some ways, she was as indelicate as a bull in a china shop; however, there was also a sharp mind behind the questions, conclusions, directing.  She knew what she wanted us to think, and she took us there, by leading, pretending to guide, snapping at our heels like a sheepdog if we weren't quite drinking the Koolaid she was dispensing, by running us into the pen she had decided was where we needed to be.

There wasn't much support, and what support she gave to others in the group eventually morphed into her adapting what they'd said, into her agenda for where she wanted things to go.

Now, before this group session I'd had an appointment with her, which went fine, since we'd made some things clear last time.  Such as the notion that I am my own person, in my own life, and I am the best one to decide what works for me, and not her.

That obviously applies to anything, but when you go to a group thing like this you try to leave yourself open to learning something, gaining some support, or insight, or something . . . by the time you realize there's a sheepdog at your heels, you've gone a ways down a path that may not be for your good.  You do your best to keep from bursting into tears through the rest of the appointment, to keep from going where it is that the sheepdog is pushing you, but you are already falling down that mountain.

So there's a knife in my heart, and you'd think it'd be relatively easy to pull it out by discounting the source; obviously she's not a sensitive nor observant nor supportive nor respectful therapist.  Why would one give much weight to what she wants, what she says?

It's not that simple, however.  I wish it was.  See, the things I thought and felt, the places I went to, the conclusions I found, well, there's a train of thought and feeling that I had during this process.  Both she and the group were stimuli in that process, but I can still follow the path in my mind and heart that led me to a really bad place.

I am having difficulty discounting that, erasing it, setting it aside, or whatever.  I can't un-think how I got there.

I feel it's a therapist's professional responsibility to not command the direction of things, to not make conclusions AND present them as what IS, to not herd you towards a prticular destination.

A good therapist, even if they had a particular destination in mind for you, even a general one, that they felt was healthier for you, they would discuss things, perhaps point out paths you might not have considered, discuss how you feel about them, objectively weigh the pros and cons, but they'd never take the reins and grab you and pull or shove you down a path of their choosing.  That's part of what I mean by herding.

I feel like a therapist should respect the vulnerability of the patient(s) and use care and concern, among other things, when working with them.

To not just willy nilly, but purposefully, push patients down a path that they don't know where it's going, and by the time they have some idea they are so distressed that just about anything at that point will settle in and try to take root . . .that is bad therapy, at the least.

Of course, I'm an adult and not just turning myself over to go wherever she wants, but I didn't realize until after this happened, how vulnerable going to something like this makes you, even if you are nervous, scared, and wary.  I had made a decision some time ago to try to learn what I could from whatever the source, sometimes having to set aside my feelings about the source and just consider the infomation.  This, too, made me vulnerable, besides all my other psychological/emotional issues.

I ended up in a very bad place.  Much of that is me, but the therapy itself and the manner of it, is also a big factor.

I'm starting to think, now, that what she said in our amicable appointment a month ago, that whatever she says, it's my choice what I decide is useful for me, is partially an excuse for her brash, forceful "therapeutic" manner.  That she can excuse quite a  few things by saying or thinking that the patient can chuck it all out, if he/she wants. 

If this is so, then she's at the least rather irresponsible.  The people who go to see a psychiatrist are often vulnerable in a variety of ways, and many are not equipped to fend off or sort through her forceful assertions, her "therapy" if you will.

So I think that her expecting her patients to be confident enough and self-aware enough to discount what she says if it's not best for them is disingenuous at the least, irresponsible and harmful at worst.

Second Psychiatrist Appointment of the Year

This was in June. 

Since I'm going to be seeing her again this next week, I'd better update the blog with this exceptionally positive step forward in our relationship.  Not perfect, but positive between her and I, to this degree, was unexpected.

I even brought up being afraid of her, and the last time I did THAT, she yelled at me.  Things went much better, this time.

She was running late, this appointment.  It was late in the day, and my appointment was for 5:20.  When she came out of her previous appointment (I assumed) right then, I prepared myself to get up and go in.  Instead, on her way back to the office, she called to a different patient, and as she passed me she apologized for being behind.  I indicated I understood and that it wasn't a problem, which she seemed to appreciate.

I could see that the next people to arrive, were startled/surprised to see that someone else (me) was called in, at the appointment time they thought was theirs.  I believe she apologized to them as well.

I like that she's conscientious of her patients like that.  It gave me the beginnings of a feeling inside that maybe today might be less confrontational in the past.  Just an inkling, really.

I forget what I first mentioned, which is a shame because she usually starts our discussion with something springing from that.  Ah, I remember, she commented on my positive demeanor as I settled myself on the soft green couch.  This startled me; she was the second person in three days to use those words to describe me.

She asked about it, and I said maybe it was from having dealt with formal church discipline and now it wasn't hanging over my head, I could move forward?  I'm not sure why I said that; it still hurts deeply, but with a bit of time I've come to see that actually it is better, now, moving forward with that behind me.

She went on with the discussion for a bit but her curiousity had been peaked and she had to return to the church discipline thing, ask about it, what it was, how it worked (briefly, very), why/what for, and such.  I had thought what for would be obvious, but I briefly, in about 40 seconds or so, described the situation, including that they were disciplining me for doing something for which my mania was a contributing factor.

She got indignant on my behalf, saying things like, "Mania is part of your illness; you enter an altered state of mind!"  She went into this for a minute or two, aghast that they would penalize me as harshly as they did, for something she feels was . . . well, that I wasn't in my right mind for, wasn't acting completely from who I'd choose to be were it not for the mania. 

For myself, I've always taken responsibility for myself and my actions as soon as I return to a state of mind where I can do so; however, I didn't frame it that way for my clergy, lest they think I was trying to not be responsible.  I was being responsible, but  . . . I framed it as, the mania was a contributing factor.

She went on to tell me that I should educate my Bishop and congregation about my illness and the way it works.  No one actually has ever outright said to me before that you go into an altered state of mind.  It would be nice if sometime someone would actually tell me more about it; yeah I can read on the internet, but I need a doctor to tell ME. 

My first shrink to my face thought I was borderline, not bipolar, and when I said that to my psychologist he pointed out that, well, he prescribed a mood stabilizer, and that'd be unethical if you're not bipolar . . . I never thought about it til now, that after that I just went into symptoms etc. with each new psychiatrist, and never asked for any education; no one had ever explained anything to me.  I got more explanation from the government-contracted shrink who evaluated me for disability than I did from anyone else, ever.

So, her advocating for me, showing that she cared that people had/were judging me for things that at the very least were influenced by mania, and that she was indignant that they wouldn't know or consider my illness to be much of a contributing/mitigating factor at all, well, this made me feel good, and more importantly, made me feel more connected to her as my doctor.  This strengthened a . . .turbulent therapeutic relationship.

As she made some notes and asked something to further our discussion on other stuff, I worked in my issues with her (some of them), such as that I was intimidated by her, scared of her, and that when she threw out advice to me as to stuff she thought I should be doing, stuff that I felt didn't fit my belief system (like the previous appointment's ridiculousness where she told me working on my marriage and family was selfish, I should look to serving others instead, I took this as her karmic point of view), that I felt like they were harsh, rigid orders and that she didn't understand or accept that I needed to take what I could from her advice, sort through it, despite any difficult feelings about her manner of presentation, and keep what worked for me and set aside what didn't.

She heard me out, and seemed a bit astonished that I didn't know that she wasn't ordering me at all; that she said what she did, and that it was my life and my decisions about what to follow and what not to.  That of course we're from different backgrounds, and that it's my life, I"m the one living it and not she, so who better than I to sift through what she advises and make my choices.

I was kind of stunned; I thought that if only we could have had this conersation 18 months ago!  I was so bouyed by her remarks I added some other things to the discussion of our relationship.

As far as meds, at our first appointment this year I had just gotten to 150,g Lamictal, with a mild non-sunburny rash.  In a different place than the last two times (and according to my hairdresser, there's an allergic-looking rash on my scalp, too).  I said the Lamictal was doing ok, though I needed more time to be sure.  I actually mentioned adding Seroquel; we'd tried it two years ago for depression, which it did not work for.  I didn't have any noticeable side effects except for being sleepy alot.

She said, "I thought we stopped that because of your PCOS?"  I was confused; what does Seroquel have to do with that, does it make it worse?  I ignored asking that and said, "No, we stopped it because it wasn't working for the depression; however, isn't it supposed to be a mood stabilizer, work on mania?  It didn't cause me side effects other than tiredness, so what do you think of trying it again?"

I went on to mention, a bit embarrassedly that I'd seen on someone else's blog that they were on these two meds.  Of course there's no guarantee they'd work well in combo for me.  Still, she seemed to want to know all of why I was asking, and so I told her. 

She was very open to it and, in fact, had prescribed the Seroquel at our first 2012 appointment in May.  At the June appointment, she asked if the meds were smoothing me out, making me serene.  They were definitely helping, and I told her, but I wasn't what I'd call serene.  In fact, I wondered if we needed to raise the Seroquel?  She held it at 150mg for now, and after some key things during our appointment had made her actively diagnose me w/ADD herself, instead of relying on other shrinks' diagnosis, we discussed Vyvanse.

I'll be trying it at what is it, 30-40mg?  Since the 70 I'd been on was seeming to be too much.  I'm just in a mess of getting the new dose approved by Medicaid, and dealing with her incompetent secretarial substitutes as her main secretary has been on two one-week vacations in 4 weeks.  UGH.  I may not have the prescription by this appointment!

Oh, one other BIG thing, is I will be going to a monthly group she holds there, for ADD adults.  No fee, at 7pm.  My appointment is at 6 or 6:30.  I'm nervous about this, but somewhat less so after clearing the air in our relationship.

Pop Culture References in Psychotherapy

Some pop culture items are so . . . pervasive, they've permeated our society to a depth that one could reasonably expect someone else to understand a general reference to it; ie, Mickey Mouse, "Here's looking at you, kid!" and others.

It's not guaranteed, but most people have a frame of reference.

There's others that are so widely popular and have been mass-marketed so much (Star Wars) that it's pretty rare, though not unheard of, for people to not understand the, "Luke, I'm your Father" reference. Although when it comes to the geekier references (Dungeons & Dragons, sci-fi, fantasy, computer nerd stuff like Tron) it really depends on the "audience".

Still, sometimes in therapy the best analogy you can think of to help illustrate something you are trying to convey, involves a pop culture reference. More often on my, the patient's, part, but occasionally, though not often, my psychologist will do this as well.

For example, when Kung Fu Panda (the first movie) was out in theaters, and had been out for a couple months, I finally saw it, and the moment at the top of the stairs when Master Shifu asks him why he stayed through all the abusive treatment Shifu had dealt out to him, well, Po's (the panda) answer deeply connected with me and I almost started crying (yes, this IS Kung Fu Panda I'm talking about). I thought, someone in Hollywood understands ME.

Now, it's not that important that ANYONE in Hollywood understand me; anyone understanding me at all is excellent! Or, AWESOME as Po would say. Still, you see all sorts of people portrayed in various shows, movies, etc., and if you never see yourself there, you feel like maybe your are too odd, wierd, defective, etc. to ever have a person with any traits similar to you be portrayed.

Now, do I define myself by what's seen in the media? HELL NO! It's just, that moment of connection with Po was a sincerely touching moment for me, and while Po may not necessarily be the personality that many people would want to identify with, well, there it is, I do. My therapist had, actually, seen the movie, and so we spent about half the session talking about the movie and the things I related to in it, silly as that might sound to some, it felt productive, helpful, and validating to me.

On the other hand, if your psychotherapist is relating a pop culture analogy to you, about something you've just told him that prompted him to think of this analogy, and the reference is the movie Fatal Attraction . . . well then maybe you're in trouble. Not with him, mind you, but if your behavior, feelings, thoughts, anything you report brings up a Fatal Attraction reference to his mind . . . well, it seems like a scary thing!

Of course, since I've never SEEN Fatal Attraction, I didn't really get it; he seemed quite surprised that I hadn't seen it. I've heard certain types of references to it so many times I know a little about it just through those; enough to know having what one just told him in therapy being related back to me as a Fatal Attraction reference, is not . . . a positive reflection on me.

Now, he's objective, and I don't believe he was using the references to JUDGE me or anything like that; rather to point out the extremes that certain thought patterns can take you to (not that I think I had done or said anything Fatal Attraction-like, but then, how would I know, since I've never seen it?)

So, he took several risks in using those references, and the fact that I hadn't seen the movie meant his analogies fell kinda flat. Then again, some of mine have as well.

I just know that one probably really needs to look at ones' self and alter ones' course of thought or behavior, if said courses of thought or behavior are inspiring Fatal Attraction references in ones' therapist.

What You NEED Isn't Always What You WANT

So, a while back I posted for a heat-themed Grand Rounds blog carnival that was being hosted at/on Shrink Rap. http://sarebear.typepad.com/blog/2011/06/when-the-doctorpatient-relationship-becomes-heated.htmlUgh, I tried to insert a link the regular way, and it wouldn't.

This last week, for no reason I can figure out, I was thinking about that post, and how it led me to compare my first and third shrinks, and then further led me to realize that I could stand up to my first one (male) and not my third one (female). They were both strong, intimidating personalities. My second shrink was very laid back and mellow.

I thought to myself, "WHY could I stand up to Doctor Number One, and not to Doctor Number Three?" (Names changed for obvious reasons.)

Within about 10-15 seconds, a quiet, deeply felt thought came to me in response, even though I wasn't expecting a response . . . . "Because it was standing up to your mother that got you on the receiving end of her fist." I instantly felt the deeply personal TRUTH of this, and it felt like I'd connected up an essential puzzle piece.

I pondered then, though, that, "Didn't I already "know" that my problems with her were because she raised the same feelings of fear in me that my mother did? That I had already connected up what my mother did to me, with why I was afraid of Dr. Number Three?" What I realized was, I had intellectually realized the connection between #3 and what my mother did, and I'd even told #3 that I was afraid of her because my mother hit me; however, I'd never FELT this inside. It just made sense to me knowing how transference has shown up in the last 7 years of therapy, it just made SENSE. Yet I didn't FEEL it.

THAT's what the difference was when I had this response, this realization this last week. I FELT the truth of this, and it connected everything up on an emotional and other deep levels. It's one thing to KNOW something with your head; it's another to know it in your heart, in the depths of your being, not to get overly dramatic about it . . .

So, it's been a week since that realization, and I've come to another one because of it, and that is that I can now use the word "abuse" to describe the physical, well, abuse that my mother heaped upon me when I was a young teenager (and maybe pre-teen, but that part's fuzzy). Before this, I said in therapy that I just couldn't approach that word because it felt like it was too big, too painful, that the meaning of what she did to me would crash down on me and I couldn't . . . . I tried the word on, especially after my therapist asked me if I would think what my mom did to me was abuse if I heard of someone doing the same thing to their kid, and I said yes, at first, but after that session, I realized I'd HAVE to say NO, because I couldn't, just couldn't, approach the meaning of the word "abuse" and all the pain denying it was "abuse" was holding back.

I did try to cut through the bull a few days after that session, and say, "Really? Your first instinct was to agree that yes it was abuse for someone else, isn't it just you dancing around what's going on, to later say No?" And I thought, maybe it was, but it just felt too dark and horrible . . . this was about two months or so ago (not counting the first times I avoided approaching "abuse" several years ago when I first brought it up in therapy in more than passing.)

Back to the main point(s) of this post . . . Today I was thinking that I am actually quite GRATEFUL to my most recent psychiatrist, much as I dislike her, for helping me (not consciously on her part, as far as I can tell, given her objection to the notion of transference) to make more progress on a difficult, painful issue than I've ever had. For being what I NEEDED, even if it wasn't what I WANTED.

I realized, and I never thought I'd feel or say this about her, that I am GLAD she was my psychiatrist at this time in my life; things just came together to help me learn from her, and I can take what I've learned and appreciate both it, and the fact that she taught me, willingly or not, something that I'm not sure I'd have learned any other way.

Now, I am moving on and finding another psychiatrist. Could I perhaps have learned further from her, in dealing with her and processing my reactions, about how I feel about what my mom did to me and perhaps some measure of how to get over it? Perhaps. The thing is, I also NEED a psychiatrist I can trust, and I can't trust her to be emotionally safe, or to treat me and my feelings with respect. At this point, I think the "what if" of what I could learn from her is outweighed by my need for a safe psychiatrist; that, and it's an hour round-trip to see her and since I need to ask congregation members for rides to get to appointments sometimes, I really need a closer shrink. This next one is about 15-20 minutes away, which isn't as close as I'd like given I'm asking for rides, but it's better.

I am also quite grateful to the part that Shrink Rap played in my coming to these helpful insights and things; if it weren't for them hosting Grand Rounds, and picking the theme they picked, I'd not have come up with that blog post during the writing of which I realized the things that started off this chain of realizations. So, while they may have played a small part, it is an important part, nonetheless, and I am grateful to them for it. It also teaches me that maybe I should put myself out there more and participate more in things like this . . . Anyway, thanks guys (not that I know if they read my blog or not lol.)

Overheard Psychotherapy - Intensely Complex & Painful Fallout

Well. If one is going to overhear a loved one's psychotherapy session, wouldn't it stand to reason that various random elements in the universe might align to coincidentally allow the overhearing of probably the worst possible session for that person to have overheard?

Just kinda figures, doesn't it . . . .

Imagine, if you will, that events have happened in the previous week that have brought out a surprising (to you) amount of anger, with all sorts of angry thoughts peppered with demeaning and insulting things about a loved one. I am not proud that, in anger, I have thought some really terrible things. I am far from proud, in fact, as you'll see.

SO, in an effort to expunge this intense but over-reactive anger from me, in an effort to see things in a less blown out of proportion way, in an effort to gain a healther perspective, in an effort to process the anger and come to a realization of how I ACTUALLY feel, rather than the extremes to which my mind sometimes goes when angry . . . in all these efforts for good and positive things, and more besides, I opened up in therapy in a way that is often hard to do; I let it all out, the anger, the things I thought in the extremes of my anger, every negative, unpleasant, unkind and even cruel thing that went through my head. Some of these things are things that I know are sensitive areas for this loved one; this makes everything about this situation WORSE. Except for the fact that I recognized I didn't want to hold on to these extreme angry thoughts and feelings; I wanted to see, think, and feel a more healthier, reasonable view.

Well, imagine my shock when, a while after I'm home from therapy, I find out that this loved one overheard all but the first 10-12 minutes of my session! Imagine the feelings of, "But therapy is supposed to be PRIVATE!" Imagine the feelings of being betrayed by the loved one, by the therapeutic environment which was not sufficient to keep what was said in the office, confidential, the feelings of horror when I started to run through my mind the things I had said, and, as if in a disembodied third-person overhead cutaway view, I could "see" the office and the environs outside it, with no roof, and see everyone involved in this situation. Imagine the intense pain I began to feel as I thought of how this person might or could be feeling upon hearing the vile, angry things I was spitting out in therapy . . . . the pain that pierced my heart like a knife, realizing that, though it shouldn't have happened, it shouldn't have become public, it HAD been, and that I had deeply hurt this loved one, whether it "should" have happened or not.

I had all sorts of complex feelings, like, "But I didn't do anything WRONG; I was only trying to do the best by both this person and myself, because I had intentions to in the near future discuss the feelings of anger that had come up about them, but I first wanted to air them in therapy and gain a more healthy view as I would NEVER in a MILLION years have dreamed of ever telling this loved one the things I had thought and felt that I spilled out in therapy . . .

Mostly, though, after the first two hours of shock and a myriad of all sorts of feelings, I mostly felt PAIN. A deep and abiding pain that I had caused such (what I felt to be) DEEP pain to my loved one. As the evening wore on, this pain consumed me more and more until I quickly became incapable of functioning very well at all; in fact, I could not sleep at all that night, and at 8:30am the next morning, I asked for an urgent appointment that day with my psychologist, if he could fit me in.

He did, indeed, fit me in; and later reassured me when I enquired (inquired?) that this was an appropriate request for me to have made, given the situation and my level of distress (well, not in so many words but that's basically what he meant).

After the appointment, having gained a bit of perspective, and a little bit of distance from my pain, I was able to function a bit again, but I was still filled with pain.

I still am, close to a week later, although the feelings, especially those of an anxious nature, were mitigated and reduced by the miraculous to me fact of his eventual forgiveness of me, last week.

I am doing my best to process this and move past it, but it still has a bigger hold than I'd like. I also realize that some time may be part of the necessary healing element, here. Writing will be helpful as well.

Also helpful was the fact that my psychologist was unhappily surprised by the fact that people could hear some or all of sessions (I speak louder than many in day to day life; on the overheard session in question, I had so much to say I was unaware that I was speaking even louder than normal, but apparently not loud enough to elicit any cautions from my therapist . . . . ). See, I have heard bits & pieces of others' sessions since he moved to the bigger office down the hall a few years ago; my loved one has had the same experience of my sessions, hearing bits and pieces.

My therapist is going to put some kind of noise generator, a white noise, ambient noise thing, in the waiting area, after consulting and getting agreement from the lawyers who share that waiting area with him. This made me feel safer, although I won't feel entirely safe again there until it's done, and even then, the fear I feel inside, because I REALLY opened up COMPLETELY and showed the UGLINESS inside that I've always feared would lead to really bad things if people saw it or heard it, well, I don't know when I'll get over that fear, which is obviously fodder for therapy.

Anyway. Just because this person forgave me, doesn't mean they aren't still hurting, but it does mean they've gotten to a better place with it than I have. For my part, I forgave them for not moving to a further location when they realized they were overhearing my private session. Still, I have a whole host of other issues to deal with, and the biggest one may be how to forgive myself. That's something I'm not very good it. Yep, more fodder for therapy.

Double-Booked Psychotherapy Appointments: When It Happens To You

You feel unpleasantly surprised, when you arrive and see the waiting area (in my therapist's case, there's only seating for two) occupied, with a mother and teen son.

You feel brought up short, yanked backwards, because in the car on the way to your appointment, you've been shuffling through a whole host of important things currently going on with you, trying to prioritize, trying to decide what to talk about, and then BAM, the rug is yanked from under you.

Before the therapist's door opens to see the situation (he's running a few minutes late with his 4pm appointment, it's now after five) you start discussing the situation out loud with your husband, knowing the other patients will hear you. You say things like, "I could have sworn he said we were switching to Mondays," and other things that indicate you have a right to be there, too, as you feel as if you have to justify yourself (which you don't, at least not to the other patients, but my anxieties tend to run amok . . . .)

When his door does open, he greets the other patients and then steps out far enough where he can finally see you, and a look of being unpleasantly surprised crosses his face. There's no getting around it, seeing your psychotherapist seem to feel unpleasantly surprised by YOUR presence, by YOU, is slightly jarring to the therapeutic relationship; pushing forward through THAT awkward feeling, you realize that of course this is awkward for anyone (although throughout it all, the other patient(s) never said a word and acted as though the appointment was theirs all along).

So, you step forward to greet your therapist as he gets over his initial surprise quite quickly, flashing through some confusion as he queries you about what you are doing there . . . and you realize inside, feel, that "Oh no, I am really stupid; what and how did I get this wrong?" On the other hand, you DID bring your spouse up to his floor with you, which you usually don't do; this was done in case I remembered our schedule change incorrectly, although I had been pretty sure I'd remembered it right. I pretty much always bring my spouse up when there's been a schedule change, because of anxieties about getting it wrong.

So I explained what I was doing there, and what I thought he'd said during our discussion in December about how our schedule was going to change, and he told me, "Yes, but," and told me some other things he thought he had added that I didn't remember. Quite quickly he started apologizing since there'd obviously been a misunderstanding (it felt, to me, at the time, right there, that perhaps he was apologizing just to speed things up to get to the other people, and not because he actually thought he might have messed up), and I started apologizing as well; things before he went on vacation at the end of December WERE kind of hectic and who knows, maybe I remembered it wrong.

So, after that wrapped up, about 90 seconds total, I and my spouse left, and I said that I felt like an idiot.

Still, I got over it. One does, you know. Everyone makes mistakes, and misunderstandings happen. Whether it was his mistake or my mistake isn't very important to me, anymore, I realized after I got home. I had more time to think on it and really felt more badly for the awkwardness the situation had caused him, than for my being put out at all by it.

Still, it was VERY nice of him to call me a bit after his 5pm appointment was over; he apologized in a way that felt more thoughtful, less rushed to me, but then he'd had some time to think about it since it had happened. He said that he did feel that he'd contributed to the misunderstanding, and he was sorry that he'd had a part in creating such an awkward situation (well this isn't exactly how he put it but it's what I can remember of what it seemed he was trying to get across). I accepted his apology and gave my own; after some time at home (it took an hour lol) some of the things he'd said that he'd thought he added started to sound a little vaguely familiar. So I did indeed feel like I'd either not heard him due to distraction at our last appointment, or that I'd remembered what he said wrong; for his part, based on our conversation before his 5pm appointment started, it seemed like he had remembered our discussion a little incorrectly as well.

Regardless of who remembered and forgot what, the fact that he called me really made me feel better about the slight unpleasant feeling I'd had when he was looking at ME as though I were the cause of something unpleasant; it was really nice of him to call, and I think especially nice, as a professional courtesy, to do it.

About My Psychiatrist/Patient Relationship

My last appointment was almost two weeks ago, with the psychiatrist.

She's decided to keep me on 150mg Lamictal, though I told her I wasn't sure how effective it was. She said I need to modify my behavior, implying that I'm expecting the medication to take care of the problem.

You know, I can understand that and that's fine, I work hard on modifying my behavior anyway even if it often seems to be futile and frustrating.

The thing is, when I came back to her last November after not seeing her since July, and told her about my mania and the most troubling behavioral symptoms of it, she was all, "OH! We need to get you on some medication right away so you don't ruin your life!"

So, I feel like she's being a bit of a hypocrite; actually, what she's telling me now with, "Oh, modify your behavior," it seems the exact opposite of what she told me last November!!!

Now, regardless of whether a behavior is influenced by or triggered by my mania, I believe a person should work as hard as they can to modify/change that behavior. BUT . . . when the mania is pushing you, urging you, sometimes overwhelming you . . . . that makes it so difficult it feels impossible at times to just manage it yourself.

Another thing: If I only engage in the behavior when I'm manic, whilst other times I have enough self-control to keep from engaging in the behavior, as well as at these other non-manic times I don't have any desire or wish to engage in the behavior, well that to me says there's a biological factor influenceing and/or triggering the behavior. Meaning in order for me to deal with this, medication would be more than helpful.

I am frustrated though that so many medications have not worked out for me, but I can remember how moderately well the Risperdal worked, as opposed to how moderately poorly the Lamictal is working at 150mg. When I was on 200mg Lamictal, it felt like it was closer to the effectiveness of the Risperdal, but I can't go that high on Lamictal. We had actually been shooting for 300mg even.

I'd say the Lamictal is taking about 24% to 30% off the edge of my mania, while the Risperdal was more like roughly 55% or so. This is academic however since I can't go back on Risperdal.

I am also rather afraid of Lithium, given its high side effect profile (not sure if I'm phrasing that right.)

I think besides Lithium and Zyprexa, the only other medication might be Seroquel, which we tried last year for depression and it didn't work well for that; I wonder how it would do for the mania, though. We stopped the Seroquel (it was 300-400mg, I forget) about two months before the mania hit big-time. I will NOT take Zyprexa, after the Depakote caused me to gain weight; I can't deal with the diabetes risk. I've heard that PCOS (polycystic ovarian syndrome) is a pre-diabetic condition anyway, but I have no idea.

As far as I know, we've run through almost all of the bipolar medication options. Then again, I don't know much lol.

I'm frustrated with my psychiatrist for acting like a hypocrite though. I do realize that 25% to 30% off my mania is better than nothing. I did not put it in terms of a percentage to her, however, I just came up with that as I was writing this post.

Another frustration is that I'd heard Lamictal and birth control pills can affect each other; I've heard that either one makes the other less effective, or that both make each other less effective.

So I asked her, and she said that, if anything, the Lamictal makes the birth control less effective (I had mostly heard it was the other way around.) So I had my husband ask the pharmacist when he went to pick up my pills, and he confirmed what my psychiatrist said.

This angers me, because neither the pharmacist nor the psychiatrist told me of this side effect with potentially huge consequences. Granted, I wasn't on the birth control pills when I started the Lamictal, but when I did start the birth control pills, I emailed the psychiatrist, as well as discussed them and the reasons for them as opposed to the permanent solution to birth control I am working on getting comfortable with. So during this whole discussion about my fertility and deciding to end it, and why I'm taking birth control pills instead of doing something else right now, she never mentioned this important side effect. And neither did the pharmacist, though I thought drug interactions were part of their main concern.

I know no one is perfect, though. It just could have huge consequences . . . . this is the first time I feel my psychiatrist has not been on the ball, really sharp mentally, extremely knowledgeable, about medications and the issues related to them. So she can't remember everything, all the time, I'm telling myself, trying to not expect perfectiong. Still, of all the side effects to forget, this one is a doozy.

I REALLY don't want to do something permanent to my body, ie, the uterine ablation or whatever it's called when they freeze the lining in there, until I'm comfortable with it, until I've come to terms with how I feel about ending my fertility (what little there might be with PCOS).

I'm also frustrated with my psychiatrist for not wanting to deal with my depression; we haven't tried anything for it since the Seroquel last year. Perhaps she wanted to get the mania under control, first, but it seems she's decided it's as under control as it's going to be . . . so why not address the depression?

I think there may be a couple of reasons for that. One, anti-depressants can set off mania, and we don't want to make that worse. Two, her practice has been getting busier and busier; it was six weeks between the last two appointments, and now it's two months until the next one. While I'm kinda happy not to see her as soon, on the other hand I wonder if she's getting too busy. Although it could be that since she feels I'm as good as I can be on the Lamictal, she wants it to float that way for awhile, and see in two months how I am . . .

I keep reading back and seeing I say, I think she may have these reasons, or she may feel this way, etc., and I wince, because shouldn't she and I be DISCUSSING these things? Then again I AM afraid of her, and we've discussed what I've thought of to discuss in recent appointments; it's been less of her forced "Let's talk about whatever comes out of your mouth first" contrived technique.

Do I think my fear of her may be part of the reason I "forget" important stuff to talk about? Perhaps. I'm certainly not gonna be near as critical of her in appointment as I am on this blog. There's a difference between being critical and asking genuine questions that may sound as if I'm questioning her reasons for what she's prescribing and why; I can see why I might be afraid to ask her such questions, but in a good doctor/patient relationship the doctor should feel or act threatened by a patient wondering about these things. Our relationship is not a good one, however, and after typing this post which is helping me think through these issues, I wonder how harmful to my health IS this doctor/patient relationship becoming, if I can't ask her the questions I feel are necessary for the best care . . . .

When The Doctor/Patient Relationship Becomes Heated

I don't pretend to be an expert on this, or that what I have to say is, in fact, all that earth-shattering on this or any matter.

Still, ever since the Shrink Rappers announced a "heated" or "hot" theme for the upcoming Grand Rounds to be hosted on their blog very soon, I have NOT been able to get the above-titled topic out of my head . . . and so, I will get it out of my head and onto my blog, no matter any reservations I have about being so forward as to submit something for Grand Rounds . . .

I have had two different heated exchanges (actually, they were alot more one-sided than exchanges, with the heat all coming from the doc) with doctors, both of them psychiatrists. One male, and my first psychiatrist, and the other female, and my third and current psychiatrist.

I think it is a negative thing for ANY doctor to yell at or harangue/browbeat their patients, but I feel that with psychiatrists, even when seeing them just for medication management, that since it is usually expected that psychiatrists be sensitive to one's feelings etc., that when they act disrespectful and "heatedly", it's even a bit MORE jarring than it would be from another medical profession.

Now, doctors are human. They are not perfect; they have feelings and good days and bad days and life crises all happening just like the rest of us. I can understand this, and, in fact, in one of the two cases I mention above, it really helped me deal with the episode. The other episode, with my current, female psychiatrist, is harder for me to deal with, and in fact it still bothers me a great deal.

Before I get into specifics, let me say that as a patient, when you are sitting there on the receiving end of some "heat", or ire, or intense aggravation, or anger, even, it is shocking, bewildering, and causes you to wonder what is wrong with you or what you did wrong, as the patient, to deserve what is happening. You are shocked because, if you've had enough dealings with this doctor (about a year, in my first psychiatrist's case, when this happened) you know that he normally conducts himself much more professionally; to see and FEEL such unfettered, intense, unpleasant emotion, directed at YOU . . . well to say it is bothersome is an understatement.

It directly impinges on trust; you wonder, as you get past some of the shock, if you can trust this professional with the most intimate things that you think and feel, things that are necessary for them to diagnose and treat you correctly. If you HAVEN'T had enough dealings with the doctor to know that they usually act more professionally, OR if some of your dealings with them have been laced with discomfort from feeling they are forcing their agenda down your throat, then as you sit there feeling the "heat" you may also end up in "survival mode", doing your best to survive what feels like a verbal assault, trying to get through it as best you can. In my case with my current psychiatrist, this "survival mode" kicked in without conscious thought, and I didn't identify it until later that day or the next day.

I guess I'm trying to say that perhaps some of the difference in how I feel about, and how I handled, the two different incidents, is based, in part, how my usual interactions with that doctor go; how much a partner in my treatment I feel I am with each particular practitioner, and perhaps partly based on my past history, in the female's case, with a dominant, physically abusive woman.

So, here's what happened. With my first psychiatrist, well, he's definitely a Type A personality as they say; very strong, very opinionated, but rather intelligent, always acting in a professional manner, even though he frequently had things to say to me that were difficult to hear. I didn't always agree with those things, but the times I did, were very profound. I don't believe the times I didn't meant he was right, I was wrong, and just wouldn't see it. I really felt that sometimes he didn't listen to me and would come to his conclusion before hearing everything he needed to to come to the most informed conclusion.

This became the basis for his going off on me, one day . . . he spent 25 minutes in angry discourse at me about how I go on too much and waste his time by taking up so much time. After getting over some of the shock, I thought, wait, isn't this the pot calling the kettle black? Who is taking up a bunch of time now? Wouldn't this time be better spent working out our apparent communication problem?

Basically, I sat there and quietly listened until he was done. The appointment ended very soon thereafter, and I was rather upset, although in some ways not . . . . because it was SO UNLIKE him. I also had reason to think that he might be personally going through some emotional difficulties, because the previous summer he'd been suspended by the, whatever the Psychiatric Board or authority is that disciplines psychiatrists. I believe it was an unfounded charge, based on a random meeting long after he'd stopped treating someone, but then, he COULD be rather aggressive in his opinions and ways of interacting (nothing inappropriate, just very assertive) and someone could easily resent that and want to punish him for it.

Regardless, after I went home that day I wondered if he was still dealing with the fallout from his suspension; I imagine it's not easy to get a substitute to cover your practice for 3 months, nor would it be easy to deal with the opinions of your colleagues once they found out you'd been suspended, and even harder, dealing with your patients' feelings about it. So that is what I suspected was going on, so I had an easier time dealing with this.

Still, at the next appointment he apologized for his behavior, saying something about he'd been going through something at the time. I accepted his apology and we moved on, though I did still continue to have problems with him not listening to me enough (yes, I could keep appointments to the 15 minutes, I didn't always go over.)

Eventually, he decided to close his private practice and become a consultant-liason psychiatrist at a local hospital; the timing of this decision was such that I knew he had to have been mulling it over that fall when he ripped me a new one. The deed was done less than 6 months after the harangue.

The second, more troubling to me incident, happened in January of this year with my third, and first female, psychiatrist. I'd been seeing her since the previous March, with a break at the end of summer into late fall. She has a very different philosophy, is an "integrative" psychiatrist, is Buddhist, and is a strong, dominant female personality. At various times I've felt like she's trying to shove some random agenda of hers down my throat . . .

In January, I had finally decided to tell her I was afraid of her. This is a good thing, no? Then the doctor can understand why I seem hesitant or other things . . . Well, apparently my "mistake" was in the type of insight that had led me to realize this; I had realized that because my mother used to physically abuse me, I was afraid of my psychiatrist since she was a strong female, with dominating characteristics. To me, the connection of the two seemed like a no-brainer . . . if one woman in your life beats you and tries to dominate you (there were reasons behind the hitting), then it may make you wary and even afraid of other strong, dominating women.

BIG mistake on my part. I told her straight out, "I'm afraid of you because my mother used to hit me.", figuring that psychiatrists are extremely familiar with the concept of transference . . . . She was instantly OUTRAGED upon hearing this and so angry it took her a few moments to be able to speak and then she assaulted me with angry questions about things like, was she my mother, what does one thing have to do with the other, and eventually she asked me if she was being scary right now . . . . by this point I had unconsciously retreated into "survival mode" and really could not identify ANYTHING I was feeling at that time; I tried, and couldn't feel anything, so I said "No.".

Well, HELL YEAH she was scaring me! Once I'd had some time and space between her and I, oh boy could I identify my feelings . . . . she was proving how RIGHT I was to be scared of her. She FORCED me to answer every question, in a way that made me feel stupid and insignificant, staring me down until I answered. "Do I LOOK like your mother?" "No . . . " "AM I your mother?" "No . . . " and she asked me some other things but honestly I was too traumatized to remember it all. I just remember feeling so verbally assaulted . . . .

In thinking about it now, I feel that she really missed an important opportunity, as a doctor, to connect with her patient and deal with an issue that would interfere with the doctor/patient relationship if left unaddressed. EVEN if she couldn't recognize the validity of the transference principle as something that could fit with her very strange and different philosophies, why throw the baby out with the bathwater and not stop to consider that I said I was scared of her? If she could have set aside the philosophy she couldn't stand, and seen the very real issue between us, then she would have done what was best for her patient, in that situation, in my opinion.

But, as I say, doctors are human too, and when one REALLY objects to a particular school of thought or psychiatric philosophy, perhaps that invalidated to her everything else that was attached to it in the statement I had made. I've often wondered if I had just said, "I am afraid of you", if the reaction would have been much different.

Perhaps, but perhaps not. I suspect she would've assaulted me with questions like, "Do I look frightening?" "Am I scary?" "What, specifically, scares you about me?" and when I couldn't come up with an answer, she'd satisfactorily verbally beat me down with the fact that I couldn't possibly be scared of her, just like she did this last January. But I may be being unfair; perhaps it really WAS the "unacceptable to her" psych concept of transference that was the basis for her going off on me. Perhaps she WOULD have listened if I'd put it differently, but you see, she's the doctor, and I'm the patient, and no matter what "could have" or "should have" been done differently by me, she acted unprofessionally and unacceptably towards me.

Why do I find her behavior so much less acceptable than my first psychiatrist's? Perhaps it is because she had a history of forcing her way on me . . . but then I think, didn't Psychiatrist Number One also have a strong way about him, where he tried to get me to think along his lines of thinking? Yes, he did . . . Then again, he'd never given me an ultimatum, like she had. He'd never tried ramming wierd goals for me down my throat, like she had . . .

In the end I think I can safely say that part of the difference in how I reacted to the two incidents is, indeed, related to my fear of strong, dominant women based on how my mother treated me. Part of it, though, I think is that I had more a feeling of being a partner in my treatment with the male psychiatrist; I wouldn't hesitate to stand up to him, which was saying ALOT for me, because I usually shrink from such things, and he had VERY strong opinions. Still, since I really wanted him to understand me, I knew I had to press for standing up for my view, or my experience, or my thought process that I wanted him to UNDERSTAND before coming to a conclusion.

I guess, after writing that last paragraph, it's easy for me to see now that my mother IS a big part of it; I could stand up to HIM, but not to HER.

Six months down the line from the "heat" I received from my current shrink, and I am still having trust issues, and definitely fear issues. I finally may be getting up the courage to bring up the issue with her again (sans mother), but I am not sure if I have the courage. I do hope that if she gets angry again I can tell her what I think of her unprofessional behavior . . . and lack of insight into the issues that can interfere with a good doctor/patient relationship.

Two Complicated Words

"Not Pregnant".

This afternoon those two words stared back at me from the pregnancy test.

I was happy, I was sad. I was relieved, I was disappointed.

Our recent decision that our daughter would remain an only child has been something that is hard for me to approach all the complicated feelings surrounding the issue of reproduction.

It's long been an emotional issue for me, because with Polycystic Ovarian Syndrome, my fertility has not been very good. Also, in the LDS "culture", it's "expected" that people have several or more kids; having an only child is something that makes you stick out as, well, not fitting the "norm". In fact, people seem to think there is something wrong, if you only have one.

Granted, that's an overgeneralization, but I have run into it first-hand; the automatic questions upon finding out that you only have the one child, at this age, as if they have any right to know what happened or why you only have one or why aren't you trying for more . . .

It's not mandated by our religion to have alot of kids, although being fruitful and multiplying IS a concept we hold dear (this of course explains the cultural expectation that is sometimes taken to hurtful words or excessive questions by those who more rigidly hold to this).

I wish people would just THINK for a few minutes, and realize that my reproductive decisions, abilities or incapabilities, and plans, is all information they aren't ENTITLED to just because they may have more kids than me, or just because they think I SHOULD be doing something differently.

Ah, well, I can't change them. What IS really difficult about those two words I saw today, is that it really brings home that I may (will) never be having another child. I use both words because it is so hard to bring myself to say the definitive, even though that is what we have decided.

When I recently discussed this decision with my doctor, he immediately started telling me about a permanent option to prevent pregnancy. I listened and asked a question or two but I mostly forestalled that discussion by saying that I need a year or two to "sit" with this decision, and that I'd like to get on the pill for the next year or two until I'm ready for the permanent solution. He was happy to acommodate me, and not upset that I'd turned down the other option. I'm glad to know about it, but it was, again, an unpleasant and surprising sudden facing of the decision we'd recently made, to be placed right up against a permanent solution . . . I need some time to come to terms with it.

Feelings of feeling like less of a woman, although my brain kicks in with, "Women who are infertile or who have gone through menopause, and therefore can't reproduce, aren't any less of a woman for it, so why feel this way about yourself?" I don't know why, I just know I have alot of complicated, mixed-up emotions about the issue . . .

Last but not least, I certainly didn't FEEL pregnant but I took the test because I'm near the end of the fourth week of the birth control, the week of "placeholder" pills, and I have not yet gotten my period. I only have two placeholder pills left before I start the actual hormone pills again, and so I thought I could be pregnant, perhaps, and was really worried about it.

So if I don't get my period next time I'll call the doctor; I read the insert that came with this first batch of pills and it talked about if you don't get your period the first month and preg test is negative, that it's only if this happens two months in a row do you need to call your doctor . . . at least I think it said that, I'll be re-reading it.

Despite all the reasons that having a baby would be a bad idea, there is a part of me that is sad. That is okay. A big part of me is relieved, as I said before. It's just a mish-mash of emotion, all brought on by two simple, hoped for yet surprisingly impactful, words.