For almost 8 years I struggled with cyclical depression associated with a hormonally-induced mental illness known as premenstrual dysphoric disorder or PMDD. I also lived for 40 years with undiagnosed auditory processing disorder (APD).
APD is understood by audiologists to have severe social consequences. It is very difficult to have normal social interactions when your brain experiences difficulty getting meaning from speech. Some of my APD symptoms, such as the anxiety I experience due to my inability to focus in noisy environments, my difficulty speaking in groups, and my inability to understand and remember verbal directions, were mistaken for psychiatric disorders throughout my life as well.
I am currently working with an audiologist to address the auditory processing disorder. I was cured of the PMDD by a hysterectomy in 2014 and have not experienced depression since. In the years leading up to the diagnosis and treatment of the PMDD by a physician trained in reproductive endocrinology, I had multitudes of unfortunate interactions with psychiatrists who mischaracterized my APD and PMDD in some of the most ludicrous ways. This is a story of one of those interactions following a PMDD-induced suicide attempt.
After waiting in the emergency room lobby, I was taken to a small room and interviewed by a mental health intake nurse.
“What medications are you taking?” she asked.
“Phentermine,” I replied.
“What else?” she asked.
“Why are you taking the phentermine?” she continued.
“I’m overweight,” I said. My body was covered by a blanket. “I wasn’t able to lose weight with diet and exercise so my doctor prescribed phentermine.”
I had gained a little weight after my husband and I had started dating. My lifestyle transition from a single athlete cooking for one to a part of a family cooking for three (my husband had a daughter from a previous marriage), coupled with a few glasses of wine here and there, had caused a little weight gain. This small weight gain grew larger when I found out my then-fiancé had cancer. I had little time to exercise while I was his caregiver as he recovered from the thoracotomy he had undergone to remove a carcinoid tumor from his left lung. And then there was the Paxil, prescribed after my last PMDD-induced depressive episode. I gained 25 pounds in the first month of taking that drug, and I kept growing from there.
The intake tech told me I should be checked into the inpatient psychiatric ward immediately. I didn’t want to die, so I offered no resistance.
Upstairs on the ward, I was made to undress so that a ‘body check’ could be performed. Two young female staff members checked my skin for evidence of cuts or injuries. There were none.
Next, another young woman began to interview me.
“How long have you been depressed?”
“Off and on since around 2006.”
“And how long have you been anxious?”
“I don’t know, for maybe a couple of years?”
“How long have you had an eating disorder?”
“Huh? I don’t have an eating disorder.”
The two young women exchanged glances.
“It says here you are taking phentermine.”
“Yes, I am.”
“Why are you taking it?”
“Because I weigh about 155 pounds and a healthy weight for my height would be between 98 and 130.”
“Well, you don’t look overweight.”
“Well, thank you, but I would like to be a healthier size. When I was in better shape, I was also happier.”
“Okay, well we’ll take you to your room now and you’ll see a doctor tonight or tomorrow afternoon.”
“Okay, thank you,” I replied.
I found a lounge area with a phone and called my husband. Struggling to ignore the blaring television in the background, I tearfully explained where I was and why I was there. He was upset but supportive. I had been successfully hiding my cyclical depression from him so he was also very surprised. I told him how I was confused about being asked about an eating disorder.
He became angry when he heard this. “Idiots,” he declared. “I’ll have Dr. Good send them a fax tomorrow explaining your prescription.”
Dr. Good was the primary care provider for both my husband and I. He is a very competent physician and a very compassionate human being. My husband is a clinical laboratory scientist and he ran the lab in the same practice where Dr. Good worked, so Dr. Good knew us very well.
He knew about my husband Alec’s cancer and how it had disrupted our lives. As Alec’s doctor and co-worker he saw firsthand how painful my husband’s surgery had been, and how long his recovery had taken. He knew how much time Alec had to take off of work for his recovery, and how that had impacted our finances. He knew we were adapting to life as newlyweds and that I was adapting to life as a step parent. He knew how I had gone from running 10k races to being overweight due to stress eating, lack of time to exercise, and Paxil. The letter was faxed from Dr. Good to the hospital psychiatrist right away.
The next afternoon I met for the first time with my psychiatrist, Dr. Gaandu. He asked me about my mood, and I explained my recent depression through more tears and choking. He then abruptly said, “I got this fax from your primary care doctor this morning. It says he prescribed you phentermine for weight loss. I think it is very interesting that you went to such lengths to hide your eating disorder. I don’t know what you’re so worried about, we don’t even treat eating disorders here.”
It took me a moment to absorb what he had said. “What? I don’t have an eating disorder, that’s why I had Dr. Good fax the letter, to clear that up.”
“Don’t you think someone with an eating disorder would go to exactly that length to hide it?” Dr. Gaandu asked smugly.
I lapsed into the choking tears again. Was this really happening? How was I supposed to know what someone with an eating disorder would do? How would I know and why would I care if eating disorders were treated at this facility? I didn’t know anyone with an eating disorder and I had taken precisely one psychology course at a community college and none at the university from which I had graduated. How would I know what behavior would typify someone struggling with that? I was so bewildered and perplexed that I could no longer speak. After about five minutes of me sobbing in the chair, Dr. Gaandu released me to go back to my room.
Over the course of the next few days I was given more drugs that made me feel even worse. But I lied and told the staff I was feeling more stable, because I wanted to go home where I could kill myself in peace.
Thankfully I survived to tell this story.
The most important question about what happened is:
Why did Dr. Gaandu choose to confront me about an imaginary eating disorder instead of choosing to obtain valid information from me that could have aided in my treatment?
When we met, he had at minimum the following information about me available to him:
• General demographics such as gender and age,
• Diagnosis of major depressive disorder based on previous treatment records by other physicians at the same facility,
• Intake information describing my current state as suicidal,
• Speculation about an eating disorder based on a hasty conclusion made by a mental health intake tech in a 15 minute interview,
• A fax from my primary care physician explaining the legitimate use of my phentermine prescription with background context of my weight gain and failed weight loss attempts.
When he stepped into the room armed with the information listed above, he visually observed a slightly plump and tearful woman.
With all of the information and his visual observation, he made a choice to open our meeting by calling me a liar and implicitly weighing in his approval of an irrelevant diagnosis made by an intake tech, for which there was no real evidence.
He thought that confrontation was the best course of action that he, as my treating psychiatrist, could take. He had an enormous range of options available to him regarding our initial interaction. And he, as a board certified medical doctor specializing in psychiatry, chose to accost me over a fictitious diagnosis rendered by a non-physician (the intake tech).
He could have asked me if there was a specific event that had precipitated my suicide attempt.
He could have asked if I had a history of trauma.
He could have simply asked, “What happened?” “What are you feeling?” or “So what’s going on?”
He chose to open our meeting with an accusatory remark about a make-believe eating disorder.
He determined that was the best course of action when meeting this particular suicidal patient.
He chose to believe that his behavior was clinically appropriate and moral.
It was neither.
Of all the available choices, he chose to rely on an unsupported conclusion based on circumstantial evidence. And then he took it a step further and chose to pathologize my behavior even more because I had enlisted my primary care doctor’s aid to eliminate a mistaken diagnosis. The fact that I had believed that he would consider the professional opinion of another physician who knew me well was clearly a sign of serious mental illness!
How could such a confrontation have been beneficial for a suicidal psychiatric patient? Even one who may have legitimately been experiencing an eating disorder?
It could not have been.
Therefore, I can only conclude that his agenda consisted of something other than offering professional medical services to the patient with the patient’s best interests in mind.
I was further harmed and not at all helped. He knew this. Then I was billed for almost $7000.00.
He, on the other hand, collected his paycheck and moved on to the next patient.