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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by pretty_paints on January 26, 2005, at 7:26:27
Hi guys,
Ok, I just wanted to see how many of you were seeing a psychiatrist for meds, and a therapist for talk treatment?
Have any of you been prescribed with a specific diagnosis? Schizophrenia, bipolar, MPD, PTSD, OCD, etc. What has been your therapists response to this? Have they agreed with the diagnosis and work alongside your pdoc? Or have they completely denied that the disorder even exists?
I'd be really interested to hear any stories about this. I find the whole subject difficult - integrating therapy with meds. Who to believe, etc.
Ok, this is my story. Well at the start of the year I left Uni with massive depression. I started seeing a therapist in around June. Around the same time I started seeing a psychiatrist. I have no history of abuse in my life, or even anything unpleasant to be honest. There was nothing I could think of that could have caused the depression. However, my therapist managed to come up with a few things. My relationship with my mum, she wasn't that affectionate when I was a child. Not horrible, just not overly affectionate. And I may have internalised this as her not caring about me or me not being careworthy. So yes, I can see how this has affected my life. There are also some other minor issues.
Anyway in about August I was admitted to hospital for a severe psychotic episode. It turns out that I had been psychotic all along, but had been too depressed to mention any of it. Besides, I thought all my thoughts were true, so why would I question any of them.
Since I've been out I've been on various antipsychotic and although I have still not found the right one, I feel MASSIVELY better on them than ever before. At first it was thought I might have psychotic depression, but now the doc says although she is not 100% sure, she thinks it is psychotic not depressive in origin. And thinks it more likely that my thoughts have been going gradually wrong over years, till the point where they got so bad I became profoundly depressed. She says it is likely to be something that comes under the umbrella of schizophrenia.
To me, it all makes sense. So many things that confused the hell out of me before I went on AP's, now have gone. I feel like things have shifted from being blurry and out of focus and terrifying, to suddenly clicking back into place. There has never really been anything substantial from therapy. That's NOT TO SAY it isn't worthwhile, definately it is. But yes, issues with my mum, sure. But at the end of the day, we get on great now. And everyone tends to have SOME issue or another from childhood - it shouldn't stop them from eating, breathing, leaving the house, being constantly terrified, the way it was for me before I went on AP's.
Anyway. I don't know what my therapist's reaction will be if I get a definitive diagnosis. We once talked about bipolar (I'm not bipolar, we were just randomly chatting about it), and she said she thought that people could have a leaning towards it but that events in their life bring it outand maybe even cause it (?). Well I don't agree with that. I believe that it's a disorder caused by chemicals in the brain being unbalanced, and I believe that people need meds to control this - not 100% of the time, but in most cases.
So what if she has a similar view about psychosis? It's really difficult because a while ago I had this feeling that a guy from my past was constantly following me and watching me. This was psychotic, and the AP's got rid of it. But every time a "psychotic" thought comes up, she doesn't seem to recognise it as one. She seems to want to delve into it and analyse it, and take it 100% at face value. Like another psychotic thought I had was that a cousin of mine had raped me. He hadn't. I don't know how that thought came about. But she comes up with all these creative explanations, like maybe I am saying that he raped me to get attention off my mum, etc etc.
I just don't know how a medical diagnosis and therapy can go hand in hand. I feel really stuck. Deep down I really believe that yes, I have had some general issues in my life, but no more than the average person. I think there is something happening in my brain which, gradually over the years has resulted in these psychotic thoughts. I believe that I need a lot of support (through therapy yes) and help, to get through this difficult time. I believe I need antipsychotics to control these thoughts, and at the moment, antidepressants, to help my mood. I believe the depression has largely been caused by my life/thoughts going off the rails over the last 5 years. I think I need therapy to go back over my life, AND to go back over what has been happening since I first got ill, and how I can put things right now. Also, the therapy helps with psychotic ideas that I have had for the past 5 years. They are stuck very firmly in my head and it feels very difficult to see things any other way.
So what happens if she doesn't "buy" the diagnosis?
What happens if she has radically different views on these "medical diagnoses"?
Can anyone give me any positive support, I'd be very grateful!! Sorry my post has been so long and rambly, but my head feels very confused about all this.
xxxxxxxxxx
Posted by sunny10 on January 26, 2005, at 9:20:05
In reply to Therapist's response to a medical diagnosis?, posted by pretty_paints on January 26, 2005, at 7:26:27
I can only tell you what I have been told. So far, no "specialist" has disagreed (but sometimes they "decide" not to disagree, I think!).
For the record, my diagnoses have been as follows:
Major Depression -through high school
BiPolar Depression - in late twenties
Recurrent Major Depression with GAD- in thirtiesAnd although they do not all agree with the actual NAMES of the diagnoses, they have all agreed that in my case it is recurrent. That either my body does not produce enough neurotransmitting chemicals, or the receptors do not work correctly, so I don't "maintain" enough of the chemicals.
One of the doctors took the time to explain that the chemicals "help maintain a balance" and that if I was not producing enough, or maintaining enough, of these balancing chemicals, that I would eventually "run out" of them and suffer a "relapse" of the Major Depression. The one that suggested that I was BiPolar was suggesting that I had periods of hypomania, but did not disagree with the prior explanation. His opinion was that it didn't matter WHY I did hypomanic things when my brain chemicals began to tank, but almost every episode HAS started as mild depression, gone over to total anger at myself and self-destructive things (I threw away, or gave to Goodwill, all of my belongings once while planning to "go away for good". At the time, I convinced myself that I was just leaving town, but I was really just cleaning out my apartment so that my landlord wouldn't have to deal with it "after").
The general theme, here, is that they all agreed in BOTH nurture and nature- that chemicals "gone bad" (in whatever way) in the brain can be exacerbated by periods of "the blues" that people without chemical issues can get through without falling into depression or acting out hypomanically.
I'm not sure if that helps you, but I did make things a little more clear for me.
-sunny10
Posted by Tabitha on January 26, 2005, at 10:53:49
In reply to Therapist's response to a medical diagnosis?, posted by pretty_paints on January 26, 2005, at 7:26:27
If you have a chemical issue in your brain, you need a therapist who's sensitive to that. Since they see you far more often than your pdoc, part of their job is to help monitor you for recurrence of your symptoms that might need a med adjustment. I would not want to work with a therapist who didn't recognize that you need to fix the chemistry first, then look for life triggers, and fix the cognitive and emotional issues. When my chemistry is out of whack, talk therapy is pretty useless.
I'm rather alarmed that your therapist doesn't seem able to help you recognize psychotic thoughts. To me you'd need to kind of shut the door on those thoughts-- treat them like OCD talking, or the voice of depression. You don't want to indulge them and analyze them and accept them as valid thoughts. For example if I go into therapy and say "everything's black and hopless, life isn't worth living, everybody is a robot going through the motions", I don't want my therapist's first response to be Hmm, why do you feel this way? I want her to tell me it sounds like my meds are out of whack and I need to call my pdoc. It's OK if she also helps me look for an event that may have triggered the episode-- but I want her to recognize that I've gotten into a bad chemical state and need help with that.
I think it's kind of useless to try and figure out the cause of these conditions. Nobody can say for sure. Whatever it is, once you've got it, you need to fix the chemistry.
However, years of talk therapy have helped my chemistry too. I'm on less meds now and don't get as bad. I don't know if that will be true for psychosis. For depression, I definitely had cognitive and emotional issues contributing to it that were helped by therapy. But the therapy didn't start helping *until* I got the chemistry reasonably normal with meds.
Posted by Bent on January 26, 2005, at 11:56:01
In reply to Therapist's response to a medical diagnosis?, posted by pretty_paints on January 26, 2005, at 7:26:27
I don’t think I can be too much help with this but, I see a T for therapy and my family doctor takes care of my meds. I have been on some form of antidepressant for about 11 years now and been with my current T for three years. I think because my doctor and me seem to like where I am with the meds, my T doesn’t interfere much with it.
My T doesn’t talk specifically about diagnoses/disorders too much and I am thankful for that. I mainly deal with moderate depression, GAD, and a little PTSD. I don’t like to talk about diagnoses because I feel like they can take away from the therapy for me. Like it’s easy to get caught up in what a particular diagnosis means rather that what I am feeling or what my own symptoms are. I could be just more sensitive to the subject than most people, I don’t know! I am glad my T is more into the treatment than diagnosis.PrettyPaints, can I ask about your diagnosis? If I am asking for more than you want to share, that's ok. I understand. You mentioned a psychotic episode and having been psychotic all along but were too depressed to mention it. What did you not mention? Were there other symptoms? Again, sorry if I am asking too much. This just really hit home with me and sparked some questions.
~S
Posted by Mark H. on January 26, 2005, at 16:18:14
In reply to Therapist's response to a medical diagnosis?, posted by pretty_paints on January 26, 2005, at 7:26:27
Hi PP,
I strongly agree with Tabitha.
If you can find a copy, I recommend reading the book "You Can Feel Good Again" which starts from the simple premise that whatever you focus on is what you're going to get more of. The author, Richard Carlson, believes that many therapists unnecessarily increase and prolong unhappiness by focusing on the past, searching for sources of conflict, and asking clients to recall and relive painful life experiences.
It's wonderful that you've found new medicines that help you lead a happier and better-balanced life.
Now the question is, "Is your therapist helping you or holding you back?"
Best wishes,
Mark H.
Posted by Poet on January 26, 2005, at 20:01:18
In reply to Therapist's response to a medical diagnosis?, posted by pretty_paints on January 26, 2005, at 7:26:27
Hi Pretty Paints,
My pdoc said that for *insurance purposes only* my diagnosis is dysthymia with recurring major depression.
Both pdoc and my T say they don't believe that a diagnosis sums up the person. I agree. There's more to me than what's on paper or what I take meds for.
Yes, I have dysthymia (low level depression that is always there.) I have recurring major depression, too.
Plus suicidal ideation, bulimia, social anxiety...
Are you comfortable enough with your therapist to talk about your concerns with your diagnosis? How you are worried that it will affect your relationship with her?
I know how hard it is for me to talk in therapy (about anything.) It's helped me to write down my issues and let her read them and answer them. You might think about that if expressing your concerns/fears out loud is too difficult.
Poet
Posted by pretty_paints on January 27, 2005, at 16:09:13
In reply to Re: Therapist's response to a medical diagnosis? » pretty_paints, posted by Poet on January 26, 2005, at 20:01:18
Hi guys,
Thanks for all your replies,
I'll try to reply to them individually.
Tabitha - Yeh I totally agree. It worries me that Charlotte (my T) won't be able to recognise psychotic symptoms, and that she'll indulge me and make things worse. Yes I agree that if I say went in going "ooh I think I'm a spy", it would not be good for her to go "Hmmm, and why do you think you are a spy today Katie?". I want her to say, "Well, you're not. That's not true". Okay, I'm exagerating but you know what I mean.
Bent - I understand what you mean about diagnoses taking away from your therapy. And I certainly don't think that a "diagnosis" is the answer to everything. However, in my case, I was so ill and there was no real reason for it. I figured there HAD to be an ANSWER, a reason for all of this. I got very very confused and started to come to all sorts of bizarre conclusions about things that must have happened to me in order to cause all this depression. So I was faced with all these horrific thoughts. I could vaguely remember some sort of "could be potentially dodgy" senario with my cousin Todd. Something really small like a time we were wrestling in the bedroom on holiday when we were kids. And from that I deduced that Todd must have raped me. I mentioned this to my Mum and she was supportive of course, but because she didn't JUMP on the idea and say "yeh you're right", I began to think she was in on it too. I thought she knew all about it but was in on it with Todd. They were in collaberation. She was trying to stop me tearing the family apart. So I became very afraid when I was around either Todd or mum.
Aaaaanyway. The point is, I came to lots of wrong, confusing conclusions. And then when I went into hospital, the idea that perhaps I was "psychotic", finally came as a relief. Because a psychotic illness would 1) mean that all of my nasty thoughts were untrue (big relief) and 2) give me an answer to what had caused all these problems.
Anyway you asked about the diagnosis, that's absolutely fine. Um, well like I said I don't have a diagnosis. My thoughts are apparently "bizzare" and "not mood congruent". This is why psychotic depression has been outruled. So the thoughts don't "tie in" with depression. Their tone is not depressive. The diagnosis apparently has been put as "a psychotic illness". I don't know of many different psychotic illness. Schizophrenia has been mentioned. I know there are other things though, like Schizoaffective (though I've never been manic) and some other things I don't know about probably.
Aaaanyway. The other two questions you asked. Well, um. When I was back in school I got some grades which got me into the paper and then into a top uni, so if you like (and I'm totally not trying to be big-headed, I'm just trying to explain) I kind of got "famous" in my school. That was fine. However after I left and started to get ill, I started thinking that EVERYONE must have seen me in the papers, everyone must know who I am, I'm famous!! I thought people were always talking about me and watching me. Then I got obsessed with a guy from my past. I knew he lived nearby so I used to go wandering around the streets for ages looking for him. Then I stopped, but by now I thought he was watching ME. You know what it's like when you fancy someone and try to impress them? So whatever I did, whatever I said, what clothes I wore, what degree I eventually chose to do, basically the whole way I lived for the next three years, was all done for HIM coz I was convinced he was following and watching me, so I had to impress him. When I got to Uni I thought I was in a special room with cameras in, I was living actually IN the college alongside tutors etc, and I was convinced every teacher was watching me constantly. I could never relax, I drank lots, couldn't study, TOTALLY couldn't concentrate, didn't bother to go to lectures (also, I had chosen completely the wrong degree to impress *him* so I wasn't enjoying it at all). I wanted to go home all the time, it's the only place I felt safe. I also heard a voice, but I knew it was my voice in my head, just commenting on my thoughts and feelings, like I was on tv talking to the viewers. Anyway there's lots of other blah but I can't really remember much, so is that ok? This was the sort of stuff I didn't tell the doctor coz I thought it was all true, plus I was too depressed. When I was depressed, I suppose my psychotic thoughts at the time WERE mood congruent. As I got more depressed, I began to think I was evil and that I should be dead (these are mood congruent thoughts). I thought I was dieing and that it was my fate. ANYWAY, with two AD's, I began to get a lot less depressed. Now, I'm not great, but I don't think I'm that depressed anymore. I think that's why psych depression was ruled out, because with that, as the depression dissapeared so should the psychosis. But mine has remained even after the depression has gone (well not now, as I'm on AP's, but you know what I mean).
Anyway, sorry if I've bored you to tears! There are a few tasters of the way things went. How so did this hit home for you? Have you had similar experiences?
Mark H - Thanks a lot for your post. It really worried me though. I worry that maybe that's the case for me? I don't think so though. My T isn't always fishing for juicy details from my past and making me relive them. In fact recently we are doing a lot of "reality testing", talking about whether certain things I believe are really true or not. That's helpful. But yeh, I'm aware of what you say. It's what's always worried me really - whether all of this is down to meds or therapy. Hmm.
Poet - Yeh I know there's more to a person than their diagnosis. It's just in my case, a diagnosis really helps me try to work out in my head what has happened to me this last year. I've constantly been trying to work out what has caused all this/what went wrong, so a diagnosis helps me to try to straighten things out. Yes I have mentioned all this to my T. We chat about it quite a lot, recently it's all we seem to talk about!! Obviously she says she supports me blah blah, but she DOESN'T think that meds are the answer to everything. She thinks they HELP facilitate therapy, but they are not the ANSWER. Whereas in my case, I'm starting to wonder whether (if I have a psychotic disorder), meds ARE in fact the answer.
Thanks a lot to all of you for replying!!
Lots of love xxxxxxxxxx
Posted by Mark H. on January 27, 2005, at 19:50:08
In reply to Re: Therapist's response to a medical diagnosis?, posted by pretty_paints on January 27, 2005, at 16:09:13
Hi PP,
Thank you for your detailed response to all of us. That was very kind of you, and reassuring. I think you're handling the situation very well. Don't let anything I write worry you. From reading your first post, I got the feeling that your therapist wasn't taking care of you, and I felt protective. It sounds now like you're helping her learn to be a better therapist for you.
I'm Bipolar II, which means I have cyclic periods of moderate to severe depression, usually bottoming out around the end of August and all of September and again in February and March. I take cytomel, methylphenidate, pindolol, Effexor, clonazepam and Zyprexa every day to remain functional. I work full-time and need to sleep about 11 hours a night to feel really good.
I had an otherwise wonderful therapist a few years ago who didn't understand bipolars, however, and he made a mistake in asking me to "practice expressing the minor irritations in your life," which quickly led to bizarre thoughts of rage that felt very crazy and out of control to me (that's when I first stared taking Zyprexa). When my psychiatrist said, "Yikes, you don't ask bipolars to 'practice' their anger," my therapist and I both said "Ooops!" and moved on.
My first wife was unusually intelligent (like you) and subject to "schizogenic breaks," basically bouts of schizophrenia-like symptoms that occurred when she was under extraordinary stress. I have often wondered if her intelligence and this underlying vulnerability to stress were linked somehow. She only had two such breakdowns during the six years we were together (hospitalized once), and otherwise has functioned completely normally as a highly competent professional (two masters degrees, fluency in several languages, lots of responsibility at work, etc.) for the past 30 years. So I know from experience that you don't have to be a bona fide schizophrenic to experience such symptoms.
I think you're doing great! It may be that you'll never have a definitive diagnosis, and that's OK. I'm just so glad that the meds and therapy are helping you.
Best wishes,
Mark H.
Posted by Bent on January 28, 2005, at 12:20:35
In reply to Re: Therapist's response to a medical diagnosis?, posted by pretty_paints on January 27, 2005, at 16:09:13
Thanks you so much for sharing. It sounds like you had a lot going on in a short period of time. I think I kinda know what you mean by thoughts that arent mood-congruent. I sometimes wonder if there’s more than just depression with me, and sometimes I am afraid to talk about things because I don’t understand. I hope your meds continue to help you out. Were you able to continue at school? Thanks again for the information.!
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