I tread carefully around this subject in the knowledge that my own Psychiatrist now has my blog address. So for the purpose of maintaining his ego, which in turn maintains my mental health support, any personal stories I give are definitely about another psychiatrist I’ve had previously and not my current one who is the best psychiatrist I’ve ever had and none of the following relates to…
“You are an attractive girl, go out and get yourself a job in Claire’s Accessories” were the last words of wisdom I was given by a red scarf wearing Psychiatrist before he promptly discharged me. I feel the red scarf detail is relevant because A. I hate red and B. He was wearing it inside which seemed odd. The problem I have always had with psychiatrists is their lack of in depth psychological knowledge, which seems to correlate positively with their medical doctor arrogance. I would not necessarily fully trust and follow a psychologist’s medical advice, in the same way I do not fully trust or follow a psychiatrist’s therapeutic advice. I am however biased towards the former having gone in psychology first rather than medicine. For those highly abnormal people who have never had to come into contact with either profession,the difference between the two is that a Psychologist is trained in Psychology and works with people on a behavioural and emotional level, whereas a Psychiatrist is trained in medicine and can prescribe drugs; debatably a few also provide some sort of therapy too. My openly critical stance of Psychiatry is, however, somewhat tongue in cheek; they do have a great value for many mental health conditions which psychologists sometimes cannot even touch. Were autism to be easily treatable with simple strategies and medication I would be the first to advocate the psychiatrists role when it comes to the disorder, but it is no mental illness, cannot be treated, and a much deeper level of understanding is required. Here is my manifesto of problems:
Problem Number 1:
You need to be cured
The very nature of medical doctors are that they are working towards a cure. At the very least if they are not working towards a cure then they are working towards prolonging your life; in the Psychiatric world this relates to suicide prevention. Autism is often only brought to the attention of psychiatrists because of severe mental health difficulties and as a result autism can often be shoved aside as the secondary condition. It is now well known that many of these mental health conditions may have been triggered by the struggles of living with autism and as such understanding first and foremost the autism in the individual patient is vital. This brings me on to my next problem.
Problem Number 2:
You are one of many disorders
There are many categories you can fit into and many labels you will be given but ultimately you fit under the one umbrella term of ‘psychiatrically disordered’. As such a one size fits all approach should suffice. However, many of the treatments and plans given to other psychiatric disorders are inappropriate for those with autism. For instance, it is quite common for those with autism to talk to themselves and have strong bizarre beliefs, which does not neccessarily equate to psychotic or delusional disorders. Similarly it is common for those with autism to have quite repetitive and ritualistic behaviours and habits, which does not signal Obsessive Compulsive Disorder even though it may look like it.
You must tolerate drugs
I have developed a pathological guilt complex due to my persistent drug intolerance and my need to give my Psychiatrists the faith that problem 1 is possible and problem 2 does not exist. But drugs don’t work the same in everyone, and autism is definitely not included in that everyone. As a whole we are more sensitive to chemicals, more prone to side effects, and need far lower levels of drugs than most. Combinations of drugs are a no no, and no matter how much you try, some problems just can’t be wiped away. You can ‘cure’ your depression but that doesn’t make social situations easier, you can ease your anxiety but that doesn’t stop change freaking you out. At what point do you stop and say ‘OK this is the maximum benefit pills can do for me’ before you end up trying every psychiatric drug and combination possible? Some of the side effects can even worsen or mimic autistic traits; twitches which turn into repetitive habits, agitation which turns into a meltdown.
Problem Number 4:
The Psychiatrists are in charge
Most teams are led by the consultant psychiatrist so all the above problems are pretty significant when your entire treatment is being based around these ideas. If you are lucky you will be pushed onto an anti-drug therapist or psychologist who has more experience with autism, but if you are not so lucky you may find yourself on a short CBT course not tackling any of your supposed problems and back to the drawing board.
Problem Number 5:
Most Psychiatrists won’t recognise these problems.
The good news is there are some pretty easy ways to tackle these problems and communicate better with your psychiatrist.
Solution Number 1:
They are human too
Egotistical maybe, but heartless no. They may be hard to decipher but they do actually want you to get better and live without them, so they will do their best to help. This isn’t really a solution, but it is good to keep in mind.
Solution Number 2:
Communication is key: write things down, bring someone along
One of the most common problems people have with their psychiatrists is miscommunication. For those with autism this is a particular problem. We may under report our feelings, when we do they may be misinterpreted, what we say is often not what we mean, and what we are being asked we have no clue. The obvious solution to this is to write it down, concisely. Psychiatrists speak in nice neat tables and graphs, so keep it simple and keep it visual. I have previously tried a mood table, a flow chart, typed bullet points and several others with varying degrees of success. Of course the other solution is to take someone into the consultation with you. This is especially important if you are prone to forget to mention things you deem unimportant or wonder afterwards how your psychiatrist couldn’t read your mind or pick up on something.
Solution Number 3:
Tell them how you feel
This seems quite obvious but you would have also thought it obvious for your psychiatrist to guess you are feeling down by seeing you cry – it doesn’t always happen. Don’t let them guess your state of mind, if you feel sad say it, if you feel worried say it. Think of all the things you don’t want to leave the consultation without having said or brought up, and just get them in wherever you can! And don’t be scared to say when something is not working, if a drug is making you ill but you have only been on it several weeks don’t be afraid to say ‘no, I can’t take that anymore, I need to try something else’. As much as a Psychiatrist wants you to believe they are making the correct choices for you, they are mostly educated guesses at best.
Solution Number 4:
You have spent years learning how to fit in and you comply with everything that is thrown at you. They are paid to be there and to understand you, so don’t be afraid to throw some extra work their way. This, I think, is the most important tactic. If they know hardly anything or have little experience of autism, how can they ever be expected to get your treatment right? Many are possibly too busy for extra training or it isn’t their ‘specialism’. So take articles you have found, symptom lists from books, books with the relevant pages highlighted, google pages, research papers, anything that you think by them reading or knowing would help your cause. The only thing I would suggest is clearly highlighting what you want them to see, a whole book is likely to get put aside and forgotten about.
Solution Number 5:
Request to be referred
Armed with the knowledge of who you would feel could help you best, ask for it. Ask to see a Psychologist or someone who specialises in autism, don’t just sit back and assume you will be automatically passed to the best people who know about the condition. There won’t always be someone available but it is worth a try.
Solution Number 6:
If you have several people involved in your care then make sure there is communication amongst them all so you don’t have to keep repeating yourself, and if one understands you more they can inform the others what you need. Ask for a Care Plan or things to be forwarded on, take letters and plans with you to your other appointments. They should do this automatically but it is best to keep a check on it.
I write this guide with a lot of hindsight and there are a few Psychiatrists I have had where it would not have been possible to employ these tactics. If this is the case then you need a new Psychiatrist; if you can’t be open about the care you are receiving then you are on the road to nowhere. Now I will leave you with the most profound statement my psychiatrist has ever made to me: ‘Hannah, your life is a bit like the Truman show’ (I still don’t really get that but if I did I am sure it would be very helpful).