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The new doctor

28/03/2014

I went to see a new psychiatrist today. The first one for over twenty years. The neurologist who is treating my peripheral neuropathy (I’m going numb from the toes up) referred me after taking my history of mood swings and psychoses, despite my insistence that I’m fine with them.

The prognosis is not good. There is almost certainly no cure. However I may be able to alleviate some of her symptoms so I’ll go back once a month for the next few months in the hope of helping her.

Naturally she tried to persuade me to take pills to ‘cure’ something that I see more as an asset than a liability.

Lamotrigine is the treatment de rigueur for bipolar I right now, even though you need to treat fourteen patients to get a response in one. So it’s about a ninth as effective as a placebo for cyclic mood disorders and about a fifth as effective as doing nothing. Though to be fair people say the results are more spectacular among the few who benefit than you would expect from sugar pills. As are the side-effects.

Lamotrigine is one of the anti-convulsants used to treat epilepsy that have come off patent. By re-imagining such medicines for new illnesses drug companies can ‘evergreen’ a patent, extending it by a decade or more. So it’s being promoted as a mood stabiliser and many are now convinced it is much more effective than clinical trials indicate, despite the near universal inability of practitioners to interrogate their own data sets properly. They believe they can assess the development of their client’s moods and the causes behind any changes from a few dozen one hour sessions at the most. So much for evidence-based medicine.

That’s one of my gripes with psychiatry. Many of its proponents see themselves as rational advocates of an objective and scientific discipline who therefore have the right to impose their world view on the poor deluded souls who find themselves in their clutches. Yet their own belief system quickly turns to dust in the light of logic and evidence. They’re like the New Atheists that way.

I’m generalising of course. A lot of psychiatrists are painfully aware of the limitations of their chosen field. Unfortunately that just prompts some of them to batter their heads even harder against the intractability of many of the problems (and non-problems) they attempt to address.

About twelve years ago I attended a conference at which one researcher presented strong evidence that SSRI antidepressants were generally no use for people under 25 and often aggravated their depression and suicidality. The discussions at the tea break that followed were quite an eye-opener to me. There were a couple of practitioners who questioned the evidence or conclusions but the majority came away convinced of the view put to them in the presentation. However most of those I spoke to (or eavesdropped on) insisted they would not be changing their prescribing practices. Some rationalised it by insisting their own clinical expertise was such that they would only prescribe SSRIs to those who would benefit from them – despite just learning that the majority of SSRI prescriptions to under 25s by their colleagues did more harm than good. One apparently humane and rational psychiatrist I spoke to said he would keep prescribing them because “These kids are desperate and suicidal so we can’t just stand by and do nothing”. So he would do something that would probably make them more desperate and suicidal. And sure enough, SSRI prescriptions to that age group have continued to rise in subsequent years, as has the incidence of suicidality and serious depression.(It should be noted that the completed suicide rate in most OECD countries has continued the downward trend it has maintained since the 1950s. This is probably due to improved support services, more effective emergency medicine and a reduction in the availability of the more lethal means of attempting suicide. Such as the potentially deadly MAOI and tricyclic antidepressants that preceded SSRIs and SNRIs).

I have never taken medications for my bipolar. Well, not legal ones anyway. In October 2012 my madness essentially ‘cured’ itself. Of me. An intense series of psychotic episodes (or religious experiences – I can’t tell the difference) resulted in a complete change in how I see myself and my ‘place’ in the universe. The crippling despair that had barely released its grip in the nine and a half preceding years lifted and I don’t believe it can touch me again. In a sense there is no longer a ‘me’ for it to touch. In another sense my mental ‘illness’ has ceased being something that attacks me from the outside and has become as much a part of me as my intellect or compassion or bad habits. Now I know what Carl Jung meant when he said “You wanted to accept everything. So accept madness too. Let the light of your madness shine, and it will suddenly dawn on you. Madness is not to be despised and not to be feared, but instead you should give it life.”

Doubtless if I’d been taking Lamotrigine when my depression turned around my prescriber would have chalked it up to another great success of psychiatric medication. Perhaps I would have agreed and this blog would be called “Saved by the Pill!”.

I don’t think my new shrink will try to poison my insanity against my will, though some psychiatrists are bull-headed and us crazies are stigmatised and the law’s on their side so you can’t be too careful. But I doubt I will be able to teach her to see my own viewpoint as anything other than symptomatic of a pathology. Still, I’ve gotta try. These psychiatrists are deluded and dangerous so I can’t just stand by and do nothing.

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From → autobiography

9 Comments
  1. Good Spotty permalink

    Bravo! Inversions are fun.

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  2. I can’t believe a practitioner, essentially an adult, remarked as ‘These kids are desperate and suicidal so we can’t just stand by and do nothing’. Like seriously? You should have punched him in the face, or maybe drowned him in hot coffee? -_-
    Besides that, there’s one thing I like about your blog. You’re always throwing away links related to neurology somehow and I spend hours being fascinated over them. For one, you are totally feeding my passion, so yeah, keep that one coming. 😉

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  3. You should have punched him in the face,

    No.

    When you’re a registered certified looney punching a psychiatrist is generally Quite A Bad Idea.

    The only answer is simultaneous world-wide revolution and immediate execution of all of them before they can strike back.

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  4. Being fine with mood swings and psychoses is where I am spending more and more time, instead of fighting who I am, being disabled by my “illness”, I am shifting my perspective to see how well-suited I am to this “disease”. It enables me to read a write a great deal. What if I didn’t like to do either? It prodded me to excel in vastly different careers. Those are tremendous memories, and stories to share! I can blame it for interfering with things I want, or keep looking for ways to overcome those challenges. I love overcoming challenges.

    Right now, I am exploring my limitations. I have a history of perceiving myself as limitless. I have used lines like, “If you can see it, you can be it” — intended as motivation — as vicious weapons of self-flagellation. The space within my limitations could actually be huge.

    I changed psychiatrists a month ago. He is the first one who agrees that the meds I’m on (including Lamotrigine) might not be doing anything. He is the first one who suggests that I systematically go off all meds. What a breath of fresh air!

    I have a chiropractor, psychotherapist and physical therapist who are working with me on similar goals.

    What a great quote by Carl Jung. This idea of seeing my “disease” as more of an asset rather than liability is something I am glad to see more of.

    Thanks for your support.

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    • I like the characterisation of bipolar offered by The Icarus Project; that it’s not a disease but a dangerous gift. The trick isn’t to defeat or control it but to learn to use it safely and constructively.

      The Jung quote is from The Red Book (Liber Novus). It’s a pretty amazing work only published in 2009 and was almost certainly largely written (and illustrated) while Jung himself was psychotic. Well worth a look.

      I’m glad you’ve found so much support for your ‘unconventional’ approach to your bipolar. It sure can be hard to find.

      I wish you the very best of luck with it.

      Liked by 1 person

  5. I take the pills, but they do not change the fact that I feel and think as a bipolar, as neuro-atypical.

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    • No, they don’t do they.

      My grandmother has been on lithium for about 50 years (she’s 96 in April) and while it’s been very important to her capacity to manage it doesn’t seem to have impacted on her quirky outlook much.

      After my grandfather was killed they put her on Zoloft as well, which instantly knocked her for a loop, sent her into utter despair and destroyed her capacity to live independently, so my family members put her in a home hundreds of kilometres away from where she’d lived most of her life and where all her friends were. Naturally she just got worse.

      The whole time both her and I were screaming at everyone that she needed to come off the Zoloft – she insisting it was preventing her from thinking and me armed with studies like STEP-BD and STAR*D that show categorically that people with bipolar have much worse prognoses when given antidepressants. No good of course. Then her cardiologist insisted she be taken off Zoloft, so it happened. The improvement in her mood and capacity was rapid and spectacular. She not only became happier and more engaged, she began producing short story accounts of aspects of her life, surprising all of us with her previously hidden writing talent.

      I like hypomania as much as the next bipolar nutcase, but what I really like is psychosis – which I gather puts me in a minority. So it will take a forced treatment order to get me to take the pills.

      Liked by 1 person

      • Well, I do hope that you are able to maintain the clear thought process that you show in your writing. I actually was medicated for many years on sertaline (Zoloft) only before I received the bipolar type II diagnosis. At a very low dose it kept me relatively stable. Now I do take a low dose of escitalopram (Lexapro) in addition to divalproex (Depakote). Seems to work for me, though I am aware of the counterindications of using antidepressants for treating bipolar disorder. Some of us, though, seem to need it.

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