personality dysmorphic disorder?
I saw the therapist and meds nurse today. I didn't want to tell the therapist that I've been eating more nutritious dinners the last few days, because I didn't want her thinking I was better... I did end up admitting I've seen my housemates slightly more than usual, though. She asked about whether I feel lonely. I said I felt lonely "sometimes", but I couldn't be any more specific. I still find it hard to figure out the answer to questions like that. There are plenty of times when I feel overwhelmingly lonely, but there are also many times when I don't think about it, or am perfectly happy on my own. She ended up asking if I'd like my family to visit me. When I said yes, she asked why I didn't ask them to, as if I could just ask and they'd immediately pay the ~$1500 and take time off to come over here, and as if I'd suddenly feel more connected if they did so. I've encouraged all my family to come and visit, but it would be a significant commitment in terms of time and money for them.
Last week, she also mentioned a group therapy program at an anxiety research group. She gave me all their information, but I would have to call and go through a phone screening interview first. She started to ask whether I'd be able to call, and I was about to say no, but she got distracted by something else, so I didn't say anything. This week, she asked if I was going to call, or if it wasn't something I thought would be a good idea. Since she didn't give whether I was able to call as a third option, I couldn't answer. What's funny is that I emailed the program a few times the first year I was here, asking for information, and whether there was a way to avoid the phone interview. That first summer, when I was doing so well with exercising and eating, I even tried calling twice (well, I tried multiple times, but twice I managed not to hang up before someone answered) but there was nobody there who could do the interview either time. I couldn't tell the therapist any of that, either.
This afternoon, I was very late for my appointment with the meds nurse, because it sucks trying to get there from lab. Every time I see her, I end up annoyed. It seems like she always sees some completely different (never matching my own) version of me. She started by saying that she thought I should stop taking the effexor and see her again after a month, to give what I'm doing with the therapist a chance to work. But I'm not doing anything different with the therapist! What's another month supposed to do? How is taking useless medication any different from none, anyway? Besides, she also said I could keep taking it if I wanted, and see what happened that way, as if something would magically happen now.
Then she started talking about how there aren't really any drugs that can treat selective mutism, unfortunately (I know I've talked about selective mutism with reference to myself, but I really felt like a freak when she did), as if that's what she's been trying to treat all along, rather than depression. Then, when I said the medication didn't work so I may as well stop it, she asked me to say what had worked, as if anything had. She was surprised when I said I felt worse than I had when I first came here (I thought she meant "came to the US", but I think she meant "came to see her", and now I'm not at all sure if I feel better or worse or the same, compared to then), so next time she's going to get me to fill out the same questionnaire as the first time I saw her. I'm worried I'll answer as if I'm better and she'll think I was making it up. Maybe I am better than I was and I just don't notice or I am making it up because I'm annoyed they don't seem to be doing anything useful?
I came to the computer lab after that appointment to write a grumpy post about it, but I've been sitting here obsessively playing spider solitaire for a while instead. I was going to make Shrinky's yummy pasta dish for dinner, but now it's hard to care about eating real food. I really just want cake and ice cream.
The title is from the post I meant to write after last week's appointment with the therapist. I was late again so I had to check in with the receptionist. The therapist heard the last part of what I said, and I was still in "pretend to be normal" mode long enough to apologise to her as well. During my appointment, the therapist said she didn't think it was me at the front desk, at first, since I was actually talking audibly. She talked about how some people do have innate problems that have to be worked around and she would tell the person that and focus on ways to compensate, but she thinks I'm perfectly fine and just can't see that, as if I have some non-physical version of body dysmorphic disorder. I'm not really convinced, though. I don't think it's possible to tell that I'm not lacking some vital skill(s) just from hearing me say "I have an appointment with the therapist at 8, but I'm late. I'm sorry".
Update: I just read this rant from Shiny Happy Person at Trick-Cycling for Beginners, which really doesn't help my confidence in the meds nurse... I guess it wasn't so different with the psychiatrist, though.
posted by Lucy @ 6:24 PM
7
comments
7 Comments:
You know, the more I read your posts, the less impressed I am with your meds nurse. I know you didn't find it much better with the psychiatrist, but maybe if you saw him more regularly (the way you see the meds nurse), he might be more helpful? (Recognizing, of course, that I am totally not a medical professional or anything, so my opinion is probably not helpful!)
Yeah, I'm with New Kid. So far the care you have received has -- to put not too fine a point on it -- sucked.
On the other hand, the meds nurse does have a bit of a valid point. You perceive yourself to be defective in ways that are simply not apparent to an outside observer. So perhaps that is as good a name for it as any.
Honestly, though, I think you *would* open up to the meds nurse and the therapist if they made something more than a half-assed effort at it.
I will respond more later - but frankly, I wouldn't put much stock in that article and associated rant by Shy Happy Person. First, training standards are hugely different in the US. Typically mental health professionals need more training here than they do in the UK. I don't know a lot about that particular area - but it might be worth looking into. Second, I honestly believe that there are a ton of individual differences in the field. I have worked (professionally) woth some horrible psychiatrists who barely spend any time with pts, who don't even get to know their pts names, and who just prescribe things willy-nilly.
I think I might be a little defensive too because it is hard for me to hear such criticism leveled against mental health workers - and especially from someone who seems to think that without an MD, no one should be able to work in the field. It doesn't take an MD to help. And frankly, I do think it can be a hindrance at times.
I think you should try not to worry about filling out the questionnaire, Lucy. If you do fill it out in a way that shows you are doing "better" than you were at first, then they surely won't think you are lying now or were lying then, or lying when you said you felt worse, or any of that.
Instead, I'm sure they realise that it is hard (maybe impossible) to remember exactly how you felt at a specific earlier point in time. That's why they do these questionnaires and keep them on record in the first place. In fact, it will probably be interesting (and maybe even helpful) for you to discover how what you feel like now matches up to what you felt like back then.
It's a win-win situation: if it shows you are feeling worse, or about the same, it might be a wake-up call for them to try something different (like meds that work!). And if it shows you are feeling better, then that's a cause for optimism that things might just keep on getting better, right?
And I think you should eat icecream and cake. (But I'm a Bad Influence).
It all sounds very frustrating, Lucy, and you so have my sympathies (esp. on the med nurse thing...) I have nothing intelligent to offer...but I'm sorry this is such a frustrating process for you.
Phantom, I'm not sure I'd be more likely to open up with anyone else. It's hard to imagine being able to talk at all. And I'm still not convinced my defectiveness wouldn't be apparent if I were less guarded.
Shrinky, I'm sorry. I didn't mean to disparage mental health workers in general and I definitely don't think an MD is necessarily the best qualification to have. I do think there's still a world of difference between the training you're going through and nursing training, though. Coming from somewhere that doesn't have them, I am uncomfortable with nurse practitioners in general, actually. If doctoral training (of any kind) is the standard for reaching the required level of knowledge, it seems odd that people are allowed to do the same job with less training.
I can certainly see that someone with fewer academic qualifications could be a far more effective therapist, though, so my reading of the rant was more influenced by my frustration with my particular meds nurse than anything else. I was feeling far more anti-my-nurse than pro-doctor.
Styley, I did have cake and ice cream. But I also had some veggie chips with spinach and kale, so maybe that should almost count as a real meal, anyway :)
SFTR, I'm similarly confused by the anxiety group requirements. Maybe I need a helper parrot to talk for me. Hmm... I wonder if it would help to pretend I were deaf and use one of those services where you can type and someone else will talk for you... Your brother sounds very nice :)
Lucy - I totally wasn't referring to you - and I worried you might think that - but I neglected to fix it. I'm sorry! I mean that Shiny Happy Person seems against anyone without an MD. My point was more that (not knowing your meds nurse) there is a lot of variance within the different fields - and that one's degree doesn't necessarily predict one's skills. I think it is so much more about *match* (based on skills, personality, interpersonal style, therapeutic approach, etc.).
I am not suggesting anything here - more just wondering about the flexibility of the system. Should you want to - *could* you switch med people? It does kind of sound to me as though she might be feeling a bit defeated or somehow unable to help - and that wouldn't be helpful. I think it's really important to at least have one person in the relationship feel like they know what they are doing :)
Again, I'm really sorry I made you think I was referring to you - I totally was not at all.
Post a Comment
<< Home