When Psychiatrists Distrust Their Patients, Their Patients Can Only Respond In Kind

I’ve been seeing psychiatrists — doctors whose purpose is primarily to examine and diagnose an emotional disorder or condition, then prescribe a plan of treatment, whether therapeutic or pharmaceutical — on and off for over half my life. The ratio of good to mediocre to bad experiences I’ve had with psychiatrists is roughly equal — the best psychiatrist I ever had listened to me when I disputed my diagnosis and insisted that I really didn’t want to take medications. He brainstormed with me about how to treat not a diagnosis, which is broad and can border on stereotyping a patient, but rather the actual, specific emotional experiences that I was having. He suggested a therapist in his practice who specialized in Dialectical Behavioral Therapy, and it was a godsend. It is a nigh-perfect treatment for me and has had significant positive effects that have served as a better long-term solution than medication.

The worst psychiatrist I had, on the other hand, seemed awesome when we started — our initial appointment was an hour long, and she probed into my family’s medical history for clues about mine. It seemed holistic. As time went on, though, appointments became sparser and shorter — she was constantly double-booked, she got to the point that she was doing five-minute refill appointments, and I was eventually on four different medications in an attempt to treat anxiety and what we thought was depression in the fallout of PTSD. When I disputed her original diagnosis at my last appointment, she responded, “That’s just not what I know about you from our work.” Our work? She had only spoken to me for a grand total of maybe two hours at that point, while I had been out in the world living my life with my emotions. I wanted to be trusted that I was the best possible source of information about my well-being, not a brief description of a few symptoms and the DSM-V.

I told her that I wanted to get off of my medications because they just weren’t working — I was still having massive, debilitating anxiety attacks, nightmares, insomnia, paranoia. I had had a full-on nervous breakdown while on medications. And I didn’t feel like anti-depressants were appropriate, because with a lot of reflection, I landed on the opinion that debilitating anxiety looks a lot like depression but is not the same thing. All of my feelings and neurotic impulses were still very intense, and yet here I was, taking more and more medications in higher and higher doses to treat them, to no effect. Instead of weaning me off of anything, she prescribed two more medications. I found out later that some of the medications she wanted me to take had unsavory interactions that she didn’t disclose to me.

I quit seeing her, signed up with a new clinic, and in the interim I weaned myself off of my medication. That medication was Lamictal. It’s prescribed for epilepsy and bipolar disorder, neither of which are conditions she and I ever discussed (and bipolar disorder was off the table for me). I found out through online communities that it can have low efficacy and extremely painful withdrawal symptoms. I don’t usually trust non-scientific, anecdotal evidence when I make health decisions (or any decisions), but all of the bad experiences people had had with the drug were precisely the same as mine. Besides, it wasn’t just anecdotal evidence — Dr. Nassir Ghaemi from Tufts had found years ago that the drug was ineffective for treating mental health symptoms. And, sure enough, when I started to very conservatively wean myself off of it, the experience turned out the same as the anecdotal accounts as well: It was weeks of painful, excruciating vertigo and nausea. I had to stay in bed for the first three days. Once I was off of it, though, I felt a marked improvement in my mood and anxiety. I don’t know if the Lamictal had a negative effect, or rather if it had no effect and my anxiety over taking it was just lifted once I weaned off — either way, I am extremely glad I no longer take it. (If Lamictal works for you, of course, I’m not suggesting that you stop taking it. But it certainly doesn’t work for everyone, and if it hasn’t worked for you, you’re not alone.)

All of this has left me feeling more than a little suspicious about psychiatry. I felt like my psychiatrist had dismissed my opinions in her care plan, and had distrusted me and my word without me having given her any reason over the course of my treatment to do so. I felt like I had had no control over my care, and that feeling of a lack of control over what was a major part of my life was devastating — I have PTSD because of abuse and rape. Control over my body is important to me.

I didn’t stop seeing psychiatrists, though, because I don’t want to discount a whole profession based on a few bad apples. I started treatment at a new clinic and wanted to take a holistic approach, so although I started there not wanting medication, I wanted to have a psychiatrist oversee my care in case I decided it would be beneficial. Initially, that was the plan that we were working with, but recently, I had to switch to a new doctor within the clinic, and it went … well, pretty much as poorly as it could.

She’d taken only a cursory glance at my records and misunderstood or misread a lot of what I had been discussing with my therapists and former psychiatrist, even insinuating that I have a drinking problem — it turns out that she misread “three drinks a week” as “three drinks a day” and just assumed she was correct, and based her judgment on that assumption, without checking until I challenged her on it. She thought it was unusual that I am “still” experiencing anxiety and insomnia after a year of treatment, despite what I think is common knowledge, that experiencing trauma over a prolonged period of time takes a very, very long time — much longer than a year of weekly therapy — to address. She told me I shouldn’t be on a medication that has been working for me and that I should be on medications that have been ineffective, despite my trying to explain to her how poorly they’ve worked and what a positive experience I’ve had on my current medication, then claimed that she wasn’t trying to “push pills.” She insinuated, against a year of notes from very good experiences with other doctors in the practice, that all I wanted was to get pills from her. I told her I was sorry if I seemed curt or defensive, but that the conversation was feeling aggressive, and I had had a very bad experience with psychiatrists in the past, and she (literally) scoffed off the idea that I’m not alone in having those bad experiences, that other psychiatric patients feel pressured, dismissed, and distrusted by their doctors as well. She kept implying that I have bipolar disorder despite my many attempts to explain that I had undergone treatment for it in the past, including many support groups with people who genuinely are bipolar, and that it just was not a good diagnosis for me. All in all, I was left feeling, again, like my doctor thought I was a liar and that my input was not necessary in my medical treatment.

Even psychiatric doctors recognize this phenomenon in their peers, as stated in an article in the British Journal of Psychiatry:

In practice, it is easy to dismiss any unusual or improbable claim a mentally ill patient makes as untrue. Being confronted by a daily barrage of unreality–ranging from the psychotic patient with frankly bizarre delusions, to the manipulative patient intending to deceive–psychiatrists perhaps more than any other specialists are at risk of developing blanket cynicism and distrust.

This blanket cynicism and distrust only adds to the well-documented stigma of mental illness. Our wider culture already unduly distrusts people with either cognitive or emotional impairments, and our doctors ask us to trust them with our care when some of them don’t return that trust in kind. So how are we supposed to feel motivated to seek care for our mental health? I’m now in a position where I have a year of glowing remarks and positive statements on my records from my last therapist, who has noted repeatedly that I’m a motivated and diligent therapeutic patient — but now I also have a note from this psychiatrist, who no doubt feels that I was defensive and conveyed that she thought I was lying to her. Will I come off as duplicitous or two-faced to my future doctors? Will they even bother to consider the possibility that the psychiatrist was at fault, or will they blame my mental “illness”? And if that’s the case, is the future of my healthcare already being decided for me without my knowledge of what that future is going to look like, without my input? Should I bother to continue treatment at this facility, or at all?

And that’s the thing: Stigma is a barrier to treatment. If doctors are the people stigmatizing us, it’s all the worse. Why would a person want to be emotionally vulnerable with a doctor who thinks so little of them?

To me, my problems are simple: I was abused. I was raped. I have PTSD, and the anxiety is overwhelming sometimes. I have always felt a lot of emotions very strongly, and although therapy helped me to deal with that, my recent traumas exacerbated the problem. All I want to do is get back into a normal groove with my life, and to me, anti-depressants, anti-psychotics, and anti-anxiety and anti-seizure medications are not a part of that — just staring down my hurt and conquering it by understanding it is. In the meantime, like anyone, I want to be validated as a whole, intelligent, capable human being — and the distrust of my doctor, earned, I guess, by the mere virtue of my asking for her help, is unacceptable.

[BeyondMeds]

[British Medical Journal]

[CLPsych]

[British Journal of Psychiatry]

[Mayo Clinic]

[NAMI]

[National Institutes of Health]

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