[reify_null]

Interesting article. I've been diagnosed with bipolar type 1 myself. I still struggle with accepting having that particular mental illness for two reasons; the way it is depicted in media and popular culture, and it being seen as a lifelong thing you can't possible get rid of. This despite having a psychotic episode twice. You'd think these things are clear cut. But they're not.

The first part of the article is spot on, really. Even medical professionals have strong biases that are pretty visible even when you're institutionalized. Mentioning drug use is almost guaranteed to put you in a certain classification bucket. What's more, once a history is taken, while being psychotic or (hypo)manic, you are once again put into some kind of classification bucket, despite not being well enough to frame things properly.

I don't mean to be completely negative here. Once you are institutionalized, this is needed to get things back on track, start some kind of medication or figure out some first line treatment. However, the stigma afterwards is very real. GP's, psychologists, even surgeons take in this information after the fact, and its almost factual. And the effects the author mentions are very much there; imagined or not, they are there for the ill person. Being extra careful not to seem overly rash, overly emotional, too impulsive around doctors. Just because they have your best interests at heart, doesn't mean they're free from bias.

[cmehdy]

One of the most fantastically positive things that happened to me on a journey for better mental health was to encounter a seasoned psychiatrist who did two amazing things:

(1) He didn't try to always resort to whatever is brand new but actually gave choices and explanations that include treatments considered "old" and misunderstood to be ineffective (for example in my case, going with MAOI/RIMA for depression instead of the ever-so-new fancy SSRI of the day - and that alone was a life-changer already).

(2) He actually had an open ear for my personal experiences with a (very) wide range of things in a "non-medical" environment, and used the input in a non-judgmental way to calibrate his understanding of my subjective reports and to find better treatment strategies - also including me in the process, therefore making me the main actor of my own healing process.

On the other hand, I've stepped into rooms with a psychologist and shared about experiences with a wide range of drugs (mainly focusing on empathogen-entactogen and psychedelics for the heavy experiences, but I've covered a wide range) and gotten the regressive "this is all shit/poison" rhetoric, thus solidly ensuring that I would mentally check out when they turn around and try to offer tools to address cognitive biases and practice mindfulness, both of which they can't even apply to their own selves.

[reify_null]

Interesting. I have a negative bias towards psychiatrists myself. Experiences with psychologists weren't that great either until I went into therapy with an analytical psychologist. None of this mindfulness stuff, which I practiced myself for years already, but a complete focus on actually figuring things out and understanding why I see things the way I do. I don't think there is a single answer for everyone (not implying that you think so). The psychologist doesn't really stop me from talking about experiences with drugs, but doesn't really see it as something helpful.

I currently see my illness as existing of two components; genetic and environmental triggers. Stress and drugs, together with past trauma interact with my genetic disposition towards psychosis/mania.

Drinking less coffee, sticking to a routine, no drugs (particularly psychedelics), and sorting through my internal web of views with a psychologist, it looks liek that's the solution for me. Medication is part of it, mainly to provide some stabilization while I sort things out. It doesn't really jive well with how psychiatrists go about things though, in my experience, since they seem to think I have to be on it til the end of time. I would love to have contact with a psychiatrist I trust, so I could make some sense out of the medication part of my healing process.

[kayodelycaon]

> In my experience, since they seem to think I have to be on it til the end of time.

Easily explained by survivorship bias. They only see the people who need to be on it for the rest of their lives.

There are people who will need to be on medication their entire lives. I'm probably one of them. My psychosis and primary insomnia hasn't been treatable with anything else.

[reify_null]

Thanks for that perspective. That could explain it indeed. The psychiatrists I saw were the ones working the ward, not outpatients. So they really do see the worst of it. That being said, I really do admire the work they do, the people there are typically not easy to work with, at least not while they are on the ward.

I am lucky in that I'm on a low dose of not too strong medication (valproate acid, 600mg slow release daily). If I go off (I've weaned off it myself before) nothing really extreme seems to happen. Hope you are doing well with your medication.

[cmehdy]

Our stories have more in common than you might think. I've always had a focus on trying to understand things, but I've also encountered people who would throw pragmatism and logic out the window as soon as I'd get real.

For me, (recreational) drugs are not the solution at all but they've been a part of my life and they're part of an explanation of things, so any therapist who would dismiss the experience entirely also dismisses the nature of my approach to those experiences, and in doing so they create their own blind spot and less useful to me because they've already established that they're unwilling or incapable of looking at the big picture.

The psychiatrist I'm talking about never mentions drugs actively, never sings praises of any of those experiences or even makes any particularly positive comment about them, but he doesn't disparage them and he inquires about what the experiences were ("what pills? what dosage?" etc, usually when relevant - otherwise I'll volunteer what I think is relevant without fear). And he is willing to answer my questions ("what are the advantages/drawbacks when taking a little bit more than the nominal dose for this treatment?"), and is willing to try different approaches that we discuss and reflect on.

This builds a trust relationship that does more for treatment than people might think. I don't need to amplify the meds using doses of Abilify and whatnot, I don't need to deal with side-effects that go unadressed, etc. If there are issues, I can talk to someone who isn't prejudiced, who is willing to offer alternatives, willing to discuss the compromises related to those alternatives, and willing to devise a plan that is medically sound to get from A to B.

As for the psychiatric help, I'm glad that for you not taking coffee and doing sports is enough. I've mistakenly thought that for years (more vitamin D, "it's S.A.D", no coffee for months, more exercise, etc etc), but I had to hit a wall hard before I encountered the help that I realized I needed my whole life.

For people who relate to this thread (with BPD) or people with severe depression and other psychiatric issues, proper psychiatric help is not really an optional thing but much more like the knee surgery required to walk properly or the wheelchair that is required to be autonomous: whether temporary (former) or permanent (latter), it's an essential element that can enable some people to actually live, and live well.

[reify_null]

> As for the psychiatric help, I'm glad that for you not taking coffee and doing sports is enough. I've mistakenly thought that for years (more vitamin D, "it's S.A.D", no coffee for months, more exercise, etc etc), but I had to hit a wall hard before I encountered the help that I realized I needed my whole life.

This is actually what I'm afraid of. I haven't confirmed it yet, I'm still on my medication now. I might be developing some kidney problems (VPA is hard on kidneys and liver), so who knows. Based on your experience, and what others have mentioned, I might look for a psychiatrist I trust as an out-patient and see what my options are. I'm still not convinced the medication is stopping any psychosis either, but I'd rather not find that out the hard way.

[cmehdy]

One thing you should make sure to retain is some trust in yourself. A fitting psychiatrist might help, but any random psychiatrist might not. Trying out stuff might take some time and be a delicate balance, but all this can get difficult if there isn't a two-way relationship of trust and respect with the doctor.

The first psychiatrists I met diagnosed me with the wrong condition and prescribed completely ineffective meds (I'm talking an entirely different category of meds altogether, entirely useless stuff that I still took just to show them that I am trying). I then met a better psychiatrist who was definitely more on the money when it comes to the diagnosis but was still inexperienced and not really interested in developing any kind of relationship of trust, so he prescribed to me whatever was at the top of his checklist and pretty much disregarded feedback, trying to double-down on the inefficiency of treatment with MORE treatment and without reasonable explanations when I asked "what about alternatives?".

After a good 6 months of that, I had started to talk in parallel with the person I've praised in my first message, and he agreed to take me on as a patient if I wanted. I politely moved on from the previous experience, pretty much immediately started changing the prescription to something that came out naturally out of a more in-depth and non-judgmental discussion with my new psychiatrist, and since then I've basically been stable. Every follow-up since has been about fine-tuning things, discussing potential alternatives if any side-effect would become difficult or the positive effects of the meds would wear off, and what tradeoffs different approaches could have from a medical standpoint but also with personal logistics (including cost).

To the first ones I met, I was barely a line on a piece of paper, and their own confirmation bias made them prescribe what they had on the shelf in their office.

To the second one, I was a person but "the whole thing" was still a blur and he "stuck with the script", correctly diagnosing things but not deviating from what his textbooks probably indicate to be the go-tos.

The last one saw me as a person, established right away that he was open to my input and very much no-bullshit, pragmatic and digging into a longer history of psychiatry and interactions with patients. I'm not there to make a friend, I'm not there to get free meds, I'm there to figure out how to not constantly suffer as much and what proportion of that can be to an extent carried through medication (until I can do without, if/whenever possible).

I stopped trying to die already at the second one, but I only started living with that third one. And that makes a world of difference. I hope that whatever journey you're on, you get to alleviate the pain in your way.

[reify_null]

I recognize what you're saying about trusting yourself. Part of having experienced psychosis is regaining trust in my own mind, afraid of 'the bottom falling out'. I feel I'm doing well there. I'm also wondering if they have diagnosed me correctly. I pretty much haven't had any depressive symptoms for at least five years now, it stopped a long time before I ever had a psychotic episode. In fact, the depression was in line with my living conditions, it was something that made perfect sense at the time. Sounds like a question for a psychiatrist.

Unfortunately, like you experienced too, part of the healthcare industry still has a parent-child relationship between doctor and patient. I notice that the doctors which worked out, never really had that aspect, but treated me as someone with valid input. Especially for me, I like to understand things, dive into them, see what the mechanics of medication, disease and diagnosis are all about. It doesn't really work well with a doctor that just wants to prescribe whatever they think is right. I'm sure you can relate to that.

Thanks for the well wishes. I can say that I've been pretty much completely symptom free for a year now, and it does feel like I've only now started to really explore myself, and find out what I want out of life. All the best to you as well.

[kayodelycaon]

I have to second your two points on finding a seasoned psychiatrist. I also found an extremely good therapist who didn't case judgement on my experiences.

Between the two of them, I was able to take charge of my own treatment and be able to help myself instead of being backed into a corner.

Poor mental health treatment just makes things worse. I have friends who badly need therapy and coping skill but can't get over a therapist who hurt them in the past.

[wtracy]

Meanwhile, I know of a practicing therapist in my community who stops just short of encouraging patients to experiment with hallucinogenics. (She's also fairly vocally anti-vaccine.)

The range of attitudes within the profession just astounds me.