How to Talk to a Doctor About Your Mental Illness

Hello Natasha,
I've read much of the documentation you and your clients have put out (above) and I'm hopeful that you can advise me with regard to my psychiatrist, who agrees with my write-up that I've had many traumas in my 75 years (I firmly believe I have complex PTSD), but she states that she thinks I have delusional disorder (DD). You seem to have an interest in bipolar, but I hope you won't be averse to looking at DD and C-PTSD.
I was diagnosed with DD some 30 years ago (though no one told me until 2019) and despite the fact that there is much in the literature that misdiagnoses are common with DD, she seems adament with a DD diagnosis.
I've written up my unusual experiences that lead me to think I have C-PTSD, but that didn't help with my psychiatrist. I'm wondering if I sent my documentation to you, if you could give me your opinion (I know this isn't how you'd usually 'do business', but I'm hopeful, anyway).
Sincerely,
Brett Aubrey.

I never knew how much information there was out there on this!
Thank you for making this all easy to grasp

Thank you for such a well-written article. I'm one of the lucky few who actually ended up being friends with my doctor. The upside of that is that she has dropped by the house a time or two if I can't get out. She also knows me well enough to know when I am not telling her exactly how bad it is... so then she asks, and asks.
The truth is, I could have used this article for many years, for many different doctors I've seen over the years, and most especially when my daughter was having a lot of trouble. We know we must be clear about our own issues, but as advocates for young people, we must also be very clear about their issues. And we must teach them to be clear as well!

Natasha,
you're awesome! Keep blogging and posting, you're putting info out there that others, i.e. mental health professionals and insurance companies won't or don't give out so readily. Being bipolar and accepting that and finding a way to deal with it has to be the hardest thing I've ever attempted to do. So again thanks for all the good info!

Hi Tina,
It depends on what you mean by "holistically and naturally," technically, lithium is as natural as it gets as it's a salt.
If you leave a comment on my personal blog, not affiliated with HealthyPlace in any way, I can be of more help: http://natashatracy.com/
(Sorry for the redirect.)
- Natasha

Hi Natasha, I have read about just a few people treating bi-polar disorder holistically and naturally. I hate the drugs because they tend to kill your creativity. Is there anything new on this front? Thanks

Hi Natasha,
I haven't been in contact for a long time. My efforts to help mt friend have had to be put on hold.
My personality system is in major upheaval, and has been for a while. I have no spare energy to be able to help anyone else. We are all totally exhausted by what is happening in The System, and I am certainly not in a position to be worrying about my friend's arguments and opposition to meds.
esterday she asked me to come and sit with her, as she didn't want to be alone, but when she told me she refused to see her case worker, and had cancelled her doctor's appointment, I just couldn't cope. I had gone there prepared to just listen and nothing else, but her stubborness just became too much, and I had to go home. I think she is angry with me, though in the evening she called me to come back again, I couldn't do it. She has no idea what my problem is and I can't explain -- both for ethical reasons and knowing she would not understand anyway. I don't think I can continue to be her support system, and have spoken to my progran co-ordinator about this. Now I have to find a way to ease myself out of this without seeming to abandon and reject her. Any ideas?
Best wishes,
Diane

Hi Natasha,
I sometimes wonder what I would do if I didn't have you to to write to. The co-ordinator of my volunteer group would take me off this case i fshe knew what I was really doing, but I don't want that. I'm a nurse and I don't give up on my patients. Trouble is, I am not working as a nurse in this case, and she is not my patient. Old habits die hard!
Unfortunately, the Community Health Centre does not have case conferences, and I doubt if I would be allowed to attend if they did. Neither do the have in-patient care. She would have to go to the psych unit at our local hospital, and they are so overworked and short-staffed there, I doubt if they would consider her sick enough for admission. There seems to me to be an ever-increasing need for psych services these days, though I suspect these illnesses are more readily recognised now than ever before, and new services can't keep up with the need.
I think I am the only one she really tells all her difficulties to, because of the stigma attached to mental illnesses, as you and I well know. I used to be able to talk to her previous case worker, but he has moved on, and the new one doesn't want to talk to me. She probably has a superiority complex and thinks I have nothing worthwhile to say! She seems to think I am an unskilled community worker, and has sometimes told Rhonda to avoid seeing me so often, though Rhonda is not going to accept that!
I have breached confidentiality by using her name here, but I don't really think it matters with you. I can't see anyone trying to trace her here in Australia, even though your blog is international.
Tomorrow I will be giong with her to see her GP, and I think I might actually voice some of my concerns, I'll play it by ear. As I have already told you, she wants me to see her psychiatrist with her on her next visit, but it depends on the time of her appointment, as I see my own psychiatrist on the same day and as he will have been away for two weeks by then, I won't be cancelling my own appointment.
But at the moment I have to seriously re-consider my own position, as the whole situation is seriously and adversely affecting my current bout of depression. I will have to see how much co-operation I get from her two doctors, let alone the caseworker. I hate giving up on anyone, but I do have to consider my own health too, and especially the alters in my personality system, many of whom want me to drop this.
Well, I'll let you know what happens, and thanks for your support.
Diane

Hi Diane,
It sounds like things are really challenging for you right now. All I can say is if you're in the room with her health providers make sure you state all of your concerns and then listen to what they say. If she's delusional, what do the doctors say about that? How are they addresses that?
I can't remember if you said this or not but it sounds like she needs to be in a care center, at least right now. People who are truly delusional can't really take care of themselves or their treatment without constant supervision, and certainly you can't be expected to provide that.
- Natasha

Hi Natasha,
It's quite a while since I wrote, but things have been somewhat difficult for me. As well as DID, I have Major Depressive Illness which is really interfering with my life at present, butI know it will eventually pass.
Trying to cope with my friend is especially difficult at present of course, but I battle on. When I have been unable to fulfil her needs, she has accused me of rejecting her, which hurts a bit as she doesn't want to recognise that I have problems too.
We are also having transference problems at present, and she tells me I only want to talk about myself, when she is actually the one doing all the talking. I understand the dynamics, but it is difficult to deal with.
Although she only sees her psychiatrist about every eight weeks, she is part of the Community Health Service, and sees a psychologist every Tuesday, has a caseworker, and attends Group Therapy weekly, so she is not really short on support services. Unfortunately, she still talks constantly to me about her meds. I keep on trying to change the subject, or take her out somewhere, but I'm finding it a real strain.
Nevertheless, I will be attending her next session with her psychiatrist, so I will be able to sort a few things out. Unfortunately, she misinterprets what she is told incorrectly, so I have to remind her of what has been said. I also attend her sessions with her GP, and she misinterprets what is said there too. I am rapidly coming to the conclusion that she has schizo-affective disorder too.
My main aims at present are to distract her from her delusions, which is successful at times, but I'm finding it very wearing. I don't think there is sufficient communication between her different service providers, which adds to her confusion.At present she is pretty depressed, but is convinced that coming off anti-depressants wil sort her out. I haven't yet been able to get her to see the incongruity of that. I really don't think her physical problems are real, as I can get her to forget them if I work hard at changing the direction of her thoughts.
When she is "high", she wants me to take her to all sorts of places, but usually backs out at the last minute and restarts the "medication Mambo" again.It's all very difficult, as I am only a volunteer. If I was her caseworker I would set up regular patient conferences with all parties present, but I'm not in a position to organise that.
Anyway, I have complained enough for one session, so will leave it at that for now.
Best wishes, Diane

Hi Diane,
Obviously it would depend on the actual behavior, but I don't think looking up drug information is unusual. And heart palpitations are quite possible from medication. When a doctor says "it's not the drugs" what they mean is that it's unlikely. They don't know. The only way to know is to go off the drugs and see if it goes away. Weird side-effects happen every day. I'd say med-fixation is fairly normal for newly-treated patients.
That doesn't mean though that your friend should adjust her own medication. She needs to talk to her doctor (which obviously you know). Unfortunately she is in a really bad situation if she only sees her doctor every two months. She's obviously not getting the help she needs. She's causing issues for herself because there's so much time in between appointments.
The only thing I can suggest is to visit the doctor with this person. Write the doctor a letter. The problem here is lack of medical attention, and she may not be particularly forthcoming with her doctor about this so he may not even realize there's a problem.
Medical concerns including side-effects, panic attacks, and diagnosis need to be brought to the doctor. He's the only one that can help.
Good luck.
- Natasha

Hi Natasha,
Thanks for the info. I don't seem to be getting very far in helping my friend. She has to go to a doctor at the Community Mental Health Centre, and, unlike me, she doesn't get to see her therapist as often as I do.
She has now been diagnosed with Schizo-affective Disorder, but that doesn't seem right to me. Of course, I would never say that to her, but she still asks my advice about meds.
She seems to be fixated on meds. she is always looking up info about them, and deciding which ones are causing the physical symptoms she seems to feel. I know they have nothing to do with those symptoms, but she has now decided that the increased dose of anti-depressants her doctor ordered cause palpitations, so she won't take them. I asked my own doctor, just to make sure, then printed off info from the internet, but it didn't help.
I recently spent 9 hours at the A/E dept. of the hospital with her. She had called an ambulance to take her in, as she thought she was having a heart attack, and needed my presence. I think it was a panic attack, but she has had 2 attacks before and has a stent in place, so there was no way I would have tried to dissuade her. This is the second time this has happened since I met her.
I volunteer for a Mental Health organisation, which is how she came to be my client, but I am somewhat worried about her dependency issues. Because I am an RN she wants advice from me, but in this position, I can't advise her about much.
From my own knowledge and observations, I still feel she is Bipolar, but I can't tell her that. Unfortunately she only gets to see her doctor every 2 months. She wants me to go with her next time, as she says she can't always remember what the doctor said, but I tried to tell her to follow his advice and take the extra meds. It's pretty difficult for me at times as I have to keep most of my knowledge to myself, and just advise her to follow what she has been told.
So really, I can only give her support. She also worries about drug interactions as she has physical problems as well, so she tries to adjust her meds herself, which doesn't help at all. Is it normal to be fixated on something as she is with the meds? I'm not sure about that, seems to be a bit like OCD at times.
Anyway, best wishes,
Diane

Hi Diane,
I cope in a variety of ways, but what works for me isn't terribly relevant. What's relevant is what works for each individual. Yes, I think a support system is vital. A good doctor, psychiatrist, therapist, friends and family are all important. In my case I don't have all of those, but I still recommend that people do.
Meds evolve pretty much constantly and it varies by doctor due to all the off-label use. A great place to start is here: http://psycheducation.org/depression/meds/moodstabilizers.htm
I trust that source, it's evidence-based and really useful. If you investigate the author you'll see he's a doctor that specializes in bipolar. (I've looked into him extensively.)
I do not tend to do the type of dramatic things you described. I have an extremely strong hold of my psyche and behavior. I'm just that way. As egotistical as this is, I have a high intellect and that keeps my behaviors in check. This is not terribly common.
For a client like you describe, the best thing for her is a good doctor and therapist. If she's that fragmented, it's either the disorder or the medication, and someone needs to know which one and deal with it. It is undoubtedly difficult to keep up with a person like you describe, clearly because the medications are not stabilizing her.
Mood stabilization is extremely difficult and can take _years_. The best things she can do is:
1. Get a good doctor
2. Be as honest and open as possible
3. If she's not talking about some important issues, someone needs to go with her
4. Take all her meds as prescribed at the same time every day
Sorry. No secrets. She just has to do the hard work of therapy and medication.
- Natasha

Hi Natasha,
I was very interested to learn from you,but how do you yourself cope? Do you have a support system, and what meds are used these days?
The things I told you about you about were pretty dramatic, but do you ever have episodes similar to that too?
I have a client whose diagnosis is all over the shop. She is continually given new diagnoses, and has her meds modified pretty regularly. She also "monitors her own health" and calls on me fairly often for help. I personally think she is Bi-Polar, but I'm just a retired nurse, so I couldn't possibly know what I'm talking about. She reads up on every pill she is given, then describes weird sensations re every one. It's exhausting to keep up with her, but no way will I give her medical advice. I try to take her out as often as possible to see diffrernt sights, but her concentration is limited, and we're soon back to pill stories.
Have you got any hints you can pass on? I try to always stick to the reality principle, but she still goes off at tangents.
Love, Diane

Hi Diane,
What you're describing sounds like rapid-cycling type I bipolar, and yes, it's completely possible. Spending sprees, hypersexuality (or romance) and other impulsive behaviors are common in mania. Many mentally ill people reject medication and doctors. This is common for two reasons:
1. As your friend said, she doesn't want to lose the "up" times.
2. When the person is "up" or even stable, they think they are fine so they stop taking the pills.
That's the illness more than simple delusion.
As for your second example, yes, that is entirely possible. People in a manic state, by definition, act in ways that harm their life. This is not typically violent behavior, it is more like:
- having many sexual partners
- losing huge amounts of money gambling
- driving at _excessive_ speeds
- spending sprees
And so on. This is because in a manic episode the person often feels "god-like", unstoppable, like a genius, like they can do no wrong. They are also prone to engage in pleasurable activities like spending money and sex.
(There are other aspects to mania as well, that's just related to what you asked about.)
Hope that helps.
- Natasha

Hi Natasha,
I'm very relieved to know I didn't breach confidentiality with you. Having worked in the Health Services for a long time, I know how important it is. I hope you are not having a hard time at the moment.
As I have ogoing interests in Mental Health, could you please answer a couple of questions for me? I have DID, but do not know as much as I would like about Bipolar Disorder. I can research it, but the answers are pretty clinical, and I would like to get your perspective as a sufferer. A friend of mine who has Bipolar frequently goes off her medication, and I asked her why. She was pretty manic at the time, so I don't know if her answer is valid. Now I haven't seen her for about two years.
She told me she had no intention of seeing any more doctors or taking any mor medications. Her rationale for this was that she fely so absolutely wonderful when on a high, alive, very aware, energetic and so on ,that she was willing to put up with the lows until the high arrived again. She seemed to have a very rapid cycle, about 2-4 weeks, and told me "no damned doctor was going to interfere with the good times". She seemed to me to be a very sick girl, but would not countenance any interference from anyone. She was in severe financial difficulties because of her spending sprees such as booking a world tour, buying $1200 worth of clothes on her mother's credit card, getting engaged to a guy she had known for only two days, then deciding to take up prostitution to help with the finances. At that point I lost contact with her.
Is it possible that such a thing could happen, or was she likely to have just been delusional? one other friend I knew just went beserk with his credit card, but his wife immediately cancelled it. He and I were both in hospital at that time and I know she managed to sort it out legally. His meds were adjusted and he levelled out. I never saw him depressed, he went home soon after that.
But do things like this really happen, or have I just seen 2 really sick people? research doesn't provide me with answers like that, and I haven't yet found any case histories. Confidentiality I suppose. I would really like to know more from the point of view of a sufferer, not just from idle curiousity, but because I am really interested. I'm looking for a way to make Mental Disorders more acceptable, and over come that damn STIGMA we all live with.
Don't give up, so many people care about you, including me.
Diane

Hi Diane,
There is nothing unforgivable about what you wrote and there is no invasion of privacy. You have the right to express your opinion and that's totally OK with me. I'm sorry I didn't respond but sometimes my life gets a bit busy and I don't make it to responding to every comment.
Yes, I am a difficult case, I am treatment resistant as they say.
It's true, of course, we can all be our worst enemy. I'm not particularly mad at doctors, save perhaps one or two, but that's about them specifically and not the profession as a whole. The advice I gave is because I hear all the time from people who can't seem to get the answers to the questions they want from their doctor. I think this is because they're not communicating very well. Doctors are on a planet of their own and while it's their job to cross the bridge to you, some are just better at it than others. I've seen something like 10 doctors and by and large they just respond better to certain techniques.
I don't expect doctors to support me. It's not their role. Their role is to hand out drugs. (It wasn't always this way, and perhaps it still isn't in other countries, but here, in North America, it is.)
Yes, agree, friends and family are important. That's why I talk about bringing someone with you to appointments. That support can be very helpful when you don't have the strength yourself to speak up. As it happens, I don't have the type of relationships conducive to such things, but I know other people do.
Sometimes my blatant, intellectual, realistic opinion comes across as anger. I can understand that. It's just hard-won knowledge through over a decade of trying. People prefer softened edges and positive-thinking and depiction of world we don't live in. I don't offer that. Lots of people do, I'm just not one of them. And of course I realize that many people will have much more successful treatments than I do. I try to acknowledge that.
If you have suggestions you think would help, please feel free to share. I would be interested in hearing them, as would many others I'm sure.
So Diane, no reason to be sorry. I write publicly. Which means the public (you and others) get to respond.
- Natasha

Dear Natasha,
You haven't written anything since my last message, and I feel I may have done the unforgiveable --- invaded your privacy. I have no right to ask you the type of questions I did.
I should know better as mental health issues are a very private subject. I'm an RN, so I know about confidentiality and I feel I certainly overstepped the boundaries with you. I am really sorry, I tend to get carried away with good intentions, but I overstep the mark sometimes, as I feel I have done with you.
I really am so very sorry, and hope I have not done any damage.
Diane

Natasha my friend,
I really feel close to you, and hope what I have to say will be taken the right way.
First, in what way are you a very difficult case? you don't need to answer that if you feel it is your business, but I would really like to help you in ways that a Professional can't do. Friends can often be more helpful that the most knowledgable doctors, particularly as you say they are detached scientific types.
There are times when you can be your own worst enemy, and I say that because I feel a lot of anger coming from you --- and justifiably. This is not meant to be a criticism, I really want to help you. The doctors can provide the medication you need, but don't seem to be supporting you. This is where friends can help.
I have had experiences in the mental health field for 26 years now, and have seen a lot. Help from friends and family who have your best interests at heart can often do much more for you tha any doctor. I hope I can be a friend to you and tell you things which I believe could help, but if you want me to butt out, just say so. I really do care.
Love to you, Diane

Hi Diane,
Sorry for the confusion. Treatment resistance refers to someone who has tried a number of treatments and is still sick. I have tried, maybe, 50.
And as for the "very best" I put it in quotes to indicate that the doctors are considered the best by peers and whatnot. I'm not saying they actually _are_ the best. I really have no idea.
I have found the more specialized the doctor is and the more highly regarded they are in their field, the less human they appear to be. Certainly I respect that you can walk away from doctors like that, I don't blame you at all, but that's not really an option for me. Not only am I an extremely difficult case, _very_ few doctors work with the VNS I have implanted. Moreoever I now live in an area where the people who work with very difficult cases can be counted on one hand, and even seeing one is extremely difficult. There just aren't enough good psychiatrists here. Oh, and I'm on an island so it's pretty expensive to try and get a doctor off the island.
(I suspect outside of Sydney you have a lot more choice.)
I do believe that doctors get trained differently in different parts of the world and they view their roles differently. The people I see are detached scientist types and have nothing to do you other than prescribing medications. Out of the 9 doctors I have seen, they have all been that way and I think it's due to the type of people they work with and their training.
I appreciate your kind words.
- Natasha

Natasha,
I'm not sure just what you mean by "treatment resistant". As far as I am concerned I also see the "very best", but only rarely have I found a doctor who treats the hard cases and not found them to be less pleasant than most. Occasionally I find one who seems pretty arrogant or not particularly interested, but when that happens, I say what I think and never go back. I won't tolerate that kind of treatment.
But, as you say, in North America you have a very different Health Service, so is it difficult to change doctors? It's very hard for me to imagine having to go to a doctor I despise, just because of his/her qualifications.
Even with something as supposedly rare as DID, I have found several psychiatrists who have a working knowledge of DID, even in my area, which is a suburb of Sydney. I know from all my reading that health services can be very difficult financially to access, but although I am on a Disability Pension, I can still see almost any doctor I need. My last sentence refers to the US. I have a married daughter who lives in Connecticut and she tells me a bit about the system you have there. Is it possible for you to find a doctor you can really relate to? I've read some more about you on a few other sites, and your pain shines through. I really feel for you and wish I could somehow help you. My email address is above, so ifyou would like to mail me directly, please feel free.
I wish for better times ahead for you,
Diane

Diane -
Well I don't know if I would say horrific but highly unpleasant, yes. (one time I'll have to write about a doctor causing extreme nerve pain in his office)
Admittedly, these stories are coming from North America and different countries do have different typical experiences. I think also because I'm treatment resistent I tend to see "the very best" (those who handle hard cases) and they seem to be less pleasant than most.
But it's great that you don't identify!
- Natasha

Hi Natasha,
you must have had some pretty horrific experiences with doctors. I can barely relate to what you have said.
I am Australian, and we seem to have a very good Health Service compared to yours, going by what you have written.
My psychiatrist is wonderful, very professional but a wonderful human being. I can tell him anything and everything, and know I will be understood, not judged. I have cried many, many times and at the worst times, I even get a hug --- if I ask for it. But I must ask first because of professional ethics. My experiences with doctors in general have been very positive, and usually free. I have DID, but even my alters trust our doctors.
Anyway, all the best to you. Diane

Carolann,
I completely agree. I always recommend that people see a psychiatrist that specializes in your disorder. When I say "doctors" above, I include all types.
- Natasha

not all docs r required to get mental illness YOU SHOULD go to a PDOC not a GP for depressive disorders .I found out the hard way they just gaveme hormones n sent me home.........I like alot of american's deal with a major
depressive disorder...A GP cannot help u