The importance psychiatric empathy and engagement in patient /doctor relationship

Today I had a routine FaceTime appointment with my psychiatrist. I wasn’t expecting much. We were just going to discuss the usual.

Yet, the first thing he told me

was “I read your blog”.

I was taken back for so many reasons. I had no idea he would have such interest in his patients, or have the time really.

What is interesting is that I had written my last entry on how I am suffering from the side effects of the meds I am taking, especially how I have lost hope, and how I feel disabled mostly because of the antipsychotic quetiapine of which I take a significant dose. Although I had shared this with him before, reading my words seemed to have had a different impact on him I would discover.

Yes. My doctor told me something I would have never ever have imagined any medical practitioner to ever say. He told me I have failed to treat you.

I could not believe what I just heard. First of all we are far from being done. I am still being treated. And I am a thousand times better my dear doctor than the first time I saw you. I cannot even find words to describe the state I was in when I first talked to you and you said yes I will take you as my patient. I could barely speak, yet you were able to translate my pain and understood me.

Today my doctor showed me how he truly listens to his patients. I had talked to him over and over again about reducing the dose of my antipsychotic. He had refused categorically on many different occasions and told me if I did I would relapse. He told me I had to bare the side effects and be patient. He was extremely worried about me.

Today however, he told me that he thought long and hard about my blog piece and decided to change the treatment plan.

He decided to change it to accommodate to my needs and because he had already increased during the past weeks my levothyroxine. [My treatment is based on three pillars: levothyroxine, quetiapine, and rTMS]. I had also a few sessions of rTMS as a back up before this new treatment plan. He also told me that if I don’t respond well to reducing the quetiapine, he would shift me to another antipsychotic. This was all I needed to hear. Hope is the most powerful medicine of all.

I am sharing this story today because it is really a breakthrough on so many levels. I rarely hear of anyone admitting or alluding that they are wrong or even questioning themselves really- especially if they have any kind of authority over you. Two, who has the time to read or listen or care about their patient outside of the 15 minute appointment slot they have? Who cares what they feel, like or dislike? I have seen my share of psychiatrists and usually when I start slightly feeling uncomfortable it means that the relationship is going south and the end is near my friend.

I have all the respect and admiration to you Dr Andy Zamar, a great man, extremely bright and sensitive.

Mind you this is just the top to the iceberg. My admiration for this great doctor has no limit.

I only hope that he has the opportunity to train other fellow psychiatrists.

Thank you for your humanity.

TBC

You must know

Know that I love you since before I was born

Know that I loved you since before you were born

Know that you are my every reason for being

Know that I want to leave to set you free

I try and I fail and I try again and I fail and fall harder

Maybe this time it will work

You are not the problem; you are the solution

I have been away from writing for a while. It was a period of re-evaluation. I needed time to gather my thoughts before I share them with you.

Today, I want to talk about living in the now. I want to talk about living without fear. I want to talk about hope…

I want to talk about waking up without wanting the day to end. I want to tell you that it’s possible to enjoy life even if circumstances are not ideal.

I want to share with you today my insight about a previously feared decision that I was very hesitant to make.

I was hesitant to live.

My fear blocked me. Doubt was consuming me inside out. I didn’t like the present (my illness) , I regretted the past (my recent diagnosis with depression and bipolar disorder, my genes, my upbringing…), and worried incessantly about the future (relapses, pain, facing myself or even another day).

This topic was my obsession. I thought of nothing but bipolar disorder. I was not sick with the disease, I was the disease itself. I couldn’t put a distance between me and “it”. Bipolar was the boss of me, and I didn’t know any better.

Little by little my dissatisfaction with the situation kept building up. It was sort of an unconscious rebellion surfacing. With hindsight, I understand why I opposed certain hospitalizations and certain drugs or doctors. I refused over and over again to be numbed. Because when I get numb, I forget why I am in this situation in the first place.

I knew something was amiss.

The healing system I surrendered to was treating my symptoms and not my illness.

Traditional psychiatry attempted to take my pain away without telling me that I will also lose myself in the process.

I have been aware for a while that my condition is psychological but to a big big extent also physiological.

I couldn’t accept that my childhood, no matter how sad it was could still affect me some 30 years later. I couldn’t accept that moving from one country to another is enough of a reason to have me sedated by force while I was trying to escape from the ICU after a suicide attempt.

What couldn’t they see? What is being told to me by this suffering? Why is my family witnessing this? Is it all coincidence? Is it all in vain? I was a mental health practitioner at some point, how could I be the patient now? What happened to me???

As my rebellion became my revolution, I weaned myself off drugs. But that was only the beginning. Slowly my cognitive abilities came back. Not all, I still have memory blockage, or loss. I lack concentration sometimes too. But in general I can tell you with confidence that this is my brain. Those are my feelings. This is my reality.

I began to put 2 and 2 together and made some parallels- and those made and still make sense to me. They might not be universal truths; but is there such a thing?

I thought that each hospitalization began with a series of blood tests. Why do they keep on saying that there is no bio marker for mental illness!! A lie. A big fat ugly lie.

I don’t know about you, but I would rather have a half truth than none at all. The medical community has knowledge about biological, pure physiological imbalances that accompany depression, or any illness to that end.

People just take the easy track and stop investigating, or they don’t want to claim responsibility. Tell me why is my sedimentation rate (ESR) abnormal? Why is my vitamin D so low? Why is my thyroid imbalanced? Why did I bleed for weeks with no end between my periods staining every surface I touched before I was diagnosed? Hormones anyone? My ferritin was low, my proteins were in the wrong values. Soon after I started treatment I began to have bad cholesterol. Is my mother the reason for all that? Or is it rainy Paris? Or maybe my then 2 extra kilograms?

I was prescribed “vitamins and supplements” yes, but no one ever told me that they would be key in healing me if taken religiously and monitored regularly. I was told not to miss my antipsychotics, my antidepressants, my anxiolytics; those drugs that alienated me further and further from me, from those around me and most importantly from the truth.

I was told I need to play sports and bathe when I was pinned to my bed by drugs. Yes yes, exercise is good for depression. Not once was I told that there is a link between what goes into my body (food yes food!) and my physical or psychological condition.

Not once was meditation mentioned. Not once was yoga mentioned. Not once was even coloring-in mandalas brought up. Just take the drugs and come back for more. I was offered psychotherapy, but I didn’t give it much importance then. I think now it was because I felt to a huge degree that talking about my problems wouldn’t make them disappear.

I realized that no matter the good will around me is, no one would help me but me. I decided to take charge of my life.

At 38, I finally decided to become an adult.

I will listen to the medical community orthodox or not, because yes they do have insight. But most importantly, I will now forward listen to myself. I started to believe in me. I started to believe in my cognitive abilities surfacing and my instinct.

I knew I am no longer Bipolar Disorder. I am Me.

Simply put I began to circle around the idea of inflammation. I knew that illness meant imbalance and imbalance was often caused by inflammation. I also thought that inflammation is not only physical but psychological. I thought I would enforce a way of doing – a way of living – that is anti inflammatory.

When you are ready, the stars align. Without being esoteric, when you buy a red car you start seeing red cars all around you. When you brain focuses on a certain topic, you see it in plenitude.

I began to dig for links and for alternative remedies. I found that others – plenty of others- think the same. I hadn’t given alternative ways a serious thought before. Cancer healed by pure will and some plants? Yeah right!

I think that if you want to go alternative and drive off road, you cannot pick and chose. It has to be integral or better still systematic. Again that is me talking not science.

So it figures that turmeric or curcuma is a miracle drug that treats a wide range of problems relating to inflammation. It figures that I need to treat my candida problem that has been an integral part of my life for the past 10 plus years if I want to heal. Not one, not a single medical authority wanted to establish this link; as if I had several bodies or as if my organs were not related and living in the same ecosystem.

It figures there is a link. And yes, essential oils do work if taken long enough and right enough. It seems that the liver needs a proper cleanse to get rid of all the bad stuff we feed ourselves all the time. Otherwise healing would be in vain.

It figures that sugar and gluten can also be part of the problem, feeding regularly the inflammatory machine. The more you eat it, the more inflamed your body will be, and the more you will crave it. Funny, I consumed jar after jar of jam before my first hospitalization; a food that I truly dislike.

Activities are also inflammatory. Sitting hours in traffic jams is inflammatory. Dealing with negative people and draining meaningless tasks is inflammatory. Going for a walk is anti inflammatory and so is listening to music. Playing with the kids is anti inflammatory; trying to prove that I am right all the time is inflammatory. You get my point.

None of that would work alone. It is a system. A wholistic system that you create and you alone- it has to make sense to you.

The knowledge is there. I am no genius and you don’t have to be one.

We went through hell and back – all of us. Whether you lost a child, a limb, a job, or financial security. You are unhappy because you chose to define yourself as a problem. I Am The One without a Mother. I Am Bipolar Disorder. I am Divorce. I am Unemployment. I am Obesity.

While doing that we forget all the other things that we are, or aren’t! Yes you could be bipolar and it is sad, but you are so much more than that. And you are not so many other bad bad things.

The truth is there is always better; but mind you there is always worse.

So let us take a leap of faith and try to breath it out.

Say it out loud with me

I am not my illness, I am me.

I know this is not an ideal situation, but there is no such a thing.

I know I cannot control tomorrow, but thinking about it constantly won’t change a thing;

When I need help I will ask for it, but I am in charge of my existence;

I live for a reason; and that reason is to understand and free myself from suffering;

I am as happy today as I could ever be….

I beg you please to listen to yourself. Listen to your body. You are not the problem: You are the solution.

Bless

TBC

Dealing with suicidal thoughts when you have Bipolar II

suicide

ˈs(j)uːɪsʌɪd/

noun

plural noun: suicides

1 1.
the action of killing oneself intentionally.”he committed suicide at the age of forty”

2 synonyms:

3 self-destruction, taking one’s own life, self-murder, self-slaughter, felo de se; Moreself-immolation;
historicalsuttee;
historicalhara-kiri, seppuku;
informaltopping oneself, ending it all
“she committed suicide”


Definition of suicide

a : the act or an instance of taking one’s own life voluntarily and intentionally

2: one that commits or attempts suicide


So I am admitting: I am suicidal. I have suicidal thoughts that lead me nowhere. I cannot commit the act for so many reasons. The most obvious is my family. I cannot do this to them… I just cannot imagine their distress, sadness, and feelings of betrayal.

Secondly, maybe not secondly but anyway, I cannot commit suicide because I have no access to any of my favorite tools- Benzo* meds. I am hospitalized and thus I am only allowed one dose at a time; always checking that I actually swallow everything they give me.

Thirdly, down deep inside, I feel like a coward wanting the easy way out. But honestly I sometimes I do not even see the “difficult” way out.

Good news now I have quit Seresta, “used for the treatment of anxiety and insomnia and in the control of symptoms of alcohol withdrawal”, a Benzo but that for me does absolutely nothing. From reading about it, I think it does not work for me because it is an intermediate acting Benzo which supposedly should’ve decreased my anxiety. It works on GABA receptors – which basically makes your brain less anxious. I talked to several patients here with me and many said even at high dosage, it is quite useless…

But of course, this antianxiolytic has to be replaced by something else, otherwise I will have horrible withdrawal effects: the last thing I need. So now I am on Valium, which honestly decreases my anxiety levels and reminds me of my favorite Benzo Lexomil. I cannot take my fav because I overdosed on it. So now this Valium (Diazepam if you are keen to know the real name for it) is great as it is a long acting Benzo, which is similar to Lixomil. This means less anxiety and more muscle relaxation.

*Benzodiazepines: are a class of psychoactive drugs whose core chemical structure is the fusion of a benzene ring and a diazepine ring. [They] enhance the effect of the neurotransmittergamma-aminobutyric acid (GABA) at the GABAA receptor, resulting in sedative, hypnotic (sleep-inducing), anxiolytic (anti-anxiety), anticonvulsant, and muscle relaxant properties

Continue reading “Dealing with suicidal thoughts when you have Bipolar II”

Getting out of the closet

Getting out of the closet would make you think of sexual orientation. But many others have gotten out. Today, I will write about why I decided to link my blog to Instagram and Facebook.

I have been writing for a while now. I am documenting my journey fighting mental illness as a person, a woman, and as a mother. It has been rough mostly, but it taught me a lot. You might be surprised by some of the topics or posts that will be shared. The main purpose of this blog is to promote awareness of mental illness. I want to also tackle a broken system, where mentally ill people are seen as helpless beings with no choice of treatment or quality of life.

Although I am supposedly a clinical psychologist, please do not take this blog as as a place for “medical” advise. It is just a safe heaven for broken hearts. I hope that in our unity we will be able to free ourselves from the burden of depression, bipolarity, eating disorders, addiction, or else.

Thank you for respecting other points of views, and thank you for trying to understand what the other is saying. We shall not blame each other or use inappropriate words. We are builders – it is enough to fight our inner battle; we do not need a wall to fight on to.

Bless