Rant.
If you're mentally ill and being treated well by your doctor, praise your doctor, and more importantly, praise him or her to his supervisor or director. The good doctors are few and far between and the directors rarely know one from another. Not only will your recommendation carry weight with employment / promotion / sacking decisions, it also will make a huge difference in letters of recommendation and peer reviews of their work if their hard work is known and rewarded. This work is thankless, and it's made in part thankless by the fact that lacking patient feedback, they have to go on some fairly arbitrary criteria.
If you're mentally ill and being treated unfairly by your doctor, say something. Say something and say it now. Half the time, the doctor has no idea because you're bottling it up, half the time, the doctor is burned out. Broach it with your physician. Then broach it with your physician's supervisor. If need be, change doctors and tell the doctor who referred you to the old doctor why.
If you're mentally ill and being neglected by your own doctor, e.g. calls routinely not returned, no advocacy or visit taking place if you're hospitalised for your condition, billing issues being used to disrupt treatment or a medication regimen (prescriptions being held hostage because "insurance hasn't paid yet" is not unheard of, sadly), having therapy interrupted routinely for lengthy telephone consultations, raise hell. This is inappropriate patient care. Tell your doctor you're disappointed, but if you've been around long enough to notice the pattern, but you will be seeking treatment elsewhere. Tell his or her supervisor why, as well. Be sure to tell the doctor who referred you exactly why you're leaving this person, at length, and your concern that this person will take on new patients with the same attitude. Tell the insurer who's been paying for your treatment why you are discontinuing treatment with this person and you would appreciate their assistance in finding a new doctor immediately. Inform the professional groups that the doctor is a member of (state medical societies, APA, & c.) as well as the state medical board.
Please recognise that while you may raise a bit of hell, you cannot expect miracles. However, enough people saying these things will lead this person to have fewer and fewer referrals, fewer and fewer defences from their colleagues, and less and less patience from the people who do affect them, namely the people who employ them, advocate for them, defend them, send patients to them or consider whether this person should be given leadership positions in organisations.
Assuming you may not have a great relationship with your primary doctor or may not even have one, good places to ask for treatment include a local medical school or nursing school's site for mental health rotations and clinics that work closely with the local hospital (if you've not been hospitalised, telephone their psychiatric ward anyway and ask where they refer patients for post-discharge care). If these fail, you should get in touch with your state's medical society and medical board, and a psychiatrists' society should they have one, and ask for referrals to practitioners in your area.
Interview any new doctor carefully, with the following list of questions:
- "What is your philosophy on treating someone in crisis?"
- "What is your philosophy on treating someone who is having some interruption of their ability to cope but is not suicidal?"
- "What is your philosophy on treating someone who doesn't want to be medicated or is frightened of medication?"
- "How do you approach a patient who is well-informed on treatments but suggests an approach you disagree with?"
- "What influences your choice of medications?"
- "How should a patient contact you outside of treatment hours? What sort of events warrant being contacted outside of appointment times? How is paging handled? When can I expect a return telephone call?"
In exchange for all these rights, there are a lot of responsibilities.
Describe your symptoms honestly. Don't try to self-diagnose, and for gods' sake don't leave things out. Try keeping a mood diary. Ask your friends and family what they've noticed. Spouses, parents, siblings and children are particularly good bets. You need not traumatise them, but ask them honest questions and tell them to be honest, because you need to tell a doctor how you're doing. Do you seem ill? Out of sorts? Distractible? Irritable? Withdrawn? If they don't feel comfortable saying this to you (not uncommon), ask if you can have their impressions in a short paragraph or two in an envelope they seal and you give to your doctor. Unless you're totally nutters at the moment of intake, you will be presenting as far differently than you do when you're not being interviewed. You weren't put through intake because of how you behaved in the waiting room. You were put through intake because this is something you asked for based on the day you called and asked for the interview.
In describing symptoms honestly, this means everything. *Everything.* "Do you believe in magic?" Well, yes, if you do, say yes. Saying yes to one of these questions doesn't make you schizophrenic anymore than admitting self-injury makes you have borderline personality disorder. You have what you have. And being labelled either (correctly, that is) means you'll get better treatment focussed on your problems. Admit if you smoke pot. Admit if you take cocaine. Admit if you drink. Admit if you hear voices. Admit, admit, admit. As computer geeks say, Garbage In, Garbage Out. You can't feed these people non-information and lies and expect them to come out with a useful answer. Whatever symptoms you have, you are just as crazy as you are if you hide them, but if you hide them, you're wasting your own time. Stop worrying about stigma and start worrying about getting better.
Be honest about your own medication compliance. If you weren't med compliant, say why. "I didn't feel like taking it" is a valid reason in this case — it indicates depression, for one thing, lack of confidence in the treatment for another, and possibly intolerable side effects for a third. Your doctor needs to know what you can take and how and why and what warrants discontinuation and what should be pushed a little harder, and this is *your* brain all these chemical reactions are happening in and you are allowed to choose what goes into it. You also need to remember that *you* didn't go to medical school and your doctor did, so be very open minded.
On the third hand, you also need to remember that you are supposed to be a partner in your own care. Investigate medications you're prescribed. If they don't seem to add up, say something. Have your pharmacist check for interactions. Do your best to be compliant with all medications prescribed — mobile phone alarms, pill cases, patterns and routine (meds right next to toothbrush) will all make it easier to give the medication a fair try.
Honesty with yourself is key. Honesty with the person trying to fix your problems is key. Taking an active interest in your own mental health is key. Learning to advocate for yourself and your needs is part of recovering your mental health.
A lifelong medication and treatment régimen doesn't mean that you're hopeless. Hardly. Most diabetics, renal patients, bone marrow transplant patients, etc. go on to live healthy and full lives. Yes, there are a few pains in the ass in their lives and there were intense times where everything was dropped in favor of getting better. Just because your illness is in the brain does not mean that you should accept less — either fighting for medical care for what is a medical condition, or deciding you'll never survive in the world because of it and giving up.*
Never give up. Be honest with yourself, your family, your doctors. Be an informed patient. Work with people you trust. Be willing to take chances — on being a psychiatric resident's first case, on a new medication, on a change in lifestyle.
* Note that in no way am I impugning applying for disability benefits. If you're disabled for 40 hours of work per week, that's that. But assuming you'll be completely incapacited and you'll never be able to do anything in life at all, such as run a website, a knitting circle, or bake cookies and sell them, and things will never get better, that's a defeatist attitude, and you'll never kick this thing's ass into shape should you continue thinking like that.
