“The greatest communication barrier known to man is the lack of the
common core of experience "When’s the last time you had a Manic Episode
Doctor"?”
~Stanley Victor PaskavichPerhaps the most frightening truth about doctors is that they are human. That's right, folks; the person sitting comfortably on the other side of the desk in his or her crisp white coat, staring with beady eyes at your apparent wreck of a self, belongs to the same classification of species as you do. Psychiatrists have bad days, marital troubles, ulcers, sleepless nights, bad Chinese for dinner, and fights with their teenage daughters just like the average Joe. They don't always know the answer, or the right thing to say, and sometimes their mind wanders while you are trying oh so hard to find the perfect way to tell them how you really feel deep, deep inside. Trouble is, we look at our doctors like they should know all of this stuff already. They should understand that our past week was spent in a whirling manic blender, spinning so fast that we can't find any sane words to describe it. They should know when we've been so depressed we don't want to exert the effort to breathe, let alone try to piece together an intelligent blow-by-blow account. They should be able to just look at us and know exactly what medication is going to be our own personal one-way ticket back to sanity, minus the grueling side effects, thank you very much. They should know what to do, what to say. That's their job. That's what they went to school for. That Ph. D means they should know and what's more, actually care, right?
I've had the same Psychiatrist for the past five years and I can't stand him, to tell you the truth. He barely speaks English, for one thing, so I can't understand half of what he says, and he appears to have trouble understanding my dialect as well. He never acts like he remembers me from the last visit; in fact, half the time he picks up the wrong chart and asks me if I am still taking a medication that I have never even been prescribed, and he has an annoying habit of asking me each visit how long I have been clean and sober. If he picked the right chart and actually read it, he would realize I have-fortunately!-never had a drug or alcohol problem. And he never smiles. How can you trust someone who never smiles? How do you open up and tell this person what symptoms are really bothering you when you can't even get them to show you their teeth?
Go find another doctor, you say. But this is the only one I can afford, and the only other Psychiatrist at this establishment speaks even less English than my current doctor does, not to mention he is hideous to look at, and permeates a weird rotten fruit scent.
These are not the only two Psychiatrists I have met with. My first one came across as crazier than I was. Her whole persona screamed mania and disorder, and she asked me directions to the same store every time I saw her. I tried to assume it was a psychiatric test of some sort, but I think she actually wanted to go to that Dollar General very badly. My Obsessive-Compulsive tendencies were thrown into overdrive each time I stepped into her chaotic office; she had gym equipment and smelly sneakers and work out clothes spread haphazardly upon the floor and on any other surface imaginable, except for her desk, which was piled high with messily stacked papers and Diet Coke cans. She urged me to start a work out program to help with my moods, and I would have, only every time I tried to get physical at home I was overcome by the memory of her sweaty shoes and I would have to go lie down from nausea.
I saw another female Psychiatrist in between Smelly Manic Woman and Frowning Clean and Sober Guy, and she was by far the worst. When I tried to explain to her that my current medication was not only failing to tame my symptoms, but was also making me gain five pounds a week and see dead people, she said I would just have to deal with the side effects or not bother coming back. I totally did not go back to see her.
All of these less-than-ideal experiences have made me wonder what it's really like to have a good Psychiatrist. Are there any good ones out there?? If so, why did I get stuck with the bad apples (one fully equipped with the smell)? Ah yes, it's quite possible that the good doctors all flock to the nicer medical office buildings and steer clear of state-funded mental health facilities geared toward lower-income individuals such as myself. What a shame. But hey, you get what you pay for, eh?
A shame, indeed.
I have a feeling that even under the best circumstances, it is still quite a difficult task to communicate with a doctor about the struggles of Bipolar Disorder, or any other mental illness. While I'm sure a few of them may actually suffer from these types of illnesses themselves, I would speculate that the vast majority of Psychiatrists do not have personal experience with it. And anyone with Bipolar Disorder knows firsthand how nearly impossible it is to make a non-sufferer understand what it's truly like. Still, these doctors went into this particular field of medicine for a reason. Hopefully, it was because they have a passion for treating patients. They want to help...we've just gotta help them help us.
So how do we do that? Well, here are a couple of things to keep in mind:
- Doctors can't read your mind. Yeah, you would think with all the schooling they've went through they would have picked up on that skill somewhere along the way, but that's just not the way it works. This means if you have had a new symptom to crop up, or an old one has resurfaced, your Psychiatrist won't know it unless you tell him.
- Patients can't remember everything. No matter how good your memory is, or how many times you've went over in your mind what you need to make your Psychiatrist aware of, you are bound to forget a key element of your story in the rush of that 15 minute window of opportunity during your appointment. I have found the most useful tool ever, for both therapy sessions and doctor visits, is to keep a well documented mood journal. Jotting down your daily mood status along with a bit of detail about the day will help you have a better idea of how your illness is really affecting you, and it will alert you to triggers that you may have otherwise missed. Bringing this journal with you to your appointment can act as a checklist for the issues you want to bring to your doctor or therapist's attention. If you have a nervous personality like I do, highlighting certain parts that you want to go over, or even handing the whole thing over to the doctor to read, will ensure that all the bases are covered. The following is an example of the type of mood journal I am referring to, and is an actual excerpt from my own journal:
July 1--good mood
July 2--irritable, yelled and screamed at my family and then had a bad crying fit and felt very suicidal.
July 3--antsy, annoyed, want to do a million things all at once, cynical.
July 4--irritable, paranoid, feel like everyone around me is crazy and stupid. Ended up with a migraine. Couldn’t get any rest or sleep because my mind was racing so badly.
July 5--very irritable, wanted to be left alone but felt very lonely at the same time. Suicidal. Excerpt from my journal doesn't make much sense: “I would rather be depressed than to feel like this. Everything moves too fast and too slow at the same time. It’s all too loud but I can’t hear it. The lights are too bright but I can’t see. Racing thoughts. Heart beating out of my chest. I want to cry but I’m too angry to cry. Too happy to feel happy. There’s no way to explain it. I just want it to stop. I want it to stop no matter what it takes to make it stop. I want it to stop.”
July 6--felt better, calmer, got a lot done. “I’m so happy!”
July 7--very up and down, crying spells in between feeling really good. A little paranoid toward the end of the day
July 8--great mood, got a lot accomplished
July 9--felt really good, then crashed, became depressed and ashamed of myself for being so self-centered.
July 10--irritable, perhaps a little delusional because I kept seeing and hearing things that my husband swore wasn’t there (hearing it pour down rain when it wasn’t raining at all, saw my husband crying with tears running down his face but he said he wasn’t crying, kept thinking I saw someone dart across the room in the corner of my eye but when I looked there was no one there-very creepy feeling). I became hyper and energetic that night and didn’t sleep.
July 11--felt terrific, still hyper and energetic, but began to feel really sped up, frustrated, extremely irritable, wanting to do too many things at one time but I couldn’t concentrate on anything long enough to do it, racing thoughts, constant appetite.
July 12--started out in a mixed elated/sad, uncomfortable, anxious feeling, became a little depressed, in a fog.
July 13--was feeling better, then had a panic attack, then became wired and spent the whole night writing because it was the only thing I could concentrate on doing.
July 14--nerves were completely shot, in a panic, shaking, very agitated, irritable, wanted to hurt somebody, couldn’t concentrate. Late that night I felt suicidal because I couldn’t sleep or calm down. I wanted to die just so I could rest. The whole day and night was like a never ending panic attack.
July 15--tired, wired, and confused
July 16--felt more mellowed out but still anxious.
It also helps to compile a summary from your mood journal:
July 1-16 felt terrible for the most part, not because I was depressed but because I was too happy, sped up, very anxious. Hardly any sleep. Haven’t had more than 6 hours sleep a night in at least 3 weeks, often more like 3 or 4, and that was only after taking Tylenol PM or alcohol to help calm me down. I’m exhausted but I just can’t sleep and when I do go to sleep I have very confusing, vivid dreams so that when I wake up I don’t know what’s real or what was just a dream I had.
Something that seems to be getting worse is that I have these disturbing images of me killing myself. For instance, if I am in the bathtub I get this image of the water being red with blood because I have slit my wrists. If I am driving I imagine myself running off the road on purpose. If I am cutting vegetables I see myself cutting myself and blood going everywhere. These are just a couple of examples, there are many more. While I rarely get to the point that I would actually act on a suicidal impulse, I see these images in my head more and more. I flinch and try to block them out of my head but I can’t seem to make them go away. It bothers me a lot.
See what I mean? Remembering all of those emotions and details off the tip of my head would have been impossible. If I had went in to see the doctor without these notes, I would have most likely mumbled something vague to the effect of "I've just been all over the place with my moods" and that would not have revealed much about the extent of what I was dealing with. With the details laid out before us, though, my doctor was able to piece together that I was graduating into a psychotic episode at the time and needed my medication adjusted.
What if, despite your journal, the doctor just doesn't get it? What if he or she still comes across as stern and apathetic to your concerns? This does not mean you are a lost cause. On the contrary, your doctor is. Okay, no, I take that back! Seriously, though, if you have the option to switch doctors, then do so. It's a gamble; you may end up with someone better, worse, or the same. You won't know until you try. If you are in the same fashion of raft as me, however, and the option to change doctors is void, you may want to consider getting another staff member to converse with him or her on your behalf. Case in point: I discussed my problem with being listened to and understood with my therapist, and she actually arranged to discuss (with my permission, of course) my treatment needs with him. If your therapist cannot or is not willing to take this step for you, ask the front desk what your options are. They may be able to direct you to someone who can help you with breaking down the communication barrier. Persistence is key. Don't give up until you are thoroughly heard by your doctor. Your well being depends on it.
-Amy Purdy
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