My psychiatrist and me: a clash of ideologies

I told my psychiatrist about the drug plan I had discussed with my GP a couple days earlier.  He didn’t like it.

I had discussed with my GP the possibility of taking a reduced dosage of Zyprexa two nights a week (from 5mg at night to 3.75mg). This was actually my GP’s suggestion.  My GP said he’d have a hard time believing that any psychiatrist would have an issue with it.

Anyway, when I arrived at my psychiatrist’s office, he asked me how I was doing and then without skipping a beat launched into sales pitch for two newer medications, Saphris and Latuda.  I heard him out, but said I wasn’t interested at this time and proceeded to tell him my idea.

He got really defensive and borderline belligerent.  Seeing many inpatients who have been hospitalized against their will, I can appreciate his inclination to get defensive (needless to say, this situation tends to make people indignant).  But this warring attitude seemed counterproductive to me.

He told me he wasn’t stupid-  that he’d read my chart and saw the dosage being reduced every 6 months in small increments.  He said he knew I was heading toward zero mg, and made it sound like I was playing him or something.  I didn’t think I was being deceitful, I just wanted to find the minimum dose at which I could function optimally.

He told me that it was just a matter of time until I had another episode if I went any lower than 5mg.  Selecting various anecdotes from his arsenal of horror stories designed to instill fear, he tried to convince me why I needed to take medication for the rest of my life.  Well, I can say with certainty that I don’t want to have another episode of psychosis.  But do I have to stay on these drugs for the rest of my life? Really?  He said that two episodes pretty much equals three.

Maintaining my cool, I proposed the alternative view that medication might not be the answer in all cases.  In acute cases, they are perhaps invaluable.  I know they save lives.  But as a long term treatment, are outcomes really better with regular doses of antipsychotic meds?

I’m about halfway through the book, Rethinking Madness: Towards a Paradigm Shift in Our Understanding and Treatment of Psychosis by Paris Williams.  I think a book of this calibre lends a lot of credibility to the possibility of alternate ways of regarding and dealing with psychosis.  I won’t get into it here, but the book is worth checking out if you haven’t already.

My psychiatrist acknowledged that our ideologies clashed.  I agreed and said I was afraid this might compromise our therapeutic relationship.

“You want another psychiatrist?” he asked.

“I don’t want to burn any bridges, as I think you’ve done a great job getting me to this point, but it might have to come to that” I replied.

He asked if I was merely seeking someone who would tell me what I wanted to hear.  I reflected, and decided that he was largely right.  Was this all it came down to?  Could I not handle the difficult truth? Would I just have to submit and swallow these bitter tasting pills till I die? Or were my bullshit detectors calibrated correctly, and there are in fact healthy alternatives to drugs?

He told me he could refer me to psychiatrists who would do nothing, psychiatrists who would tell me I never had an episode of psychosis and did not have a mental illness.  He could send me to someone who would prescribe any drug I wanted.  He was ready to write the referral.  He made sure to make all these alternatives sound inferior, but perhaps he was right: he didn’t have to be combative; he gets paid the same amount as these other psychiatrists who take a more passive approach, and one could argue his job is more difficult by opposing his (purportedly incompetent) patients (though one could also argue that this approach is unnecessary and counterproductive).

It would be easy to dislike him if he had no redeeming qualities.  But he is actually a pretty good psychiatrist in many respects.  He will fill out important forms quickly, no big deal.  He is quick and responsive to my questions.  I can talk with him, and he seems pretty connected to what’s concrete and real.  For better or worse, he’s quick to invoke examples and analogies.  Above all though, I know that he actually cares and wants to see me continuing to do well.

I didn’t want this conversation to culminate in a big “F you.”  At the same time though, I’m an avid reader of info on blogs like Beyond Meds and have read about the danger of taking these amiable/trusting feelings as an indicator that things are a okay (see posts on Stockholm Syndrome).

I was far from satisfied, but I wasn’t ready to fire him.  He gave me an appointment card for next month and we shook hands and told one another to “take care.”

I don’t know what to think.  Ultimately it’s my decision.  He told me he wasn’t going to “phone the cops.”  But does two psychotic episodes really equal three without meds?  Are his facts accurate?  I like to think that I’m an exception, but doesn’t everyone?

Any thoughts or ideas are most welcome.  Anyone been in a similar situation?

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