You are Welcome Here!

It’s nice to meet you! My name is Sarah, and I have a mental illness. If we have this trait in common, then you’ve come to a good place. I started this blog for you and people like you because I want you to know three things:

1) You are not alone.

2) You are not hopeless.

3) You are not helpless.

This blog will feature practical advice and information about coping with mental illness, straight from the front lines. In the Survival Kit, you’ll find information about resources to help you survive the struggle, from tips on fighting insomnia to a comprehensive list of crisis hotlines. In the Survival Skills section, you’ll find active strategies you can use to improve the quality of your daily life, including posts about how to enjoy exercise (no, really!) and how to remember your medications. And in the Mad Money section, you’ll find tips on managing the financial aspects of living with mental illness, including information about managing mental illness in the workplace and getting your insurance company to pay for your medications.

Right now, you may be afraid that the rest of your life is only going to be about suffering. But I’m here to tell you from personal experience that life is about so much more; it’s about striving in the face of great adversity and surviving despite the odds. You won’t find any flowery, sugary “hang in there, sport!” or “pull yourself up by your bootstraps!” bullshit here; people who give that kind of advice have only the most superfluous experience with mental illness, and I’ve always found it only serves to further my distress. What you will find are strategies backed by data and vouched for by someone who’s tried them. I plan to tell it like it is, but always with the underlying message that it is possible to live with mental illness – to live in the fullest sense of the word – and not just to suffer from it.

I’m right here with you. And if I can do it, so can you.

(To read a tentative schedule of upcoming posts, click here or click the link in the sidebar. To read the story of my journey with mental illness, click here. To read my pledge to you, the reader, click here. If you have any questions or comments about any of the posts, feel free to leave them; I’ll make every effort to respond. If you’d like to share your story or request a post on a specific topic, you’re welcome to send me an email at strivingsurvivor@gmail.com.)

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Psych Meds – Straight Talk from a Great Psychiatrist

To my surprise and delight, I received a response today to the questions I emailed about two weeks ago to Dr. Douglas Romero, an expert in psychiatry and psychopharmacology from the Centro de Mejoramiento Personal (Center for Personal Improvement) in San Juan, Puerto Rico. I was about to give up on hearing back from him, but it turns out the reason he took so long to respond was because he apparently took the time necessary to write an extremely thorough, thoughtful response to each of my questions. (This is a man who, like most doctors, has very little free time, and yet he generously gave up a lot of his to help me and all of you understand how psych meds work.) Because he did such an excellent job, I’m not going to summarize what he had to say; instead, here is his insight in his own words.

Dr. Romero responded to questions I had that were provoked by this article from the New Yorker, which makes the claim that science does not yet know exactly how or why psychiatric medications work in terms of what goes on in the brain. Dr. Romero’s answers shed light on this issue, and this article from the MIT Technology Review gave me hope that science is headed in the right direction.

Me: Is it true that scientists still don’t know exactly why or how psychiatric medications work?

Dr. Romero: It is true that the neurosciences and psychiatry have yet a lot to understand about the brain, both in its normal and diseased states. However, in the last few decades neuroscientists have mapped the major anatomical and functional areas of the brain. Every decade brings better understanding of the human body and its brain.

Take for example the dopamine theory of schizophrenia. The theory was developed on the observation that hallucinogens increase dopamine and cause hallucinations. Medicines that increase dopamine in the brain, like those for Parkinson’s disease, can cause hallucinations and paranoia. So we know that can be a factor. That knowledge is the basis for anti-psychotic medications, which block dopamine in the brain, and can be very effective for the treatment of paranoia and hallucinations in people with schizophrenia.

As we become more sophisticated on our knowledge of the brain we will continue to develop better pharmacologic therapies. But no sane person in the field of psychiatry or neurosciences would claim that we completely understand the brain, the most complex system known to science.

Me: What progress is being made towards discovering this information?

Dr. Romero: Our biggest challenges lies in understanding better how the brain works, even in a normal state. We know the basics, and in some cases we have pretty solid information a=on how the brain processes information (the visual cortex has been mapped extensively). But having a good understanding of something is not equal to understanding it completely.

Understanding the brain is compounded by the fact that psychiatry intersects with what has been called the Hard Problem, the how and why we have experiences. So psychiatry attempts to understand the brain, the mind, genetics, and how we might be able to help people when they go wrong.

Diverse academic institutions continue mapping the brain through technologies such as functional MRI, SPECT, and PET scanning. Those are expensive machines that are limited resources not available to the average clinician. That’s the reason a psychiatrist doesn’t order those tests on a regular basis. Our ability to map brain function on a live brain is something very recent.

The National Institute of Health continues to do basic research on how that knowledge correlates with people with brain disorders like depression. From that research, new medicines will hopefully emerge that work better than the ones before them.

Me: What are the current prevailing theories on how psychiatric medications work?

Dr. Romero: The prevailing theory of the brain is that it is a neural network of interconnected areas, frequently specialized, which configuration allows a person to experience the world and change the environment. Various biochemical process must align in a coherent pattern for the functional brain to work. Over the years, several biochemicals and brain areas have been identified that appear to correlate with diseased states of the brain.

The serotonin-dopamine-norepinephrine theory of mood disorders do a good job of explaining our current understanding of what goes wrong in the brain when someone is depressed. Recent research is exploring the role of inflammation and other neurotransmitters in brain dysfunction. Theories of dopamine in the brain provide reasonable explanation for the salient aspects of schizophrenia and manic episodes. Part of the reason the field of psychiatry has such a hard time explaining to the public how the brain is affected in psychiatric illnesses is that these are very complex systems that are difficult to understand, even with advanced knowledge of human anatomy and physiology. Just ask any first year medical student if neuroanatomy is easy and you will get very emotive responses.

Yet clinicians every day, including primary care physicians who don’t specialize in the brain, have to treat people who are severely mentally ill and offer them a cursory explanation of what is going wrong in their bodies.

Me: Can you explain in layman’s terms how you understand psychiatric medications to work?

Dr. Romero:  The explanation I give my patients is that medications for depression, say Prozac, get into the brain and regulate certain areas that are affected by increasing the level of serotonin in the brain. It is a limited explanation but true at a basic level.

Each medication has its peculiarities, and even though we know a lot about them, there is still a lot more we would like to know. For example, we don’t know exactly how lithium curbs manic episodes. We how it affects how neurons communicate and affect the transport of sodium into neurons, which affect the electric conduction of brain cells. But there is still much we need to know. Yet, lithium is the gold standard for the treatment of bipolar disorder.

Medicine is a practical field. I tend to think of medicine as art guided by science. We tend to use what works. And every generation tends to chuckle at what we did a hundred years ago, but at that time that was what we knew. It is always useful to remember that medicine used aspirin for almost a hundred years before we knew how it worked. But worked it did. Every year we know more than the year before.

Every good scientist, physicians included, should question the established theories and paradigm of their field. Psychiatry is no different. That is the way knowledge advances.

Me: What advice would you give someone who is “on the fence” about taking psychiatric medication that has been prescribed for them?

Dr. Romero:  I would recommend the person have a discussion with his or her physician about the use of medication, explore alternatives to medication, and get a second opinion if in doubt. For some patients a course of psychotherapy can be a good idea, and the need for medication can be reassessed depending on how well that works for them. Having a supportive health care provider who is willing to address your concerns and is sensitive to your needs is always of great importance. Usually someone who is “on the fence” has valid concerns which the clinician must address in order for that person to understand the potential benefits and risks of taking medication and make an informed decision.

To find out more about Dr. Romero’s work at the Center for Personal Improvement, visit the center’s website (if you use Google Chrome as your Internet browser, it will give you the option to translate the site into English).

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Decrescendo

One night last week my husband came home from work, kissed me on the forehead, and listened patiently while I excitedly told him about contacting Dr. Romero in Puerto Rico and about the organizations who’ve expressed support for this blog. Then he took my hands and looked me right in the eyes and said, “Honey, your original goal was to start a freelance writing career. You were supposed to use this blog to generate samples of your work to show potential clients and employers. I don’t think writing about your mental illness is the best way to make a good impression on people you want to work for.”

See, my husband is a really wonderful person. He’s patient and supportive, and he provides for me while I take the time to pursue my dream of being a writer, which I only decided to do after my mental illness lost me yet another paying job back in December. But boy, does he know how to burst a bubble.

Because he’s right; I have a passion for helping people and bringing about positive change in the world, and this blog was a way for me to do that, but I also have an obligation to help my husband pay the bills. All my life I’ve had to cope with the crushing guilt of being a huge financial burden on other people, and I wouldn’t want to keep living with that guilt even if I wasn’t expected to work.

The biggest kick in the pants was having to accept that the very stigma I set out to help erase will likely interfere with my own ability to get hired. But since that is, in fact, the reality of the situation, I have no alternative but to spend some time producing samples of my writing that I can actually show to employers without the fear of never being called back. (Plus, I still haven’t heard back from any of the experts who agreed to contribute to my blog.)

This is not a goodbye letter. I haven’t run out of steam in my support of our cause, and I’m not abandoning this blog so early in its development. I put a lot of work into setting this blog up, and I haven’t yet accomplished the goals I set out to achieve with it.

All I’m saying is that I need to scale back for a while so I can focus more of my energy on finding a way to get paid. I still have big plans for this blog, and I still intend to update once a week at the very least. But I am going to stop posting due dates for my updates, because I don’t know that I will be able to meet them precisely anymore.

Please keep checking back; this blog will be up and running for as long as I’m able to write or as long as it takes the world to get over its fear and mistrust (and sometimes disbelief) in mental illness.

Thank you so much for your support so far, and I look forward to contributing once more to your well-being.

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Status Update: Unexpected Health Issues and Corresponding with Experts

Slowly but surely, this blog is shaping into something that more closely resembles what I had in mind when I first set out to start writing it. It may not be the prettiest-looking blog out there right now, and the formatting of the posts may still be uneven, and navigation through the blog may not be entirely intuitive yet, but hopefully the content I aim to provide here will make up for in usefulness what the blog itself lacks in aesthetics.

I spent a lot of time this week sprucing up the blog rather than writing posts, but there were a couple of good reasons for that. First of all, as I stated in my “Author’s Pledge,” I want to present the most accurate, up-to-date, and applicable advice and information that I can, so that my readers can come here and get information that is valuable and trustworthy. To that end, I have been sending out emails like mad to any and all mental health professionals whose names come up in my searches, asking for volunteers to lend me their expertise so that I can share it with you. So far, I have managed to establish connections with the following experts: Dr. Douglas Romero of the Centro de Mejoramiento Personal (Center for Personal Improvement) in San Juan, Puerto Rico, winner of the Vital.com Most Compassionate Doctor award; as-yet-unnamed members of a team of clinicians from the Menninger Clinic in Houston, Texas, a psychiatric hospital whose inpatient program approaches the treatment of mental illness from a holistic (whole-body) standpoint; and Susan Lindau, a licensed counselor from Los Angeles who specializes in Dialectical Behavioral Therapy. (Several hospital and university PR people responded to the query I submitted through a database for journalists, offering to put me in touch with their clients, but I guess they must have changed their minds after they saw how basic my blog is.) Sending out emails and waiting for replies took up about a third of my time this week, in addition to the third taken up by trying to make my blog look halfway presentable so it won’t scare off any more potential contributors.

The remaining third of my time, in case you were wondering, was spent in doctor’s offices. I went to the OB-GYN for my yearly exam on Monday, which is humiliating and awful under the best circumstances but was made even awful-er by the discovery of a lump in my left breast. Tuesday and today I went to the chiropractor to work on straightening out the pronounced curvature in my spine I’ve had since childhood. Wednesday I went to the neurologist so I could get recent medical documentation about my stroke in case I need to apply for disability benefits in a few years. Tomorrow I will be waking up at 5:30 so I can get cleaned up and head over to the hospital to have a blood panel drawn and get an MRI; after that I’ll probably head home and try to get something done before heading back to the hospital at 1:00 to have an ultrasound that will tell me whether or not I need to be worried about the lump.

I’m not going to try to write anything tomorrow; my plan is to organize my home office to make it easier for me to access my resources and research materials and to map out a new (official) editorial calendar so that I can hopefully do a better job of staying on track with my blog posts. I’ve come a loooooooong way since I was first diagnosed with bipolar disorder, when I would play World of Warcraft for 15 hours every day while due dates and deadlines whizzed past and dirty dishes piled up in the sink. I look forward to sharing with you the tips and tricks that helped me become someone who manages to keep most of her promises and actually show up for appointments, but for now I’ve got to employ those tricks successfully to help me get through this week!

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Psychiatric Medications 101: An Introduction

One of the most prevailing (and damning) myths about mental illness has to do with psychiatric medications and the notion that taking them will somehow either turn you into a robot or make you even more crazy than you already are. Unfortunately, like most myths, there is some truth hidden behind the hyperbole, and that’s the point of this series of posts: to present that truth and to give you the tools to make up your own mind about it.

I feel I should confess right up front that I am a supporter of psychiatric medications. When I started taking Geodon after my bipolar diagnosis during my first year of college, I experienced such a turnaround in terms of outlook and behavior that everyone who had accused me of “making it up” my whole life now had no choice but to believe there had really been something wrong with me before the medication. Also, there is no way in hell I would have made it through grad school without Adderall. I honestly feel that if someone had given me Adderall in the seventh grade, I might actually be good at math and know where Pakistan is on a map. (Or, you know… any of the countries that aren’t the one in which I live…. Seriously, where is Serbia?)

That being said, I have tried around 15 or 20 different medications since that diagnosis, and some of them were about as much fun as sitting through The Human Centipede. I have been on medications that made me inappropriately weepy, that made me irrationally angry about 95% of the time, that made everything taste really funny (and not in a good way), and, yes, that turned me into an android (albeit a fully functional one). Being deprived of basically all emotion was wonderful at first; before, I had experienced near-constant emotional anguish, and having that sensation finally cut off felt kind of like sticking my arm under a cold faucet after burning it on the stove. After the initial wave of relief passed, though, I became aware that the medication had not just eradicated my “lows” – it had also caused me to flatline, preventing my brain from registering the “ups” that normal people experience after hearing their favorite song on the radio or going outside on a beautiful day. So you know what I did? I lived the rest of my life that way, and to this day I have yet to experience a single moment of happiness.

Just kidding. I told my doctor, who put me on a new medication, and about six weeks later I was once again able to give a flying flip whenever the local radio station played “Paralyzer” by Finger Eleven (what? it was 2008). All told, I “lost” about four months of my life to that medication, which seems like a lot unless you measure it in new episodes of The Walking Dead.

The worst experiences I’ve had with medication didn’t happen when I was on them, but rather when I was coming off of them. Some psychiatric drugs have terrible withdrawal symptoms, which is why you should never abruptly stop taking them. One day about seven years ago I decided I wanted to stop taking Effexor because of some stupid reason I’m sure made sense at the time, so when my prescription ran out I just never got it refilled. What followed that decision were the worst 48 hours of my life. I spent literally the whole time either writhing on the floor or crawling to the bathroom. I’m going to say it once more, because I really don’t want you to go through the same thing: Do not abruptly stop taking any psychiatric medication. Let your doctor give you directions for weaning yourself off of it.

There’s one last thing I want to do in this introductory post, and that is to tell you to avoid these idiots (http://www.cchrint.org/). The Citizens [sic] Commission on Human Rights, or CCHR, (http://www.cchr.org/) touts itself as a “mental health watchdog” organization and sure does a good job masquerading as a legitimate activist group, but in reality they’re funded and manned by the Church of Scientology, which is a crazy-ass cult whose religious beliefs include the belief that people have the souls of ancient space aliens who reincarnate themselves over and over. No, I’m being 100% serious. And their #1 goal is to discredit both people who treat mental illness and people who live with it. That’s right, folks, the same group of people who believe aliens traveled to Earth under the leadership of the great Xenu and created human beings by dropping atom bombs into active volcanoes wants to convince everyone there’s no such thing as being crazy. Any time you’re browsing the Internet for information on mental illness you’re bound to run into some of these people’s ignorant diatribes about how mental illness isn’t real and psychiatrists are trying to take over the world by over-prescribing medications. I don’t like to belittle anyone’s beliefs, because we all march to the beat of a different drummer, but here’s the thing: If real life was an 80’s movie, the CCHR would be the overly competitive douchebag who deliberately kicks the hero’s bad knee at the karate tournament.

Now that that’s out of the way, let me tell you what my next few posts will be about:

How psychiatric medications work

Different kinds of psychiatric medications

Hanging in there until the medication kicks in

Coping with side effects and withdrawal symptoms

Counterarguments to the CCHR (just to put your mind at ease)

Keep checking back – I’ll have more information for you as soon as possible. Oh, and have a good day!

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Stamp Out Stigma #1

So we’ve already got TiMMYS, which stands for This Might Make You Smile, and now I’d like to begin another acronym: S.O.S., which stands for Stamp Out Stigma. In S.O.S. posts I’ll be shining the spotlight on our friends out in the big world who are helping to make the world a safer, less bigoted place.

Check out photographer Anne Breton’s beautiful gallery of photos of mentally ill people. Thank you, Anne, for doing your part to stamp out stigma!

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Road Construction Underway

The next group of posts I plan to write cover the topic of therapy: what it is, why it works, how to locate a good provider of it, the different flavors it comes in, and how to get the most out of it. To this end, I’ve reached out to experts who can help me explain the many aspects of therapy to you in the clearest, most accurate way possible. Now, I just have to wait for them to reply.

In the meantime, I’ll post on something that doesn’t require as much research. I’m also going to revamp my “Upcoming Articles” post again, this time into more of a list than a calendar. Again, I know this looks like I’m starting to flake out, but I promise my drive to help people with this blog is as earnest and strong as it was the day I wrote my first post. It’s just – that was my first post. Like, ever. And I’m learning all the ups and downs of maintaining a blog as I go, which is what leads to posts like this one.

One last item: I may be moving the whole blog itself over to a different host. I can’t afford to host it independently (like at tostriveandsurvive.com, for example), but I’m discovering that blog.com tends to have issues with loading pages reliably, so I’m looking for another place to set up shop. If I do move, I will be sure to leave a link here directing visitors to the new site.

In short: I want to provide you with the best content. Good content requires research. Research takes longer than I thought it would. But above all, keep checking back; I’m not going to leave you hanging.

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Recalibrating… Recalibrating… Recalibrating…

You know how sometimes you set out to go somewhere and you program your destination into your GPS or your smartphone, only to get halfway there and need to pull over for a bathroom break? (This happens about every 20 minutes when I’m in the car; my bladder hates long drives.) As soon as you take the next exit on the Interstate or hang a U-turn into the gas station parking lot, your poor GPS announces “RECALIBRATING,” as if your car had suddenly transported to a different planet and the voice inside the machine belonged to the person responsible for making sure you didn’t get sucked out into space. (Or maybe I’m just imagining the panic in Siri’s voice.)

Anyway, in case it isn’t obvious, this is my very first blog, and I haven’t quite gotten the hang of it yet. For one thing, I don’t know how to shut up. For another, I think I may have grossly overestimated the amount of writing I can produce daily. I’m headed to bed in a few minutes (because sleep is crucial to effectively managing a mental illness), but in the morning I plan to edit my “Upcoming Articles” calendar to reflect a more realistic schedule. I will still post as often as I can, so don’t be worried about long dry spells; I just apparently need to take more breaks than I was anticipating.

That being said, I probably won’t be able to do any writing tomorrow because I need to complete the training to volunteer at a local crisis hotline, and that might end up taking most of the day. Thanks for sticking with me; I’ll try to post a TiMMYS or something in the morning if I have time.

Do yourself a favor and go to bed early tonight.

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What to Expect on Your First Visit to the Psychiatrist

Your first appointment is only a few days or hours from now. You’re probably feeling at least a little bit nervous. You may be picturing a scene in your mind of a square brown room with a couch made of hard leather and a balding, bespectacled man with a goatee perched imperiously on a stool next to it, wielding – gasp!a clipboard. “Lie down right here and make yourself nice and vulnerable,” the man says, gesturing towards the couch. “Tell me all your deepest, darkest secrets. Start with the sex stuff.”

Good grief, who wouldn’t be nervous?

Listen, try and relax. Your psychiatrist may very well be balding and wear glasses and have a brown office with uncomfortable seating (which may or may not include a couch), but he is not going to ask you any really, deeply personal questions on your very first visit. Those types of questions belong in a therapy session, not an initial evaluation. As a matter of fact, the first thing you can expect your psychiatrist to do is to greet you, briefly make some innocuous small talk (“Isn’t it nice outside?”;  “Man, I’m glad the Vols won the game last night”, etc.), and then ask you how you’ve been doing lately. The small talk is to prove that he’s just a human being and not a pod person – in other words, it’s meant to put you at ease.

Let’s back up a step, though, because one of the most important things to remember is to be on time for your appointment. As a matter of fact, be ten minutes early. They usually have some pretty good magazines in the waiting area, or you can fill the time by fiddling with your smartphone. If you show up late for your first appointment, not only does it set a really bad precedent, but sometimes they won’t even see you. I read a complaint on an online forum yesterday about someone who waited months to get an appointment, showed up ten minutes late, and then had to reschedule for several more months down the road. Psychiatrists are busy people, and you should respect that their time equals their pay. They’re not trying to be evil witch doctors by canceling an appointment you show up late to; they’re making sure that all their other patients get seen on time, because they want to make sure they help somebody each day. Trust me, there’ll be a day when you’re hanging out in the waiting room for an hour (no, seriously, an entire hour – sometimes longer) before being seen because someone who had an appointment earlier in the day showed up late. Don’t be that someone.

Oh, that reminds me, if you show up early they’ll probably give you an inventory, which resembles a survey in that you have to indicate which items are relevant to you and your symptoms. The inventory may have items like, “I feel anxious and worried,” “I have trouble falling asleep,” and/or “I have no interest in things I used to enjoy,” and you’ll be asked to mark which response applies to you: every day, most of the time, some of the time, or never. If you followed my previous advice, this should be fairly quick and simple because you’ve already described your symptoms in written detail.  This is standard procedure because not all patients have taken the time to nail down and describe their symptoms as carefully as you have, and the survey helps the doctor determine the nature and severity of their problems. It also provides the doctor with evidence of each patient’s current state of mind, so he can use the inventory to easily gauge the patients’ progress over time. It’s a valuable tool and a big help to your psychiatrist, so go ahead and do it even if you already have your issues written down.

Okay. Ten minutes early; check. Inventory filled out; check. Doctor introduces himself, appears to be human. Check. Small talk out of the way; check. It’s time for… the clipboard.

But first, the couch. Or maybe not; it may be just a chair. In my opinion, chairs are preferable to couches because lying down makes me feel vulnerable and exposed. Whenever I’ve had to use a couch in the past, I’ve found myself adopting the Burt Reynolds pose so I can still see my psychiatrist’s face. (Although I did keep my clothes on, for the record, thank you very much. By the way, I hope you didn’t open that link at work.) Actually, according to some therapists and psychiatrists, it’s better if the patient can’t see the doctor’s face; part of our nature as human beings is to tailor our behavior based on perceived reactions from other people, which means a patient might perceive a change in his psychiatrist’s expression and decide to withhold information related to a potentially controversial issue that he or she is experiencing – even if it turns out the doctor just has an itch in his eye. Psychiatrists and therapists also point out that when a patient is lying down, the brain may enter a more relaxed, almost dreamy state that allows the patient’s thoughts to be expressed with less inhibition or interference from outside stimuli. If you’re like me, however, and you just don’t think you can relax enough to open up if you can’t see who you’re talking to, your psychiatrist will probably allow you to sit up until you get to know him well enough to know him.

Okay. So you’ve situated yourself comfortably on whatever type of furniture your psychiatrist intends for you to light upon. Now it’s time for… the clipboard.

Actually, your psychiatrist may not even have a clipboard. Mine doesn’t; he takes notes when I leave (I know because he shuffles through them at the beginning of every appointment). My therapist has a clipboard, and I’m assuming she also knows some form of shorthand, because apparently everything I’ve told her in the three years I’ve known her will fit on two sheets of paper. (I’m kidding. Obviously she only writes down the important stuff. As a matter of fact, I tell you what: The next time I go to see her, I’ll ask her what sorts of things she writes down so I can relay the information to you. It might put your mind at ease to know your therapist isn’t writing down every embarrassing thing you say.)

So you may get lucky and not even have to face off against… the clipboard. And by this point, you’ve already done all the really hard work – deciding to get help, making all the necessary phone calls, scheduling an appointment, showing up for said appointment – and if your doctor isn’t morphing into a squishy clone of you by this point, it’s pretty safe to say he’s not a pod person. Now all that’s left is the final hurdle – talking about your symptoms. As I mentioned in a previous post, depending on how nervous you are, you can imagine the psychiatrist as an android, recording your data in his computer-brain so he can determine and produce your diagnosis. I did this the first time I saw a therapist and it worked great. (I was 9 and a big fan of Data on Star Trek: The Next Generation – he was my favorite action figure.) If you prefer a more grown-up approach, remind yourself that your psychiatrist suffered through medical school to get to where he or she is right now. That’s not an ordeal people undertake unless they really care about helping people get better. Besides, if you followed my advice about preparing for your appointment, you should have a list you can refer to when answering his questions, and if your nerves fail you utterly you can just read straight from it the way you did in the Thanksgiving play in second grade (or was that me?).

 Before you leave, think back to your primary objective for this mission: the diagnosis. At the end of your session, make sure you ask your psychiatrist what he thinks is causing your symptoms. You should ask him to write down for you the name of the condition, the names of the medications he is prescribing (in my experience, prescription slips are usually illegible), and any books you can get or websites you can visit for information and support. Don’t just leave the office going, “Welp, looks like I’m bipolar” (or schizophrenic, or borderline personality disordered, or whatever). This information is a tool to help you determine what, exactly, that means for your life. Do some research. Reach out to some people who share your condition. Knowledge is power you can use to take your life back.

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Preparing for Your First Visit to a Psychiatrist

So you’ve found a psychiatrist, hopefully one who’s board-certified and well-reviewed by his or her patients, and you’ve scheduled your first appointment. Now what? There are several things you can do to get the most out of your first visit:

Enlist a comrade.

If you’re feeling especially nervous about your upcoming appointment, you might ask a friend or a family member to go with you for moral support. This is common, so don’t worry about your companion being asked to wait outside while you face the gauntlet alone. Your friend might even think of things to tell or ask the doctor that didn’t occur to you yourself, especially if you’ve confided in him or her before.

 Write everything down.

There are certain specific things the doctor will need to know in order to diagnose your symptoms. Do not rely on your own memory. Going to the psychiatrist for the first time is stressful, whether you’re consciously worried or not, and it’s harder for some people to remember things under stressful circumstances; plus, impaired memory is a common symptom of many mental illnesses. Writing down this information before going to your first visit will aid you in painting the clearest possible picture of your situation, so that your doctor can make an accurate diagnosis and recommend effective treatment. So grab a pen and some paper, and make a list of each of the following things:

1) Your medications

When listing your medications, include any vitamins or supplements that you take and any over-the-counter medications like Nyquil or ibuprofen in addition to your prescribed medications; some psychiatric medications interact badly and even dangerously with other medications, so you should definitely make sure your psychiatrist knows what else you’re taking. Don’t forget to write down what each medication is for, how often you take it and in what dose.

2) Your health issues

It’s very important that you tell your doctor about any health conditions you currently have, whether they’re something “big” – like arthritis, diabetes, high blood pressure, or a heart murmur – or something “small,” like seasonal allergies or a yeast infection. You’ll also need to divulge any issues you’ve had in the past, like mononucleosis, frequent ear infections, or surgery. Health issues below the neck can complicate treatment for mental illness, and mental illness can make managing your physical health more complicated as well; for example, the mood stabilizer I take for bipolar disorder II causes my blood sugar levels to run high, and I have to monitor them more closely as a result. If you make it a point to inform your psychiatrist about everything that is going on in your body, he can adjust your treatment to take your overall health into account.

3) Family medical history, including any history of mental illness

Remember that your mission here is to identify your enemy. Your family medical history will aid your psychiatrist in narrowing the field, but learning it can make for some awkward conversations. Try to broach the subject with relatives as tactfully as possible; they’re more likely to be comfortable telling you about their acid reflux or bouts of gout than they are sharing personal accounts of struggling with depression or hearing voices, but if you show them the same understanding and respect that you’d want to be shown yourself, they may open up to you, especially if you explain that you’re trying to get help for your own mental health. However, if asking questions about your family’s medical history is far outside your comfort zone or likely to provoke a reaction that would cause you undue harm, it’s all right to skip this step and explain the situation to your psychiatrist. Your diagnosis won’t be totally thrown off by the absence of a family history.

4) Your current symptoms

Try to be as specific and descriptive as possible when listing your symptoms. Make notes about how the symptoms make you feel physically as well as emotionally and how they affect your day-to-day life. If you can, give the approximate date the symptoms started or that you first noticed them. Think back to the times you have experienced the symptoms: Were they “triggered” by something? If so, write that down too. One thing that might help when making this list is asking your significant other or someone who spends a lot of time with you whether they have noticed anything odd or different about your behavior recently; you may have been exhibiting symptoms that you yourself weren’t aware of, but which could be indicative of a mental illness.

5) Your questions or concerns

Your upcoming appointment is your chance to get answers to all the questions that have been keeping you up at night since you decided to seek help for your condition, so do yourself a favor and write them all down! Here are some questions you might want to ask your doctor:

What do you think is causing my symptoms?

Is it possible to recover from my condition?

What kinds of treatment are available for my mental illness?

Will I need to see a therapist?

What is the success rate for recovery?

In what ways can I expect my life to change because of my diagnosis?

Are there any steps I need to take or circumstances I need to avoid in order to help myself get better?

 6) Compatibility questions

Think of your first visit like a first date. There are obviously certain things you would want to know about the person sitting across the restaurant booth from you before deciding to ask him or her on a second date, like which political party your date aligns himself or herself with and what his or her favorite football team is. (My father always warned me against Republicans, and my mother preferred my dates to be Steelers fans.) Seeing a psychiatrist is no different – well, maybe a little different, because he’s not going to pick up the tab and you won’t get a kiss goodnight, but the point is that you need to be compatible with one another, and to determine if he or she is “the one,” you should ask questions like:

How often can I expect to be seen?

How much time do you usually spend with patients during an appointment?

How easy would it be to contact you in an emergency?

Do you provide therapy? (If not, ask if he or she can recommend a therapist.)

What is your stance on alternative (non-medicated) methods of treatment?

What plan do you have in mind for my treatment and recovery?

As evidenced by this blog, I’m obviously not someone who has any reservations about spilling her guts in public, but I understand that for most people it’s a lot harder to divulge personal information to a complete stranger, especially when your symptoms are embarrassing, damning, or downright weird. One way you might handle your discomfort is to think of your psychiatrist as an android, like Data on Star Trek; his or her brain is a computer, and all you are doing is entering your information into a private, secure database so that you can be issued with a diagnosis. I don’t recommend doing this on every visit, though, because it’s important to remember that psychiatrists are people, too – and what’s more, they are people who chose to become psychiatrists, meaning at least some of them possess a heartfelt desire to help people like you and me. (The rest might just be in it for the money, but even they aren’t going to judge you for having a mental illness, because you’re the one paying them.)

What I’m trying to say is, don’t be frightened and don’t be worried. This is the step you have to take to get out the door and start down the road to getting better; as soon as you put your foot down, you’re on your way. You can do this.

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TiMMYS #2

Good morning, everyone! As I was waiting for my Adderall to kick in so I could get started in earnest on writing today’s post, I found this video online and thought it would make an excellent installment for the TiMMYS series (again, that stands for This Might Make You Smile). I suppose you could look at it as a metaphor for making it through the day, but rather than trying to make it relevant somehow to our struggle, I suggest you just appreciate it for what it is: a video of a puppy learning to go downstairs.

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