Hey all. It’s been a couple days since I’ve written. The last post was the conclusion of our investigation into whether psychology is a science. We conceded, I think, on the view that it has scientific potential but isn’t quite there yet.
I had another post prepared for today, but in light of the coming Holidays, I’ve foregone my usually cynical direction and decided to engage in some positivity today.
I’m not sure how it is for you all, but for me Holidays are difficult. I didn’t know they were difficult until I realized my moods seemed to fluctuate more viciously during this time. I also realized I’ve been taken into the hospital in October/November three years in a row and last year stayed at the respite house which I work for.
And so, to celebrate the second year of not going into the hospital, I figured I’d share some ways to engage in self-care during these busy times.
Disengage When Necessary
I think what adds to the stress is this weird social pressure that comes along with being in relationships, friendships, or just apart of a family. There are parties, gatherings, The Spawn of Satan Activity a.k.a Secret Santa at work. You’re seen as weird if you don’t go, and if you’re awkward like me, weird when you do go.
Sometimes family is the exact opposite of who you need to be around. And if you have the ability to stay away, if that is what’s best for your health, than by all means stay away. If you must go, keep in mind it’s just for the holidays. Enjoy those who you are comfortable around and remember those who seem malicious toward you may have other things going on in their lives. The holidays are stressful for everyone, not just you. They might not want to be there either.
If you have a significant other who insists you pretend to want to be there, make sure that you take care of yourself while you are there. If there is too much conversation, politely excuse yourself; go for a walk maybe, or find an area with less people. Bring some music if that’s soothing to you and separate from the madness so you can gather yourself. Nothing is more important than your mental health, and if someone doesn’t understand that than you probably shouldn’t be going to parties with them.
Treat Yourself, But be Careful of Indulgence
Black Friday in particular can trigger me into spending way more money than I should. I’ve avoided spending thousands, but I think I spent a good couple hundred and it isn’t even Cyber Monday yet.
I also notice as the weather’s gotten colder (and as I’m still unsure of my back’s abilities) I haven’t been going to the gym and I haven’t been eating correctly, not with Thanksgiving and sweets and potatoes and other such delicious things being just an arm stretch away. In combination with the stress of the holidays, finals, and ridding my body of those pain meds, I can feel a shift in my mood. I’m fluctuating a lot between depression and euphoria and there’s some intense paranoia that intensifies and lessens.
And so as delicious as the food is, I need to remember to watch my sugar intake and carbohydrate intake. I need to get back into my gym routine, rain or shine, and keep away from anymore medications. My presentation this week is already torturing my anxiety enough, I don’t need any other weight.
And neither do you. If you feel yourself taking some cheat nibbles here and there, don’t spend hours hating yourself. If you spend or party or whatever, push against that guilt. It’s okay to enjoy the little things in life. When it starts affecting your body and your mental well-being, maybe then it’s time to take a look at how it could be affecting you and whether you need to adjust things.
Remind Yourself You’re Doing Enough
We often forget, in the bustle of the season, that we are doing all we can. And so we try and do more and that’s where the breakdowns come from. Maybe work picks up during this time and people go on vacation and you’re covering shifts you don’t normally do. It’s okay to make a little extra money, but be mindful of your mentality. Are you more angry than usual? More depressed? Anxious? Paranoia? Frustrated? If so, scaling away from work could do some good; your employer isn’t going to die without you. Their job is to keep their business running. Your job is to keep yourself running.
If you aren’t working right now, sometimes it can feel like you can’t contribute as much as everyone else because of income restraints or other inconveniences. Remember that whatever you can do, regardless of gossip, regardless of your own anxiety, is fantastic and someone in someway will appreciate it. Even if that someone is just you. You being appreciative of yourself is powerful.
If you’re a busy family and you’re running around throwing gatherings and planning trips or other ways to organize the kid’s winter break, remember to breathe. You can’t do everything all the time, and next year does exist. Time is something we may not always have, but we do happen to have a lot of it.
Take Some Time To Assess Why
What is it about the holidays that stress you out the most? Is it the anxiety in the air? The crazy drivers? Is there trauma around these days? The gift-giving insecurity? Work?
For me, holidays were always filled with arguments, violence, and drunken rages. When my dad still played music, he was gone every holiday at gigs so I missed him. But when he came home, there was always a lot of arguing and fights because he was drunk and/or high and got angry at little things that would have made no difference otherwise. When he stopped playing music, he was drinking at 9am and I usually woke up to things breaking and more arguing. So, no one would talk to each other for the duration of the holiday. It’s been a full three years since that has happened. So I’m just not getting used to this idea of “being together” on the holidays.
I notice that a lot of those experiences have shaped my perspective of the holidays. I turn away from parties and gatherings and family things because it’s not what I’m used to. I’m used to doing my own thing by myself.
So for me, it’s been trauma. The memories of the stress are still in my body. My body knows when November is here even if I don’t know it is. Because this is the beginning of it all. And so this year I’m remembering that my past hurt but that it’s not like that anymore. That I can embrace celebration and enjoy the time that I have with my dad sober, even though his health is in a decline and his short-term memory is deeply bruised. We can have a new tradition and that won’t be possible if we all resist it.
The point of identifying the source of your holiday stress is so that you may put your attention there, not to wallow in it but to nurture it and coddle it and respect its existence. Doing so lets you see the gap between what may have happened last year or as far back into your childhood, versus what this year could be. It reminds you to mold your perspective a bit. If it’s the crazy driving, try and identify times where drivers aren’t so crazy. If it’s parties, maybe choose a few not to go to. If it’s gift-giving, maybe investigate those you wish to give gifts more than you usually would, or opt to remember gift receipts; if this is a route you choose, and the person returns the item, resist the urge to blame yourself. If this is a regular pattern of there’s, maybe a gift card is best.
But most importantly everyone, identify what makes you happiest during these stressful times and embrace that. Take care of you. Tis the season of giving, so give yourself a little love.
We’ve arrived to the conclusion of this series, and bullet point number two: psychology is the quantum physics of human study.
There is valid psychological research out there. The world has learned many things thanks to proper psychological researchers following proper scientific methods and procedures. Politics and bureaucracy, warped ethics and poorly developed philosophy has given much of psychology and psychiatry a bad name. The fact of the matter is psychology is the study of the mind, the mind studying itself, and it takes a certain level of scientific measure to do so.
There are many aspects for why there won’t be a yes or no answer to the title. We find ways to quantify behavior of everything we observe in psychology and other sciences; that’s the point, really, to quantify our observations so that we can logically and mathematically find systems and patterns and create better understanding. It’s how the DSM should be developed, but it hasn’t been. In fact, there isn’t much science involved in that infamous book. None of the members of the board are researchers or scientists.
Emil Kraepelinian, a german psychiatrist and researcher who furthered much psychiatric thought in his time pushed for empirical evidence in clinical study when it came to mental conditions. His love of philosophy sputtered a bit, as he focused more on the natural science of the mind; realism became his muse. Psychiatry, he said, and the science of it, should focus on what is presented, what is seen, and what is really “real”, observed and reported objectively.
He pushed for diagnostic causes, the scientific philosophy that is supposed to be backed by the DSM. That is, each diagnostic label is used as explanation for the behavior observed, a cause. He said “cases arising from the same causes would always have to present the same symptoms and the same post-mortem result”.
What I find interesting about almost anyone who supports the medical model, and almost anyone who advocates for anti-psychiatry, is this idea that any of this is based in absolutes. As if something as complicated as the human brain, something which is as unique chemically as a fingerprint, could present the same symptoms and the same post-mortem result. As if chemicals in the brain don’t play any role at all. As if genes don’t. As if environment doesn’t. As if individual variation in perception of life, in thought, in personality, doesn’t. As if we will ever be able to quantify exactly what a combination of all of that means.
So why do I call psychology the quantum physics of human study? Normally it would be a compliment, a toast to the complexity and beauty of psychology, but until the science of it actually starts behaving as such, I refuse to compliment it.
My reasoning can be summed up in one simple, and pretty obvious word: probability.
You can calculate the trajectory of a ball and where it will land based on the height the ball starts and the force which propels it. You’ll look at angles and velocity. It’s pretty straight forward classical physics, just like you can take a look at a particular chemical structure in the brain and label it dopamine, serotonin, or GABA; when you see each structure, you can accurately predict the label, just as you can accurately predict where the ball will land as long as you can do math.
But when you get into particles that seem to appear chaotically, randomly, and pop out of existence just as suddenly as they’ve popped into existence, when you can’t observe the actions with the naked eye, things become less obvious. When you start attempting to measure when serotonin will be released, how, where, and the effects that will cause, with the same types of stipulations, things also become less obvious.
As much as they tell you serotonin causes anxiety, there is no certainty in this. There’s no certainty in the dopamine hypothesis or even the entire “theory” of chemical imbalance. There is some research, often funded by pharmaceutical companies, which claim reliable and valid results with a minimally valid sample size that allows them to generalize, or predict, that for many people, a rise or decrease in serotonin (there’s been research showing both instances) can cause anxiety and/or depression.
Statistics gives an idea of how many of these pop-up particles will/can appear at a given time, in a given space, but it will never be 100% accurate. Statistics gives us an idea of how many people will experience a given “symptom” compared with their genetics, their neurochemistry, and their life experiences. But because we don’t have solid understanding of any of those categories, the predictions and statistical significance must still be taken with a grain of salt.
So what does this mean? If we can only observe a small amount of our physical existence, if that can only be quantified using a symbolic system which is also only based in our observable spectrum of the universe, than does anything matter? If we can never be sure of anything, what’s the point?
Curiosity, I suppose. Curiosity and acceptance.
Part of the philosophy behind the Uncertainty Principal and the paradoxes within, which we discussed here, is that we must, particularly within the study of ourselves, of the universe, find acceptance in our limitations because we are inherently limited by our physicality. We will never see with our own objective, naked eyes whether that photon’s interference pattern is being influenced by the light we use to see said interference pattern, or if the photon indeed behaves as both a wave and a particle depending on observation.
There is indeed always a confounding variable we can never control for: our humanity.
And so I say, my friends, don’t take things so seriously. I lose myself in delusions quite consistently. It’s terrifying. Sometimes it’s beautiful. Sometimes the terror is beautiful and I’m not sure when I was able to see that beauty, but I’m thankful for the psychosis showing me the light side of the dark–and by this, I don’t mean “the bright side” or “the light at the end of the tunnel”. There is a lightness nestled within the darkness, and you have to go very deep to find it. But it’s there. It’s there because the same darkness lies deep within the light.
I laughed at myself the other day because most people I speak with who have experienced psychosis have found some kind of light, spiritual light in all of this, been pained by demons and blessed by God (or Gods) and I’ve been quite the opposite. I’ve embraced the demons and the darkness and recognized their validity. I’ve called them my protectors more than once this last week, terrified that they’ve been steering me purposefully this whole time and I’ve been resisting out of fear and misunderstanding.
They’ve become false angels–angelic in their intent but false in their goodness and I can appreciate a being which can drop its pride and admit the unity of good/bad which churns inside them. If you’re curious of this, and my thoughts on my voices/where my beliefs come from, I’ll write a post explaining it all. It’s quite detailed.
Hell, even if you’re not interested, I’ll probably write on it.
And so psychology is as science as philosophy in the sense that thoughts/ideas can never be proven and neither can the theory of chemical imbalance.
We can provide enough evidence to disprove it.
And I promise, we will.
P.S: It is inherently and philosophically inaccurate to call this theory a chemical “imbalance” as there is no “balance” to compare it to. And so I say we will disprove the imbalance aspect not because I don’t believe chemicals play a role, but because I recognize that there is no standard for comparison. Neurotransmitters and neurons change and grow depending on experience and variation, and therefore we can never have a generalized “true north” version of our chemical make-up.
You’re here–great! This post would have been here yesterday, but I took an extra two shifts at work this week and am worn out for other reasons.
In the last post, we talked about the Clinical Method and the Actuarial method, and declared the Actuarial method more accurate. We are still under bullet point number 1: practitioners and their intuition/expertise, or what I’ve been calling Clinical Arrogance for years.
Now, why is there such a level of clinical arrogance out there? Well, it probably has something to do with the lack of push for randomized clinical trials in psychology and this idea that case studies are the best way to identify/predict other client’s behavior.
For example, Ronald Fox, a previous president of the APA is quoted with:
“Psychologists do not have to apologize for their treatments. Nor is there any actual need to prove their effectiveness.”Why Many People Perceive the Study of Human Behavior Unscientific
For those unaware, the APA is the American Psychological Association. They argue over the DSM and other irrelevant things.
There was a push for randomized clinical trials to become a staple for the understanding of the mind, for understanding better avenues of treatment for mental health adversities, but this would have sprung detailed instructions for treatments (backed by the research) and standardized treatments. Psychologists had a somewhat valid argument, that there needs to be some flexibility in treatment. Standardized tests are shit, and I believe there’s probably a huge chance standardized treatment could end in the same category. However, I’m not sure if the standardized tests given in school are backed by any research saying they are accurate predictors of a student’s knowledge. These standardized treatments would be developed based solely on the research.
But clinical psychologists disagreed for other really stupid reasons too, rest assured. They believed psychology is an art, not a science. It doesn’t need to measure variables. Intensive case study analysis gives better understanding and insight anyway.
They’re quoted with:
“Alternative ways of knowing [case study, intuition], for which the scientific method is irrelevant, should be valued and supported in the practice of clinical psychology.”Defining Psychology: is it worth the trouble?
Another APA president was found to say starting up randomized clinical trials would be “fundamentally insane” .
Why is this a thing? Well, I could think of many reasons. Some reasons revolve around the fact that psychologists are educated in psychology minus research. They take a couple courses maybe in their career, but there is no effort put into helping them really understand the value research has in their practice, and so we have many clinical psychologists who firmly believe psychotherapy techniques emerge from experience. Research says differently: there are certain techniques, like CBT, that work better for certain adversities, but because no one reads the research, no one implements the technique when it’s most appropriate.
This provides for a very naive group of professionals. And what does naivete strengthen?
Well, drug companies for one. They could have research that says a medication has zero efficacy and it will still be prescribed by practitioners.
For example, Abilify has no efficacy above 10mg. It’s in the physicians desk reference. I read it. Back when I was on medication, my psychiatrist kept pushing me to 20mg because it would “help my voices”.
She obviously doesn’t read, obviously doesn’t know much about Abilify, and obviously doesn’t understand anything about the spectrum of voices.
It’s a well known fact that insurance companies, drug companies, and the APA are all very connected. That can be another series I’ll push out when I’m less worn out. It’s a very tangled web.
The issue with ignoring research which says certain treatments are more likely to have an effect over others is that psychologists never learn from their mistakes–mostly because they don’t know they’re making any mistakes. If a treatment doesn’t work, it’s because the client isn’t focused. The client isn’t “putting in the work”. While that can be the case, it can also be the case that the psychologist hasn’t kept updated with the information in their field and therefore has some build up clinical arrogance.
There was a push in 1990 for evidence based practices to be the center of psychological practice. The APA’s response? Let’s lower what it means to have “evidence”; more things will be approved and more treatments will be made.
A group of scientists and researchers realized their efforts to drill logic and intelligence into the APA was vain. They then formed the APS, the Association for Psychological Science.
In the same way that Peer Respites and peer alternative programs were started out of the need for compassion in mental health care, the APS was started out of the need for competent practitioners and valid research in psychology. They sponsor science-based clinical psychology and there are many universities in the united states which hold their Psychological Clinical Science Accreditation. More are being accredited each year. UC Berkeley is one. I mention them only because I plan to attend that program for graduate school assuming I continue with psychological research.
So there are many elements of science within psychology. The issue isn’t with whether or not it’s a science. The issue is with whether or not the science is embraced and whether or not we are too limited in our human ability to learn anything worth while. Is human variation too much of an obstacle? Is that what pushes clinical psychologists to believe their intuition can outsmart a math formula? Math formulas, after all, can only describe what we observe and what we observe is inherently limited. We can generalize behavior from a sample size, we can generate neurological predictions when observing the behavior of neurotransmitters but none of it ever seems to be certain; even what we’ve studied, the effects we see, are simply based in probability.
Tomorrow we’ll talk about bullet point number 2: how this probability relates to other sciences and why I call psychology the quantum physics of human study.
Welcome back. Yesterday we touched on clinical arrogance a bit, and discovered that the real problem with it isn’t the arrogance of the provider, but the blockade it provides against learning new techniques and staying updated with proper research. I mentioned I had two examples, one was personal, and one was a more wide-scale issue. You can read about clinical arrogance and my psychiatrist visit here.
I want to start this section of the series off with the second example. We are still under my first bullet point from yesterday: practitioners most often rely on intuition rather than verified and reliable research.
One thing psychologists attempt to do is predict a client’s behavior. This already sounds wishy-washy. No one can predict behavior 100% as we are limited in our understanding of ourselves (more on this once we get to my second bullet point), but there are two main methods which are used: The Actuarial Method and The Clinical Method.
The Actuarial Method
With this method, data is gathered within the range of the target population. That data is then plugged into a formula or some charts or graphs, anything that quantifies the data in some way, and what this yields is a general percentage. That general percentage represents how likely someone is to behave a certain way given the observations of their behavior (or scores on an MMPI, or this or that). So, theoretically, and very simply put, if Johnny is experiencing a psychosis we can use this method to get a general idea of how he may behave and what the best treatment may be given the outcome of others who have experienced similar things.
In trying to predict the rate of degeneration in patients who had been diagnosed with neuro-degenerative diseases, this method was correct 83% of the time.
Why is this important? Well, one thing practitioners may need to predict, especially in the current mental health system and current mental health wards is this concept of “dangerousness”. You hear all the time that people particularly labeled with schizophrenia are dangerous, unpredictable, violent. You also have probably heard that the truth is people with mental health adversaries are more likely to be a victim of a crime than to commit one. So let me tell you why this stereotype continues to persist.
In 1999, a researcher, Liener (I tried to find the full paper, I couldn’t; when I do, I’ll link it) asked clinicians to rate clients’ based on their intake interviews. These clients were hallucinating. The providers were supposed to give an answer for which clients were more likely to become violent. He gave the same case studies to untrained, random high school students and requested the same service. Conclusion?
There was no difference in the predictions. That is, the high school students predicted the same level of danger as the clinicians did, and those who were seen as withdrawn were all rated as most likely to be violent. Research shows the opposite. In fact, when mass amounts of individuals locked in criminally insane wards were let out, 97.3% never got into trouble again. 2.7% wound up back in a hospital or prison.
It’s not the public’s lack of awareness, so you can chill on your lovey-dovey, let’s all unite instagram Mental Health Awareness campaigns. We don’t need as much awareness of experiences as you think–we need research. I’ve been saying this before I even started my college journey. Talked about it every May on my previous blog Mental Truths, in fact. Want to bring awareness to something? Bring awareness to the fact that none of the research is being paid attention to. That’s what needs awareness.
The Clinical Method
In this method, we gather data about the individual and use that information to attempt to predict what the individual will do. There is no real, clear-cut formula for this as far as I’m aware, it’s kind of a guess and check system. Kind of like taking psychiatric meds.
In the neuro-degenerative disease study, it was found that this method was correct 58% of the time. Diagnosis was generally accurate, but judgments and human error lead to incorrect predictions. I mean, 58% isn’t bad, that’s ore than half, but it’s no where near 83%.
And so we see the Actuarial method is quite effective when it comes to doing something human brains on their own can’t always do very well: predict things. We see in some Meta Analysis that there was either no difference in correctness between the two study methods or the actuarial worked better. Never once could the clinical method beat it’s cousin.
You can read more about both methods here.
And still, Practitioners insist that their expertise provides a better prediction. Again, this is what I like to call Clinical Arrogance. And maybe it’s not purposeful–as I said yesterday, they worked hard for their degrees and spent long hours accumulating all that knowledge in their head. Let’s not bash these individuals, a lot of them are very bright and are in the field to support people who really need it. They just can’t read. Kind of like the HumanCentIPad from South Park.
“Why won’t it read!” (22 second clip. Totally worth it.)
I think the most hilarious thing out of all of this is that a lot of pracitioners say they never use the actuarial method, and the majority of them say one reason is because they were never trained in it.
And remember now, we’re trying to figure out how much of a science psychology really is. This is a tough question, because so far we see that there are methods which meet the standards for the label of scientific. But they’re not being used, and when they are and the research is done properly, free from bribes by pharmaceutical companies and researchers looking for fame, the results aren’t given any attention. Can something be called a science if it neglects the only aspect of it which is a science?
I want to stop here and let this kind of sink in, because tomorrow we’re going to shoot to the top. We’re going to investigate how this trickles down and make some speculation to why.
It seems like everything is negative, but it’s not. We hear a lot of the positive in most psychology classes, at least the ones I’ve completed, and that’s great. But some of that is misinformation and that’s problematic. This isn’t about focusing on what’s wrong with the industry, this is about awareness. I think it’s great that people feel making a social media page dedicated to a “Safe Space” or whatever can help others–and for people who are super isolated, it probably is nice to see other people experience their pain. But that’s not the kind of awareness that’s going to shift the system. More people knowing the word “Schizophrenia” could indeed perpetuate stigma if you have no research to back it up.
In fact, why not raise awareness about the fact that the dopamine hypothesis is actually kind of a shoddy hypothesis? Why not find some of the studies that point toward the many holes in the chemical imbalance hypothesis? The ones that discount genes as the biggest player in mental health heritability? Where is the awareness of this?
Oh wait. No one reads.
And if someone does read, and they have articles contradicting me, please, please send them. I’m always looking for something challenging! I only ask that the articles either cite actual research so I can find the papers, or are the papers themselves.
That question won’t be answered in this post.
This will be a multi-part series I think. There is a lot to say here, a lot to absorb, and it’s not really a matter of opinion. That tends to turn people away, because they want their opinion heard and other’s heard. Your opinion can be heard, just know its validity lies in facts and not how much you (or anyone else for that matter) believes in it.
We hear a lot today that disorders are on the rise, specifically ADHD, Autism, and Bipolar (in children). We hear that there are all these new holistic approaches. We hear about EMDR, we hear about Mindfulness, we hear that long-term medication is the only reasonable approach for certain experiences. We hear supplements will one day replace these medications. We hear psychiatry kills. We hear psychiatry saves. We hear a mix of the two–not sure how you can both kill and save someone, but psychiatry seems to be pretty good at it.
So, how do we make decisions on what is accurate and what is not? Most of the time it’s a matter of opinion. You read something good on the internet, an article that cites specific sources and looks very professional and so you trust it. You do the same with your doctor. You hear things from friends and somehow generalize their great experience to all the population of mental health consumers and suddenly you’re an advocate for acupuncture exercising demons from the tips of your fingers and you’re not quite sure how you got there, but now you’re there and you really believe it.
The thing we don’t ask for is research. The things doctors don’t read is research.
There are about 40,000 psychological research papers published each year. The majority of clinical psychologists read 1 of those research papers a month. That’s about .03% of all psychological research papers.
So let’s talk about what’s going on. There are two main issues:
We’ll start with number 1.
We talked in the last post about the differences between a Ph.D and Psy.D (both psychologists), MFT’s and LCSW’s. We talked about how the technique the clinician uses dictates the effect on the client more than the supposed higher or lower degree/education level of the clinician. What we didn’t talk much about is why a lot of repeatedly proven therapeutic techniques are being replaced with new fad-like “holistic” and “client-centered” approaches. There are a couple reasons and one of those reasons has to do with practitioner intuition.
They have gone through years of school. Residency for some. Internships. Hours upon hours of supervised practice (3000 for those who want licensing in my home state of California, 1000 most everywhere else). They’ve made sacrifices for this, thrown themselves into debt, worked shitty jobs, lived in cramped situations. They gave up a lot for their passion and now they can be called an expert. That means they’re, well, the expert.
It’s very difficult to read a paper that says your technique has been proven multiple times to present no significant effect on the wellness of most people (we’ll talk about this idea of “most people equating to the general population later, that’s related to my second point) and be forced to change your method of practice that you’ve grown comfortable with. It’s hard when you have to admit you may very well be wrong. It’s much easier to come up with reasons why the research may be wrong–you’ve seen the progress in your clients (confirmation bias; you want to see that, so you will see that), your colleagues are using the same techniques with great success (they may be biased in the same way, and may have not read the research), and you’ve read articles which said this technique is effective; in fact, you went to a specialized school for that technique. And so you ignore the shoddy research–there’s probably no control groups, a poor sample size/selection, not evidence of peer review, and a lot of pseudo-science talk telling you that this new discovery they’re providing you with is being “stifled” and “shunned” by the medical community.
It boils down to practitioners struggling to admit they may be wrong. Ironic considering the work they’re in.
The issue with this isn’t their pride. The issue is that by not considering the possibility that they don’t know everything, they don’t have the chance to learn something that could indeed improve their practice and the well-being of their clients.
Now, the effectiveness of clients (as much as I despise that word, it’s appropriate for what I’m talking about) is measured by behavior noted by neutral observers. To properly do this, behavior is measured before and after “treatment”.
From this scientific approach, we’ve learned that ECT has been “effective” (when effective is defined as a positive change in behavior, and “positive change” is defined as the patient’s depression lessening). But, the effects have been found to be temporary, we don’t know why it temporarily works, and it causes a myriad of health issues, most severely memory loss.
We’ve learned that CBT treats panic disorder better than no treatment, better than a placebo, and better than Alprazolam (A version of Xanax). 87% of participants reported they were free of symptoms 15 weeks into CBT. 50% reported freedom after 15 weeks of Xanax. 36% with the placebo, and 33% with no treatment–they were told they were put on a waiting list (Klosko, 1990). Now what this shows us is a couple things.
The scary thing is a lot of people who struggle with panic don’t get CBT treatment. I didn’t, not for many years.
Now, I have two examples of practitioners believing more in their expertise than research. One is a wide-spread example, and the other is a personal experience from 10:30am this morning.
I’ll start tomorrow’s post with the wide-spread example, because there is a little background needed.
This personal experience of mine sent me in a tail spin. My thoughts today have been taken over with good and evil (not the separation of them, but the unification of it) and the spirits, the voices, have essentially been trying to thwart my success and I’m struggling with whether they’re doing it to save me or to torment me for both. They played a particular song to mock me in the store today, and there was a woman following me around, going where I went, picking products next to me just to let me know that they’re here with me again, the spirits. And so this is an example of why clinicians need to pay attention to how they speak with people.
I literally just did a panel presentation on this shit to some local mental health workers yesterday, and then this asshole comes along.
He wasn’t trying to be an asshole, I know this. He is a young psychiatrist, very kind, and struggled to find the right words to dominate me with. I made an appointment with him because the person who’d been recommended to me had appointments months out and I couldn’t wait; I’m looking for a PRN for my panic as my current techniques (CBT, and processing my emotions) haven’t been working as well lately. I want it for short-term use so I can get back on track. I am on no other medications right now.
Problem is, I was prescribed Percocet and Valium for my back two weeks ago. And he saw this.
He didn’t ask me much about myself. Which was strange; usually psychiatrists go very in-depth at the first appointment. He asked what my diagnoses had been. I told him one psychiatrist couldn’t decide between Psychosis NOS or Schizoaffective. I told him my current therapist believes Bipolar 1 with Psychotic Features (mainly because she believes schizoaffective means your psychosis is only in your depressive episodes; we’re discussing this).
In ten minutes, he says he thinks I’m Bipolar 2.
This is after I tell him about my voices. This is after I tell him I was hospitalized after the Vegas shooting as it perpetuated a delusion of mine. He didn’t ask me about the voices really, or the delusion.
The problem with his diagnosis is that psychosis doesn’t happen in Bipolar 2. That would automatically make it bipolar 1. I also haven’t been depressed in over a year, and Bipolar 2 is mainly depression and hypomania. He believes my manic episode in the beginning of college was not mania because I’d get at least two hours of sleep every day. I understand that reasoning. But it’s not a reason to conclude bipolar 2 in ten minutes.
So he didn’t believe the voices. Why? I’m not sure. He didn’t ask if they were external or internal. He asked me what they said and I gave him a couple examples. He asked me if I’d heard them within the last week. I said yes, and within the last month. I told him it’s not a constant roll of voices all the time, every day. When i’m doing well, it’s less frequent. When i’m not doing well, it’s constant.
He didn’t want to prescribe a PRN because of the Oxycodone prescribed to me. I told him I’m not using the Percocet for back pain; I have 16 out of the 20 pills left. I don’t need them. He seemed intent of giving me more Valium. I said I didn’t want Valium; it has a half life of three days and I don’t want a slight risk of physical dependence.
He suggested Gabapentin (the nerve pain and anti-convulsant that keeps being prescribed in psychiatry even though it shouldn’t be, like many other drugs)or Busbar. Both are taken daily. I said no. I told him three times SSRI medication did not work well for me, and he respected that. But he still tried to squeeze it in there, advertising it as a safer drug than Valium.
What this ended with is me with a 30 day supply of Klonopin (which I’ll use maybe once every two months??? I don’t need it all the damn time) and a lot of anger. A lot. I felt invalidated. Ignored. He was young, confused maybe, thinking I was lying, manipulative, and the voices told me that’s what he thought and I believe them. He thinks I was there for drugs and he didn’t believe my psychosis.
Who lies about psychosis?
This sprung a lot of thoughts. The store I stopped to shop in was malevolent. Class was difficult. My thoughts are not nice, they’re disorganized right now, and I’m disheveled.
But it’s an amazing example for today’s post: if you’re a clinician or a psychiatrist and you rely heavily on your intuition, you’re invalidating the tiny scientific standing psychiatry has in the medical community.
Take a day off and read some research.
To Be Continued . . .
Yesterday I said today’s post would be about whether or not psychology is a science and how certain types of philosophy play into the ideals psychologists and M.D’s are trained with, but right now I don’t have access to the notes I made in regard to that topic. So today will be kind of an introduction.
We’ll talk about the importance of education and its scary insignificance.
If you’ve ever taken an introductory psychology course, you have most likely heard the story of “Little Albert”. In using classical conditioning, John Watson and Rosalie Rayner conditioned Albert to have a fear of a white rat. They did this, according to my recollection, by making loud, sudden, scary noises when presenting the white rat.
Now, if you’ve taken a recent introductory psychology course which covered this case, and you are not in California, there is a slim chance you were not told what I was told. I’m betting you were, though.
I took General Psychology 5 years ago and was informed that the experimenters discovered this infamous baby known as Little Albert had also been conditioned to fear white things in general. Fluffy, white, harmless things like a puffy rabbit or a dust bunny. My class was then told this fear persisted throughout this child’s life, and that fears could be unconditioned as well. This example is used as evidence to prove that classical conditioning in humans perpetuates specific phobias.
The study was referenced in a few other courses as well, all with similar conclusions. The textbooks were no different.
So, imagine my surprise when my research course revealed Little Albert had been fearful for ten days. After that, his reactions subsided. When they attempted to recondition the fears, his responses were lessened than the first time and the fears did not stick. My research professor said he had never learned this until he actually read the paper Watson and Rayner published.
And so this brings up many serious issues, one of which I’ll talk about tomorrow.
But for today, we can just focus on one main issue: if we can’t trust our education, how can we trust our practical training? Are they following research or intuition? Are they creating programs and trainings that are based in research topics but finalized by idealism?
This doesn’t mean we flush our meds down the toilet and spit at our therapists. Maybe it means that for some people but for me it means self-research is probably one of the most important things I can do for myself as a mental health consumer. I don’t like to say “question everything” because that implies a lack of trust and in order for people to trust you, you also must sacrifice some vulnerability and offer trust. What I say instead is “research everything.”
Get a new diagnosis? Great! It matters to you, it explains what you feel and how you think and you really identify with it. Learn about it, if that’s something that matters to you. And that doesn’t mean googling “schizophrenia” and reading about how your negative symptoms will take over your life after medication quiets the positive symptoms and how medication is the recommended long-term treatment and how some people can still live meaningful lives (after the author spent six pages ripping your self-esteem to shreds).
Learn about negative symptoms if you want. Learn about positive symptoms. Learn about different medications, different therapies (usually CBT) used to help people cope with confused thoughts. Learn about why the dopamine hypothesis is only a hypothesis. Learn about how medications work and how they don’t work. Learn about support groups. Learn about alternative treatments. Learn about how they work and how they don’t work. Learn about hearing voices (if applicable) and learn about the Hearing Voices Network, and affiliated organizations/movements. And most importantly, be objective.
Don’t just swallow the information you’re provided and internalize it. Not even the information in this post: research it for yourself.
This is hard to do when you’re in a crisis. That’s when we’re at our most vulnerable. That’s when we put up defenses and refuse help that may be useful. Or that’s when we’re so outside of ourselves that we have no defenses and so we absorb any help, and sometimes that means forceful and hurtful help.
It took me years of mental growth supported (sometimes unknowingly) by the connections I’ve made at the Peer Respite house I work for, and my own inner revelations, my own retraction from society and sanity, to really learn things which I would have never known had I not had a few questions and some hours of research.
And so the second lesson here is patience. While you go through the horror and the terror and wallow in darkness, look around. Touch the walls you’re trapped in. Smell the air that’s tainted and stale. Feel the ache in your heart. Hear your own screams. Explore the desolation because there is nothing more all-encompassing. And when something is all-encompassing, there is no escaping. So don’t run. Melt into it.
Let me give an example.
I was part of a cultural competency training/story telling event for the company which helps run and fund the respite house. There were other providers from within the company who attended, nurses and clinicians from other mental health and housing programs. (For some background, the company runs 100+ other programs and the Respite is the only fully peer program).
I was one of three who was scheduled to tell my mental health story and how I interacted with providers during the worst of my crisis. This was to provide them a view from the other side.
However, public speaking isn’t usually my thing. I used to faint in elementary school when I had to stand up in front of people, and this fear continued through high school and college until about a year ago. It still makes me intensely nervous, but I’ve gotten just a smidgen better at controlling my body and my thoughts during my presentations.
And so my anxiety sky rocketed the moment I stepped into the building. What this usually means is I go sit somewhere quietly and ignore the room and put some music in my ears and try not to listen to my own self-criticism or voices.
What it meant this time was understanding my limits and using my crutch to further develop my own skills. I took some valium I’d been prescribed for my back. This doesn’t last very long in my body with my metabolism, but it lasted just enough to calm my body. I wear a Google Wear smartwatch that tracks my heart rate religiously and I use it as a biofeedback because biofeedback was what helped me see how my mind exaggerates my feelings.
When the medication kicked in, my heart rate went from 109 to 68. And in this period I felt it. I felt my body and my hands and how cold they were. I felt my eyes moving in their sockets and my tongue brushing across my lips. All the while my mind panicked.
And so I focused my awareness on that disconnect. I spoke with my brain and my body and I told my brain: do you see how the body feels right now? It’s okay. This situation is okay. Feel how grounded we are right now? Feel how I’m leaning on the counter top? See, you made that person laugh. You’re having conversations. Do you feel how loose the body is?
And so I didn’t run. I dove into the discomfort and identified the disconnect that perpetuated my fears. I will and do talk quite a lot of shit about medication. It’s understudied and should not be cleared for long-term use in any one human being or animal. It is studied for short-term usage, all of it (meaning 4 weeks to 3 months) and the only medication I am comfortable with my body enduring is as-needed medication for panic. And the only way I will take one is if I recognize I won’t learn anything from the panic if I can’t get out of my body and into my mind. I have to reconnect the two, and one needs to be isolated (calm) in order for me to show the other one everything is okay.
I quite enjoyed my talk. I’m sure there are many things I could have done better, things I could have said better maybe. But it was the first time I spoke to a room of people without pouring sweat, stumbling over words, or fainting. By the time the talk started, the Valium had left my system.
The key notes to take from this post?
For those of you unfamiliar with the mental health system or are unsure about therapy or whether or not a psychiatrist is a good idea, this post is for you.
For the rest of us, it’s also a good post for you. It’s a good post for everyone.
Anyone (with a degree and some version of licensing of course) can be a therapist. That could be a LCSW (Licensed Clinical Social Worker), a MFT (Marriage & Family Therapist/Master’s of Family Therapy), a clinical psychologist (Ph.D) or Psy.D (Doctorate of Psychology). A psychiatrist (MD) could as well, but many of them have zero background in psychology other than your average level of undergraduate study.
An LCSW and MFT will indeed make less than a Clinical Psychologist or Psy.D. Those two will generally make less than any Psychiatrist depending on where you live and what clinics each individual works. If you feel that someone with a Ph.D will be much more knowledgeable and better trained than an LCSW, you would be terribly, terribly wrong. In fact, the main difference between them is the amount of money they make.
Studies (and the lecture in my research course) have shown that credentials have no effect on success rate; that is, just because you have a Ph.D doesn’t mean your “clients” do better than an LCSW’s clients. That includes the M.D’s.
This might seem obvious: it depends on the clinician, right?
It depends on the techniques. If a clinical psychologist with a Ph.D is certified as an International Board of Repression Therapist (a non-scientific therapy) and their colleague in the office next to them is an MFT certified in Cognitive Behavioral Therapy (a scientific therapy) and one client experiences IBRT and the other experiences CBT, chances are CBT will provide a hefty affect over the IBRT. Yes, there are other factors which play into this, some important ones being what the client is seeking support with and their drive level. Connection to the provider plays a role as well. However, speaking from a technical point, there is no solid (well-done) research supporting IBRT, and plenty of well-done research supporting CBT.
That doesn’t mean IBRT is useless. One day perhaps someone will come up with some verifiable, testable, and reliable data. But until then, I won’t be seeing anyone specializing in IBRT. The Inner Child exploration therapy is another “non-scientific therapy” and I’ll have a post on that later, as I have experienced it and have mixed reviews.
There are three basic differences between a Psy.D and a Ph.D.
Colleges which offer Psy.D programs are by far much easier to get into and much less regulated. They also cost thousands of dollars more (unless you’re trying to get Ivy league training in which case good luck paying out of pocket for your Ph.D from Yale. I suspect school type also doesn’t correlate with client success rate) compared to your average Ph.D training.
There is a school which I had planned on attending back when I was ready to transfer for a Psy.D until I realized their training isn’t really based in any science. And psychology is supposed to be a science of the mind, right? (More on THIS in tomorrow’s post). The success rate was large, in the 80 percent or so, the school was still working on its accreditation, and the classes they required were scant. In fact, they didn’t really require anything other than a couple of psychology classes. They claimed integrated, client-centered approaches, which is great. And I’m sure once we have more actual data on the effectiveness of their techniques, that school will be booming.
I believe they got accreditation some months after I learned they weren’t yet accredited.
I have seen MFT’s, LCSW’s, Psy.D’s, M.D’s, and now my first Ph.D therapist.
And so how do you pick?There’s all these choices, all this research you have no access to, all these articles online pulling you this way and that and are probably based more in opinion than actuality.
I used to choose my therapists by their profile picture and their degree level. If they looked friendly and had a high degree from a reputable school, I’d try them. And every time I left them.
This time I tried a different approach. I searched for therapists in town at all degree levels. If they didn’t have a website explaining their practice methods, mission, and specialties, I did not consider them. If their picture seemed unfriendly or strict, I also did not consider them (and that’s a totally unscientific, personal preference). If they did have a website but didn’t meet my specialty requirements, I crossed them off too. If their website wasn’t fully developed or seemed unprofessionally dull or full of metaphysical intuitive opinions about nature and life, I also crossed them off.
I love philosophy and enjoy metaphysics. But I’m also aware that people with that mindset are more inclined to tell me “if you believe it, you can achieve it” and I don’t need cliche sayings. Believing the demons will go away will not make them go away. I need to learn how to work with them, not shove them off a metaphorical cliff that I created in my mind and watch as they tumble helplessly into the locked drawer which I also created in my mind. Not my type of therapy.
Now, if someone had a decent, updated website that laid out their specialties which coincided with my needs, what insurance they accepted (if any), their location, phone number, and a blurb about their practice and themselves, I’d investigate further.
I eventually came down to three people: two women and one man.
I eventually crossed off the man because he had been in practice for many years, thirty or forty, and while that’s not a bad thing there is also no notable effect between years of experience and better rate of client success. I’ll explain why in tomorrow’s post as well. The reason the years influenced my decision is because many still maintain old views of specific “disorders” and treatment methods. I refuse to see a psychiatrist who graduated in 1979 and below.
The two women: one was a LSCW and the other a Ph.D. Both had well defined websites and structure to their treatment methods. I went for the LSCW because the Ph.D had listed their G.P.A and grades and I considered that rather conceited.
The LCSW was on vacation and when she got back she called me to let me know she wasn’t accepting new patients.
As disappointing as that was, my last choice was the Ph.D. I was nervous because of her degree and her listing of her G.P.As. I predicted she’d have an arrogance about her and see me as less than. I was indeed very wrong. This will be relevant in tomorrow’s post as well, how intuition can lead us far astray.
This particular therapist and I connected immediately. I have only connected in such a way with two other people in my life, one girl when I was in first grade and a guy when I was 14 in high school.
She is attentive and didn’t seem to mind that I hadn’t mentioned on our phone consultation that I hear voices and have experienced psychosis. She did believe that voices went away with medication (which isn’t the case for most of us, and I filled her in on my experience) and that schizoaffective can only be diagnosed under the condition that psychosis appears alongside depression (I didn’t correct that because I felt awkward doing so; it’s in the DSM-5, she can check it out if she wants. I have a DSM-5 PDF copy if she needs it) but overall she validates my feelings but also challenges me when something doesn’t seem quite right.
She will help me see alternatives and consider alternatives. She is full of humor, and gets my humor, and I’ve never laughed as much with a psychologist as I have this woman. I don’t feel judged usually, and have felt free talking about my voices with her. I have not talked in depth with anyone else about my voices, and I certainly haven’t told anyone else that I hear both internal and external.
Why did she work out? Because I didn’t follow my intuition, I followed a set of criteria I set for myself that weeded out those who were specializing in what I needed support with versus what I didn’t. And her listing her G.P.A has nothing to do with that.
And so what it comes down to is:
And most importantly? Remember you have a say in your treatment. Make the therapy and partnership and it could become one of the better relationships you’ll establish in your life.
I’ve been absent because the pain of sitting with this back injury was too great. I wish I would have injured my back before I started this blog; not writing for days isn’t the proper way to re-build a blog. I know at least that much.
In the midst of all this pain, I’ve been challenged philosophically once more. That seems to happen a lot. You think our minds gets off on presenting existential issues with every little aspect of life?
My drug record is as follows: Marijuana. Psychiatric cocktails.
Marijuana made me feel normal in high school. I stopped when I started college and psychiatric medication. Then 7 years on and off of those medications. Antipsychotics dull your mind, but I wouldn’t call it a high. Benzos knocked me out a couple times. But I’ve never experienced the bliss that is an opioid-based medication.
This medication (which only cost me two dollars compared to the 40 I used to pay for my psych meds each month–there’s your opiate crisis plain and simple) was prescribed strictly for that insurmountable pain I mentioned earlier. I couldn’t sit, I couldn’t lay down, I couldn’t walk. I also couldn’t give up going to class and work during recovery, and so the pain med and the valium came into play.
Valium is shit, in my opinion. I don’t like that the halflife is up to 72 hours, which can make your body very dependent very quickly if you’re taking it regularly. It was prescribed for muscle spams, which have been plaguing my entire body since the back injury.
The issue I’ve had isn’t with addiction. I’m not crushing the pain med and snorting it. I’m not injecting it, I’m not smoking it. I like the feeling, I enjoyed floating while in class, and in that high I realized how much I missed feeling THIS kind of disconnected. A happy disconnection. And then I wondered if it was really the disconnection I missed. That just didn’t feel right; I’m always disconnected in some way, and often that’s how I make it through my day.
It’s the sense of altering my mind state which I missed. That felt right, until it didn’t. This year has been the happiest year of my life; I’ve lost all the weight I gained from my depression, I’ve stayed off all psychiatric medication, including anti-psychotics, I’ve got friends, I’ve been more open with people. I’ve enjoyed work. I bought a 2019 car. I’m successfully completing the research course which I kept dropping because of psychosis and depression. I’m writing again, submitting fiction again, starting this blog, finished a manuscript draft. I feel mentally and physically back on track. So what is making me want to change this?
I don’t have an answer.
I can look at human behavior and make some guesses, though.
Some of us want to alter our state more than others. For me, it’s not about running from feeling anymore. Now it’s about boredom, it’s about routine, it’s about doing the same thing over and over again and being content, but wanting something more. And I think that’s something everyone can relate to: wanting something more.
People say if you’re satisfied where you are, content with yourself, you won’t want anything more because you have everything you need. Perhaps it’s the ideal case. It just doesn’t seem practical though.
Or, maybe I’m not as happy as I think I am. In that case, what aren’t I happy about? Maybe those who indulge in recreational drugs also aren’t as happy as they think they are. In that case, maybe no one is ever certain about how they’re actually feeling. Freaky.
Maybe the feeling of a new experience is exciting, maybe the devil hooked a Twinkie on his fishing line and we’re all chasing it into hell.
Maybe we convince ourselves of one thing to justify what we know isn’t true. For example, I enjoy the body high. I’m always so tense from anxiety, have been all my life. Marijuana could never take it away, and neither could psychiatric meds. But the pain meds can. And so maybe I’m saying I’m not trying to subdue my feelings or run away from something so I can justify continuing to use them even though I’ve finally made it past the most severe pain.
Seeing as that’s highly likely, although my mind is pushing hundreds of reasons why I shouldn’t admit to that truth, the question then becomes: is enjoying something like a high wrong?
Most people would say yes, if it interferes with your life. If it becomes an addiction and reduces your level of functioning (i.e, using the language we hear all the time in mental health). I would say that wouldn’t make it wrong. It would make it pointless. And pointless isn’t always wrong.
Other people may say yes, it’s wrong, because you’re avoiding life. You can’t cheat like that.
Then people go off on tangents of addiction, of blaming you for “putting your family through this”–similar to shaming you for considering suicide. Then they talk about death–you’ll kill yourself. You can see my analysis on THAT argument here.
I don’t quite know what the point of this post is anymore.
To indulge or not to indulge, that is the human question.
I did not post yesterday as I was in too much pain. Today is better, although I don’t really have a set topic for today’s post. Self-care would be a good one.
I’ve learned a lot about what that means in just the last six months. Some of it came from the guidance of others, and an equal amount came from me learning my body and my brain and what connects the two of them back together. In regards to psychosis and anxiety, although they tend to be categorized as separate, they have similar attributes. I’d say the biggest difference is anxiety you still recognize your physical and mental place in the world during your disconnect. With psychosis, nothing has a place and you are the center of that nothingness.
But they are similar in that you feel dissociated from the people around you, from life, from everything. Panic can make you believe you’re dying, psychosis can make you believe you’re already dead. Anxiety makes you think badly about yourself, psychosis is lazy and will just let the voices reprimand you. And the biggest part of all of this is that separation between the turmoil in your mind and the placement of your body. This is where the idea of grounding techniques come from; there’s this idea–quite an effective one–that if you can center yourself in your limbs, remind yourself who you are and that you exist in this moment, you become more aware of right now instead of tomorrow or yesterday or the future. That’s great for anxiety.
Grounding probably won’t stop you from believing your dead. But it may help ease the anxiety of the idea of being dead, and in that process you learn to accept death. In learning to accept death and the terror and trauma which may be circling death, you accept the idea of being dead. Once you’re there it becomes a little easier to put some weight to both sides: maybe I’m dead, maybe I’m not dead. Either way, I accept what is. That can take some power from the psychosis.
Professionals talk about wanting to break people from their delusions by presenting facts or evidence or saying “well, if that was true, why is this happening?” but that makes zero sense because in delusion everything has a place. And if it doesn’t have a place, we’ll make it have a place with “I don’t know how it works, but that’s how it works” and you won’t have any evidence (to us) against that solid argument.
And so breaking is an illogical step. Telling your loved one that this can’t happen because of that and then getting frustrated at them because they don’t believe you only adds more stress.
The power of unifying the mind and body, accepting uncomfortable thoughts and ideas, giving Anxiety a place to disperse is my greatest form of self-care. Giving my mind a chance to feel how my body is affected by certain thoughts, giving my body a chance to react to my fear and anxiety my mind tumbles through, gives me a chance to tether the two back together and gives me a sense of being a whole person. Because one thing about both anxiety and psychosis is that you feel shattered. You feel like a million pieces being pulled in a million and one directions and none of the directions make much sense. Or they make perfect sense and in that, make no sense because nothing can be perfect.
Self-care doesn’t always mean “doing what makes you feel good”. Sometimes it means doing what you need to in order to grow. And that can be quite uncomfortable.
Reconnecting your physical and mental selves doesn’t just have to be through mindfulness or meditation or mindful-meditation, I’ve learned. Although those ways are quite useful. For example, music reconnects my mind to my body, especially if I’m in my room and playing it on speakers where I can really feel the vibration of the sound and move with it. Japanese Karaoke, the Karaoke in the private rooms, is one of the best ways my mind and body sync up again, my mind riding waves of emotion and my body, my diaphragm and stomach and throat specifically, capturing those emotions into vocalization.
People wonder why medication doesn’t take their mental pain away and that’s because it can’t. We all know this, and if some of us don’t, well, get comfortable with the idea that there’s no such thing as a quick fix. Medication is a bandage. It will do nothing for your thoughts but numb you from them. It will do nothing for your trauma. For a lot of us, it will do nothing for voices besides make them fainter and easier to ignore (which isn’t a bad thing, it can be quite helpful). But, if all you do is throw some chemicals at your brain and roll some dice, you’re essentially allowing yourself to shatter. You’re blockading a chance to be whole again and maybe that’s because the idea of being whole is so foreign to you. Or maybe it’s too terrifying. Maybe it’s too real and too raw and it’s much easier to hide behind numbness than to face sharpness.
And that’s okay too. If that’s where you are your best, if that’s how you function best, if it’s not going to bite you in the ass ten years down the road, great. For me, I didn’t function being a shattered person. And so I listen to myself. I listen to every pain, every ache, every burst of happiness, every drop of sadness, every small voice, every screaming voice, every immovable belief, because all of it means something. It’s not random and useless. It’s annoying and tiring, but it’s a reflection of turmoil and an indication that I’m separating from myself again. That’s a warning sign.
What happens when we bury those warning signs? Or hide from them? Well, they just seem to multiply. And for me, I’d rather care for myself and nurture one warning than feel trampled by thirty.
Today’s post is a little late because I’ve just come back from Urgent Care to get my back checked out. I overextended in the gym and have torn some lower back muscles. The pain is pretty severe, the doctor is thinking it’s very deep tissue, and let me know what I need to do to continue recovery.
But the events leading up to Urgent Care inspired this post on how important it is to own your care, both physical and mental.
The thing is, you’re going into the office of a person who (usually) doesn’t know you very well other then the check ups or issues you come in for on a haphazard basis, and even if they do know you well they don’t know you so well that they are aware of your body more than you are. The same goes for psychiatrists.
An important thing I’ve learned to remember in both my physical and mental health care is that no one, regardless of Ivy League education or multiple specialties/degrees, knows my body better than me. No one.
For example, I’m considering getting a PRN (as needed) medication for my anxiety, as my panic has been off the Richter scale lately. It would be something I took maybe once a month, or even less, as I tend to work very hard on balancing my panic when it comes on. (I’m careful not to say I “control” my panic, because I’m not going to run around in circles and play Panic’s power-struggle game).
Since I’ve got to find a new psychiatrist for this, I filled out an intake form which asked me what my primary concerns were and if I had any other information about medication or suicidal tendencies. I wrote something along the lines of: “SSRI’s and SNRI’s do not work for anxiety for me; I do not want them. I don’t need anymore antipsychotics, they make me dead. I am coming in for a PRN for anxiety, and nothing more. I have been happily off medication for a year and three months.”
I stated that twice.
The reason being when the psychiatrist sees my history of psychosis and mood swings and depression and says “weeeeeeeell, how would you feel if we also try a little–”
I can then say “Weeeeeeeeell, why don’t we try reading my intake form where I state exactly what I’m here for?”
Because the fact of the matter is that yes, I still struggle, often daily. But I know myself. I know my limits. And I know that getting back on meds would wreck more havoc on my body. No psychiatrist can know that. All they know is what they read in a textbook.
Conversely, if you are content with taking poorly-researched medications, and you feel they improve your well-being, it doesn’t cause any side effects and hasn’t yet ruined your physical health and a doctor tries to tell you “this med isn’t very good, I’d like to try another,” your response should be something along the lines of “well this doctor isn’t very good, I’d like to try another.”
Not to be a smart ass. Not to insert your dominance. But to make sure you’re being heard and that you’re in control of your health. A lot of people like to say “doctor’s work for you”, but I don’t use that phrase because that initiates yet another power-dynamic with you on top. That’s not the goal here. The goal is fair collaboration.
Having an advocate accompany you to your psychiatrist appointments can be helpful as well, preferably someone who is very clear on what your concerns and wants are, and someone who has been through similar situations. Not only will you walk in the office with confidence, but if you’re someone like me who wasn’t always present or aware of what was going on and so assertiveness took a backseat, you have someone to fall back on who you know will do you justice. Doctor’s can be intimidating with their degrees and “factual” knowledge and they’ll blurt things at you that make you feel lesser, not always out of intention but just because that’s how they show you they “know what they’re talking about”.
This doesn’t mean be afraid of new things or ideas. If something isn’t working for you, speak about what’s not working specifically. Don’t say “I just don’t like it,” because that gives them more of a reason to convince you you’re just not giving it enough chance. If you feel coming off medication is something you’d like to try, find the doctor that will support your decisions. Don’t let anyone tell you that you can’t, because you’ll start believing it. Yes, you can come off medication, even with severe psychosis. If you’ve been on them for years, 10+ as many are, you’ll be needing to come down 50x slower. Even as small as .025mg at a time. Doctor’s words, not mine. Also, researcher’s words, not mine.
In the world of psychiatry, we must be wary of manipulative words. Whether they mean to be manipulative or not. When our brains are fragile we are at our most vulnerable.
And so take this post with you to your next psychiatrist appointment if you’d like, if you feel you haven’t been heard or respected and you’d like some strong words from an internet stranger to back you up. Hell, have your advocate read it and them snap their fingers in the “Z” formation afterward. Your doctor’s response will tell you all you need to know about that doctor.