I’m rarely moved to anger. Holding a grudge is an even rarer event; I can only remember a few of them in my entire 30+ years. But this is one that’s been festering for months and months. Perhaps even getting worse.
So, out with it, I say! Therapeutic blogging and what-not, let others know that their experiences with this kind of thing aren’t unique. And warning: this is a very long post. I have to really let the whole thing spill out.
This all started in December of 2010. I went to the college counseling center with my concerns about bipolar disorder. The short-term counselor felt that I needed to see a psychiatrist for proper treatment. She gave me a list of referrals. I called them. No one would take me. Not one. For someone who was really suffering, this was pretty traumatic in itself.
I went back to the counseling center in January, and described the problem: one psych would only take me if I already had a diagnosis and a referral (which isn’t required for my insurance), another does child psychiatry now, others simply weren’t taking patients, or at least that’s what they told me. I was given another list of psychiatrists to call. The top one on the list (whose office I now frequent, though I’ve never met him) had one nasty online review. The last one on the list had a couple favorable reviews. After striking out on two more, I called the lady at the bottom of the list.
She would take me on, but she doesn’t bill insurance. Out of pocket payment only, and often insurance will reimburse most of the expense. (TRAP!!!) I was getting a little desperate to get somewhere with this thing before I second-guessed myself, gave up on the psychiatrists, and ended up back in a miserable depressive state. So I agreed and went in for an initial 2-hour evaluation (cost: $580). Initially I sort of liked her, but she almost immediately threw me off by suggesting that I may have Borderline Personality Disorder rather than Bipolar Disorder. She told me that bipolar disorder was the flavor of the week, being massively over-diagnosed, and so it wasn’t likely that I was actually bipolar. She said the long-term prognosis was better for BPD than bipolar, that I really didn’t want a bipolar diagnosis (well, duh!) as it tended to lead to degradation over time. I’d never heard of BPD, so I sort of sat back in surprise, listened quietly to what she told me, and then went home.
When I saw the counselor the next week, she was shocked to hear about this, and looked genuinely concerned. I had done a little digging around in the meantime, and I couldn’t understand this either – just because I used to cut myself up over 10 years ago? After doing a bit more reading, I found that there’s really no way I fit the DSM-IV criteria for BPD. She might have been able to pin it on me 10 years ago (and would still have been wrong, by the way) but there weren’t enough current symptoms for that diagnosis. It was really confusing and in many ways hurtful, especially to hear that on the first visit.
As in the past, I kept going back, trusting in professionals, and eventually felt like an idiot for being so blindly trusting. At $275 a session, out of pocket (remember, I’m a grad student, so this is a ton of money for me) I got nowhere fast. She insisted that I get completely clean and sober as a condition of trying to make a diagnosis. OK, so that made sense. I went along with it for a month, felt worse than ever, and went right back to self-medicating – which is what I told her I was doing from the start! (Fast forward: I had to get stable on the right meds before I could stop self-medicating.) She upped my dose of Wellbutrin XL to the max – 450mg – and I ended up with a month of migraines that kept me from working. And it didn’t really help, but it had been so long since I felt well that I couldn’t really say whether it made a difference. She had me quit my stimulants to rule them out as a cause of mania. Of course, without Adderall, I couldn’t think or work worth a tin nickel. She also tried to convince me that I don’t have ADD at all, so I stayed off the meds that I desperately needed to function until December. That was disastrous; my work was getting nowhere and I was just getting more anxious.
The part that really annoyed me was that she was asking me the same damn questions over and over. ARE YOU LISTENING, DOCTOR?!? No. And there was no need to talk about my research methodology or any of the work-related stuff that I can discuss with any of my intelligent, caring colleagues without paying $275 an hour. It sure wasn’t building rapport; it’s not my job to educate her in social science research methods – I get paid for that, not the other way around! I didn’t go any more often than every other week, because despite not doing very well overall, I just couldn’t afford anything more frequent – it was all going on my credit card anyway, and it’s still going to take awhile before it’s all paid off.
The Bad Psychiatrist spent a ridiculous amount of time trying to talk me into fighting with my insurance to try to get more reimbursement out of them – before I ever got the first response from them and had no idea what their response would be. So I was supposed to keep shelling out and racking up credit debt, wasting time on the phone with an insurance company that was never going to give in, and waiting a ridiculously long time to find out that they weren’t going to reimburse more than about $21 per session? Yeah, right. I don’t think I was the naive one in that conversation.
She also tried to convince me that my symptoms were normal. That I’m just more sensitive than average people. That everyone loses track of time and stays up late sometimes. I pushed back hard on that one. I said that I know most people sleep more than 2 hours a night for a week at a time. That’s a fact. I’m not deluded about that, and it’s not just a misconception on my part due to the fact that I don’t really know what normal is. And if others get only 2 hours of sleep, they can’t function – but me? I’d be having a blast! I told her in no uncertain terms that I know that’s not normal. She actually shut up about it at that point, but the damage to her credibility was done.
Over the summer, I went away to France for a month, and she had a vacation that overlapped as well, so there was a long gap in appointments. By the time I had another appointment, I had heard back from my insurance what they were going to reimburse: up to $90 per session, minus a $25 copay and a 30% “coinsurance”. And there was also a minimum amount I’d have to pay out before I could even get that level of reimbursement. This is insurance speak for “we’re going to screw you as hard as we can, and you’re going to like it and ask for more. Squeal, piggy, squeal!” So my first reimbursement submission, which took more than 12 weeks to process, came out to a piddling $121 on over $1000 of expenses. That was something I just couldn’t keep doing, especially because by then I could tell that it really wasn’t working out.
I kept my last appointment, though my hubby (rightfully) grumbled about my spending another $275 to break it off. When I went back, she asked me about France. I told the truth – it was hell. I made a couple new friends by the end, enjoyed true French champagne (eat your heart out, California sparkling crap), gathered a lot of sea glass on lonely evenings by myself at the Atlantic shore, and upgraded my French skills substantially. But I was physically and culturally isolated, lived in student dorms with traumatically filthy shared bathrooms and kitchen, drank more than I ever had before (we’re talking a liter of wine a day – that’s more than a standard bottle, almost every day, and on weekends, starting before noon) and had massive mood swings: a few days up, a few days down, lather, rinse, and repeat.
By then, I’d also accumulated a good 8 months of mood charts, entered them into Excel, and had statistical evidence that the biggest predictor of mood swings was sleep. So when she asked me yet again about my triggers, I rather irritably said that it was sleep, a lack of sleep sets me off into these high moods. She kind of got this knowing look at that point. But let me back up for just a moment – that day when I had come in, there was some magazine about Bipolar Disorder in the waiting room. This was new: previously they were vapid women’s magazines that I’d never touch. I’d finally clued into her style of being generally manipulative and much-too-subtle for a logical literal gal like me, so I guessed immediately that this was a thinly veiled message.
So yeah. I raced irritably through the update, and then said something to the effect of, “Look, what I really have to discuss today is that I can’t see you anymore. I just can’t afford it. (like I’d been saying for months, you daft bitch) What should I do next?” She wasn’t particularly graceful about that, but there was no way you could say I hadn’t given warning. Over and over. She basically said I could go back to university health services and try my luck at getting prescriptions from them, and I should try to find someone else that my insurance covers. But she wouldn’t suggest anyone, and literally sneered at the options I could mention off the top of my head. She said that if I really needed to, I could always come back, but she wouldn’t be comfortable prescribing if she only saw me every month or so. At this point, I was getting pretty pissed off at the money-grubbing wench; maybe my husband’s healthy sense of distrust had finally worn off on me.
While she wrote up another receipt for $275, I casually said, “So I originally came here for a diagnosis. What is it?” After months of beating around the bush, she hadn’t actually said yet. If she was waiting for me to ask, that was just further evidence that it was a terrible match, because I assumed she’d cough it up when she came to a conclusion. Then she got this very vindictive expression on her face and said, “Well, that would be a one-word answer, and I think it should be a conversation.” She refused to give me the diagnosis I had paid thousands of dollars for! So I politely said, thank you very much (for nothing) and goodbye. No way in hell I’d ever go back, but I think she had already tipped her hand with the waiting room magazine and saying that it was a one-word answer. It would be hard to say that Borderline Personality Disorder is a one-word answer, no?
I can’t say that no harm was done. I had spent another 6 months suffering from symptoms that could have been cleared up in weeks, during which time my self-medicating substance use got substantially worse. I was very confused, hurt, and alienated by her so-called therapy. I developed even more distrust of mental health professionals, and yet still had to go back and find more of them to get the help I knew I needed. Now I’ll admit, I wasn’t always the most understanding or cooperative patient, but I wasn’t a resistant and counterproductive jerk either – it was costing me way too much for me to be consciously working against “the process.” If I was ill-behaved at any point, it was largely because of the way she treated me – in particular, the constant feeling that I was being manipulated and her not being upfront and straightforward with me, the classic example of which would be refusing to tell me the diagnosis.
But there’s a (sort of) happy ending to this sordid tale. I went to the university health center to ask for prescriptions, but for once, I told the Nurse Practitioner about the bipolar symptoms. She ran through the diagnostic criteria, and in 15 minutes had me set up with an appointment for evaluation for both ADD and bipolar with a behavioral health intern. Once I went through that evaluation, which came out a resounding “yes” on both counts, I was told that at a minimum, I needed to get into therapy to learn better coping skills for depression (I’ll get into that fallacy another day) or no one would prescribe for me anymore.
So I went to a big agency that my insurance covers, and on the first date the therapist said I really had to see a psychiatrist for a proper diagnosis and medication. Unlike the Bad Psychiatrist, he was genuinely concerned that I wasn’t on mood stabilizers; everyone who knows anything about bipolar disorder knows that antidepressants alone is asking for trouble. He referred me to the agency that the Bad Psychiatrist had sneered at, acknowledged that they’re a pill mill, and said that if what I really need is medication management (right on, old hippie dude!) then that’s a decent place to get it. Without getting into the rest of the details, because this is already over 2,300 words long, I had a proper diagnosis and started the mood stabilizers in under 6 weeks from telling the nurse at the health center about my symptoms. And it cost me $50 because my insurance covered both the therapist and psych office.
Moral of the story? Just because someone has an MD does not indicate competency or compassion. There are Bad Psychiatrists out there. They can hurt you. Be careful, kiddies.