19 April 2011

Finding a doctor / therapist

by Nia
Reflection on Depression's 3/20/11 post on choosing a mental health professional gives a good outline of the various types of practitioners — psychiatrists, GPs and nurse practitioners, psychologists, mental health social workers, and licensed counselors/therapists — and their strengths and weaknesses (based on the blogger's experience).

I would like to emphasize your right, and the need, to shop around. I realize your ability to do this depends on insurance coverage, finances, childcare, and work hours, never mind your mental and physical energy. But if at all possible, if the practitioner does not display compassion or good communication, or if he does that thing I call "denying you your own experience," or automatically contradicting your observations and conclusions, dump his ass and move on.

Some statements I've heard from doctors that made me sense I was in the wrong place:

"You just need to go to more parties."

"There is no such thing as nutritional deficiencies in America."

"Insomnia is almost always caused by anxiety."

"I think [the chest pain] was just a muscle pull."

"Why do you not wear makeup? Don't you want to get married?"

If you are interested in pursuing a particular line of treatment (medications, cognitive behavioral therapy, leeches, etc.), here are What My Body Wants' Rachael West's comments about what she learned about communicating with doctors as she investigated the cause of her extreme exhaustion. (This is from her pdf What My Body Wants: Part Two (Getting Help). A link to it is on this page.)

"While the medical profession is continuously evolving, we do know that the system as it is currently set up is more helpful if you want to know whether you are sick or not, rather than how to be well in a greater sense of the word. My relationship with doctors improved greatly when I accepted how they operated and changed my way of asking for what I wanted. I recognise that time is short for them and that if I’m clear about my expectations and needs it will make it easier for them to help me.

...It’s a bit like I might approach a meeting with a very expensive consultant I have hired to work for me – you prepare for the meeting ahead of time, approach the discussion methodically and before leaving check that everyone is happy with what has been discussed and what happens next.

...To see [a certain chronic fatigue specialist], I needed a recommendation from my GP so I trundled off to an appointment at the local surgery and asked for just that. I didn’t ask if my GP thought I SHOULD see this physician, I simply told him what I wanted."

Finally, if you're like me you might have worried that your morose affect has influenced the way doctors treat you, and that unless the doctor is extraordinary you won't get decent care unless you act like a trained monkey. And you're right! To wit:

Doctors Often Don't 'Get' Their Patients, Study Finds
ScienceDaily (July 26, 2010)

'Difficult' Patients More Likely to Experience Worse Symptoms
ScienceDaily (Jan. 27, 2011)

Image: detail of 18th-century French illustration of trepanation (trepanning); from Wikipedia entry on trepanning. {{PD-old}}.

14 April 2011

I coulda been a cult leadah

by Nia

At my last job in the big corporate world, I heard a rumor that one of our big cheeses — the one we trusted, the only one who bothered to tell us that yes, the new office in India is indeed the death knell for you all — had "lost" two family members to a cult.

Eventually I got to know him well enough to ask him about it and was surprised to hear that it came about during his wife's search for treatment for depression. She had suffered from it all her life and felt horribly guilty, he said, for passing it on to their daughter, now grown. The wife had been seeing a certain doctor for months before the big cheese noticed that she had gone through an amount of money greater than my annual salary.

His brief account of his wife's, and then their daughter's, involvement with this doctor's practice matched several characteristics of cults that I remembered learning about in school. One or both of them gave large amounts of money to the organization; distanced themselves from relatives and friends who did not approve of the organization (the big cheese no longer had contact with either of them); relocated to be near the organization; and deferred to organization leaders when making decisions about their personal lives. An internet search revealed that the doctor was being investigated for fraudulent medical practice.

When I visited the doctor's website I discovered it was something I myself might have looked at at the nadir of my depression, when I was spending half the day searching the internet and the other half curled up in a ball on my parents' guest-room floor. His practice advertised itself as an alternative medical center for environmental allergies, and offered the usual alternative treatments like magnetic therapy, reiki, acupuncture, allergy testing, etc. In fact, the center offered more services than I'd ever seen at one place.

On the home page I found a potential hook in a long list of steps describing how new patients were evaluated and treated. Number one was an interview by a staff person. Number two was supplementation with an unspecified assortment of vitamins and minerals, to make sure the patient had basic nutritional support. The tone was almost apologetic, as if it were a legal precaution and the staff was embarrassed to have to bother anyone with it.

I am not the only person who's discovered that just a big dose of B-complex from the drugstore can make a difference in mood in a few weeks. If the new patient actually took those "just-in-case" supplements and then underwent another treatment at the same time, she might feel just better enough to notice and might attribute it to that other treatment. If you are miserable enough, have suffered long enough, know nothing about biochemistry, and believe that depression is a mysterious mental process that only experts can understand, a slight easing of it would be like a miracle and it would be easy to convince you to try one treatment after another.
Without insurance coverage, it could quickly add up to tens of thousands of dollars.

As to the psychological manipulation end of it, I am reminded of my friend's comment: "I'd cut off my right leg if I thought it'd make me feel better." Who's to say what your thinking would be about your deliverer from life-long mental torture. Or maybe semi-deliverer: I'm guessing that the promise of further improvement would be part of the reeling-in.

I wondered if I would have gotten sucked in by Dr. Whozits if I had stumbled across his innocuous website ten years before. I hope not: I had heard about my grandfather's supplement experiments on himself my entire life (he died at 94 after collapsing on a golf course), and my mother was quite the one for the scientific method, so I'm assuming that if I had taken the supplements, eventually something would've dinged in my head about cause and effect. Luckily, I never had the money to get there in the first place.

Hard upon that thought came the urge to kick myself for not thinking of the ruse myself. I'd start small, maybe pretending to run a clinical trial and enlisting cash-strapped college students, who, once slightly less depressed, would spread the word among their social networks. A one-room office would turn into a lease on a building in an industrial park, with arrangements with local hotels for out-of-town guests. Eventually I'd start hiding my earnings in real estate. Then I'd winnow my acolytes and in each of the beach houses and the Aspen chalet and the Rio penthouse I'd install a serenely grateful guy with really white teeth who looked exactly like Daniel Dae Kim, James Franco, or Mel Gibson circa "The Year of Living Dangerously."

Image: Remix by M. Rhea of photo of poster of Kim Il-Sung and his subjects, by yeowatzup, September 2008. Photo is published under a Creative Commons Attribution 2.0 Generic license.

07 April 2011

Movies to avoid when you're depres blesthfully dipped

by Nia

It would be more positive to offer a list of movies that are safe to watch when you're depressed, but people's triggers are too unpredictable. Take "Amélie," for example: watching a gorgeous skinny French chick traipsing around one of the world's most beautiful, romantic, and expensive cities might or might not be the thing for you right now.

This list is also influenced by my abhorrence for scenes shot in cheap housing with overhead lighting, and for vampires who are not glamorous or intelligent. One must put one's foot down.

Your suggestions are welcome.

Black Hawk Down
Children of Men
Das Boot
The Deer Hunter
Easy Rider
Eraserhead (crappy housing)
Frankenstein / Bride of Frankenstein
The Killing Fields
Leaving Las Vegas
Let the Right One In (sad child vampire in crappy housing)
Martin (dumb young-adult vampire in crappy housing)
Midnight Cowboy
Mystic River
Requiem for a Dream
The Road
Stranger than Paradise (crappy housing, crappy town)
Taxi Driver
The Texas Chain Saw Massacre
Welcome to Sarajevo
The Wrestler (more crappy housing, but that's not really the issue)

Image: Chicago Tribune photo of Biograph theater, July 22, 1934, after John Dillinger was shot. No, I don't have permission to use it.

04 April 2011

What revelations have you had about your mental state?

by Nia

Four times now I've received a big, sudden dose of insight into my mood that changed my way of thinking about it. They were delivered via friend, my own noggin, and what I'll call the ether. The latter mode was a bit of a surprise, for despite my love for science fiction, I have rarely experienced anything twilight-zone-y. (I did once briefly convince myself that I had closed the refrigerator door telepathically, but I'm filing that under Zoloft Weirdness.)

1. Depression does not make you special.
In my old life in the Exciting City, one of my closest friends drove in from the suburbs to visit me. I was talking about how I wasn't supposed to eat chocolate because it worsens depression (I don't remember why I thought that). Something about the way I said it made this patient, gentle person snap, "Do you think that makes you SPECIAL? Why do you think so many people do drugs?"

I had never thought of that before. I had only met three people who had mentioned having it, so I had always felt pretty isolated. And thus a bit unique. As I drove home I laughed at myself for having half my identity wiped out in two sentences.

2. This is not my fault.
Several years later, when I had figured out the celiac aspect of the depression but hadn't mastered gluten avoidance yet, after a few weeks of feeling better I suddenly felt much, much worse. Sitting in my car at a train crossing at night, I was visited by a force that can be described thusly:

{[(bereavement-level grief).80]3s∆t + [(bereavement-level grief).10]5s∆t}30s∆t

Or: imagine the grief of bereavement. Reduce it to 80%, because obviously I was not actually bereaved, but the scale was still b-i-g. Inject that in the brain for three seconds, like a wave. Halt the injection for five seconds, then start again.

The whole WHOOOOMMM....... WHOOOOOMMMM........ WHOOOOOOOM etc. lasted about 30 seconds. It was riveting. And almost funny. A brand new way of experiencing mental pain! Completely pure! Totally impersonal! No memories, anxieties, or experiences attached! Then a slightly hysterical protest bubbled up from my psyche: "This isn't ME." (As in, I'm not the one doing this.) And there went the last ounce of suspicion that my depression was a factor of not trying hard enough or being mature enough.

I went home, looked at the ingredients of all the products I had purchased recently, cross-referenced them with Ruth Winter's Consumer's Dictionary of Food Additives, and discovered I had been ingesting gluten.  

3. I'm not angry, I'm happy.
Once at my desk, after I had been enjoying a decent, stable, reliable mood for several years, I was wondering why my good mood had just veered into anger, at nothing of any consequence. It dawned on me that I'd been either depressed or angry for so long -- irrational anger being a classic celiac trait (along with short legs and long eyelashes, if you must know) -- that once the depression was gone, anger had become my default. My light mood had gone skipping through my brain and fallen into the huge anger groove that had been carved out by my neurons over the years. I wasn't angry, I was happy. How stupid can you be?

4. My anger is in this box.
When I was yet again starting to lose my temper over some minor thing, there appeared around the center of my mind's eye a white rectangular border, like a camera viewfinder, accompanied by the thought "My anger is in this box." Meaning, I can store the anger there and not react to it. Weird, but helpful.