I am of course not a psychiatrist. But I regularly marvel at the omissions of psychiatrists. Matters that are pure common sense never seem to enter their repertoire, or do so but occasionally.
Patient relationships with psychiatrists and psychologists are inherently abusive, because the moment you have walked out the door and paid the bill, you are forgotten, no matter how ill or desperate you are – and sorry, waving a magic wand and invoking bourgeois capitalist professional detachment doesn’t change this brutal fact any more than does any other kind of magic. Delving into my deepest vulnerabilities, taking my money and then forgetting about me, without necessarily having made a jot of difference to my suffering, IS abusive. This means that as a mental health professional, you better work bloody hard during your consultation to earn your detachment.
These are some of the points I believe must be raised in a good consultation.
- Issues of general psychosocial distress. Relationships, past abuse, work, living circumstances, finances – all these are enormous potential additions to intrinsic psychic distress, yet all are all too often neglected.
- Lifestyle: Exercise, sleep, quality of food, substance abuse, addictions of habit.
- What makes me feel good, and what makes me feel bad? What empowers me or makes me feel powerless. How can I get more of the first, and less of the second?
- Have I created a care plan to help friends and family assist me? How many people have copies?
- Adherence! How the hell do you know I’m going to take the pills you nonchalantly prescribe? Ask me how I feel about them. Give me a proper and comprehensive idea of the side-effects. I’ve lost count of the times I’ve returned to a psychiatrist saying, ‘I’m having problems with X,’ and heard the response, ‘Oh yes, that’s sometimes a problem.’ Homicidal thoughts while on fluoxetine/Prozac – no-one told me about those. Thank god, I’d read about them myself. Ask how I’m feeling about the pills, if I have a way of remembering to take them, if I’m reluctant – these questions are vital.
- Listen. Listen properly. Ask me if I have concerns, because I may not be strong enough to raise them if you don’t. I have raised my problems with concentration with two psychiatrists, and don’t feel either takes them at all seriously. Yet my problems with concentration are an immense – IMMENSE – source of misery and distress. If you, oh immortal psychiatrist, don’t know what the fuck to do, then say so, fine, but don’t just skate past the issue or dismiss it with an air of lofty omniscience.
Yes, addressing all these issues may not fix my bipolar disorder. Probably only the pills can do that. But all these other factors may determine whether or not I live long enough to find the right combination of pills.