[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.