Choosing a Psychiatrist

There’s a line I love to quote from the movie Good Morning, Vietnam in which the main character, a radio DJ named Adrian Cronauer (played by the late, great Robin Williams), does a humorous impersonation of a field intelligence operative in the Vietnam War: “We’re having a very difficult time finding the enemy,” states the make-believe soldier. In his normal radio announcer’s voice, Cronauer asks, “How are you going about it?” and in the voice of the operative, who sounds a little like Gomer Pyle, he answers, “Well, we go up to people and we ask, ‘Are you the enemy?’ And if they say yes, we shoot them.”

That’s what going through the early stages of mental illness is like; there’s some massive, invisible enemy looming behind you, and you know it’s there because you can see its shadow and feel its breath on the back of your neck, but you can’t seem to pin it down. So you have to ask every aspect of your life “Are you the enemy?” and wait for something to say yes. Seeing your family doctor first will help you rule out most possible enemies; if you’re lucky, it will be something like diabetes or not getting enough sleep, and you can shoot it down with relative ease. If it turns out to be a mental illness, however, you’re going to have to pull out the big guns.

As the ancient and great tactician Sun Tzu teaches in his military handbook, The Art of War, the best way to defeat an enemy is to get to know him intimately, to study his weaknesses and learn his plan of attack – that way, when he strikes at you, you’ll either be so well-fortified that you can absorb the damage or, better yet, be ready with an even craftier counterattack. But first, of course, you have to identify who or what the enemy is. That’s what psychiatrists are for, and that’s why you should absolutely see one. Not all mental illnesses respond to the same treatment, so if you go running in with an “all-purpose” flamethrower you bought from a motivational speaker on eBay, you’ll be shit out of luck if your particular mental illness happens to be flame retardant.

So you need to see a psychiatrist. Got it. Which one? That’s the tricky part. This is, of course, assuming that your GP didn’t already recommend a psychiatrist to you after your last appointment (you did see your GP first, right?). I recommend starting your search at HealthGrades.com. This site provides a complete listing of psychiatrists within a given geographical region and shows how each psychiatrist was rated by his or her actual patients, according to a range of criteria like how easy or difficult it is to schedule an urgent appointment and how clearly the psychiatrist explained his or her findings to the patient. You can also view each psychiatrist’s credentials from the site (you definitely want a psychiatrist who’s board-certified) and see whether or not he or she has ever been accused of malpractice. If you happen to live in a town near a teaching hospital or a university with a medical college, you could also start by contacting their psychiatry department and asking if you can get a consultation there. You might think that seeing a student psychiatrist would be risky because they have less experience, but a blog I visited recently rightly points out that students are more likely to possess the most up-to-date psychiatric knowledge.

(A quick interjection: Obviously you should try to find a psychiatrist who accepts your insurance, but unfortunately, most of them don’t accept insurance, period. In this particular post, I’m not going to discuss the financial aspects involved. Instead, I’m just going to try and impress this fact upon you: of all the things it’s okay to spend a lot of money on, your own well-being is the single most important investment you can make. Don’t put yourself on the backburner because you don’t feel justified in forking over the funds for treatment. You’re worth it, trust me.)

If you’re feeling overwhelmed by the decision, remember that the first psychiatrist you see doesn’t have to be your psychiatrist for life. My suggestion is that you first take the time to consider whether you would feel more comfortable divulging your personal information to a male psychiatrist or a female psychiatrist, and then take it from there. (But really think about it, because it can be stressful to have to discuss distinctly female problems with a male psychiatrist – and, I’m assuming, vice-versa.) What matters at this point is finding someone who is highly qualified and highly rated, so you can be confident in their initial diagnosis. That diagnosis is your number one quest objective because it represents the name of your enemy, and once you know who’s been attacking you, you can track him down and fight back.

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Getting Sidetracked

One of the hardest things I struggle with as a writer and as a bipolar person with adult ADHD is maintaining focus and concentration when I’m trying to write. I started out two days ago writing about how to find a good psychiatrist and then somehow wound up spending the entire weekend so far researching the anti-psychiatry movement and a type of discrimination called “ableism.” Obviously these are really fascinating topics, and I’m trying my best to wrap my brain around the concepts so I can distill them down into an article to share here on my blog at some point in the future; in the meantime, however, I’m painfully aware that I’ve missed the deadline for two or three other posts. (Granted, I set the deadlines myself, but I’m disappointed in myself for not being able to overcome my challenges and stick to them.)

So, this is me apologizing for letting my readers down. It might be presumptuous of me to assume any of my readers (and according to Google Analytics, I have around 15 of them right now) are really so engaged by what I have to say that they’ll feel disappointed by having to wait a little longer for my next post, and I realize that those of you reading probably already understand the difficulties I have on a daily basis and probably wouldn’t begrudge me for them; but still, I made a pledge, and I feel honor-bound to keep it. That being said, I am currently striving towards completing today’s promised post and will have it up as soon as possible.

I hope it’s sunny today where you live and that your day has been wonderful so far (or, barring that, at least tolerable).

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This Might Make You Smile #1

Good morning, friends! It’s my sincere hope that you had a restful night’s sleep and that you woke up feeling well (or at least less awful than usual). I’m still working on today’s official post, but I’d like to take the opportunity this morning to introduce the debut of another new feature to my blog: This Might Make You Smile, or TiMMYS, as I like to call it, because acronyms are fun.

I can’t count the times I’ve been on the receiving end of well-meaning but idiotic advice like “Cheer up!” or “Smile; your face will freeze that way!”, and I’m not going to insult you by offering that same advice myself. Those of us who have experienced true depression know that sometimes smiling takes as much effort as lifting two cars and their drivers and that if “cheering up” was really that easy, then we’d already be doing it (seriously, DUH).

The point of TiMMYS is to share with you things I have found that made a subtle improvement in my mood. None of these things cured me; none of them gave me any sort of epiphany about the value of life or inspired me to overcome anything. They did, however, make me smile (and sometimes even laugh – today’s TiMMYS actually made me dance a little), and often that tiny change makes my suffering a tiny bit easier to bear. When you’re already carrying a five-ton elephant on your back, clipping its toenails may seem like an insignificant  difference, but if the bridge you’re trying to cross has a weight limit of 9,999 pounds, it can make all the difference in the world.

So without further ado, here is the very first TiMMYS, courtesy of my husband (how he finds these things, I will never know) – you’ll want to turn your computer speakers on to get the full effect.

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Change of Plans!

Hello again! I hope you are having a good day, or at the very least a not-terrible one. It’s been rainy and cold all day where I live, and my mood always seems to be exacerbated by the weather; I’m usually quieter and sadder on rainy days and louder and more energetic on sunny days.

I’m going to have to change my plans for today’s post; I wanted to include some dialogue from a fellow mentally ill person to add authenticity to the article, but I’m having trouble finding one willing to give me a quote. So I’m putting today’s post on hold for now and skipping ahead to tomorrow’s, which I will try to have up by the end of the day. My in-laws called just now and spontaneously invited my husband and I to dinner in… five minutes, so I unfortunately can’t make any promises to meet my deadline today – but I promise I will do my best.

I hope you have a safe, quiet evening and that you sleep well tonight, and if you don’t hear from me again tonight then I’ll see you in the morning!

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What to Do if You Think You Have a Mental Illness

Let’s say you haven’t been officially diagnosed with a mental illness yet. Maybe someone recently pointed out that you’ve been a lot quieter than usual lately, or that you always have a fretful look on your face, or that they’ve noticed you tend to tap the corner of every item within arm’s reach at least five times before you can settle down. Maybe it’s come to your attention that you’ve lost interest in all your favorite hobbies, or that you dread getting in bed at night because all you do is lie there and think distressing thoughts until you finally fall asleep at around 3:00 AM. Maybe you’re experiencing the sensation I lived with as a teenager, a gnawing, overwhelming feeling that something is wrong inside. Whatever your situation is, you’ve now been faced with this question: Could I have a mental illness?

My first piece of advice to you is “Don’t Google the mental illness you think you have.” I’m too late, aren’t I? Who am I kidding, of course I’m too late. That’s probably the very first thing you did. Don’t feel bad; if Google had been around when I was a kid, it would have been the first thing I did, too. Since that particular piece of advice is probably moot, amend it to “Forget everything Google told you about the mental illness you think you have.” As a general Rule of Life, it’s a good idea to take everything you read on the Internet with a grain of salt unless it’s from a legitimate, established source, like the National Institute of Mental Health (NIMH) , the National Alliance on Mental Illness (NAMI) , the Depression and Bipolar Support Alliance (DBSA) , or (of course) this blog – because unlike many bloggers out there, I always check my facts. Coincidentally, if you really have no idea whether or not you should even be concerned about having a mental illness, NAMI has a great checklist of common warning signs that might help convince you one way or the other.

If you took a look at the aforementioned list of warning signs and found that many of them apply to you, don’t assume you definitely have a mental illness and immediately start searching Google for miracle cures. Only a psychiatrist can make an official diagnosis, but you’ll want to make an appointment with your GP (general practitioner) first so he or she can rule out any diseases or disorders of the body. Regular run-of-the-mill health problems like diabetes, strep throat, and bacterial infections can cause many symptoms also associated with mental illness, such as irritability, confusion, increased or decreased appetite, trouble concentrating, and excessive fatigue, so it’s entirely possible that if your symptoms appeared very recently, they may originate from someplace other than the brain. If everything from the neck down passes inspection, your GP will then be able to give you a referral to a psychiatrist, who will conduct his own examination before pronouncing a diagnosis.

What if you’re self-conscious about your symptoms or feel uncomfortable divulging such personal information to someone you don’t know all that well? Write a list of the symptoms you’re experiencing and add all the questions you have about them. Your doctor will still have to read them, but it will save you from having to say them out loud. Another trick that helps me when I have to explain my conditions to someone out loud is avoiding eye contact. Pick an object or a spot on the wall far enough away from your doctor that you won’t be tempted to look at him or her and stare it down while you talk. Don’t mumble, though, and don’t speed through it, because then you’ll just be asked to repeat the whole thing. Speak clearly and slowly and make sure to include all the gory details, because they might contain crucial information your doctor can use to determine what’s causing the problem. I know this is hard; I recently had to explain to an insurance representative that the reason I needed the company to pay for this specific medication was because it was the only one I had tried that allowed me to have a normal sex life. Thing is, people are a lot nicer than you think they are. I was expecting shocked silence or a snide remark about “too much information,” but she was surprisingly sympathetic. A few days later (still trying to get the medication covered) I called again and had to explain the situation once more, this time to a man. I think I even cried a little, I was so humiliated. But to my amazement, the guy said he and his wife had been through a similar situation – and then he said a prayer for me right there on the phone. (He still couldn’t get the medication approved, but that’s beside the point.)

The most important thing to take away today is the fact that you can’t get better if you don’t see a doctor. Mental illness is a lot like regular illness in that it can be treated, managed, and sometimes even cured, but one thing it won’t do is go away on its own – and the longer you go without getting it checked out, the more likely you are to end up in the hospital or make a bad decision that could affect the rest of your life.

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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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“Isn’t This Crazy?”: Confronting Misconceptions about Mental Illness

Whoever you are, wherever you’re from, chances are good that you came to this blog today with at least a vague idea of what mental illness is and what it means when you have one; people tend to pick up on certain things over the course of a lifetime even without learning about them explicitly. And if you’re like I was when I was much, much younger, the picture of mental illness you already have in your mind is an altogether ugly, unsavory, and frightening one. Society as a larger unit tends to grossly misunderstand and misrepresent mental illness, such that the reality of mental illness is often so different from its representation in books, television, and movies that it is unrecognizable to anyone who hasn’t experienced it – and, worse yet, to those who are experiencing it. In other words, mentally ill people in real life are so unlike mentally ill people on TV that you can be mentally ill and not even know it.

Thanks to the fact that the socially-taboo nature of the condition prevents open, honest discussion, misconceptions about mental illness abound. Some of the most common misconceptions also carry the risk of causing great harm to those of us who actually live with mental illness. In the hope of both protecting you from these misconceptions and arming you against people who possess them, I’d like to confront the ones that have harmed me and present the truth of the matter.

Misconception #1: “There’s nothing wrong with you; every teenager feels this emotional.”

This one is hard to write about without getting angry, because it held me back from getting treatment for years. Parents, if you’re reading this, your teenager knows when something is wrong with him or her. Teenagers, even under the influence of raging hormones and rapidly intensifying social pressures, can tell the difference between a bad day and a black hole. To any teenage readers: please hang in there and check back later for a post detailing what you can do to get yourself help if no one is taking you seriously. Your teenage years should not consist of struggling to get through each day.

Misconception #2:  “Mental illness” isn’t real. People use it to get attention or to escape blame after misbehaving.

Yowch! This one leaves a bruise. Mental illness most definitely is real. Like diabetes signifies that the pancreas is failing to produce adequate insulin, diseases like bipolar disorder and schizophrenia are the result of a chemical deficit in the brain. Scientists haven’t pinpointed the exact cause of mental illness yet – medical technology simply isn’t advanced enough – but they’re getting closer every day, and for now they know more than enough to verify that mental illness is definitely a real condition caused by something going wrong within the brain. (It’s also important to note that “something going wrong within the brain” is very different than “something the person did on purpose to get attention, get out of trouble, and/or make themselves into an unnecessary burden on everyone around.”) As for escaping blame: Yes, I suppose it’s true that someone could conceivably shoplift from a store, post naked pictures of himself or herself online, and/or cheat on his or her significant other with not one but three other people and then claim to have been affected with bipolar disorder, but it’s much more likely that that person became legitimately affected with bipolar disorder before doing all that other stuff – much the same way that the handful of people who abuse the welfare system make it harder and more shameful for single working mothers, college students, and underemployed persons to benefit from it.

Misconception #3: People who claim to be depressed or mentally ill just need to try harder to get over it. After all, “pain is weakness leaving the body.” Anyone worth anything can pull himself or herself up by the bootstraps.

Oooooooh, this one burns me up. Going through emotional trauma does not mean that you are somehow morphing into a superhero, just like being overwhelmed by emotional trauma does not mean your system was too “weak” to handle the transformation. Listen to the words that are coming out of my mouth: my brain is broken and science does not know how to fix it yet. If you fell down a flight of stairs and broke your leg in half, would you just “try harder” to get up and walk? No! You’d call a freaking ambulance, you idiot! It’s the same thing. Friends, if someone has lobbied this gem at you, I know they probably meant well and had no idea they sounded like a mouth-breathing moron, but for the love of hot dogs, don’t listen to them! When you’re mentally ill, all you do is try; try to get out of bed in the morning, try not to cry into your cereal, try to make it through the day without accidentally embarrassing yourself, try to interact normally with other people, try to pay attention, try to suppress all your weird compulsions…. With all the stuff you’re already trying to do, “pulling yourself up by your bootstraps” is asking a little too much.

“But Sarah, I heard a story in church/on the news/from a motivational speaker about a guy who lived with depression for years and then cured himself by being tough and riding it out/keeping a daily gratitude journal/looking on the bright side of things.”

Yes, I heard it too, and I’m here to tell you it means nothing as far as your own struggle is concerned, and here’s why. In Nova Scotia in 1993, a man named Gregg Ernst shattered the world’s record for heaviest weight lifted by hoisting into the air a platform holding two cars and their drivers. The platform weighed over 5,000 pounds. Obviously this is an amazing feat, one that Ernst identified as a goal early on and spent his lifetime training for. Okay, so picture a guy about your age who goes to the gym five days a week and can crush a beer can by flexing his bicep. Would you call him “weak” to his face? Would you think he was less of an athlete because he can’t also lift two cars and their drivers? Because he didn’t decide at a young age that he was going to one day physically pick up two automobiles and immediately start training to do that very thing? What if just managing to work out every day is a big triumph for him because he was in a car accident as a kid that left him in leg braces for years, or because he was born with multiple sclerosis? Are you going to think this guy is spiritually weak because he can’t muster enough “willpower” to lift those two cars?

When we’re kids, we don’t stop and think, “Gee, one day I might develop a mental illness. I’d better start training my mind to get over being depressed!” And not all of us have the psychological and spiritual resources to just “will” our way out of depression; some of us, for example, may have other serious health issues to cope with, may be survivors of an extraordinarily difficult upbringing, or may simply be trying to deal with a lot of stressful life events occurring all at once. If you wouldn’t expect our friend the Beer Can Guy to go around picking up cars like Godzilla, then you shouldn’t also expect yourself to somehow magically have the “inner strength” to overcome mental illness on your own. You got out of bed this morning. There’s proof of inner strength.

Misconception #4: Mentally ill people are dangerous to be around.

The image of mental illness most people have in their heads, thanks to Hollywood, is that of a raving lunatic, wielding a chainsaw and chasing a scantily clad teenager down the road while wearing the face of his last victim. Oh, did I mention he has tea parties in the basement with his mother’s corpse and once made a whole suit out of human skin? You get the idea. Yeah, we’re so obviously not like that at all. Even those of us with anger issues (due to medication side effects or the natural effects of a mood disorder, mind you, not due to a flaw in moral character – more on that in a minute) aren’t likely to suddenly break out in murder, especially if we’re aware of the issue; if that’s the case, it’s highly likely that we’re better equipped to keep an eye on our temper than “normal” folks.

Misconception #5: Mental illness makes you a special butterfly, and psychiatric medication is poison that will turn you into a joyless robot.

You can (mostly) thank Hollywood for this one, too. Mental illness is often portrayed as the driving force behind a character’s genius/creativity/passion, the spark that makes them interesting and unique. But it’s not just movies and television reinforcing this trope; historians and biographers have attributed the greatness of people like Ludwig van Beethoven, Vincent Van Gogh, and Abraham Lincoln to their mental illnesses. And yes, it’s unfortunately true that enhanced creativity, increased energy, and exceptional lucidity of thought are all symptoms of mania, the “upswing” of bipolar disorder; it’s also unfortunately true that once a person undergoes effective treatment for the negative aspects of bipolar disorder, they often find that the positive aspects have been blunted, rendering them less creative and energetic than before. I took one medication for a while shortly after being diagnosed as bipolar that made me feel like a cardboard cutout of a person, all flat and two-dimensional, existing in a colorless world like Dorothy before she visits the Land of Oz. But you know what? I asked for a different medication.

And here I am now, still special, still unique, only now I don’t have to slog through months of bleak wintery depression before waking up one morning with a blinding burst of energy and creativity; instead, now I sit down at my laptop and say to myself, “Write.” And then I pound keys and make words come out. The thing about creativity is, if everybody waited until they felt “inspired” before attempting to create something, authors would literally starve to death in the streets after being kicked out of their apartments for not paying rent. TV shows would go on hiatus for years at a time while the actors and set designers waited to hear “the call of the Muse.” Nobody would ever be able to get any advertising done for their products, and we’d have a lot fewer inventions making our lives easier.

Misconception #6: Mental illness means you’re a bad person with a weak moral character.

Oh Lord. Really? You think I got up this morning and decided ahead of time that it might be a good idea to burst into tears in the middle of my family reunion? Or that I thought it might be really funny to flake out on the job interview a friend went to the trouble of setting up for me in addition to skipping all of my classes this week? My husband likes to say, “There are no good people and there are no bad people; there’s just people.” People with mental illness have a lot going on in their heads, and very little of it has to do with hurting someone else’s feelings. About seven years ago I forgot my husband’s birthday because at that point in time, I was having trouble keeping track of what month it was. And two years ago I was so stressed out by grad school that my own mother’s birthday came and went without so much as an “I love you, Mom.” In neither situation was I intentionally being selfish; self-centered, possibly, but when you’re suffering intensely it’s very easy to get trapped in what I like to call “the awful bubble.” Bottom line: Anyone can do bad things, even “normal” people, and doing a bad thing doesn’t automatically make you a bad person.

Have you encountered any damaging misconceptions that you’d like me to add to the list? Leave me a comment about them!

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