The problem with treatment

My brain has been somewhat exercised of late, both by my own internal wrangles about psychiatric treatments and by various online debates, particularly about ECT. These debates often seem to be moral and emotional in nature, making it particularly hard to contribute or indeed come to any conclusions.

I am someone with a very precarious belief in my own diagnosis, and whether treatment is helpful. I have a long career of arguing about both diagnosis and treatment, and don’t suppose I will ever achieve the certainty that a blood test or some distinctive pathology would convey. I even worry that, should a blood test become available, it will disprove my diagnosis, and I will be found to be a fake after all these years. There is no way to win this one, not that there is anything to win. My mood is me, and I don’t feel it as a disorder. Sometimes, looking back, I can see that things may have been amiss, but the moment is past, and I can no longer live it. Instead I try to accept what my partner says, and what my psychiatrist says, but I exist uneasily. What if I get a new psychiatrist who disagrees with the diagnosis? Or a new partner (God forbid) who doesn’t believe in psychiatry?

So there I am, waiting to be unconvinced, and there is plenty of information out there which will do this for me. The problem is that it is very hard to find a middle ground. No-one argues that because, for example, asthma has both genetic and environmental (& even psychological) aspects, then it is not an illness; but there seem to be all sorts of problems when it comes to mental illness. I don’t want to get into an argument about any of this (even with myself), but what it does do is cause immense difficulties for the patient. If I have decided to accept my illness and swallow my pills (even if they do make me fat & kill my libido – a double whammy) then I am extremely vulnerable to any article suggesting that this may all be unnecessary. I am sure there may also be articles suggesting that asthmatics don’t take their inhalers, but I like to think that these would get torn apart by the great British public. There are always a few outliers, but nothing like what you get when you read an article about ECT. Strangely, I feel less bothered by the question of ECT, probably because even I can see that it made a rapid difference when things were very bad. The memory loss is significant, and much does not return; but this is acceptable if explained and acknowledged afterwards. It won’t be well remembered, ironically, if only discussed beforehand.

Drugs are far harder. Not only are you struggling with a dubious diagnosis, which some of your family and friends don’t believe, but you are also taking nasty pills which have very little immediate effect other than semi-consciousness or irritability. My family took years to accept my diagnosis, and even now it is barely mentioned. They still don’t accept my cousin’s illness, which makes their belief in mine a little suspect.  

I think one of my difficulties is that I am actually taking my medication at present. Aside from the aforementioned problems, these pills may ultimately damage my kidneys and do strange things to my metabolism. So I have to believe in them, I have to believe that they are doing me good. This in turn makes it very hard to judge whether they actually are or not, as I have a lot invested in their success. Conversely, if I wish to stop them, I may magnify the adverse effects, even to myself.

Psychotherapy is also problematic, as there is no guarantee that this will work either. I trained in cognitive behavioural therapy many years ago, and felt great enthusiasm, but sadly my own experiences as a patient ended with undone homework and consequent reduced self-esteem. Again, I think the difficulty is one of extremes – if you are committed to practising, or receiving, one particular type of therapy, it can be hard to accept that other treatments, including other therapies and drugs, may at times be better.

Ideally, I’d like to be the kind of psychiatrist that makes perfect diagnoses then offers a range of ideal treatments, lasting and costing as long and as much as is required. No-one would criticise me, and everyone would get better. Of course, this is never going to happen, as we are always swayed by our own experiences, our own training, our colleagues and what is available to us. But at times it can feel very competitive. In my specialty of addictions we have the models of abstinence and harm reduction (the latter often associated largely with opioid substitution). Many of us see the value in both, but it can be very hard to dangle between the two. Biological versus psychological psychiatry – they shouldn’t oppose, but, again, often do.

I used to be fairly sure that I was right in my views, which were maybe a bit black and white. To be honest, I probably had a rather biological approach, except of course when it concerned myself. In some ways I look back at that and think – how conceited to think that I was special. Now I’m trying to accept that I just don’t know, at least in relation to myself. As regards others, all I can do is continue to listen and hear, and use what knowledge I have.

But when I read or hear others, proclaiming their rightness and denouncing what I am trying to believe about myself, I find that very difficult. I don’t want to dismiss anyone else’s experiences, but I think it is vital to acknowledge that these are subjective, they are important, but cannot be immediately generalised. As are the answers to questions, but don’t tell me that I’m wrong when I know that I might not be right.