More psychiatrist fun

I haven’t updated because I’ve been sunken into the worst depression I’ve had in years. It is so hard to remember that just three months ago I was fine. I am sorry I ever thought to change meds, even with the side effects.

But I’m also tortured by the sneaking idea that those 4 years I had that were ok, when I was just like a normal person, were borrowed time. During that whole time, I knew that sooner or later I would have to pay. And now I am.

It’s funny, this depression is so different than my usual ones. In some ways, I’m suffering less. Usually I have some fairly mixed features – I’m anxious and my thoughts race and I’m hypersensitive. Now, I’m just washed out.

They always say that people deal with their first episode of depression the worst. Something about the experience being new, and in later episodes, knowing what to expect and also knowing that it will pass. This is grinding me down like a first episode because it is so different than before. I can’t get out of bed. Everything hurts. My mind is blank. I constantly want to throw up.

Outside Over There
So the goblins came. / They pushed their way in / and pulled baby out, / leaving another all made of ice.

The thing is, my other depressions, my natural ones, not the ones from some weird drug reaction or withdrawal or whatever the fuck this is, are rich experiences. They can be miserable, but there is also a heightened sensitivity in them. Sensitivity to what is ugly, dark, yes, but they are a complement to my normal sunny, conquer-the-world self. I used to always be able to crawl into bed with the a beloved book, watch a dark film, and cry in a deeper way than most people ever get to. I don’t even want to feel good again right now. I would be happy to have my tears back.

As to the shrink, I’d like some audience feedback.

I’m lucky, here, most psychiatrists still do therapy. I understand this is a huge problem for a lot of people – they can’t have the same person manage their meds and talk to them.

This guy always wants to do more therapy and spend less time fixing meds. But I hate therapy. I feel way too exposed. And I don’t think it really helps, and in this country they are still doing a lot of psychodynamic therapy which I find particularly useless. I am a very rational person, and psychodynamic stuff seems like voodoo to me. A non-predictive system. And I don’t buy the basic premise – that insight does one damn thing to make you stop doing the same shit you always do. So you know why you are fucked up? So what? CBT is the way to go in my eyes. Address thoughts, address behavior. Simple learning theory. It was incredibly helpful in my past. Even supportive therapy is probably ok. Someone to tell you it’s going to be better, that you can hang on, is valuable. But I’m just not into that whole childhood trauma shit. I mean, there’s got to be a statute of limitations somewhere. And I function well and when I’m well-medicated I’m reasonably happy – so why fuck with things?

Here’s the other issue. Despite that I know the guy for maybe 6 years or so, we’ve never really clicked. I’m not sure why. I like him well enough, well enough to keep coming back even after all the shit like this. I think he is good at what he does, and also a decent person.

I know a lot of it is my fault. I don’t trust anyone and all kinds of things like that. But I think that there is more.

Despite that he’s nice and respectful and really ok and not stupid (all of which are problems with many, many shrinks), I just don’t seem to trust him for some reason. But I have a very bad record of deciding who I should and shouldn’t trust. The fact that I don’t trust him should, based on the evidence, almost certainly mean that he is trustworthy. And I don’t know why I don’t trust him. He does all the right shrink stuff, is warm and empathetic in all the right places, is professional.

I just can’t put my finger on it. I think that secretly he thinks I should be more boring, which is no good for me. I always get the sneaking feeling he thinks I should be married with three kids and a mortgage, that doing much else with my life is a sign of immaturity or something. He uses too much shrink silence, which I hate. He never tells me what he’s thinking, just drops his profound statement at the end.

I think that really flipped me out when he first diagnosed me, was why I never went back all those years ago. He just said, “I want you on a mood stabilizer,” with all that that implied, without explaining why. That was brutal when I was so sure I was unipolar only. He asked me a million times back then if I was sure I’d never had a manic episode, in a million different ways. I always said no, because when I was so low, I couldn’t remember having had them. If he had said, “Look, I’m saying that because even though you feel depressed, you are talking at 100 miles an hour, and seem a little too confident in your abilities, and you can’t sit still for even 10 minutes,” I might have been forced to agree. But he didn’t. He just sat there in shrinky silence, waiting for the proclamation to sink in, which it didn’t for years.

A couple of times though, he has surprised me in a good way. One was this last suicidal week, where he promised not to call the cops on me no matter what. I’m not sure I believe it, but at least he was perceptive enough to see that that was the right thing to say. The other time was when he actually, contrary to what I expected, didn’t tell me to just go be a good doctor and give up writing, but rather encouraged me to do the opposite. That shows at least a minimum of non-bourgeois sensibility.

So – did anyone ever get anything out of that kind of therapy? And should I try to salvage the relationship with this guy or just use him for meds? Would it be reasonable to just tell him all this and see what happens? Or is that just going to lead to me not getting anywhere and wrecking my comfort level for going to him for meds?



  1. wow…hey, Sara….it sounds like you and this guy just don’t click and i totally agree about the psychodynamic thing…uhg! i went to a psychiatrist for a few months who did that, he creeped me out, why, oh why did i keep going back? Who knows? i mean, this one time he told me the story of Rapunzel and how she cut her hair off to spite her mother when he noticed my “freshly cut” hair and the fact that my parents were coming to visit…the fuck? What did that have to do with my severe anxiety and depression, etc ? The resident i see now is v e r y much in to CBT and we really “click”…at least, i think so. i am very fortunate to “have” him, while i do. i am doing much better since i started to see him a few months back…what will happen in June…shudder. If it is at all possible, could you find someone else to see, someone you feel you can trust, at least a little, who does more of the CBT thing and less “let’s talk about your childhood” shit? i mean, Dr. K and i do talk some about that, but it is mostly, “let’s deal with the here and now”, which i really need to do. i really hope you find someone else…fast. and hope you feel better fast…he is right…it i s so sad to see you this way…sniff, so very sad. an e-mail later. love, tracy

  2. About finding someone else, no idea. I don’t really have the energy to do that. I don’t even really want any kind of therapy.

    This is something that makes me very curious – almost all patients, forums, etc, all say that CBT is good and psychodynamic is bad. But the professionals still think of it as the gold standard. Strange, strange. I think eventually it will have to fall out of favor. Now there are more and more studies showing it might harm more than help.

    And now, just when I thought nothing could be worse, my face has exploded into a sunburn. So I may have to change meds again. I don’t think I can do that now.

  3. “Would it be reasonable to just tell him all this and see what happens?”

    Absolutely. You need to. If he’s any good, he’ll know what to do with it. (And I suspect he is some good, or you’d have left him long ago.)

  4. I was leaning toward that. I think I probably will, but I’m just afraid of it ending up like last time, when it got so confrontational and all that I felt like I couldn’t go back. The same basic confrontation, though when I was totally manic, led to me just saying flat out that I hate psychiatry and the whole psychoanalytic model (true, but not the most diplomatic way of putting it), and I possibly even made some crack about his profession not being a real doctor.

    So. I don’t want to wreck the drug dealer – client relationship. He sort of hinted last time that he didn’t think I should be coming to him for meds if I didn’t trust him for therapy. And we parted ways like that, angry. It took 4 years and many, many blistering sunburns for me to swallow my pride enough to call back…now, true, at the time I knowingly and happily pushed all his buttons in the worst way I knew…but still.

    That is some good advice I’ve gotten here. And a shrink reads this, which is weird beyond belief. I always assumed everyone following along was a patient.

  5. Im a very logical person too, but I can tell you from experience that the voodoo stuff WORKS.
    If you want to see the logic behind it, start with freud, jung and kraepelin and read all you can find. Just like the reading up on medication, it will be very helpful in healing yourself.

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