How To Be a Good Mental Patient, Part 1: Before You’re Medicated

(Note: I am not a medical doctor and cannot give professional advice. All of the following is my opinion, based on my experience as a patient.)

Psychiatric doctors are fascinating people*. They, more than most, are able to understand human consciousness as a function of biology. They see right through the misconception that the mind is greater than what the brain is capable of generating.

And they also have a medical degree, so you should probably listen to them.

 

The questions that are asked in this article are the questions I would have deeply benefitted from knowing the answers to when I first stepped foot into a psychiatrist’s office almost ten years ago. Hopefully, the answers I have provided (which are, at best, all partial) will aid you in your journey toward finding effective psychiatric help.

Q) Will taking psych meds change my personality?

A) The short answer is no.

The longer answer is an analogy. Imagine you’re a kid who’s been playing in mud, and now you’re covered in it head to foot. Do you, the human, cease to exist because you’re coated in an outer layer of muck? Of course not. You’re still there; you’re just obscured by something stuck to you. It isn’t actually a part of you.  

The mud, of course, represents your mental illness; and you represent, y’know, you. Your disease sticks to you like a foreign substance, but isn’t an inherent part of your personality (mostly – but that’s an issue to discuss another time). Underneath it, you are still there, perfectly intact despite being out of view; perhaps just living in the shadow of disease. When you take a shower and the mud washes off, has any part of you fundamentally changed? Not even remotely. You’ve simply scrubbed away the muck that was blocking your eyes, and now you can feel the warmth of the sun again.

The shower represents psychiatric medication. It doesn’t change the nature of who you are. Quite the opposite – it cleans off the part that isn’t you (again, mostly) so that your real personality, intact, can come out and play again.

It’s worth noting that sometimes the shower ends up rinsing you with syrup instead of water – that is, more sticky stuff that covers you up instead of cleaning you off. I’m talking specifically about psychiatric medications that cause personality-clouding side effects, like mania or dissociation, which do occur sometimes when a person is mistakenly overmedicated. However, the mud analogy still applies: you still exist underneath the drugs, and your sense of self can often be excavated (though not always immediately) just by stopping the medication, or at least lowering the dose.

Q) What kinds of things should I tell my doctor?

A) Tell your doctor everything. If you notice new feelings cropping up in your day-to-day life, tell them about it. If your experience of pain changes, tell them about it. Even if you think it’s not a big deal, tell them about it. What may seem like a small moment of the day to you (“I might have gotten a little angrier than I should have” or “I was energetic for no real reason, no big deal”) may turn out to be the defining symptom that illuminates your true diagnosis to your doctor. Sometimes the line separating diseases is razor thin, and it only takes a couple of odd, even seemingly insignificant experiences to push you over the edge into having a particular illness. But your doctor can’t know unless you share those “insignificant” experiences with them.

That being said, it’s also important to manage your time with them wisely. Many prescribing mental health professionals only meet with a patient for 20 minutes at a time once a month, so it’s hopeless to believe you’ll be able to cover everything you feel, think, and do in the detail you might like. If you aren’t allotted much time with your doctor, pick out the highlights (or lowlights) of your month, and be willing to sacrifice some of the less essential details – but don’t censor anything.

Q) What do I do if I’m miserable, but my doctor tells me I’m not actually sick?

A) The good news is, I can answer this question in one word. The bad news is, it’s an extremely loaded, complex, and often expensive word: psychotherapy.

You don’t need a diagnosis to get something out of therapy – in fact, it’s my sturdy belief that everyone could benefit from at least a few sessions, regardless of the nature of their problems, because therapy is designed to handle any kind of problem. That’s partially because the word “therapy” denotes endless schools of thought, from psychodynamics (which emphasizes the role that early childhood experiences may have in your current issues) to cognitive therapy (which aims to correct your problematic thinking) to behavioral therapy (which helps you adjust your behaviors to help you act more effectively). There’s something out there for everyone, whether you lie within the bounds of psychological disease or not. And therapy has been proven to work. There is no doubt about this: in many carefully controlled experiments, those who had been given therapy sessions had a much lower risk of relapse than those who hadn’t.

The downsides of therapy often include its cost and its availability. Private therapists, much like their psychiatrist cousins, often don’t take insurance, so you may end up paying a lot of money per session out of pocket for a good counselor. (Don’t get me wrong: a good therapist is worth that much, if you can swing it.) That’s assuming you can find someone, however: on top of locating a counselor who performs the right kind of therapy for you, there is an imperceptible, essential “click” that must occur between therapist and client. Your personalities and communication styles must sync, or else you may be constantly at odds, or treatment may move very slowly, or even be ineffective.

It may take a long time and many attempts, but finding a therapist is critically important, especially if your problems can’t be soothed with medication.

Q) My loved one is suffering. What medical advice can I give them?

A) None.

Actually, there is one thing you can tell them: See a doctor.

If you are not a doctor, you are not qualified to give medical advice. To anyone. Including yourself. If you do, not only are you taking a legal risk, you are also morally responsible for anything bad that happens to the person you’re advising – again, even if that person is yourself. Don’t start, stop, or change the dose of anything you’re taking without talking to your doctor first. Don’t take anything recreationally before checking with them to make sure there are no interactions between that drug and your prescribed meds. I don’t say this because it’s the “proper” advice. I say this because it’s the only advice (and trust me, I know what a bad time it can be to mix even one drink with psych meds – we’re talking about episodes of paranoid delusions).

Remember above all that doctors know more about medicine than you do. If you’re not sure where to turn in a tough situation, whether it concerns yourself or someone you care about, go to a doctor and let them make the call.**

Q) Aren’t psych meds poisonous/full of water/not as effective as alternative and Eastern medicines?

A) Generally, I’m not one of Theodore Roosevelt’s biggest advocates (game hunting), but his decision to found the Food and Drug Administration is, in my mind, one of the greatest ideas anyone has ever had. The FDA’s purpose is to conduct double-blind, randomized clinical trials that test, test, and retest again the effectiveness and potential hazards of new medicines. I cannot stress enough how many carefully controlled trials a popular drug like a mood stabilizer or an antipsychotic must go through before it is released onto the market. Millions of dollars and many years get spent on this process for every single drug that gains FDA approval. Claiming that FDA approved drugs are unsafe amounts to bragging that you’re smarter than a national organization of well-trained scientists. Ironic, isn’t it?

What’s truly unsafe is swallowing a pill that likely hasn’t been properly tested – like, for example, some “healing oil” with a Chinese label you can’t even read, or knock off Prozac from a locally owned pharmacy that could be laced with arsenic for all you know.

And as for the efficacy of Eastern and alternative “medicine”: One of my all-time favorite quotes comes from singer/songwriter Tim Minchin: “Do you know what they call alternative medicine that’s been proved to work? Medicine.”

 

Hopefully by now you’re feeling a little more confident about beginning a medicine regimen with your psychiatrist or other prescribing mental health professional. Sifting through side effects of different meds is torturous at times, to be honest, but your brain has presented you with only one other choice: suffer at the hands of unmitigated disease. Neither option is positive, but one is clearly superior: it is extremely rewarding when you discover a drug that eases your symptoms and improves your quality of life.

 

*Psychiatrists are medical doctors who prescribe medicine for the management of mental disorders and symptoms. They are often confused with psychologists, who can administer psychotherapy but cannot legally prescribe medication. Psychoanalysis is a particular type of therapy invented by Freud that I, personally, find to be mostly bullshit.

**This advice is useful across all medical disciplines, not just psychiatry.