Mental Illness 101
A friend encouraged me to post this in a longer format to my journal so that everyone can see it. To that end, if you find value in it, consider linking to it. You have my permission to link!
This is all stuff that I wish people had said to me just before and after I'd been diagnosed as bipolar: very basic advice for dealing with the time right after diagnosis, or when one is seeking treatment for the first time. This is one of the most densely confusing and frustrating part of being mentally ill: your symptoms are really nasty, and your whole life is upside-down, and you have not yet developed protective routines. You are probably receiving little or no effective treatment. It sucks like Justin Bieber in a wind tunnel.
At this stage people need, above all, to have the confidence to Get Shit Done, and hope is a huge part of that. That's what I'm trying to offer here, so I've tried not to be too heavy. If you want to read discussions of the harder stuff, I discuss that a lot under my lycanthropy tag: lycanthropy. Yes, there's stuff about werewolves in there, mixed in. It's not real hard to tell the difference.
All this is my opinion, and I'm just one person, not a medical authority. The advice here won't apply to every situation or illness or person. If something you read is inapplicable to you and I don't offer an alternative, I'm truly sorry. This is the best I could do, based on my experience. Feel free to offer your own advice in comments so that someone might be able to benefit from it!
People email me a lot for advice, and while I am totally okay with that and while being able to help makes being crazy a little less shitty, I often don't have the resources to deal with these requests in a timely fashion. To that end, I've decided to centralize the advice I tend to give most often so that I can point people here instead of making someone in crisis wait a week for a cogent response. When you are talking about mental health stuff, fast matters.
And, finally, if you need help now, act now. Call a friend, a family member, a doctor, a suicide hotline, email someone you know, write it out, tear up a phone book, stab a pillow, do something. I can't do crisis intervention for people I don't know well. Sometimes I can't do it for people I do know well. I hate to say it so bluntly, but I have my own issues; I'm often flaky and kind of a fuckup. I'm a kindred spirit, sure, but I really can't handle being responsible for another human being. Frankly, it fucking terrifies me. That's why I'm not a parent to anything more complicated than a really annoying cat.
That said, I do care, I care so much about every single person who has to go through this horrible fucking bullshit, which is why I am telling you to take action - any action besides harming yourself (or someone else, but mostly, we are a risk only to ourselves).
That said, on to the good stuff.
Know what you need to achieve.
Here are some things to think about:
Do you know what is actually wrong? Do you need a diagnosis?
Were you diagnosed with something, but suspect you were diagnosed improperly?
Are you okay with taking drugs? (Much of what I say assumes you are, but if you aren't, that's okay, too.)
Do you want some sort of talk therapy?
Do you need guidance to decide what to do? As in, are you not sure whether you want drugs or therapy, or you don't have a diagnosis, or one that you trust? Do you need more information before you can decide what to do?
Do you need to find a doctor?
Do you need immediate help/supervision? (If you do, the rest of this will probably not be very helpful. Call a friend, family member, your doctor, a local or national suicide hotline, call someone, and figure out what to do from there.)
These are the big steps, but they break down nicely into smaller steps.
So here, in no particular order, are the answers to some questions, and some things that you can do.
Should I try prescription drugs to treat my mental illness?
I can't tell you that. That's a decision you have to make based on advice from your doctor and your own personal preferences.
I will say that some people really need them, and that there is nothing wrong with that, any more than there is something wrong with needing to take a drug to make your heart work properly or a drug to stop the pain of a broken leg. It doesn't make you a weak person!
I will also say that some people can get along without them, and that this is not a better or worse choice than taking drugs. People who can go without are not stronger than people who cannot. They are just different people who have an option that a lot of folks don't. Which in no way obligates anyone to take advantage of that option. I'm just saying it’s there.
And, last, I will say that drugs are scary, yes. But when they work, they are so very much worth the trouble. I personally do believe that people should be less afraid of trying this approach.
However, I also believe that people should be less afraid to abandon an approach that isn't working for them, whether that approach is taking drugs, or avoiding them.
Will drugs change me?
These drugs will affect you. That is what they are meant to do.
If you've always been ill, your new state of mind may feel unfamiliar and scary. Totally understandable. Even positive change is hard. Try to remember that, because it's easy to forget.
Ideally, drugs help bolster you enough so that you are yourself, only more capable, more on an even keel. This is the goal, no matter how you are trying to achieve it.
Drugs shouldn't cause negative changes in your personality. If they do, that's bad, and you should consider going off that drug. I am obligated to tell you not to do this without talking to your doctor because there may be side effects to discontinuation. As these side effects can include sudden seizures, feeling like complete shit, and smelling weird and horrible things for no reason (hey, depends on what drug you're on; two of those happened to me), discontinuation is nothing to fuck around with.
Anyway. Nobody with an ounce of sense or empathy would expect you to stay on drugs that truly turned you into a more unhappy person, when the goal is to make you a more content person. (Note: not a better person!)
Bottom line: you'll still be you. If you feel like not-you (the way I did on a particularly soporific drug), that's a legitimate problem. Negative changes in your selfitude are not desirable changes, and you do not have to accept them.
And remember this: the drugs won't make you into a worse person, or into a better person. They can't. There's nothing wrong with you as a person right now, right this minute. How can they make you a better person if this condition doesn't make you a bad one? How can they make you a worse person if there is not a better kind of person to be? Your brain might be doing some nasty shit to you, it may be making you unable to do much of anything right now, it would probably be easier and "better" to not have this problem at all, but that in no way diminishes your value as a human being, or makes you worse than anyone else.
You are more than your illness, your drugs, your side effects. These things are important parts of you and your experience, they are not all of you. It can be easy to forget that, early on, but try to remember it.
But who would I be without my mental illness?
You. You'd be you whether you had never had it or whether you treat it so that it no longer harms you. You might be different, but trust me, the fundamental pillars of what make you you, those are really unlikely to change. Don't be afraid of losing your sense of self. If that starts happening, something's wrong. That is not supposed to happen, and you don't have to accept it.
Will I still be able to feel anything?
Ideally, absolutely, yes, but that depends on you and on the drug.
Enter the world's most awkward metaphor. Please bear with me.
Think of your feelings like a box in your head. Your head box has a floor, which is the worst you are able to feel, ever, and it has a ceiling, which is the best you are able to feel, ever. You are happier with more head room. When the floor is too low, you feel like crap. That's depression. If your floor is too low and you have a really high ceiling, that can be like bipolar I. (It's a crappy metaphor, but also flexible!)
So. Different people have different sized and shaped head boxes.
Meds are like a NEW box that fit inside, over, around, or through your current head box.
They can be bigger or smaller than your head box, and they can have a floor or ceiling that is higher or lower than your head box. So when you take meds, you are in BOTH boxes. If the meds have a higher floor than your box, to keep you from reaching the bottom of your box, that is good. Sometimes, though, the meds have a lower ceiling than your box, which means that it can feel like they've capped off your positive feelings, too (Prozac did that to me). And sometimes, the meds have a ceiling so high it pulls the top off your head box, and you find yourself in some kind of manic state from being too up, which is bad.
Finding the right drug is a process of finding a box that has a better floor than yours, and a high enough ceiling that you aren't too cramped, but not so high that you have no roof over your head.
You don't have to settle for a box that is too small right off the bat. It could be that, eventually, you conclude that your best option really is a drug that keeps you from having the high highs. That happens sometimes. Sometimes the only box you can find that really works has a less than ideal ceiling or floor, but it's not a given that this will be the case. There are a lot of boxes out there. Be prepared to make the best of whatever boxes you try, but when you're starting out, don't assume any box you try is the best you can find. If it makes you unhappy, try something else. You can almost always go back to the box that almost-sorta worked.
Will I still be creative?
Some people do experience creative blocks on certain drugs. It isn't guaranteed, and again, you can try a different drug if this happens. Creativity is a valid concern. My doctor is a great guy, and he knows that I need to be creative to feel good. Other doctors may not be as understanding, so you may have to defend your boundaries here, but they are worth defending.
Creativity is not what I would personally consider an acceptable loss, long-term. Not writing is better than being dead, but only just, and only because I know that I might eventually live to write again (and so far, I've been right about that).
If you find a drug that works for you, you will actually have more energy to devote to creative efforts because you won't just be trying to hold yourself steady. When you are mentally ill, a huge amount of your energy goes into maintaining your mind and your body and defending your equilibrium.
Have you ever ridden a horse? (It's pretty cool, if you're into that kind of thing.) You have to use muscles you didn't even know you had to stay balanced in the saddle, and it's way more exhausting than sitting on a saddle that isn't moving.
Being mentally ill is like that. You are using so much energy trying to stay balanced that it exhausts you because your horse is a crazy damn horse. He's cinchy, and he slams his hooves while you're trying to pick them, he tips buckets, he likes to go post-legged in the middle of a nice run, and sometimes he bucks or runs underneath low branches trying to scrape you off or tries to squish you against a tree or a fence or the side of a barn. He's not a mean horse, but he has some Issues.
The drugs calm the horse down. Suddenly, all the energy you were using just to stay in the saddle can be used for all kinds of other things, like communicating with your horse. You and your crazy-ass horse can then go more places, do more things, can gallop or trot or just stand still without it being a constant struggle. Suddenly, you have choices again. The drugs have freed up all this energy, and after a time of healing (hey, your muscles are going to be sore after a ride like that; mine were sore for about two years) you will be able to use that energy creatively. This is the ideal outcome. The wrong drug won't get you there, which is why you keep trying, even if you fall off the horse.
Sorry. Moving away from horses.
I've had creative blocks while drugged and un-drugged, and creative phases while drugged and un-drugged; at this point I think it's safe to say that those had nothing to do with the drugs, and was just my mind collapsing under the weight of the depression and mood swings and bipolar crap. If I had been just a little less familiar with myself, I would have blamed the drugs. I personally think drugs get blamed for this more often than they actually deserve, because the person is speaking from within the healing period that comes after you are stabilized. Creativity that has been driven off by mental illness can take a long time to come back. Mine did. I'm not all better, but it's returning.
The other possibility is that, if you are something like bipolar I, a lot of your creative energy truly for-real is tied up in your manic states, and the drugs used to manage that can affect your creative productivity, either by fucking up your ability to use that energy, or by removing the energy itself. Sometimes you can adjust to this, sometimes you can't. Sometimes it's a sacrifice people are willing to make, sometimes it's not.
This possibility is one of the hardest ones to deal with, both pharmacologically and emotionally, personally. It can feel like a terrible defeat or even a kind of death to lose your creativity. All I can say is that if you are dealing with this kind of creativity, which is a lot like lightning or fire, my advice alone isn't going to cut it. You need support from a damn good professional and you need the company of your own kind. You need to take some time to make the decision that is best for you.
How do I find the right drug? How do I know it's the right one for me? How long should I wait?
This is bolded because it is an absolutely critical part of dealing with doctors that too few people implement:
You need to set conditions for failure!
So many people don't do this. It's so important.
When you start taking a drug, ask the doctor flat out: "How long should I wait after taking this to see if it is working? At what point should I notify you if I am not feeling improvement?" Write that down on a piece of paper if you have to. You need to ask that question!
A lot of drugs take a while to build up in the system. Some don't (the one that actually worked for me didn't). Trying out drugs is basically a weeding-out process of seeing which drugs have side effects bearable enough to stick them out until you can see if the drug is actually working. Is that ideal? No. Is it frustrating as hell? Yes. Is it worth a shot? You bet. And, for me at least, it wasn't as bad as I was afraid it was going to be. And I was afraid.
Trying to find the right drug is daunting to say the least. If you bear down and stick with it, the results are very often worth it. Don't be afraid to demand results. If you reach a point where the drug should be working and you're like "Weeeeeellll, I think this might be working, I don't know, maybe I just suck at self-assessment?" the drug probably isn't helping enough, and you probably need to get on something else. It's okay to make that call. It's okay to try something new.
I wasted months waiting for the meds to "kick in" or start really helping, assuming that it was my problem that it wasn't working out (blaming everything from my weight to not getting enough sleep), when it was really the drugs that were poor matches for me. I was also putting it off because I didn't want to give up a drug that wasn't working but at least wasn't making me worse, in favor of a new drug that might have worse side effects.
When I DID find the right thing, it worked pretty much immediately (Wellbutrin; unlike SSRIs, it doesn't take weeks to build up in your system but pretty much starts acting on your brain chemistry right away). It isn't like that for most people, no. That's not the point. The point is that I walked away from stuff that didn't work at all until I found something that did. It wasn't my first try that wound up working. I wish I had thought to try this drug sooner, but hey, at least I'm on it now!
Ideally, you do this in such a way that you are not paying for new prescriptions all the time, because that can suck like whoa. If your doctor can give you samples, that's ideal.
I won't pretend that money never plays a role in finding a drug. Certainly I tried cheap things first because they were cheap and I am poor. I tried a couple of drugs because my doctor had samples of them on hand. So that's okay to do. Unless the doctor has a powerful conviction that X drug is what you need to take, and you agree with her, it's okay to explore laterally within your price range before moving up the cost ladder.
If you are busted-ass broke, I am sorry. I've been there. You already know you will have fewer options, and you may have to get creative to get what you need. Again, physician samples. If your doctor knows you are poor, it might surprise you how sympathetic and accommodating she can be. (Then again, some doctors are bastards. If you run across this, try not to let it make you feel hopeless and worthless. Angry is a good alternative.)
Obtaining mental health care while poor is a huge barrel of monkeys, though, which I don't want to go into here, so I will give you one good tip and move on.
Once you are on a drug that seems okay to you, Google "prescription assistance program (name of drug) (name of manufacturer)" and see if you can find a way to get them for cheap or for free. It's worth investigating.
Folks, I encourage you to offer your advice on getting treatment while poor in comments.
I have a prescription. Now what?
You fill it or you take your samples home. You follow your doctor's directions and take it, and you research the shit out of it. Which you do first depends on you. If you find anything that raises questions or concerns your doctor didn't cover, it's okay to call her.
I'm a little concerned about telling people to do this, as there is basically enough negative information out there about any drug to scare someone off it, especially because people who really don't want to be on drugs will often latch onto this as an excuse to dig up any information that lets them feel comfortable declining the drug. (I have done that, by the way, and I am not accusing or saying that those people are bad and wrong, just that this is a tendency you should watch out for in yourself because it can turn self-defeating really fast.)
I firmly believe, however, that you should look into all drugs your doctor gives you, from antibiotics to psych meds, so that you can be aware of possible interactions, and also so that you never take a drug unnecessarily: antibiotics for a viral infection, a drug to counteract side effects of a drug that you could switch out for another that would work just as well. Best case scenario, you are managing your condition effectively while on as few drugs as humanly possible.
Note I say "managing" in the sense of "I have brought this bitch to heel," not "managing" in the sense of "the dog is taking me for a drag." I say this because a lot of medical professionals and a lot of people seeking treatment tend to medicate to the lowest threshold of functionality and stop there, which is an approach that does not actually help much over the long term. (You chronic pain people will know what I mean.)
So, while you want to keep the number of drugs you are on down, don't feel bad if it takes a high number to do it.
A casual scholarly interest in different drugs never hurt anyone. You never know when you will learn something you will need to know later. I spend a lot of time reading about meds that I will probably never take. That knowledge has helped me a great deal, though, on other occasions.
Yeah, what about side effects?
They can suck.
Again, set conditions for failure.
Talk to your doctor about potential side effects so that you know what to look for. Also ask how long you can expect them to last. If the side effects haven't disappeared by X date, then you can safely assume that they won't. You need to find the value of X.
Ask your doctor what side effects mean you should stop taking it immediately.
This is really important. For instance, tingling in the limbs or unexplained twitching can be a sign that it's affecting your nervous system. If you keep taking the drugs, the effects might be permanent. You need to be aware of the risks, and what the signs of those risks are.
If you have mild side effects, you will need to decide whether it's worth it. If the drug is working well and you expect the side effects to be transitory, or if they aren't so bad you can't live with them, they you might decide to continue. If the side effects are too horrible in the short term or long term, you may take another drug to control the side effects (not ideal) or move on to another drug.
If your side effects are too unbearable for you to deal with, that's okay!
It doesn't reflect badly on you!
Also, your doctor is not you. Only you know how you feel, and only you know what is too much for you to handle.
Listen to yourself. It's very easy, when you are vulnerable in this way, newly diagnosed or newly seeking treatment, or even at any other time while living with a mental illness, it can be easy for people to make you question your own judgment. You are the crazy one, after all. Don't fall for this trick. Your doctor doesn't know better about everything. Your body and how you feel is an area in which she is going to be particularly inexperienced. Yes, you ARE the crazy one. That makes you the expert on you.
Psychiatrist or psychologist?
This part is even more my opinion and limited by my experience than the rest. Be aware of that while reading.
So. You need a diagnosis and maybe you need meds and/or therapy.
A psychiatrist can prescribe things, and make a diagnosis. They are good people to see. If you need to get a diagnosis and a plan of action in the same place, these are the people you need to talk to. Especially if you suspect your problem is more complicated to diagnose than unipolar depression, or if you are having multiple linked conditions, like anxiety, panic attacks, depression, and some compulsive behavior.
Do not be afraid to pursue an actual diagnosis rather than just treating whatever is ailing you with drugs and hoping it behaves itself like whatever it is you were hoping you had.
Remember that a diagnosis doesn't change who you are. You are the same person you were the day before. You are you. That cannot be taken away from you by an entry in the DSM. It can make you feel like shit for a while, no lie, but a diagnosis is not about who you are in your heart of hearts. You already know that person. The diagnosis doesn't change her, only her perception of her future, which is, admittedly, suddenly more complicated and frustrating, but now also contains the possibility of possible effective treatment, which was not a likelihood before. A diagnosis is a good and helpful thing. (Personally; there can be times when having one is a liability insurance-wise or socially. I will not address that here. If you are in that situation, you likely know it already.)
If you have a primary care physician who can prescribe you crazy meds, you may be able to do with a psychologist, who in my experience are more like therapists, or maybe you can do with just a therapist. I saw a psychologist for a number of years as a teenager, not a therapist. I liked him immensely. I saw a psychiatrist every once in a while to get the drugs, and I didn't know him very well, but that was okay. He was getting reports from my psychologist, we would talk about symptoms that could be altered/controlled with drugs, and he would work on it from that angle.
Right now, my regular doc prescribes my drugs and I only see a therapist, and I like both of them immensely.
There are a lot of arrangements that can work, and no one perfect way to go about it. Okay. Not true. Doing ANYTHING rather than NOTHING is the best way.
If you have no insurance, in my opinion, you will definitely want either a really, really competent GP, or a psychiatrist. You will need diagnosis and prescription in one place, preferably in a minimum of visits. Make sure that both office staff and the doctor herself understand that you don't have insurance, and that you need to do this as efficiently as possible. I don't know what rates are for docs in other locales are like, but here, you can expect to pay about $150 for a visit. In my opinion, it's worth it if you can get the money.
Call and ask about their rates. Some places have a sliding scale. Many states or cities have programs that you might qualify for. For example, my city has special low-cost counseling available for women, there are often benefits extended to parents, and there's special crisis counseling for teens. Google-fu comes in handy here. Also, your phone book, which will often list available services of this kind.
If you don't qualify, that truly sucks, and I'm so sorry. I have been there, and I am pissed off on your behalf, believe me. If you do qualify, don't be afraid to use the service just because it's not fair - and it isn't - that it's not available to all. I am not going to glare at you from across time and space for getting help I couldn't get because I don't have children. I am glaring at insurance companies, who are the real villains in most stories of this kind. You go get help! Shoo!
Turning help away because you genuinely don't need it is fine. Don't ever turn down help on the basis that "someone else needs it more" unless that person is, like, your critically ill child or something, where self-sacrifice is not entirely self-defeating.
Turning help away because you don't feel like you are sick or hurt or fucked up enough to deserve or need it is a strong indicator that you really do need it. If nothing else, remember I said so, and trust me on that. Take what help you are offered. For a while, while you are getting this under control and learning to live with it, you literally are the most important person in the world, and you have my permission to treat yourself that way until you are stable and feeling much better. A certain amount of selfishness - or "enlightened self-interest" - is both helpful and necessary to recovery. You have to be willing to take help, set boundaries, say no, and ask for what you want.
Those things are really, really hard. I know. Believe me, I know. Just . . . never ever ever use your own perceived unworthiness as an excuse not to do those things. You're worth it, you deserve it.
How do I find a psychiatrist/therapist/doctor?
Finding a good one can be hard; I had to rely heavily on the friend network and luck. The person recommended to me by a friend of a friend was booked, but I asked him if he had any recommendations, and he gave me a couple of other names, one of whom is my therapist now.
Ask your primary care doc who they would recommend, if you have one. Also, ask them who they would avoid. Not all doctors will tell you this, but some will, and it's worth asking. Listen carefully. Some might warn you off of getting treatment at a particular clinic, for instance. Ask your friends, too.
Google names. You might be surprised by what you can find, and if it's negative, you've dodged a bullet.
If you don't have connections, call around. It sucks to have to do, but it pays off. Specifically, request that you talk to the person before the appointment. Paint this as a good thing: you don't want to waste the staff or doctor's time, and a five minute phone call can save them time and frustration, and you money. If they can't afford the time to take a five minute call, they may not be able to afford to take on a new patient. Keep that in mind.
When a doctor doesn't get back to you, bump them to the bottom of the list - don't necessarily check them off - and investigate a couple other possibilities. Don't just wait for a call that may not come. You could wait weeks, or forever. Keep moving! Them not calling has absolutely nothing to do with you, I swear. There is not a secret email bulletin that goes out to all mental health professionals that says "Let's all fuck with Naamah this week and not return her calls." It can seem this way! But with doctors, never attribute to malice what can be explained by either 1) busy-ness or 2) stupidity.
It's not a given that a doctor whose office staff is slow to return calls and get stuff done is a bad doctor. It IS a given that dealing with office staff like that will make getting the help you need a lot harder. Don't be afraid to pass up a doctor because of accessibility issues with his staff. In my experience, you can't get the doc's staff to work any faster, even if you complain to him, so you are pretty much going to be stuck with things the way they are. Be aware of that. Some doctors are worth administrative incompetence. Mine is worth it. Some aren't.
When you get that call and can finally talk to a prospective psychiatrist or -ologist or therapist, lay it all out. "Hey, look, I don't want to waste your time, so do you have a problem working with a kinky atheist bisexual pornographer who doesn't believe that any of those things are a problem necessitating treatment?"
Sound scary and embarrassing? It kind of is (also, kind of awesome to just throw down the gauntlet like that). Is it worth it? Absofuckinglutely. It's still kind of a crapshoot, as they may have biases they aren't aware of, but it can help weed the most undesirable people out.
You may find it helps to have a friend or family member to help with the calling, or take it over altogether. I certainly needed this. That's okay. Don't be afraid to ask for help, here!
I know I need drugs. How can I make the process of selecting one easier on me and my doctor?
Go in armed with some basic knowledge.
Look into the various drug classes. There are many, but the most common are SSRIs, SNRIs, tricyclics, and Wellbutrin, which is in a class of its own and merits mentioning both because it's effective in a unique way and because it is prescribed very often.
The Wikipedia page on antidepressants is pretty good for just basic information and links to individual classes. You want to understand what the classes are and roughly how they work and what they are prescribed for. You need to know this so that you will know if you are being prescribed something wildly inappropriate.
For instance, if you are or suspect you are bipolar, an SSRI is probably not the way to go. It's fine to take a drug off-label if the doctor prescribes it that way, but you at least need to know that the drug is not contra-indicated for your condition.
Spend some time familiarizing yourself with a couple of drugs in each class, the potential side effects, the usual benefits.
Crazymeds (http://www.crazymeds.us/) is a great resource.
If there are drugs that you have particular concerns about taking (there were a few I vetoed before even going to the doctor; lithium was one of those because I could not afford the blood tests, as was Depakote, because I didn't like what I had read about it, or seen personally in friends who took it), note those.
If there are some that sound pretty good to you, note those, too. I made a list before I went in to see my primary care doc when I decided to seek help for what I figured was probably bipolar disorder. I gave my doctor the list, and while he didn't end up prescribing me anything on it, it was a conversation starter, and it paved the way for the next thing I did, which was to ask him to give me a choice between two or three other drugs.
I did this so that I could do my research, call him back, and get a scrip for the drug that sounded least horrible. If that didn't work, I would move to the next on the list. That was my plan. (See "Have a Plan!") He actually turned out to be knowledgeable enough that I felt confident making a decision right there in the office.
Was it the right drug? No! It took at least three more. Was it the right approach? It made me feel safe and in control, so, yes. It was the right approach. Anything that makes you feel safe and in control, or at least less stressed out, is a good approach, as long as it doesn't involve bloodshed or inappropriate use of farm animals or other felony-type activities.
Last, you can ask for recommendations from friends. I don't recommend doing this first or relying on it much, maybe unless you are asking friends with conditions very much like yours, or family members, or friends or family members who have some appropriate medical experience and can actually give you more than personal anecdotes.
Why don't I recommend this?
Because you will find people who had horrible experiences with every drug you can think of, and you will find people who have had wonderful experiences with those same drugs. You will get a lot of really interesting information, but it will take you next to nowhere. And after a while, the anecdata and oft-accompanying stories of woe become exhausting to read.
Remember that other people seeking treatment, even those with the same thing you have, are not YOU.
Nothing they say is guaranteed to be true for you.
I found it more helpful to ask for advice about general drugs for my condition and advice about my condition, than to ask about specific drugs.
This drug/doctor/therapist isn't working, and I want to bail.
Good! Good for you. Seriously. It's a GOOD thing, and rarer than you would think, to be able to recognize when something isn't working, and to make the decision - sometimes scary decision - to try something new.
But you were thinking more of a way to, you know, do that, weren't you?
The truth is that treatment does involve trial and error. This can suck wild goat balls, but if you are prepared for it (See: Have A Plan!) it is SO much less sucky! (Unlike sucking actual wild goat balls, which I find hard to believe would improve with planning. Please do not disabuse me of this notion with first person anecdotes. No, on second thought, do. That is fucking hilarious.)
You can pretty much count on a couple of false starts. (Which is fine, by the way. I promise it doesn't mean you're a weak or stupid person, and I promise it doesn't mean that you have no options and nothing will ever work and you are worthless and might as well go lie under a rock until you mummify into something slightly more interesting.)
I'd like to promise you that you will find something that works quickly, but I can't. Sometimes it takes a really long time. If you are just now getting diagnosed and trying drugs, don't think about that. At least, try not to. Worrying about that will only make this harder. Are your odds 100%? No. But they are a lot better than you think they are right now, that I do guarantee. And you know what? Just the act of getting help and actually engaging in problem-solving can make it so much easier to bear the trial-and-error phase. Like, way more than you would think.
Failures often contain information that you can use. For instance, the consistent failure of drugs that alter serotonin levels to work on me helped point the way to a deficiency in dopamine. Once treated for that, I began to improve quickly. Does failure lead to success? Not really, not directly. Does failure lead to information? Often. Does information lead to success? Also often. There you have it.
If a drug doesn't work or a doctor or therapist is not working out for you, hey, that is a failure of the interaction between you and that thing, a process you have virtually no control over. It is not a failure of you, personally, because of something you did or did not do.
It is likely there will be failures. So, be prepared to say, at some point, "I need to try a different drug now," or "I am not sure this treatment is helpful, after all." Don't even be afraid to say "I am questioning my diagnosis" if you have to. I was wrongly diagnosed with recurrent depression because I'm bipolar II, and they look similar. While I had the diagnosis of depression, I did not improve. It took a while after being diagnosed as bipolar to improve, but it did happen.
You aren't helpless here. You actually have a lot of control over what happens even if you can't control what is wrong or what a given drug does or does not do. And part of that control is the ability to walk away. To stop treatment.
While practical considerations such as no insurance, living in a small town, being poor, having a rare condition, and so on may mean you have fewer options or only crappy ones, always remember that you, personally, you, morally, are not obligated to stay with any drug, any doctor, any plan of treatment, even if you must, practically. Do not be afraid to do this if you feel it is necessary! If you want to walk away, and you can, DO IT.
Remind yourself of this option early and often!
It may seem silly, but trust me, knowing this deep down makes a huge difference in how in control you feel and how you feel about yourself after your diagnosis, when it's easy to feel like you have no control over anything. It also leads to you getting better treatment, and getting effective treatment much faster.
If you are afraid to walk away, your brain WILL find ways to rationalize staying with a treatment/drug/doctor that is not working. You already invested time and money in this treatment! A part of your brain will want to stay the course, to make that investment pay off. You can see this principle at work in gamblers and people who take too long to bail on bad business deals and folks who rationalize staying with a spouse who treats them like shit. It's just something our brains do, sometimes to our detriment.
So know that your brain will probably come up with absolutely ridiculous excuses to stay. It will assure you these are VERY GOOD reasons. You need to make sure that part of your brain never gains a foothold. It wants to help, it really does, but it doesn't know what it is doing. Keep it where it belongs: leash it and use its tenacity and toughness to support you in other areas, helping you pull through. Invest its energy in YOU, not any one thing you are doing. Make how YOU feel the most important thing, not whether or not you are pursuing treatment the Right Way or are being a Good Patient.
Have A Plan!
When I was in the management-intensive phase, shortly after diagnosis, trying to find drugs and therapists and so on, I tried to have a plan at all times, mapped out two steps ahead. It wasn't always easy, and sometimes there was only one step that I could see from where I was, and sometimes I failed completely to have a plan at all because I was in pretty rotten shape, but it helped so much, and has helped a lot since then (for more problems than just mental health ones).
The main reason you need a plan is this: it's SO much easier to go to the next step of a plan you've already worked out than to decide where to go while you are in a bad place.
Also, it helps you to feel more in control, and this is a great way to feel. You need to make sure that you feel like you have a choice in your treatment.
Notice what I said there. "Feel like." Yes, you SHOULD have choices. Absolutely. That is the ideal situation. But if you don't really have many choices, you should at least feel like you have them. Is this dishonest? Well, yeah, it is. Does it help? Surprisingly, sometimes it does. It's a useful tool to have at your disposal.
I phrase it like that because I've learned that my stupid lizard brain doesn't always recognize the difference between a false choice and a real one, and if I can trick it, it will sometimes still shut up long enough for me to get on with business.
An example would be offering a fussy, carseat-bound child who wants a snack two things you are pretty sure that she won't accept, and one thing that you want her to accept. Sure, you could tell her that she HAS to take the apple, but she might fight you about it. If you give her a choice, she may not choose the apple, it is true, she might call your bluff and be upset that her choices suck, but often, this works. People feel better and function better when they feel like they have agency. It doesn't even have to be real. The little girl is not sophisticated enough to recognize that the choice is false, and that you are manipulating her.
Is this unfair to her? Well, yes and no. There was only one option you were going to allow, and you presented it in such a way that she can feel content about it because she chose. It's manipulative, it's certainly not a tactic that you want to use every day on other human beings to get your own way, but you saved both of you a confrontation in a confined space where nothing else was really possible.
You and your brain need to avoid confrontation! If your brain feels cornered, it can do all kinds of bizarre and unpleasant things.
Thankfully, your lizard brain is like that little girl, and is frequently incapable of distinguishing between a real choice and a choice like the one above.
If it feels like it made a meaningful choice it will quiet down and you will feel a lot safer and in control. It's easier to have hope and to slog through the hard part if you keep reassuring yourself that you do have other options. Which you nearly always do, especially early on. If you don't have options, it's worth trying to fool yourself into feeling like a crappy choice is less crappy. It can't hurt. The worst your brain can do is call your bluff, and you start at square one again. Not fun, but you've lost nothing.
This is why having A plan is better than having NO plan, even if your plan is a BAD plan and has only three options, two of which suck.
My point being, have choices, and have a plan for what comes next, and what you will try next if this step doesn't work. Even if that is a crappy plan.
Do that with drugs: know what you will try next.
Do this with your doctors: know when you will see your doctor again. Touch base with her regularly so that you keep communications open; it makes it easier to bring up problems in a timely fashion. Don't just say "When should I come in again?" The answer may be weeks from now, and that may be too long. Also say "When can I call you to check in with you so that you can see I'm safe and I can tell you if everything is okay?" Make sure you can contact your doctor directly in case of a major problem or pressing question or concern.
Don't be afraid to abandon a plan if you suddenly see another path that looks promising. The plan's purpose is not to keep you on the straight and narrow. The plan's purpose is to give you confidence, and to give you something to fall back on should you reach a point where you are too tired, frustrated, or scared to make decisions. If you are feeling good, are feeling able to make decisions, and you are confident or at least hopeful, put the plan aside (you can come back to it later) and go on and wander off the path.
Howl!
This process sucks. It takes a great emotional and physical toll sometimes. Sometimes it's depressing, it's hard, it's heartbreaking. You will experience sadness, frustration, denial, grief, desperation, doubt . . . all kinds of powerful feelings. You may also be experiencing relief, which can both help a lot and make the other stuff seem weird or especially gross in comparison, especially when it's happening all at once.
People will tell you to suck it up, remind you that you have to stay focused and determined to get a favorable outcome. They say this because they want to make you stronger, they want you to succeed. (That or they are just assholes, but we'll give most folks the benefit of the doubt.) And to an extent, these people are right. Things are not guaranteed to be okay, and if you don't calm down and take constructive action, they can't be okay. Which is just a little bit like being told that to get to the hospital to have your busted leg set, you have to walk on it.
Maybe it's true, but it's singularly sucky.
So I'm going to remind you of something else. All those feelings, those are part of you. You don't want them controlling you, but you can't just cut them out or wall them off.
It is okay to feel these things. Don't let anyone tell you it isn't. How you feel will change with time. You don't have to force yourself to be cheerful if you don't want to be. There is nothing wrong with having these feelings. They are yours, they are precious, they are powerful.
So, I'm giving you permission to wallow. Ideally, you do this for an hour or a half hour a day, maybe not all at once, and the rest of the time you are aware that things suck, but you aren't currently being hamstrung by how much that hurts. Sometimes you need to do this for longer. Sometimes you have to feel like shit for an entire day. I felt like shit for . . . several weeks. Like it was my job.
And you know what? That's fine. A lot of the time, feelings are like cats. They want to be noticed. They will pester you until you acknowledge them, but then, a lot of the time, they will go away for a while. If you ignore them, they resort to more and more annoying behavior to get your attention.
Paying attention to your feelings and acknowledging that they are there and respecting your right to feel that way is an important part of moving through it. Don't waste time telling yourself that you "shouldn't" feel a certain way.
Whatever you do, set aside time to feel things. Paint, go for a walk, scream into a pillow, go into the park, stroll through the woods, sit in the shower stall with the water running, lock yourself in the bathroom, throw rocks at things, punch something inanimate and sufficiently yielding, lie on the grass outside or lie on the floor just to feel some stillness, pile pillows or cushions on top of yourself if you find the weight comforting, drive somewhere remote and swear, scream, or sing in the car, draw, write, journal. Break. Mend. Howl.
Especially writing. You don't have to be good at writing for it to help you. You don't have to be very good at expressing yourself at all. Likewise with art. No professional skill is required. The important thing is that you let yourself feel and channel these feelings, and release them in a helpful and hopefully harmless way.
You won't need to do this forever. In fact, if you make a habit of it for too long, it can be problematic, and you might generate hard feelings just to be able to release them, you might keep reminding yourself of your wounds, picking them open so that they don't ever heal, but I guarantee you that right now, that's not the problem!
If you take care of yourself, you will know when you can stop doing these things and you will be okay. But first, you have to feel. You simply must.
This is an act of self-acceptance - not acceptance of your illness, but of you, the wild, animal, childlike, untouchable core of you that you must love and take care of now more than ever before. Give it room to express itself sometimes, so that it knows you love it, that you are listening. This sounds really new-agey, and I'm sorry about that, but it is absolutely true. The part of you inside that is scared and freaking out needs to know that you accept it and want to protect it. It - and by extension, you - needs to feel worth protecting, because one of the worst things about illness like this is how easy it is to start to feel "not worth the trouble," "not worth saving," especially if things get difficult and it feels like nobody else wants to help you. "Not worth it" is a terrible lie, and a terribly easy one to tell ourselves.
There's a thing inside you that needs to express itself sometimes, or it breaks out and does ugly things. It is not ugly on its own, it is not unloveable, but you need to learn to live with it, because it is powerful and can be dangerous if mistreated. Let it come out. Show it that you care, and that you accept its presence and want to work with it. Meet it halfway.
Howl.
. . . And with that, I will leave you. I don't think this is adequate, but if I don't post it now, I might never get around to it.
Please link this around or share it with people you think it might help. Twitter, Faceboobs, all that. If you want to friend me, go for it! I never mind comments saying so, but don't feel like you have to ask. I'm good.
A final note: If this gets the traffic I hope it will, I may be slow answering comments and email for a couple days.
This is all stuff that I wish people had said to me just before and after I'd been diagnosed as bipolar: very basic advice for dealing with the time right after diagnosis, or when one is seeking treatment for the first time. This is one of the most densely confusing and frustrating part of being mentally ill: your symptoms are really nasty, and your whole life is upside-down, and you have not yet developed protective routines. You are probably receiving little or no effective treatment. It sucks like Justin Bieber in a wind tunnel.
At this stage people need, above all, to have the confidence to Get Shit Done, and hope is a huge part of that. That's what I'm trying to offer here, so I've tried not to be too heavy. If you want to read discussions of the harder stuff, I discuss that a lot under my lycanthropy tag: lycanthropy. Yes, there's stuff about werewolves in there, mixed in. It's not real hard to tell the difference.
All this is my opinion, and I'm just one person, not a medical authority. The advice here won't apply to every situation or illness or person. If something you read is inapplicable to you and I don't offer an alternative, I'm truly sorry. This is the best I could do, based on my experience. Feel free to offer your own advice in comments so that someone might be able to benefit from it!
People email me a lot for advice, and while I am totally okay with that and while being able to help makes being crazy a little less shitty, I often don't have the resources to deal with these requests in a timely fashion. To that end, I've decided to centralize the advice I tend to give most often so that I can point people here instead of making someone in crisis wait a week for a cogent response. When you are talking about mental health stuff, fast matters.
And, finally, if you need help now, act now. Call a friend, a family member, a doctor, a suicide hotline, email someone you know, write it out, tear up a phone book, stab a pillow, do something. I can't do crisis intervention for people I don't know well. Sometimes I can't do it for people I do know well. I hate to say it so bluntly, but I have my own issues; I'm often flaky and kind of a fuckup. I'm a kindred spirit, sure, but I really can't handle being responsible for another human being. Frankly, it fucking terrifies me. That's why I'm not a parent to anything more complicated than a really annoying cat.
That said, I do care, I care so much about every single person who has to go through this horrible fucking bullshit, which is why I am telling you to take action - any action besides harming yourself (or someone else, but mostly, we are a risk only to ourselves).
That said, on to the good stuff.
Know what you need to achieve.
Here are some things to think about:
Do you know what is actually wrong? Do you need a diagnosis?
Were you diagnosed with something, but suspect you were diagnosed improperly?
Are you okay with taking drugs? (Much of what I say assumes you are, but if you aren't, that's okay, too.)
Do you want some sort of talk therapy?
Do you need guidance to decide what to do? As in, are you not sure whether you want drugs or therapy, or you don't have a diagnosis, or one that you trust? Do you need more information before you can decide what to do?
Do you need to find a doctor?
Do you need immediate help/supervision? (If you do, the rest of this will probably not be very helpful. Call a friend, family member, your doctor, a local or national suicide hotline, call someone, and figure out what to do from there.)
These are the big steps, but they break down nicely into smaller steps.
So here, in no particular order, are the answers to some questions, and some things that you can do.
Should I try prescription drugs to treat my mental illness?
I can't tell you that. That's a decision you have to make based on advice from your doctor and your own personal preferences.
I will say that some people really need them, and that there is nothing wrong with that, any more than there is something wrong with needing to take a drug to make your heart work properly or a drug to stop the pain of a broken leg. It doesn't make you a weak person!
I will also say that some people can get along without them, and that this is not a better or worse choice than taking drugs. People who can go without are not stronger than people who cannot. They are just different people who have an option that a lot of folks don't. Which in no way obligates anyone to take advantage of that option. I'm just saying it’s there.
And, last, I will say that drugs are scary, yes. But when they work, they are so very much worth the trouble. I personally do believe that people should be less afraid of trying this approach.
However, I also believe that people should be less afraid to abandon an approach that isn't working for them, whether that approach is taking drugs, or avoiding them.
Will drugs change me?
These drugs will affect you. That is what they are meant to do.
If you've always been ill, your new state of mind may feel unfamiliar and scary. Totally understandable. Even positive change is hard. Try to remember that, because it's easy to forget.
Ideally, drugs help bolster you enough so that you are yourself, only more capable, more on an even keel. This is the goal, no matter how you are trying to achieve it.
Drugs shouldn't cause negative changes in your personality. If they do, that's bad, and you should consider going off that drug. I am obligated to tell you not to do this without talking to your doctor because there may be side effects to discontinuation. As these side effects can include sudden seizures, feeling like complete shit, and smelling weird and horrible things for no reason (hey, depends on what drug you're on; two of those happened to me), discontinuation is nothing to fuck around with.
Anyway. Nobody with an ounce of sense or empathy would expect you to stay on drugs that truly turned you into a more unhappy person, when the goal is to make you a more content person. (Note: not a better person!)
Bottom line: you'll still be you. If you feel like not-you (the way I did on a particularly soporific drug), that's a legitimate problem. Negative changes in your selfitude are not desirable changes, and you do not have to accept them.
And remember this: the drugs won't make you into a worse person, or into a better person. They can't. There's nothing wrong with you as a person right now, right this minute. How can they make you a better person if this condition doesn't make you a bad one? How can they make you a worse person if there is not a better kind of person to be? Your brain might be doing some nasty shit to you, it may be making you unable to do much of anything right now, it would probably be easier and "better" to not have this problem at all, but that in no way diminishes your value as a human being, or makes you worse than anyone else.
You are more than your illness, your drugs, your side effects. These things are important parts of you and your experience, they are not all of you. It can be easy to forget that, early on, but try to remember it.
But who would I be without my mental illness?
You. You'd be you whether you had never had it or whether you treat it so that it no longer harms you. You might be different, but trust me, the fundamental pillars of what make you you, those are really unlikely to change. Don't be afraid of losing your sense of self. If that starts happening, something's wrong. That is not supposed to happen, and you don't have to accept it.
Will I still be able to feel anything?
Ideally, absolutely, yes, but that depends on you and on the drug.
Enter the world's most awkward metaphor. Please bear with me.
Think of your feelings like a box in your head. Your head box has a floor, which is the worst you are able to feel, ever, and it has a ceiling, which is the best you are able to feel, ever. You are happier with more head room. When the floor is too low, you feel like crap. That's depression. If your floor is too low and you have a really high ceiling, that can be like bipolar I. (It's a crappy metaphor, but also flexible!)
So. Different people have different sized and shaped head boxes.
Meds are like a NEW box that fit inside, over, around, or through your current head box.
They can be bigger or smaller than your head box, and they can have a floor or ceiling that is higher or lower than your head box. So when you take meds, you are in BOTH boxes. If the meds have a higher floor than your box, to keep you from reaching the bottom of your box, that is good. Sometimes, though, the meds have a lower ceiling than your box, which means that it can feel like they've capped off your positive feelings, too (Prozac did that to me). And sometimes, the meds have a ceiling so high it pulls the top off your head box, and you find yourself in some kind of manic state from being too up, which is bad.
Finding the right drug is a process of finding a box that has a better floor than yours, and a high enough ceiling that you aren't too cramped, but not so high that you have no roof over your head.
You don't have to settle for a box that is too small right off the bat. It could be that, eventually, you conclude that your best option really is a drug that keeps you from having the high highs. That happens sometimes. Sometimes the only box you can find that really works has a less than ideal ceiling or floor, but it's not a given that this will be the case. There are a lot of boxes out there. Be prepared to make the best of whatever boxes you try, but when you're starting out, don't assume any box you try is the best you can find. If it makes you unhappy, try something else. You can almost always go back to the box that almost-sorta worked.
Will I still be creative?
Some people do experience creative blocks on certain drugs. It isn't guaranteed, and again, you can try a different drug if this happens. Creativity is a valid concern. My doctor is a great guy, and he knows that I need to be creative to feel good. Other doctors may not be as understanding, so you may have to defend your boundaries here, but they are worth defending.
Creativity is not what I would personally consider an acceptable loss, long-term. Not writing is better than being dead, but only just, and only because I know that I might eventually live to write again (and so far, I've been right about that).
If you find a drug that works for you, you will actually have more energy to devote to creative efforts because you won't just be trying to hold yourself steady. When you are mentally ill, a huge amount of your energy goes into maintaining your mind and your body and defending your equilibrium.
Have you ever ridden a horse? (It's pretty cool, if you're into that kind of thing.) You have to use muscles you didn't even know you had to stay balanced in the saddle, and it's way more exhausting than sitting on a saddle that isn't moving.
Being mentally ill is like that. You are using so much energy trying to stay balanced that it exhausts you because your horse is a crazy damn horse. He's cinchy, and he slams his hooves while you're trying to pick them, he tips buckets, he likes to go post-legged in the middle of a nice run, and sometimes he bucks or runs underneath low branches trying to scrape you off or tries to squish you against a tree or a fence or the side of a barn. He's not a mean horse, but he has some Issues.
The drugs calm the horse down. Suddenly, all the energy you were using just to stay in the saddle can be used for all kinds of other things, like communicating with your horse. You and your crazy-ass horse can then go more places, do more things, can gallop or trot or just stand still without it being a constant struggle. Suddenly, you have choices again. The drugs have freed up all this energy, and after a time of healing (hey, your muscles are going to be sore after a ride like that; mine were sore for about two years) you will be able to use that energy creatively. This is the ideal outcome. The wrong drug won't get you there, which is why you keep trying, even if you fall off the horse.
Sorry. Moving away from horses.
I've had creative blocks while drugged and un-drugged, and creative phases while drugged and un-drugged; at this point I think it's safe to say that those had nothing to do with the drugs, and was just my mind collapsing under the weight of the depression and mood swings and bipolar crap. If I had been just a little less familiar with myself, I would have blamed the drugs. I personally think drugs get blamed for this more often than they actually deserve, because the person is speaking from within the healing period that comes after you are stabilized. Creativity that has been driven off by mental illness can take a long time to come back. Mine did. I'm not all better, but it's returning.
The other possibility is that, if you are something like bipolar I, a lot of your creative energy truly for-real is tied up in your manic states, and the drugs used to manage that can affect your creative productivity, either by fucking up your ability to use that energy, or by removing the energy itself. Sometimes you can adjust to this, sometimes you can't. Sometimes it's a sacrifice people are willing to make, sometimes it's not.
This possibility is one of the hardest ones to deal with, both pharmacologically and emotionally, personally. It can feel like a terrible defeat or even a kind of death to lose your creativity. All I can say is that if you are dealing with this kind of creativity, which is a lot like lightning or fire, my advice alone isn't going to cut it. You need support from a damn good professional and you need the company of your own kind. You need to take some time to make the decision that is best for you.
How do I find the right drug? How do I know it's the right one for me? How long should I wait?
This is bolded because it is an absolutely critical part of dealing with doctors that too few people implement:
You need to set conditions for failure!
So many people don't do this. It's so important.
When you start taking a drug, ask the doctor flat out: "How long should I wait after taking this to see if it is working? At what point should I notify you if I am not feeling improvement?" Write that down on a piece of paper if you have to. You need to ask that question!
A lot of drugs take a while to build up in the system. Some don't (the one that actually worked for me didn't). Trying out drugs is basically a weeding-out process of seeing which drugs have side effects bearable enough to stick them out until you can see if the drug is actually working. Is that ideal? No. Is it frustrating as hell? Yes. Is it worth a shot? You bet. And, for me at least, it wasn't as bad as I was afraid it was going to be. And I was afraid.
Trying to find the right drug is daunting to say the least. If you bear down and stick with it, the results are very often worth it. Don't be afraid to demand results. If you reach a point where the drug should be working and you're like "Weeeeeellll, I think this might be working, I don't know, maybe I just suck at self-assessment?" the drug probably isn't helping enough, and you probably need to get on something else. It's okay to make that call. It's okay to try something new.
I wasted months waiting for the meds to "kick in" or start really helping, assuming that it was my problem that it wasn't working out (blaming everything from my weight to not getting enough sleep), when it was really the drugs that were poor matches for me. I was also putting it off because I didn't want to give up a drug that wasn't working but at least wasn't making me worse, in favor of a new drug that might have worse side effects.
When I DID find the right thing, it worked pretty much immediately (Wellbutrin; unlike SSRIs, it doesn't take weeks to build up in your system but pretty much starts acting on your brain chemistry right away). It isn't like that for most people, no. That's not the point. The point is that I walked away from stuff that didn't work at all until I found something that did. It wasn't my first try that wound up working. I wish I had thought to try this drug sooner, but hey, at least I'm on it now!
Ideally, you do this in such a way that you are not paying for new prescriptions all the time, because that can suck like whoa. If your doctor can give you samples, that's ideal.
I won't pretend that money never plays a role in finding a drug. Certainly I tried cheap things first because they were cheap and I am poor. I tried a couple of drugs because my doctor had samples of them on hand. So that's okay to do. Unless the doctor has a powerful conviction that X drug is what you need to take, and you agree with her, it's okay to explore laterally within your price range before moving up the cost ladder.
If you are busted-ass broke, I am sorry. I've been there. You already know you will have fewer options, and you may have to get creative to get what you need. Again, physician samples. If your doctor knows you are poor, it might surprise you how sympathetic and accommodating she can be. (Then again, some doctors are bastards. If you run across this, try not to let it make you feel hopeless and worthless. Angry is a good alternative.)
Obtaining mental health care while poor is a huge barrel of monkeys, though, which I don't want to go into here, so I will give you one good tip and move on.
Once you are on a drug that seems okay to you, Google "prescription assistance program (name of drug) (name of manufacturer)" and see if you can find a way to get them for cheap or for free. It's worth investigating.
Folks, I encourage you to offer your advice on getting treatment while poor in comments.
I have a prescription. Now what?
You fill it or you take your samples home. You follow your doctor's directions and take it, and you research the shit out of it. Which you do first depends on you. If you find anything that raises questions or concerns your doctor didn't cover, it's okay to call her.
I'm a little concerned about telling people to do this, as there is basically enough negative information out there about any drug to scare someone off it, especially because people who really don't want to be on drugs will often latch onto this as an excuse to dig up any information that lets them feel comfortable declining the drug. (I have done that, by the way, and I am not accusing or saying that those people are bad and wrong, just that this is a tendency you should watch out for in yourself because it can turn self-defeating really fast.)
I firmly believe, however, that you should look into all drugs your doctor gives you, from antibiotics to psych meds, so that you can be aware of possible interactions, and also so that you never take a drug unnecessarily: antibiotics for a viral infection, a drug to counteract side effects of a drug that you could switch out for another that would work just as well. Best case scenario, you are managing your condition effectively while on as few drugs as humanly possible.
Note I say "managing" in the sense of "I have brought this bitch to heel," not "managing" in the sense of "the dog is taking me for a drag." I say this because a lot of medical professionals and a lot of people seeking treatment tend to medicate to the lowest threshold of functionality and stop there, which is an approach that does not actually help much over the long term. (You chronic pain people will know what I mean.)
So, while you want to keep the number of drugs you are on down, don't feel bad if it takes a high number to do it.
A casual scholarly interest in different drugs never hurt anyone. You never know when you will learn something you will need to know later. I spend a lot of time reading about meds that I will probably never take. That knowledge has helped me a great deal, though, on other occasions.
Yeah, what about side effects?
They can suck.
Again, set conditions for failure.
Talk to your doctor about potential side effects so that you know what to look for. Also ask how long you can expect them to last. If the side effects haven't disappeared by X date, then you can safely assume that they won't. You need to find the value of X.
Ask your doctor what side effects mean you should stop taking it immediately.
This is really important. For instance, tingling in the limbs or unexplained twitching can be a sign that it's affecting your nervous system. If you keep taking the drugs, the effects might be permanent. You need to be aware of the risks, and what the signs of those risks are.
If you have mild side effects, you will need to decide whether it's worth it. If the drug is working well and you expect the side effects to be transitory, or if they aren't so bad you can't live with them, they you might decide to continue. If the side effects are too horrible in the short term or long term, you may take another drug to control the side effects (not ideal) or move on to another drug.
If your side effects are too unbearable for you to deal with, that's okay!
It doesn't reflect badly on you!
Also, your doctor is not you. Only you know how you feel, and only you know what is too much for you to handle.
Listen to yourself. It's very easy, when you are vulnerable in this way, newly diagnosed or newly seeking treatment, or even at any other time while living with a mental illness, it can be easy for people to make you question your own judgment. You are the crazy one, after all. Don't fall for this trick. Your doctor doesn't know better about everything. Your body and how you feel is an area in which she is going to be particularly inexperienced. Yes, you ARE the crazy one. That makes you the expert on you.
Psychiatrist or psychologist?
This part is even more my opinion and limited by my experience than the rest. Be aware of that while reading.
So. You need a diagnosis and maybe you need meds and/or therapy.
A psychiatrist can prescribe things, and make a diagnosis. They are good people to see. If you need to get a diagnosis and a plan of action in the same place, these are the people you need to talk to. Especially if you suspect your problem is more complicated to diagnose than unipolar depression, or if you are having multiple linked conditions, like anxiety, panic attacks, depression, and some compulsive behavior.
Do not be afraid to pursue an actual diagnosis rather than just treating whatever is ailing you with drugs and hoping it behaves itself like whatever it is you were hoping you had.
Remember that a diagnosis doesn't change who you are. You are the same person you were the day before. You are you. That cannot be taken away from you by an entry in the DSM. It can make you feel like shit for a while, no lie, but a diagnosis is not about who you are in your heart of hearts. You already know that person. The diagnosis doesn't change her, only her perception of her future, which is, admittedly, suddenly more complicated and frustrating, but now also contains the possibility of possible effective treatment, which was not a likelihood before. A diagnosis is a good and helpful thing. (Personally; there can be times when having one is a liability insurance-wise or socially. I will not address that here. If you are in that situation, you likely know it already.)
If you have a primary care physician who can prescribe you crazy meds, you may be able to do with a psychologist, who in my experience are more like therapists, or maybe you can do with just a therapist. I saw a psychologist for a number of years as a teenager, not a therapist. I liked him immensely. I saw a psychiatrist every once in a while to get the drugs, and I didn't know him very well, but that was okay. He was getting reports from my psychologist, we would talk about symptoms that could be altered/controlled with drugs, and he would work on it from that angle.
Right now, my regular doc prescribes my drugs and I only see a therapist, and I like both of them immensely.
There are a lot of arrangements that can work, and no one perfect way to go about it. Okay. Not true. Doing ANYTHING rather than NOTHING is the best way.
If you have no insurance, in my opinion, you will definitely want either a really, really competent GP, or a psychiatrist. You will need diagnosis and prescription in one place, preferably in a minimum of visits. Make sure that both office staff and the doctor herself understand that you don't have insurance, and that you need to do this as efficiently as possible. I don't know what rates are for docs in other locales are like, but here, you can expect to pay about $150 for a visit. In my opinion, it's worth it if you can get the money.
Call and ask about their rates. Some places have a sliding scale. Many states or cities have programs that you might qualify for. For example, my city has special low-cost counseling available for women, there are often benefits extended to parents, and there's special crisis counseling for teens. Google-fu comes in handy here. Also, your phone book, which will often list available services of this kind.
If you don't qualify, that truly sucks, and I'm so sorry. I have been there, and I am pissed off on your behalf, believe me. If you do qualify, don't be afraid to use the service just because it's not fair - and it isn't - that it's not available to all. I am not going to glare at you from across time and space for getting help I couldn't get because I don't have children. I am glaring at insurance companies, who are the real villains in most stories of this kind. You go get help! Shoo!
Turning help away because you genuinely don't need it is fine. Don't ever turn down help on the basis that "someone else needs it more" unless that person is, like, your critically ill child or something, where self-sacrifice is not entirely self-defeating.
Turning help away because you don't feel like you are sick or hurt or fucked up enough to deserve or need it is a strong indicator that you really do need it. If nothing else, remember I said so, and trust me on that. Take what help you are offered. For a while, while you are getting this under control and learning to live with it, you literally are the most important person in the world, and you have my permission to treat yourself that way until you are stable and feeling much better. A certain amount of selfishness - or "enlightened self-interest" - is both helpful and necessary to recovery. You have to be willing to take help, set boundaries, say no, and ask for what you want.
Those things are really, really hard. I know. Believe me, I know. Just . . . never ever ever use your own perceived unworthiness as an excuse not to do those things. You're worth it, you deserve it.
How do I find a psychiatrist/therapist/doctor?
Finding a good one can be hard; I had to rely heavily on the friend network and luck. The person recommended to me by a friend of a friend was booked, but I asked him if he had any recommendations, and he gave me a couple of other names, one of whom is my therapist now.
Ask your primary care doc who they would recommend, if you have one. Also, ask them who they would avoid. Not all doctors will tell you this, but some will, and it's worth asking. Listen carefully. Some might warn you off of getting treatment at a particular clinic, for instance. Ask your friends, too.
Google names. You might be surprised by what you can find, and if it's negative, you've dodged a bullet.
If you don't have connections, call around. It sucks to have to do, but it pays off. Specifically, request that you talk to the person before the appointment. Paint this as a good thing: you don't want to waste the staff or doctor's time, and a five minute phone call can save them time and frustration, and you money. If they can't afford the time to take a five minute call, they may not be able to afford to take on a new patient. Keep that in mind.
When a doctor doesn't get back to you, bump them to the bottom of the list - don't necessarily check them off - and investigate a couple other possibilities. Don't just wait for a call that may not come. You could wait weeks, or forever. Keep moving! Them not calling has absolutely nothing to do with you, I swear. There is not a secret email bulletin that goes out to all mental health professionals that says "Let's all fuck with Naamah this week and not return her calls." It can seem this way! But with doctors, never attribute to malice what can be explained by either 1) busy-ness or 2) stupidity.
It's not a given that a doctor whose office staff is slow to return calls and get stuff done is a bad doctor. It IS a given that dealing with office staff like that will make getting the help you need a lot harder. Don't be afraid to pass up a doctor because of accessibility issues with his staff. In my experience, you can't get the doc's staff to work any faster, even if you complain to him, so you are pretty much going to be stuck with things the way they are. Be aware of that. Some doctors are worth administrative incompetence. Mine is worth it. Some aren't.
When you get that call and can finally talk to a prospective psychiatrist or -ologist or therapist, lay it all out. "Hey, look, I don't want to waste your time, so do you have a problem working with a kinky atheist bisexual pornographer who doesn't believe that any of those things are a problem necessitating treatment?"
Sound scary and embarrassing? It kind of is (also, kind of awesome to just throw down the gauntlet like that). Is it worth it? Absofuckinglutely. It's still kind of a crapshoot, as they may have biases they aren't aware of, but it can help weed the most undesirable people out.
You may find it helps to have a friend or family member to help with the calling, or take it over altogether. I certainly needed this. That's okay. Don't be afraid to ask for help, here!
I know I need drugs. How can I make the process of selecting one easier on me and my doctor?
Go in armed with some basic knowledge.
Look into the various drug classes. There are many, but the most common are SSRIs, SNRIs, tricyclics, and Wellbutrin, which is in a class of its own and merits mentioning both because it's effective in a unique way and because it is prescribed very often.
The Wikipedia page on antidepressants is pretty good for just basic information and links to individual classes. You want to understand what the classes are and roughly how they work and what they are prescribed for. You need to know this so that you will know if you are being prescribed something wildly inappropriate.
For instance, if you are or suspect you are bipolar, an SSRI is probably not the way to go. It's fine to take a drug off-label if the doctor prescribes it that way, but you at least need to know that the drug is not contra-indicated for your condition.
Spend some time familiarizing yourself with a couple of drugs in each class, the potential side effects, the usual benefits.
Crazymeds (http://www.crazymeds.us/) is a great resource.
If there are drugs that you have particular concerns about taking (there were a few I vetoed before even going to the doctor; lithium was one of those because I could not afford the blood tests, as was Depakote, because I didn't like what I had read about it, or seen personally in friends who took it), note those.
If there are some that sound pretty good to you, note those, too. I made a list before I went in to see my primary care doc when I decided to seek help for what I figured was probably bipolar disorder. I gave my doctor the list, and while he didn't end up prescribing me anything on it, it was a conversation starter, and it paved the way for the next thing I did, which was to ask him to give me a choice between two or three other drugs.
I did this so that I could do my research, call him back, and get a scrip for the drug that sounded least horrible. If that didn't work, I would move to the next on the list. That was my plan. (See "Have a Plan!") He actually turned out to be knowledgeable enough that I felt confident making a decision right there in the office.
Was it the right drug? No! It took at least three more. Was it the right approach? It made me feel safe and in control, so, yes. It was the right approach. Anything that makes you feel safe and in control, or at least less stressed out, is a good approach, as long as it doesn't involve bloodshed or inappropriate use of farm animals or other felony-type activities.
Last, you can ask for recommendations from friends. I don't recommend doing this first or relying on it much, maybe unless you are asking friends with conditions very much like yours, or family members, or friends or family members who have some appropriate medical experience and can actually give you more than personal anecdotes.
Why don't I recommend this?
Because you will find people who had horrible experiences with every drug you can think of, and you will find people who have had wonderful experiences with those same drugs. You will get a lot of really interesting information, but it will take you next to nowhere. And after a while, the anecdata and oft-accompanying stories of woe become exhausting to read.
Remember that other people seeking treatment, even those with the same thing you have, are not YOU.
Nothing they say is guaranteed to be true for you.
I found it more helpful to ask for advice about general drugs for my condition and advice about my condition, than to ask about specific drugs.
This drug/doctor/therapist isn't working, and I want to bail.
Good! Good for you. Seriously. It's a GOOD thing, and rarer than you would think, to be able to recognize when something isn't working, and to make the decision - sometimes scary decision - to try something new.
But you were thinking more of a way to, you know, do that, weren't you?
The truth is that treatment does involve trial and error. This can suck wild goat balls, but if you are prepared for it (See: Have A Plan!) it is SO much less sucky! (Unlike sucking actual wild goat balls, which I find hard to believe would improve with planning. Please do not disabuse me of this notion with first person anecdotes. No, on second thought, do. That is fucking hilarious.)
You can pretty much count on a couple of false starts. (Which is fine, by the way. I promise it doesn't mean you're a weak or stupid person, and I promise it doesn't mean that you have no options and nothing will ever work and you are worthless and might as well go lie under a rock until you mummify into something slightly more interesting.)
I'd like to promise you that you will find something that works quickly, but I can't. Sometimes it takes a really long time. If you are just now getting diagnosed and trying drugs, don't think about that. At least, try not to. Worrying about that will only make this harder. Are your odds 100%? No. But they are a lot better than you think they are right now, that I do guarantee. And you know what? Just the act of getting help and actually engaging in problem-solving can make it so much easier to bear the trial-and-error phase. Like, way more than you would think.
Failures often contain information that you can use. For instance, the consistent failure of drugs that alter serotonin levels to work on me helped point the way to a deficiency in dopamine. Once treated for that, I began to improve quickly. Does failure lead to success? Not really, not directly. Does failure lead to information? Often. Does information lead to success? Also often. There you have it.
If a drug doesn't work or a doctor or therapist is not working out for you, hey, that is a failure of the interaction between you and that thing, a process you have virtually no control over. It is not a failure of you, personally, because of something you did or did not do.
It is likely there will be failures. So, be prepared to say, at some point, "I need to try a different drug now," or "I am not sure this treatment is helpful, after all." Don't even be afraid to say "I am questioning my diagnosis" if you have to. I was wrongly diagnosed with recurrent depression because I'm bipolar II, and they look similar. While I had the diagnosis of depression, I did not improve. It took a while after being diagnosed as bipolar to improve, but it did happen.
You aren't helpless here. You actually have a lot of control over what happens even if you can't control what is wrong or what a given drug does or does not do. And part of that control is the ability to walk away. To stop treatment.
While practical considerations such as no insurance, living in a small town, being poor, having a rare condition, and so on may mean you have fewer options or only crappy ones, always remember that you, personally, you, morally, are not obligated to stay with any drug, any doctor, any plan of treatment, even if you must, practically. Do not be afraid to do this if you feel it is necessary! If you want to walk away, and you can, DO IT.
Remind yourself of this option early and often!
It may seem silly, but trust me, knowing this deep down makes a huge difference in how in control you feel and how you feel about yourself after your diagnosis, when it's easy to feel like you have no control over anything. It also leads to you getting better treatment, and getting effective treatment much faster.
If you are afraid to walk away, your brain WILL find ways to rationalize staying with a treatment/drug/doctor that is not working. You already invested time and money in this treatment! A part of your brain will want to stay the course, to make that investment pay off. You can see this principle at work in gamblers and people who take too long to bail on bad business deals and folks who rationalize staying with a spouse who treats them like shit. It's just something our brains do, sometimes to our detriment.
So know that your brain will probably come up with absolutely ridiculous excuses to stay. It will assure you these are VERY GOOD reasons. You need to make sure that part of your brain never gains a foothold. It wants to help, it really does, but it doesn't know what it is doing. Keep it where it belongs: leash it and use its tenacity and toughness to support you in other areas, helping you pull through. Invest its energy in YOU, not any one thing you are doing. Make how YOU feel the most important thing, not whether or not you are pursuing treatment the Right Way or are being a Good Patient.
Have A Plan!
When I was in the management-intensive phase, shortly after diagnosis, trying to find drugs and therapists and so on, I tried to have a plan at all times, mapped out two steps ahead. It wasn't always easy, and sometimes there was only one step that I could see from where I was, and sometimes I failed completely to have a plan at all because I was in pretty rotten shape, but it helped so much, and has helped a lot since then (for more problems than just mental health ones).
The main reason you need a plan is this: it's SO much easier to go to the next step of a plan you've already worked out than to decide where to go while you are in a bad place.
Also, it helps you to feel more in control, and this is a great way to feel. You need to make sure that you feel like you have a choice in your treatment.
Notice what I said there. "Feel like." Yes, you SHOULD have choices. Absolutely. That is the ideal situation. But if you don't really have many choices, you should at least feel like you have them. Is this dishonest? Well, yeah, it is. Does it help? Surprisingly, sometimes it does. It's a useful tool to have at your disposal.
I phrase it like that because I've learned that my stupid lizard brain doesn't always recognize the difference between a false choice and a real one, and if I can trick it, it will sometimes still shut up long enough for me to get on with business.
An example would be offering a fussy, carseat-bound child who wants a snack two things you are pretty sure that she won't accept, and one thing that you want her to accept. Sure, you could tell her that she HAS to take the apple, but she might fight you about it. If you give her a choice, she may not choose the apple, it is true, she might call your bluff and be upset that her choices suck, but often, this works. People feel better and function better when they feel like they have agency. It doesn't even have to be real. The little girl is not sophisticated enough to recognize that the choice is false, and that you are manipulating her.
Is this unfair to her? Well, yes and no. There was only one option you were going to allow, and you presented it in such a way that she can feel content about it because she chose. It's manipulative, it's certainly not a tactic that you want to use every day on other human beings to get your own way, but you saved both of you a confrontation in a confined space where nothing else was really possible.
You and your brain need to avoid confrontation! If your brain feels cornered, it can do all kinds of bizarre and unpleasant things.
Thankfully, your lizard brain is like that little girl, and is frequently incapable of distinguishing between a real choice and a choice like the one above.
If it feels like it made a meaningful choice it will quiet down and you will feel a lot safer and in control. It's easier to have hope and to slog through the hard part if you keep reassuring yourself that you do have other options. Which you nearly always do, especially early on. If you don't have options, it's worth trying to fool yourself into feeling like a crappy choice is less crappy. It can't hurt. The worst your brain can do is call your bluff, and you start at square one again. Not fun, but you've lost nothing.
This is why having A plan is better than having NO plan, even if your plan is a BAD plan and has only three options, two of which suck.
My point being, have choices, and have a plan for what comes next, and what you will try next if this step doesn't work. Even if that is a crappy plan.
Do that with drugs: know what you will try next.
Do this with your doctors: know when you will see your doctor again. Touch base with her regularly so that you keep communications open; it makes it easier to bring up problems in a timely fashion. Don't just say "When should I come in again?" The answer may be weeks from now, and that may be too long. Also say "When can I call you to check in with you so that you can see I'm safe and I can tell you if everything is okay?" Make sure you can contact your doctor directly in case of a major problem or pressing question or concern.
Don't be afraid to abandon a plan if you suddenly see another path that looks promising. The plan's purpose is not to keep you on the straight and narrow. The plan's purpose is to give you confidence, and to give you something to fall back on should you reach a point where you are too tired, frustrated, or scared to make decisions. If you are feeling good, are feeling able to make decisions, and you are confident or at least hopeful, put the plan aside (you can come back to it later) and go on and wander off the path.
Howl!
This process sucks. It takes a great emotional and physical toll sometimes. Sometimes it's depressing, it's hard, it's heartbreaking. You will experience sadness, frustration, denial, grief, desperation, doubt . . . all kinds of powerful feelings. You may also be experiencing relief, which can both help a lot and make the other stuff seem weird or especially gross in comparison, especially when it's happening all at once.
People will tell you to suck it up, remind you that you have to stay focused and determined to get a favorable outcome. They say this because they want to make you stronger, they want you to succeed. (That or they are just assholes, but we'll give most folks the benefit of the doubt.) And to an extent, these people are right. Things are not guaranteed to be okay, and if you don't calm down and take constructive action, they can't be okay. Which is just a little bit like being told that to get to the hospital to have your busted leg set, you have to walk on it.
Maybe it's true, but it's singularly sucky.
So I'm going to remind you of something else. All those feelings, those are part of you. You don't want them controlling you, but you can't just cut them out or wall them off.
It is okay to feel these things. Don't let anyone tell you it isn't. How you feel will change with time. You don't have to force yourself to be cheerful if you don't want to be. There is nothing wrong with having these feelings. They are yours, they are precious, they are powerful.
So, I'm giving you permission to wallow. Ideally, you do this for an hour or a half hour a day, maybe not all at once, and the rest of the time you are aware that things suck, but you aren't currently being hamstrung by how much that hurts. Sometimes you need to do this for longer. Sometimes you have to feel like shit for an entire day. I felt like shit for . . . several weeks. Like it was my job.
And you know what? That's fine. A lot of the time, feelings are like cats. They want to be noticed. They will pester you until you acknowledge them, but then, a lot of the time, they will go away for a while. If you ignore them, they resort to more and more annoying behavior to get your attention.
Paying attention to your feelings and acknowledging that they are there and respecting your right to feel that way is an important part of moving through it. Don't waste time telling yourself that you "shouldn't" feel a certain way.
Whatever you do, set aside time to feel things. Paint, go for a walk, scream into a pillow, go into the park, stroll through the woods, sit in the shower stall with the water running, lock yourself in the bathroom, throw rocks at things, punch something inanimate and sufficiently yielding, lie on the grass outside or lie on the floor just to feel some stillness, pile pillows or cushions on top of yourself if you find the weight comforting, drive somewhere remote and swear, scream, or sing in the car, draw, write, journal. Break. Mend. Howl.
Especially writing. You don't have to be good at writing for it to help you. You don't have to be very good at expressing yourself at all. Likewise with art. No professional skill is required. The important thing is that you let yourself feel and channel these feelings, and release them in a helpful and hopefully harmless way.
You won't need to do this forever. In fact, if you make a habit of it for too long, it can be problematic, and you might generate hard feelings just to be able to release them, you might keep reminding yourself of your wounds, picking them open so that they don't ever heal, but I guarantee you that right now, that's not the problem!
If you take care of yourself, you will know when you can stop doing these things and you will be okay. But first, you have to feel. You simply must.
This is an act of self-acceptance - not acceptance of your illness, but of you, the wild, animal, childlike, untouchable core of you that you must love and take care of now more than ever before. Give it room to express itself sometimes, so that it knows you love it, that you are listening. This sounds really new-agey, and I'm sorry about that, but it is absolutely true. The part of you inside that is scared and freaking out needs to know that you accept it and want to protect it. It - and by extension, you - needs to feel worth protecting, because one of the worst things about illness like this is how easy it is to start to feel "not worth the trouble," "not worth saving," especially if things get difficult and it feels like nobody else wants to help you. "Not worth it" is a terrible lie, and a terribly easy one to tell ourselves.
There's a thing inside you that needs to express itself sometimes, or it breaks out and does ugly things. It is not ugly on its own, it is not unloveable, but you need to learn to live with it, because it is powerful and can be dangerous if mistreated. Let it come out. Show it that you care, and that you accept its presence and want to work with it. Meet it halfway.
Howl.
. . . And with that, I will leave you. I don't think this is adequate, but if I don't post it now, I might never get around to it.
Please link this around or share it with people you think it might help. Twitter, Faceboobs, all that. If you want to friend me, go for it! I never mind comments saying so, but don't feel like you have to ask. I'm good.
A final note: If this gets the traffic I hope it will, I may be slow answering comments and email for a couple days.