It’s difficult for me to speak positively about the psychiatric profession. In spite of my own negative experiences, I see therapists on television who seem wonderful, dynamic and caring. Gabriel Byrne’s Dr. Weston on “In Treatment” was fascinating. Even when he made ethically questionable decisions and recommendations to his patients, there’s a man I’d enjoy talking to. And Vanessa Redgrave on “Black Box” has already demonstrated in one episode that she is able to unflinchingly tackle her patient’s flawed thought processes head-on, while still managing to remain kind and compassionate.
But those aren’t real people. Real psychiatrists generally aren’t like what you see on television. I’d like to believe that those types of practitioners exist — because it’s hard to remain hopeful if you believe an entire field of medicine is a sham — but I have yet to meet any of them.
I know I’m probably being somewhat unfair in my expectations. One of the reasons television pdocs have the right answers is because they’re written by the same people who ask the questions. It’s not real life. In real life you have to think on your toes and answer off-the-cuff.
Except… not really. Psychiatrists are supposed to be trained for this sort of thing. It’s their job. They have scripts and scenarios. They are supposed to know the warning signs. They are supposed to know what to say and what not to say.
And yet in my experience, most of them say almost nothing at all.
Getting a referral to a psychiatrist is no small feat. If you’re lucky, you might see one within a year of a referral from your family doctor.* At the time when I first asked my doctor for help with my mood, her only option while awaiting referral was to diagnose me with suspected depression and anxiety and to prescribe me antidepressants. They only made me more anxious, so she increased the dose. This induced mania and psychosis. I still had no referral.
In a moment of clarity between psychosis and the ensuing crash, I returned to the doctor’s office and told them I thought I might do something bad. They insisted I go to the ER, whether by ambulance or they could call my mother. I opted for my mother.
I went through the (unlocked) drawers and cupboards. I found a box of razor blades.
I took one out. I stared at it for a long time. I put it in my purse.
We waited for several hours in the ER. Eventually a doctor from psych came to talk to me. We discussed how I was feeling and the fact that I had been suffering from insomnia for several months and that I had lost more than 20 lbs. She confirmed that I had a referral to a psychiatrist. She told me it would be best to wait for the referral.
I told her again that I was feeling suicidal and I asked to be admitted.
She said that wouldn’t be possible as the psych ward had no beds. She said it would be best to wait for the referral and she could give me an emergency hotline number and a bottle of sleeping pills to help me sleep.
A bottle of sleeping pills.
I asked her if she thought giving a bottle of sleeping pills to someone who says they are suicidal was good medicine.
She said she would only give me 3 or 4 instead.
I removed the razor from my purse and put it on the table.
I was admitted to the hospital. Because there was no room in the psych ward, I was admitted to one of the regular floors with a security guard posted to sit in the room with me for the first 24 hours. The next morning I saw a psychiatrist. He offered to prescribe antipsychotics and change the antidepressant I was on. But only on the condition that they would give me one-third the dose of the narcotics I was on for pain.
Their strategy to turf me was bitterly transparent. They would give me what I needed — the drugs for my as-yet undiagnosed bipolar — but I’d have to be willing to go through narcotic withdrawal. The fact that I had been legally and justifiably prescribed those narcotics by my doctor didn’t make any difference. Ultimately they knew I’d either refuse and sign myself out of my voluntary committal or I’d accept and bail after a few days of withdrawal. I lasted about 3 days. But at least I now had the medications I needed to bring me out of mania.
When my referral appointment finally came, I met with the psychiatrist at the Royal Ottawa Hospital. She reviewed my history. She reviewed my medications and asked me if I felt they were working. (No.) She upped the dosage. I saw her several more times. Every time, she asked if I felt there was an improvement. There was no counselling. (Unless you count “try to think positive thoughts” and “try to focus on what makes you happy”) She just continued to make changes to the medication and say “these things take time.” Then I got transferred to a different psychiatrist. Same thing. Then a third.
There was no therapy. There were only drugs. Antipsychotics, sleeping pills, antidepressants, anti-anxiety pills, lithium. I stopped going.
When it comes to mental illness in Canada* there is a certain pattern of triage that consistently occurs. If you suffer from depression, maybe you stand a chance. You’ll see either a psychiatrist or a psychologist and the chances are good that eventually you’ll get talk therapy or behavioural therapy to change any faulty thought patterns that you need to go along with any drug cocktail they deem necessary to change your brain chemistry. Someone will ask you about your trauma. Someone will help you deal with your abuse.
But if you have bipolar disorder or schizophrenia, you become a medical patient. Drug therapy is the only perceived solution.
And that is incredibly short-sighted. The human mind is complex. In the same way that my bipolar has shaped my experiences, my experiences have shaped my bipolar. Why wouldn’t I benefit from therapy? When the voices in my head haunt me and taunt me, why shouldn’t I be prepared with the tools to fight them? With all the studies that show links between trauma and mental illness, it is completely irresponsible how the mental health industry fails certain categories of patients.
I acknowledge that it’s a complicated issue. First and foremost are the restrictions placed on mental health treatment by the government. Under OHIP, there are limits to coverage for mental healthcare as well as limits to the number of visits that are covered (which might make sense for things like situational depression or seasonal affective disorder, but not for a great majority of permanent and lifelong mental illnesses). Compounding the problem is the unhappy marriage of the fields of Psychology and Psychiatry. They are unwilling bedfellows at best. Disagreement (and occasional outright disdain) between the two professions stands in the way of patients receiving possibly more effective combined therapies.
I try not to be pessimistic. I don’t always succeed. At a time when mental health organizations are pushing social media campaigns to remove stigma and encourage an open dialogue about mental health with things like Bell Canada’s “Let’s Talk” and ROH’s “You Know Who I Am” (and weirdly named “Friends with Benefits”), there is still a more important area of dialogue that I feel is missing.
And that is the one between mental health professionals and their patients.
You have a responsibility that extends beyond your prescription pad.
*For reference, I am in Ontario, Canada in a fairly large city. Referral times for other locations certainly vary, but it seems to be a common theme in most places that referral times are one of the things that pose the greatest risk for patients with mental illness, especially those at risk of suicide.