Life in the Era of Push-button Psychiatry

Sometimes I think of myself as an Old-Timer, but maybe that term has seen better days. In Alcoholics Anonymous the term is used to describe an older and hopefully wiser longtime member who might be called upon to guide the newcomers. Although I am a new arrival to what we might call the Movement, I spent many years as a psychiatric slave, a total of 33 to be exact. I shyly approached my first outpatient therapist at age 23 in the summer of 1981, telling her I had trouble with my eating. Since no one seemed to know what to do with me, I got tossed around, and was given one wrong diagnosis after another, and more wrong advice than I care to remember for the next few decades. I begrudgingly went to my last psychiatry appointment with an NP in September 2013. In between I endured over 50 incarcerations. A number of these involved “sectioning,” that is, being hauled away from my home by ambulance against my will under orders of a mental health professional who told the EMTs that I was either “dangerous” or “possibly dangerous” or “I guess she’s dangerous” or “please go get her again before she writes another word.”

For the most part, I was praised for my high degree of compliance. I was often called upon to be Queen Guinea Pig for that reason. I did this in hopes that something might cure my eating disorder, but for sure, these drugs were never given for that purpose, since the fools I saw rarely took me seriously. I sampled the latest drugs, including Clozaril. When Clozaril made me pee in my underwear I got to try out Ditropan and found it worked.  Finally, that often-praised larger-than-life vein in my right arm quit on the phlebotomists, so they had to ruin the vein in my left arm after that, too. A few months on Risperdal made my periods stop. It tends to do that. The doctors couldn’t figure out why, so they blew thousands of dollars on an MRI of my pituitary, checking for a tumor. Why didn’t they realize the obvious?

I was so good at monitoring what I thought were “symptoms of mental illness.” After ECT I blew about $20 at Staples and invested in four different types of graph paper and fancy erasable art crayons to produce multi-featured “mood graphs” charting my normal fluctuating moods.  My use of contrasting color earned me the label “bipolar.” I was such a good patient. My doctor, a resident of highest order, examined my erratic tendencies, reflective of normal patient life and declared me hopelessly female. I was so amazed at his level of genius.  Later, I sat with my boyfriend Joe and we laughed together over the incident.

Joe said, “Dr. B looks like a preppie with that bow tie. Ask him. I dare you, Jules. Ask next time you see him. Ask if he went to prep school. Bet he did.”

“How do you know?”

Joe had that twinkle in his eye. “I know,” he said. “It takes one to know one.”

“Really?”

“Of course,” he said. “Ask. You’ll see.”

Next time I saw Dr. B I asked. Joe was right. He was so often right.

I wondered how long it would take these genius doctors to figure out what I had come to them for in the first place, some few decades ago back in 1981, my eating disorder. They seemed to have forgotten all about that in the shuffle. They gave me 600mgs of Seroquel. I gained a lot of weight, and I said I was “depressed” over it, so they raised the dose to 900. My weight went up another 50 pounds. I weighed nearly 200 pounds so finally I guess they noticed me. Was I big enough finally to make an impression? My doctors said it couldn’t possibly be the drug. “It doesn’t do that,” they insisted, but then finally agreed to take me off of it. A few years later I was skinny. That’s when they finally noticed I had an eating disorder. Now? Isn’t it too late for this?

I got marched off to “eating disorders care,” which makes me laugh now, since I’d been complaining of ED all along, and now, someone finally decided to notice, some 30 years too late. Most of the other patients were teens. I helped them with their knitting, rescuing dropped stitches, so they decided I was “okay for a granny.”

Then, I suddenly realized something. Not only did I realize that “care” was completely inhumane. It wasn’t just that.  Mental health “care” had always disappointed me terribly. By comparison, when I was a music student at the University of Massachusetts and Bennington College, I was academically challenged by the finest music faculty in the industry. I learned all the instruments of the orchestra and learned to write for all of them. I could hear intervals like a whiz, and write down anything I heard on paper instantly. I used to listen to my LP records late and night and transcribed many of them into piano scores, either two or four hands.  I had many notebooks of transcriptions, done in secret, just because I could do it. That’s called “music dictation,” considered a rare skill. In music schools they made kids do years of ear training to learn to do that, but I could do it spontaneously. Now, computers transcribe for jazz musicians, writing note for note their lengthy babbling of late-night improvisation.  To me, writing music was playing with sound combinations and experimenting endlessly to find what worked. Sometimes it felt like I was struggling with a Rubik’s cube or Sudoku puzzle, because once the sounds jived, it was like my whole world had snapped into place. The Moment of Truth came when I presented my works to the faculty. Often, I had to re-do my pieces over and over until everyone was pleased.

Performing was a joy to me. I grew out of stage fright early on. To this day I can stand in front of a large audience and read a piece of writing I have created and I do not feel fear or nervousness. I attribute this to having many music performing jobs that paid money. The incentive to continue performing for audiences and get paid to do it kept me on my toes.

From the beginning, mental health care was dull and boring by comparison. I was never challenged the same way I was in music school. I didn’t create the same way. I was never pushed to work to my fullest capacity. In fact, I had forgotten what that was, and had forgotten about the intellect I possessed.

I remember sitting in offices with one mental health professional after another and asking myself, “Is this all there is?”

In fact, it was Dr. B who said to me one day that I was smart enough that I didn’t really need a psychiatrist. “If the law allowed it, patients like you could pick your meds out of a vending machine,” he said.

I wonder to this day if he was joking. Drug addicts who essentially do not use the number of “middlemen” that psych patients use, eliminating the non-science of diagnosis, the rather nonstimulating and rhetorical “group,” or “therapy,” and the need for standing in line at the pharmacy and insurance coverage and all the arguments over payments via taxpayers, these druggies that society abhors completely cut to the quick. They don’t have to play those mental patient games. They just buy the drugs. While their decisions may or may not be intelligent or wise, they aren’t any more idiotic than the decisions made by psychiatrists, and I admit, us patients.  Addiction most likely arises more out of prescribed drugs than street drugs. And not all drugs obtained illegally are illegal to possess, though the law may require a prescription or that a person has to be a certain age.

After over three decades of psychiatry, which never demanded that I really use my brain, never challenged me, and never appreciated what I could do, I wondered if I still could think critically the way I could as a young student. Now, finally, without the drain of constant psychiatric monitoring, I finally have the chance to test that out.

The one thing that I do that by all means the institutions aimed to stop was my writing.  I recall much of what happened to me during all those years that I was enslaved to them. Not only that, but I possess the skills, patience, and wherewithal to write it all down. I can’t say I’m making my doctors very happy now.

I highly doubt my early therapists and psychiatrists even knew I was going to remember the things they said to me, word for word, nor ever publish these nasty little lines of dialogue, nor expose the things I saw while institutionalized. Nor did they realize that we patients have the right to do so, within certain limits of the law. If they didn’t want me to write such inflammatory stuff, then they should not have treated us so badly. However, they did, so I feel obligated to my fellow patients to tell the truth.

In the medical world, the more middlemen you are dealing with, the more communication breaks down. Whenever information is passed from person to person, it gets distorted. Here’s a simple example that regularly happens to me: I say “diabetes insipidus.” Invariably, the nurse writes down “diabetes” and next thing you know, the next nurse comes in obsessed over my blood sugar because someone forgot “insipidus.” Never mind how often my name is misspelled, information is recorded completely incorrectly, the words “severe” are inserted when I didn’t say that, or the time frame that I dictate to one healthcare personnel is completely skewed when she records what I have said.

I came to realize that when you’re a patient, you’re playing a game. It’s so unnecessary. Most of us know ourselves so much better than our doctors do. We’re smart and we know what’s wrong. We don’t need some dude in an office to tell us.  If you are totally convinced that the chemical route will cure you, why not go out and buy drugs directly? Why bother with the appointment, doctor, diagnosis, prescription, insurance, approval, and pharmacy method when it’s so costly, time-consuming, and you so often end up on the wrong drugs, or even incarcerated in a hospital? Do we really need psychiatrists when a vending machine will do?

Your neighborhood pusher might not dress in a lab coat and might not have such a posh office, but will he do any worse by you? Sure, there are risks, but when you consider the risks that we all took and all the regrets we now have for seeing a psychiatrist or even a therapist, and the years that psychiatry stole from our lives, that guy on the street corner does not look so menacing. By the way, if he wears a bow tie and looks like a preppie, come talk to me. We can joke about it later.