Doctor, please don't tell me how I feel

The BBQ Pit
1

You diagnose me with OCD, an anxiety disorder. You say this explains everything I’ve come to see you about. The racing thoughts, the movements I’ve always assumed were tics, and the more recent gait problems.

The thoughts, you tell me, are obsessions. They are caused by anxiety.
You tell me that my movements, including my walking issues, are voluntary compulsions. My way of “binding up” the anxiety.

I am a very anxious person, you tell me.

But when I tell you that I don’t feel anxious, which is a requirement for a OCD diagnosis, you tell me I’m wrong, wrong, wrong. I really need to read about OCD, you tell me. “You stupid little girl”, you probably wanted to add.

I leave your office with the Luvox prescription and don’t know how I feel. Anger because I get this major diagnosis from you without the merest sign of sympathy or care to help me understand it? Sadness because I’ve just been told that behaviors I thought were involuntary are indeed voluntary, so I’ve been wasting money and time for years on something I could just have stopped on my own? Frustration because I don’t understand how one can have an anxiety disorder without feeling anxiety? Hopeless because the Luvox is probably going to poop out like all the other drugs I’ve taken, but it doesn’t really matter anyway because if I could just clear myself of all the “bound-up” anxiety, I’d be alright all on my own?

The whole world could collaspe around me and I wouldn’t care, due to my strange personality and megadoses of Klonopin that I’m taking for no known reason. And yet I’m supposedly so anxious that I allow myself to freeze in the middle of busy interactions…even though it seems to me that would make a person even more anxious and that they would avoid doing it. I’m so anxious that my thoughts race as I prepare to go to sleep at night…but are strangely peaceful when I’m explaining complicated matters to my boss and co-workers. And I have so many things to be anxious about! So many things that I can’t even list them all. In fact, there are so many things that I’m anxious about that I cannot even imagine a single one. The anxiety must be making me dumb.

I know I’m not a psychiatrist. I know I don’t know about all the types of OCD out there. And I do know that having repetitive thoughts–including nonsensical words and phrases–is a symptom of OCD. I know this, doctor, because I have read up on OCD, if you had bothered to ask. I’ve known about it for a long time now. But I’ve also read up on bipolar disorder, ADHD, and schizophrenia–conditions that I’m more genetically predisposed to than OCD. Guess what? They happen not to have anxiety as a diagnostic criterion. And they, like OCD, can be linked to movement problems that are not voluntary compulsions.

I was your last patient of the day, but it wouldn’t have killed you to explain this to me, like I’m an intelligent person worthy of knowing all the weird things that could be going on in my brain. I think my co-pay, at the very least, affords me that level of respect.

Tell me why you are so highly respected? You’re laughing and smiling at your witty turns of phrases while I’m asking serious questions…a respectful attempt to understand what causes OCD and what you think my prognosis is. And I’m supposed to think you care when you won’t answer me with something substantial? You might have well have told me that my uterus is wandering around in my body and that I will be alright when I have a baby. That’s how useless my visit was.

I’ll take your Luvox and your Anafranil (which I once thought was a wonder drug, but now just makes my nose bleed, my bladder reluctant, and my appetite gone). I’ll be a good patient and do as I’m told. But if Luvox doesn’t work, I think I’ll take another vacation from psychiatrists and their walls full of diplomas and their smirky faces that don’t deign to show compassion. I’ll just keep limping along and muttering to myself and not talk about those things anymore. Because apparently wanting to be rid of these crazy symptoms means I’m anxious.

Read about it if you don’t understand, you stupid little Doper. :smiley:
:frowning:

2

Get another doctor. This one’s an asshole if he doesn’t listen to his patients.

3

Is this supposed to be a spoof of that other depression thread?

4

I think that you need another Dr. This one doesn’t seem to be working out for you.

5

BEFORE you go too far down a pharmaceutical road you don’t need. At least get a second opinion.

6

  1. Get another doctor if you can. This one either isn’t explaining things very well, or isn’t a very good diagnostician.

  2. It is my understanding, and I am no expert, that anxiety is not a requirement for anxiety disorders. They have that name because a certain part of the brain is implicated, but no actual feelings of tenseness/nervousness/etc. need be felt. A good friend was diagnosed with dissociative panic disorder, which is in the family of anxiety disorders. He would be totally fine – no depression, no anxiety, no problems at all. But one of his triggers would hit him, and he’d collapse in a twitching heap. “Anxiety” had absolutely nothing to do with it, but that was the category of his problem. His treatment was one of the traditional anti-anxiety drugs, and it seemed to work for him.

7

I agree with getting a second opinion. Anxiety is a very strange beast, and can manifest in bizarre ways, and some of the things you’ve described really do sound like an anxiety disorder, but your doctor doesn’t sound like he’s working very well with you on these issues. Also, if you do have an anxiety disorder, he shouldn’t be sending you out with just a prescription; Cognitive Behavioural Therapy (CBT) should be recommended as well, because it treats anxiety disorders so well without never-ending medication.

8

I’m not going to tell you what you feel or don’t feel. And I certainly don’t think you’re stupid.

The thing about feelings though - each of us has a subjective barometer. For example certain kinds of fear are sometimes perceived as enjoyable. Ghost stories, for example, or rollercoasters. Some people will be afraid and enjoy the adrenaline rush of one experience even though the other experience might be too intense for them. The rollercoaster is the same for everyone but each individual will have a different reaction to that experience.

This can carry-over into other emotions. A person with anxiety disorder can experience a high level of anxiety every day - but from their point of view, that’s not an anxious experience. That’s just the everyday baseline for them.

I’m not saying this is what’s going on with you, monstro. I’m not trying to diagnose you or anything. I’m just saying, feelings are slippery things and discussing them can be imprecise because everyone experiences them differently. (It seems to me that I don’t think it’s about the feelings at all really, I think it’s about how we perceive and respond to them. But that part is just my take on it.)

I would agree that by all mean get a new doctor if you don’t feel comfortable with this one. Having a good connection with your doctor makes a world of difference.

9

I think what sucks is that I’ve been told by another psychiatrist that I’m alexithymic–which means (if true) I can’t put words to feelings. Apparently this means I can feel emotions but can’t label them or describe them beyond “bad” or “good.” My current doctor knows about this diagnosis, so he might feel he has to tell me what I feel because I don’t know any better. But I’ve never fully bought the alexithymic label. I very rarely get angry, but I know what that feels like enough to say, “I am angry.” I don’t need to see myself crying to know when I’m sad. And I know what worrying feels like. There was a time in my life, especially in college, when I was a big worry wart. I would worry about test answers and grades and about what would happen if I lost my scholarship. But I don’t think I worried that much more than the average college female. I just had nerdier worries than normal, perhaps.

But not now. I’m not a bouncing ball of endles carefree joy, but I no longer worry about things. I don’t know what’s happened since I’ve turned 30, but I just don’t think about things like I used to. I walk the streets at night, fully aware of the dangers, but feeling safe just the same. I drive my jalopey all over creation even though I know good and well it could break down on any lonesome road–and me not carrying a cell phone to boot. I lost my wallet for an entire weekend once and spent no more than fifteen minutes thinking about it because I just figured it would turn up. I actually go to therapy because I know I should care more about things–from the way I look to what the hell I should be doing with my colorless life. Perhaps my profound feeling of “nothingness” is a sign of anxiety? As ridiculous and sarcastic as that sounds, I really am getting to the point where I’ve started viewing everything through this anxiety hypothesis. Just because I want this doctor to be right.

I want him to be right because he’s the fourth shrink I’ve seen in a little over two years. According to multiple people, he is the best in town. He wasn’t taking new patients until my therapist made a special request on my behalf. The other docs were too cautious to give me a diagnosis and instead prescribed me everything under the sun. So at least I have to give him credit for giving me something besides shoulder shrugs and hand-waving. But if he really is the best like they say, who would I go to for a second opinion? And how much do I really care to seek out another doctor, waiting umpity-ump weeks for an appointment to open up, filling out another bunch of paperwork, answering the same set of questions, etc.

It’s never going to end. I care just enough to take the meds I’ve been prescribed and hope for the best. If they work, I’ll regret I ever posted this drek. But if they don’t and the neurologist I see in a few weeks disappoints as well, then I will believe that I have tried hard enough and that it’s time for me to just go on with my life, damn the crazy “quirks.” If it’s anxiety and it’s all in my head, then I have nothing to worry about. And if it’s not and it develops into something worse, then I will take care of it then.

See, the solutions to my problems are so easy to come up with. It’s amazing.

10

You sure seem to explain things well enough here, but maybe I’m read-monstro-thymic or something.

The only time I’ve been put on anything resembling psychiatric drugs, it was because I’d gotten gastrenteritis due to stress; the doctor gave me both medical leave and an ansiolitic. I explained I wasn’t anxious: I was enormously tired (several weeks of 12+hr workdays followed by a visit to the Grandparents from Hell), and being given a week of night shift on one where I’d previously been approved for vacation had sent my body over the edge, but once I could get the rest I’d been expecting I’d be fine. He insisted, I took the pills once with the result of being unable to concentrate for a whole day and then said “fuck these pills with a rusty dildo, I’m not going to go through the whole day in a fog because the doctor thinks I should be anxious”.

I hope you can get a doctor who understands that “may have difficulty finding the right label for a feeling more often than most people” does not mean the same as “does not know whether she’s eating or shitting”, or eventually get this one to understand it.

11

Wow, if I’m reading you right, you are heavily and seriously worried about the fact that that you don’t worry much about the little things.

Like you, I walk the streets at night without worry.

Like you I drive a beater and often very low on gas without a charged up cell phone.

Like you, I’ve lost my glasses or wallet (with a momentary level of anxiety) and expected them to turn up even after a couple of days.

Like you, I’ve taken prescribed medications without any percieved positive results. In my case it was for depression. A change in circumstances seems far more effective.

I’m asking myself if you really aren’t chasing a problem that doesn’t really exist or if I need to go see the doctor again.

I’ve seen your picture once. Its hard to imagine that you haven’t got a picture perfect life.

12

Don’t get too caught up in the diagnosis. The fact of the matter is that no one can make an accurate mental health diagnosis on the basis of a 20 minute conversation.

The good news is it doesn’t matter much. In all honesty, we have no fricking idea why or how most psych meds work. We just know that sometimes they do. And sometimes what works isn’t a med developed or traditionally used for your diagnosis anyway. The diagnosis isn’t useful for anyone except your insurance company or the doctor trying to get paid for his work.

Have you noticed all the TV ads lately for Seroquel and Abilify, aimed at patients with Depression? Seroquel and Abilify are classified as atypical antipsychotics. Yet people with Depression don’t generally have psychoses (delusions, hallucinations, etc.). Somehow, they help anyway (some of the time.) We don’t know why. If you’re the patient and it works for you, you don’t care why!

The other thing I’d add is that there’s a possibility you’ve got some dissociation from your feelings going on. I really did have an anxiety disorder once upon a time, but I’d rarely have described myself as anxious. I wasn’t afraid or jittery or ruminating - I was numb. I was so numb and calm it was ridiculous. Yet I was numb in those situations which one would expect an anxious person to be anxious in. My own personal form of anxiety, more often than not, isn’t what I was taught anxiety looks or feels like, but is dissociative numbness. That IS anxiety, for me. And what helped most was Prozac, an antidepressant.

13

This doesn’t sound good.

14

That’s crazy :), but also very sweet. Thank you.

I’ve spent the morning reading about dissociation, just in case you guys could be on to something. Does dissociation have to be caused by a traumatic experience, or can it be totally idiopathic? Unless I have a big ole mental block going on or it happened when I was an infant, I’ve never had a traumatic event in my life. I’ve been stressed out before, yeah, but not traumatized through abuse, abandonment, or physical injury.

But I’ll concede it’s easily possible I’m cut off from my feelings. I’m not going to make myself out to be totally emotionally put-together when I know this isn’t true.

I guess it’s just the way the doctor was so cavalier about the whole thing that bothers me the most. OCD is not a trivial disorder, and if I’ve got movements associated with it, that makes my prognosis piss-poor and actually kind of scary. But I’ve had to find this out on my own, not through him. Perhaps he’s so used to working with kids that he’s gotten in the habit of treating all of his patients in a condescending way.

15

If you find that your tics, vocalizations, and bizarre movements correlate with certain environmental stimuli–regardless of your perceived emotional responses–perhaps this is why the doctor has reached his conclusions. You may not be consciously aware of this stress while you’re in the moment, but it could very well be there.

I’m not an psychiatrist, but consider that the antidepressants you’re taking are putting distance between you and certain emotional responses. Things may be going on inside of you that you can’t sense the same way you could before.

And the end of the day, it may not matter. If ten different diagnosis with ten different pathophysiologies all just happen to be treated the same way, then practically speaking, there isn’t much need to focus on which of the ten different conditions you’re dealing with.

The doctor sounds like he has poor bedside manner, though. I would hate to be talked down to like that.

16

From what I gathered from this book, no, you don’t have to have had one or a few distinct traumatizing events. A longer period of time (months, years) where you felt so bad that taking a mental leave was kind of neccesary, might also ingrain the habit of dissociation.

17

On the other hand, I think one of the basic criteria for if something is disordered is how it’s affecting your life - for example, lots of people are afraid of spiders, but it doesn’t really affect their lives, so it’s not a big deal. If you start having a phobia of leaving your house and your quality of life deteriorates, that’s probably a problem. If you have a tic that doesn’t really affect anything, is it really a problem?

18

Have you ever lost an important loved one ?

One of my sisters recently reported that a new doctor has reversed her bipolar diagnosis and identified her condition as Borderline Personality Disorder. To listen to her, it has openned up her life after many years. She described the symptoms and for the most part she was describing me as well. She claims that the rest of our 6 brothers and sisters have it as well. To varying degrees of course. I certainly believe I have it and the cause was the death of my mother at the age of 14.

Earlier I touched on several diagnostic symptoms that I had that agreed with yours.

I checked out Dissociation to find out it can be a significant part of BPD.

Has BPD ever been brought up with your doctors ?

19

I’m less bothered by the tics than the racing thoughts, which don’t really “hurt” until that time of the month. The content is bizarre but it’s really the pressure of them that I find bothersome more than anyrhing. Sometimes I can’t speak without vocalizing some of the thoughts outloud, because they’re that jam-packed into my head. That’s just obnoxious.

I really don’t like the gait issues. The tics, I can kind of play off. Even the vocalizations aren’t too bad. But when my feet suddenly feel like their entrapped in 30 lb cement blocks, and I’m walking to work and still have a long way to go, then I can’t help but feel like it’s a problem. I can convince myself that maybe it’s not that big of a deal since no one has hit me with their car yet, but I know it’s not normal. And I can’t play it off–people have asked what’s going on. I’d like to be able to say something besides, “I don’t know.”

20

The doctor I’m seeing now mentioned it as possibility along with a stream of other disorders during my first visit with him. I’ve already been diagnosed with a pathological personality–schizoid PD, which I have found to be a reasonable diagnosis (though I don’t try to think about it too much). Like BPD, it too has been linked to dissociation (or derealization). But I’ve never thought I had that particular feature.

Maybe I zone out a little when I go for my long walks, but doesn’t everyone do that? How would one know the difference between normal and abnormal degrees of dissociation?

Thanks for sharing your experiences, by the way. I know people with BPD don’t get much sympathy around here, so that was a brave thing for you to do.

That’s true. I don’t think the drugs I have deadened me, but if it’s happened gradually, how would I really know? Well, I don’t think they’ve cramped my creativity or my sense of humor :), so at least I’ve got that going for me. But I do know that you have to be careful with these chemicals. They can do a number on you without your awareness. That’s why I’m taking my new prescript so relunctantly.

When the doc said he wanted to add another drug to the ones I’m already on, I asked him (dumbly, admittedly), “So I’ll be on four drugs now?”

“Congratulations!” he said as he wrote the prescription. What was that? Some kind of whooshy type of sarcasm? Did he not hear the concern in my voice? Perhaps he’s used to popping multiple pills, mulitiple times a day and trying to keep track of which ones to take when (bedtime or morning? with or without food?), which ones make you sleepy, which ones depress your appetite and turn you into a skeleton, which ones make your nose bleed, which ones you can’t take with grapefruit juice, which ones make you wet the bed, which ones freeze your bladder, which ones turn your stools into toilet-clogging bricks, which ones make you stutter, which ones make your armpits stink–catching my breath–but I am NOT used to this! Even after a year and a half of this pharmacutical ride, I’m not used to it. A little compassion and understanding would have been nice. Not a fucking “CONGRATULATIONS!” (You’d think a psychiatrist would be a little bit more aware of how careful he should be with his humor. I let that shit slide 'cuz I’m easy like Sunday morning, but he doesn’t know me. I might have been carrying. ;))

They should just create vending machines for psychiatric drugs. You just enter your symptoms into a console and the machine spits out the appropriate bottle of pills. It would be an impersonal process, but at least I wouldn’t have to deal with Dr. Congratulations.