Yesterday I went to a local university's psychiatry clinic to see about going there for treatment. I was a little disappointed that I had to see a resident, rather than a more experienced doctor, because that is the way the clinic works, but I was interested in hearing her opinion of my symptoms and her recommendations for my medication situation. (Wow, that almost sounds poetic rather than extremely boring!). So I gave her a long history of my mental health issues, starting at age 15, which was when I was first depressed enough to attempt suicide. I don't really, in my mind, correlate being depressed at 15 with being psychotic in my twenties. I am not particularly sure that the two things are related at all, but doctors always seem to think they are.
By the time I finished this history, I realized I was talking in such a matter-of-fact way about being delusional, that there was no way this resident was going to understand that I *still am* often delusional and psychotic to some degree. I think that she gathered, from what I told her, that my worse symptoms were all mostly gone now. While it may be true that the worst ones are gone, the other ones are still a real bother, and I felt that maybe I failed to outline the severity of my current situation, because generally when you say, "I hear voices" doctors tend to think that you can't be talking about real psychosis because people who are clearly psychotic generally don't know that they are.
I think this is an important point that I'd like to explore with a little research. I feel that I almost have my experiences discounted sometimes, because I am actually aware of what I am experiencing while it happens. My regular psychiatric nurse practitioner who prescribes my medication has told me in the past that if you are aware you're "psychotic" then you're really "not psychotic". There is some other term she used for people who are aware of these symptoms, but I forget what it was.
Anyway, the university resident was kind and seemed interested in what I was telling her. She said that she is not sure why I am on the medication regimen I am on now (although I tried to explain how I ended up on the things I am on now). She said, also, however, that she wouldn't want to change my medication right away because, "this seems to be working for you." Clearly, something was lost in the translation, since what I have been repeatedly told by my therapist who I see every week is that my medication is obviously NOT working too well, since I am hearing auditory hallucinations every day of my life.
The resident explained that she would like to review some of my medical records from the clinic I go to regularly for my medication and therapy. Then she went and got her supervisor - a more experienced doctor - so that person could meet with me briefly. They basically stated that it would be hard for me to get treatment at their clinic because I would have to actually see a doctor there every two weeks to get my Risperdal injections. This would be inconvenient, since their clinic is an hour or more away from where I live, and I have a job. Also the resident then told me her schedule - and that she is only available a few hours on three days out of the week, so it is hard to get appointments with her.
So then we discussed another option, which was what I had gone in thinking anyway, and that was the idea that these doctors could consult with my ARNP at the clinic I go to, and offer some suggestions. The resident said she would like to have some bloodwork done, and receive some records which she would review, and then see me again in a month so we can discuss things. So I agreed with that. I was rather disappointed that I had not managed to secure a new doctor, but at the same time, what they explained about the requirements of me switching to their clinic made me think that this was not a good idea in the first place. For example, they have no therapists, and I do not know if I could continue to see my therapist at the mental health center if I went to a doctor elsewhere. I like my therapist, and I would not want to have to give her up. Also, they have no social workers, and the community mental health center might not let me continue to receive case management with my current caseworker who I have been with for a few years if I switched doctors.
Ideally, I would rather not see a resident or an ARNP. My goal at this point is to see an actual doctor. However rude or elitist that might sound, I think I have a right to see a full-fledged doctor with experience treating my illness, and that is what I want now. So, I may end up having to give up my case manager and possibly my therapist, at some point, in order to go elsewhere for a doctor. I am not sure that another doctor would have any great, miraculous solutions, but I do think many other doctors would take my 100 lb. weight gain from medication a lot more seriously than the person I am currently seeing does. She doesn't seem to think it even matters, or to understand that I need some real help in controlling the weight - as in an appetite suppressant or something of that nature. She said she cannot prescribe something like that, and I have no patience left to be told that saving myself from being morbidly obese is not within the realms of possibilities because I am going to a community mental health center and they just can't deal with that there. It's something I HAVE to deal with, and I am not going to keep ingesting medications and being injected with medications that make me fatter and fatter and fatter. It's out of control at this point, and I need to be taken seriously on this issue.
It bothers me sometimes that if I had any other purely physical illness, the fact that a medication made me gain this amount of weight would undoubtedly lead any reasonable person to either take me off the medication immediately, or to figure out a way to prevent any more weight gain from happening. It has been my experience with community mental health centers and hospitals, however, that no doctors really seem to care at all if your psychotropic medication makes you obese, because all that is supposed to matter is that the medication works, or does not work. I don't think this kind of discrepancy is right or fair, and I think it is related to the stigma that still exists which keeps mental illnesses relegated to some "other" category of illnesses that aren't the same as a physical illness that does not involve the brain.
So those are my thoughts on that...Now, I suppose it will partly be up to me, and largely be up to the rules of the community mental health center as to whether or not I get a new doctor somewhere else. I do not feel that it would be wise for me to lose my case manager and my therapist right now, and I also do not think it is fair for the agency to tell me I have to continue to see their ARNP and not go elsewhere for a doctor if I want to keep these other services going.
In other news, I am awaiting word from the Social Security Administration regarding my appeal of their threat to take away my disability benefits. So we shall see what happens there. Please wish me luck!
Thank you to all who continue to leave comments here; your support and good wishes are very meaningful to me, and I appreciate them all. We seem to have grown a community of mental health advocates on Blogger, and I am thrilled to be a part of that.