Tuesday, September 29, 2015

mental health bingo.

as someone who is mentally ill TRADEMARK, i have come to notice a few routine things when you go through america's healthcare system.

i've thought about this before, the day to day shuffling of getting medications and x-rays and labs and routine stuff. but it wasn't until today that i decided that this was probably worth writing about.

so without further ado, here are a few things that i encounter when i go to the doctor as someone with anxiety, depression, trichotillomania, and conversion disorder.

1. every single appointment makes you fill out some paperwork (as usual), and you find yourself going directly to the part of the paperwork that asks you about your mental health.

i don't smoke, i don't have diabetes or digestive problems (unless you count my conversion disorder making me throw up), i don't have heart problems or cancer, just asthma and anemia. so it's really easy to skip over all that stuff and go straight to the brain. and then it's like playing the mental illness bingo.


will this paperwork have anxiety? oh, this one only has depression. how much can i fit into the "other" line? should i even mention conversion disorder? no, i shouldn't mention it, they'll ask weird questions and send me to another doctor.

once i went to redimed with a fractured elbow and for the first time in my life, when i filled out the paperwork, there was not anything asking me about my mental health.

i was very confused, slightly relieved, and very annoyed. i didn't know what to do or what to think. i was relieved because honestly it's not very fun going through and checking off everything that's chemically wrong with your brain, knowing that someone is going to look at it and preemptively judge you for it. but at the same time, it's an important part of my medical history and who i am as a person. it's very important information that my doctor needs to know and it's something that we need to talk about, even during a routine "hey i hurt my elbow, can you give me an x-ray?" appointment.

2. someone asks, "what the fuck is trichotillomania?"

okay, most healthcare professionals don't say fuck. but i can count on two hands the number of healthcare professionals have looked up at me, confused, and said, "but what's trichotillomania?"

find out about trichotillomania here.

read about my struggle with trichotillomania here.

normally the conversation goes like this:

me: it's a hair pulling disorder.
nurse: oh okay. time to take your blood pressure.

except one time it was like

me: it's a hair pulling disorder.
doctor: oh. what caused it?
me: ummm
doctor: well something caused it.
me: it's like my anxiety. i've just kind of always had it.
doctor: well what caused your anxiety? normal children don't have anxiety.
me: THE CHEMICALS BEING IMBALANCED IN MY BRAIN?

i didn't see that doctor again.

3. the usual mundane and slightly shameful conversation about your antidepressants.

doctor: i see here that you take zoloft?
me: that's right. 25 mg at night.
doctor: and what's that for?
me: anxiety and depression.

every. single. time.

this is an important conversation to have. every time that i go to a doctor, we have this conversation and i fully expect it. it's a necessary conversation so that i get the best care that i can get. what's NOT fun about this normal conversation is the shame that i used to (and sometimes still do) feel about taking zoloft. this comes from a stigma surrounding antidepressants, one that i used to have when i blatantly refused to take any when i was sixteen because i didn't understand what they did. i am not ashamed to take an antidepressant, but sometimes that feeling is overwhelming. then i feel shameful that i feel shame for taking an antidepressant. it's confusing sometimes and rather unpleasant. but most of the time, it's a prompt and necessary conversation that's vital to my health and wellbeing. 

4. and the old favourite questions that come with your antidepressants:

"how are you doing on your antidepressant?"
"any changes in mood?"
"any suicidal thoughts?"

a lot of people make fun of the fact that antidepressants can cause suicidal thoughts. i used to be one of those people until i got on antidepressants.

antidepressants do not cause suicidal thoughts. some people that go on antidepressants already have suicidal thoughts and being on an antidepressant gives them the means to act out their suicide plan. people with major depression have difficulty getting out of bed, feeding themselves, cleaning, and just generally having energy. killing yourself takes energy. but when you go on antidepressants, you now have the energy to decide to go through with your plan.

antidepressants that don't mesh well with you can change your mood though, like my old lexapro did. the mood change slowly caused suicidal thoughts.  the two months i was on that drug were probably the worst two months of my life. i found myself fantasizing about driving into oncoming traffic and strangling myself with my dorm hangings.

5. getting refills is always awkward.

me: do i need to convince this doctor that i need an antidepressant?
me: what if they decide to change my dosage?!
me: if i can't get it, do i have enough to wean myself off of it properly?

i have to do this (although it normally doesn't take much convincing, if any at all) because i get my zoloft refilled at a health clinic through my parents' insurance that makes it free for teachers and their families. the initial prescription came from a psychiatrist, but rather than see her over and over each time i run out, i can see a general doctor to get it refilled quickly. i really only worry about needing to "convince" this general doctor that i need the new prescription because of my anxiety disorder, which is, of course, why i'm taking zoloft in the first place.

i once had a doctor (IN A NEUROLOGIST'S OFFICE NO LESS) tell me that i was taking such a small dosage of lexapro that i didn't need to wean myself off of it, that i could just quit it cold turkey.

HAHAHAHA NO. quitting an antidepressant cold turkey feels kind of like this:


like honestly, i spent five hours in my bed staring at my wall and someone had to force feed me because i didn't have enough energy to feed myself. 

6. wondering if doctors will take you seriously.

it wasn't until college that i realised that there was a lot of discrimination that happens to people with mental illnesses in hospitals and doctors' offices. one that particularly stuck with me was about a woman with bipolar disorder who went to the ER for unbearable pain. they gave her morphine but the pain didn't go away. she was in so much pain that she couldn't sleep and she spent the whole night screaming and crying. she realised later that her doctor gave her saline instead of morphine because she was bipolar and he didn't trust her when she told him how much pain she was in.

this has not happened to me, thank goodness. but i have seen the corners of mouths turn down, seen doctors glance at each other when looking at my medication chart, and once had a doctor ask me if i would be more comfortable staying on the psychiatric floor rather than the floor that i was on when i was hospitalised in college. 

98% of the time, doctors are doing their jobs. they take you seriously. we've come a long way when it comes to medication stigma and most of the time i don't have to worry about being taken seriously. but occasionally, like the bipolar woman i just mentioned, we are not taken seriously and it can become a problem.

7. doctors trying to keep it casual.

this is an actual conversation that i had about an hour ago refilling my zoloft.

doctor: that is SUCH a cute necklace.
me: thank you! i got it at target.
doctor: no kidding? is it still there?
me: yes, i was actually at target getting eyeliner before i came here and it's still there. they have it in gold, too.
doctor: any suicidal thoughts?
me: nope.
doctor: gold, you said? i think i like yours in silver better. target is my daughter's favourite store. 

bless doctors like that. bless doctors doing their job and not making it awkward when it doesn't have to be.

8. always having to ask "will this medication clash with my antidepressant?" 

when i was getting my back treatment last spring, i was on a bunch of hippie herbal supplements. i took them home in a big clunky bag and spent half an hour reading every single label, trying to make sure that they wouldn't offset my zoloft. sure enough, one of them did and i had to take it back and explain why i couldn't take it. 

nurse: but why can't you take it?
me: it says not to take it with antidepressants.
nurse: why?
me: i don't know, i didn't make this hippie concoction that you want me to take three times a day.
nurse: you should take it for your back treatment.
me: i would rather have back pain and be able to talk to store employees than not have back pain and be too exhausted to get out of bed regularly, thanks. 

when in doubt, most general doctors don't understand the finer workings of antidepressants, what they should and shouldn't mix with, and your routine medication schedule. so you explain why you need it, what it does for you, and leave it at that. the people are who are going to understand and know the finer workings of your medications are psychiatrists and psychologists, but going to them can be expensive and time consuming, and doesn't generally fall into a routine, at least not for me. 

being mentally ill TRADEMARK is like constantly being followed by a cloud that only you can see. you go about your day as normal. buy your groceries. pay your bills. brush your teeth. cook yourself dinner. these are things you can do if you have your mental illness under control, like i do. sometimes i cannot do these things. most of the time i can, but sometimes i can't. 

even when i can do these things and i am 100% normal and balanced and my zoloft is doing its job and i'm using my cognitive behavioural therapy toolbox to approach social situations, that cloud is still there. it's always hovering above me, reminding me constantly that my daily functions depend on something that i learned from a therapist and from a small blue pill that sometimes gives me heartburn. it's always there reminding me that i am mentally ill.

and i remind myself that this isn't my fault. that this is who i am. that all this is, really, is a chemical imbalance in my brain and that i am working to get better, just like i did when i did physical therapy to get rid of my back pain. i take my zoloft to keep my seratonin and dopamine where they're supposed to be in my brain.

i am mentally ill TRADEMARK, i take a little blue pill to help me function.

but i'm still funny, clumsy, forgetful, loud, and always always always a mental health advocate. 


(this post was edited on 9/30/15 at 8:44 am for clarity, as my good friend marie brought up some really awesome points about primary doctors and mental health care. you go, marie!)

3 comments:

  1. Oddly enough, I related to much more of this than I thought I would. I don't have a diagnosed mental health disorder (according to the DSM) but I do have a rather odd/rare form of migraine.
    I have this migraine and allergies, that's it. But do I just put migraine or do I put the specific kind. If I put down basilar migraines at a doctor's office that isn't a migraine specialist or neurologist-there's the inevitable "what is that? That doesn't sound like a migraine.". "Well it is. In fact it's not even the oddest type there's one kind that makes half a person's body paralyzed for between 6 to 72 hours, so basilar seems tame by comparison". Has sort of become my go to retort.
    Then refills. I'm on a slightly high dose of a drug that is technically an anticonvulsant (it is also labeled for migraine and bipolar disorder at lower doses- my dose is on the high end of the migraine side). Terrified looking pharmacists hand you your prescription if you drive up to pick up an anticonvulsant at the drive thru window.
    Doctors, for a while, including my neurologist when I was trying to diagnosed did not believe what I was telling them especially about the frequency of symptoms. And they still doclnt seem to pay much attention to me- I'll ask about what else I could be doing to help myself and get nothing back not even a " just keep taking the meds". Just ignored, very frustrating. I also consistently hide it from my classmates because I am sure that they wouldn't trust me as a competent colleague any more. I have had a few bad auras and have had to figure out how to work through them on my own or using techniques others have suggested.

    On a side note: another reason in the literature that depression and suicide (attempts, thoughts, events) are correlated is that people don't given them time to work. They want/expect an instant fix and it just doesn't work that way. This is worsened by the stigma preventing people from going to get help until the last possible moment

    ReplyDelete
  2. Oddly enough, I related to much more of this than I thought I would. I don't have a diagnosed mental health disorder (according to the DSM) but I do have a rather odd/rare form of migraine.
    I have this migraine and allergies, that's it. But do I just put migraine or do I put the specific kind. If I put down basilar migraines at a doctor's office that isn't a migraine specialist or neurologist-there's the inevitable "what is that? That doesn't sound like a migraine.". "Well it is. In fact it's not even the oddest type there's one kind that makes half a person's body paralyzed for between 6 to 72 hours, so basilar seems tame by comparison". Has sort of become my go to retort.
    Then refills. I'm on a slightly high dose of a drug that is technically an anticonvulsant (it is also labeled for migraine and bipolar disorder at lower doses- my dose is on the high end of the migraine side). Terrified looking pharmacists hand you your prescription if you drive up to pick up an anticonvulsant at the drive thru window.
    Doctors, for a while, including my neurologist when I was trying to diagnosed did not believe what I was telling them especially about the frequency of symptoms. And they still doclnt seem to pay much attention to me- I'll ask about what else I could be doing to help myself and get nothing back not even a " just keep taking the meds". Just ignored, very frustrating. I also consistently hide it from my classmates because I am sure that they wouldn't trust me as a competent colleague any more. I have had a few bad auras and have had to figure out how to work through them on my own or using techniques others have suggested.

    On a side note: another reason in the literature that depression and suicide (attempts, thoughts, events) are correlated is that people don't given them time to work. They want/expect an instant fix and it just doesn't work that way. This is worsened by the stigma preventing people from going to get help until the last possible moment

    ReplyDelete