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9 Signs Your Psychiatrist Isn’t Right for You

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Editor’s note: Please see a doctor before starting or stopping a medication.

“I think you should see a psychiatrist,” my primary care doctor told me. “What you need is outside of my scope.”

“At least she knows her limits,” I thought to myself with a sigh.

Generally speaking, my psychiatric medications can be managed by a general practice doctor. Occasionally, my stable cocktail of drugs loses its efficacy against my symptoms of anxiety and depression and I need a little medication reboot. When this occurs, it’s generally better for me to see someone who specializes in the roulette that is psychopharmacology.

This time around, my primary care doctor tried to absolve my symptoms based on her limited knowledge in the field of psychiatry, but that ended in misery for me and my family. She ultimately had to admit defeat. Since I was no better off and she was no more well-versed in the field of psychiatry, I was referred to the hell known as “finding
a psychiatrist.”

I’ve been down this road before and it is almost always a lengthly and painful process that makes me want to give up before I’ve even begun. There are so many barriers to finding a quality psychiatrist from shortages and limitations of access to psychiatrists to social stigma and discrimination based on race and class.

It’s easy for me to start to doubt my symptoms and placate myself in an effort to avoid the search altogether. I tell myself, “Oh, it’s not that bad. You can survive with the meds as they are. It’s good enough.” But is “good enough” really what I want to settle for in the long-term if the potential exists for me to enjoy life? The glimmer of hope that there could be something better – a life worth living – keeps me searching for the magical combination of pills which requires finding someone trained in the mysterious world of psychiatry.

If you’re getting ready to walk this route yourself, please know you aren’t alone. It can be ridiculously hard to find a quality psychiatrist. I hope that you can learn from my experiences to know when to go running in the other direction. Here’s how to know if a psychiatrist isn’t right for you:

1. They don’t treat you as the subject matter expert of your own life. 

First and foremost, you are the expert on your own life. You live in your body, your circumstances, your environment day in and day out. I don’t care how much education someone has or how many letters they have behind their name – absolutely nothing can make up for your lived experience. You, and only you, will know if something is right or wrong for you. If a psychiatrist does not treat you as the most knowledgeable person on your own life, then they are not giving you the credit you deserve. Do not give your power to judge if something is right or wrong away to someone else, regardless of their position of
power or authority.

2. They judge you on your appearance.

“Well, you don’t look depressed,” a psychiatrist once said to me during our first (and final) meeting. We should have all learned in pre-school not to judge a book by its cover. We have absolutely no idea about what’s going on in a person’s brain or life by looking at their physical appearance. This is especially true when you consider those of us struggling with “high functioning” mental illnesses – in other words, we are able to present a general “OK-ness” to the world that allows our underlying condition to go undetected, but it is no less painful for us internally. If your psychiatrist can’t see past your bravado, or conversely, makes negative assumptions about your condition based on your physical appearance (in the absence of other substantive proof), it’s time to change providers.

3. They diagnosis quickly and liberally.

Diagnoses can be helpful in that they provide a name for an experience a person is having and can help direct treatment based on what has worked for other people with similar symptoms. However, diagnoses can also be detrimental because of the stigma that they hold in our society. Sometimes practitioners stop seeing the person and only see someone’s diagnoses. This can impact their perception of the person even before meeting them and consequently affect the outcome of their care. When we go into situations with preconceived notions of what a person will be like based on a label that someone else has prescribed to them, we risk missing crucial information. This is especially true if someone is diagnosed with a highly stigmatized mental illness, such as borderline personality disorder or schizophrenia.

Mental health prescribers should be judicious when diagnosing someone because that diagnosis will likely follow the client for the rest of their lives and impact what resources are and are not available to them. Many insurance carriers require that a clinician make a diagnosis in order to bill for a visit or have prescription medications covered by insurance. In these instances, a diagnosis may be helpful to have as a (i.e. adjustment disorders, grief and bereavement disorders, anxiety not otherwise specified, etc.) as a place holder until a validated diagnosis can be made. If your psychiatrist is handing out diagnoses like candy, it may be time to reconsider your choice of prescriber.

4. They only prescribe the same medications over and over again.

If a clinician is only willing to prescribe a small group of medications, regardless of the differing symptoms and circumstances of their clientele, there is a high likelihood they could be profiting off of the prescription of that medication in some way. This is especially true if it is a brand-name drug and not yet available in a generic form. National Public Radio (2016) reported on this occurrence which you can read more about here.

There’s another way that psychiatrists can benefit from prescribing certain medications: they make you come back for more. Ever heard the song “Drug Dealer” by Macklemore? The chorus says:

“My drug dealer
was a doctor

Had the plug from
Big Pharma

He said that he
would heal me,

But he only gave
me problems”

This phenomenon can present in two ways. First, the psychiatrist prescribes a medication with a truck load of side-effects that requires the client to be prescribed additional medications to manage the side effects. The second opportunity for this occurs when a psychiatrist prescribes highly addictive controlled substances to a person with a predisposition for dependence and the client becomes reliant on it to function. There is a time and place for most all medications out there, but a medication should never cause you more agony than your original presenting problem. If your psychiatrist is pushing a medication on you that you are uncomfortable with, give them a firm “thanks, but no thanks” and move on.

5. They don’t take potential side effects into the equation, especially considering your unique daily demands and circumstances.

Once upon a time, I was prescribed an anti-psychotic at its full therapeutic dose. This might have been appropriate had I been psychotic, but I was not. It may have also been appropriate if the medication was prescribed at a sub-therapeutic dose — but again, it was not. Despite taking a new medication, I still had the same daily demands of life such as taking my children to and from school. When I began this medication, I started dozing off while driving, experiencing akathisia that caused me to twitch uncontrollably and unintentionally drooling on myself. Not only did this not make for a good look in the carpool line at school, but it could have had disastrous effects on the safety of myself and my children.

A quality psychiatrist will take your lifestyle and daily responsibilities into consideration when prescribing a new medication. At the very least, they will inform you of the potential side effects, encourage you to have a plan in place should you have an adverse reaction and slowly taper you up to a therapeutic dose. If a psychiatrist isn’t willing to consider your specific circumstances, keep looking, because you deserve better. 

6. They insinuate there is something inherently wrong with you or that you are “broken.”

“So what’s wrong with you?” one psychiatrist pestered me.

“Well, I don’t think anything is necessarily wrong with me…” I answered in my ever-positive, strengths-based, social work perspective.

“There has to be something wrong with you, otherwise you wouldn’t be here,” he answered back spitefully as if I was a waste of the very air we were sharing in his cramped office.

Here’s the thing: I can ask for help and believe I am inherently OK even in the midst of my pain. When I go to the doctor for an ear infection, I don’t believe that there is anything wrong or bad or broken about me — I conclude that I’m sick and deserving of care. I trust the doctor will treat the illness with the appropriate medication and if the ear infection comes back, then we’ll treat it again — perhaps with a slightly different approach. Being sick, whether physically or mentally, does not make anyone broken. It simply means we are occupying a different state on the spectrum of health. If your psychiatrist can’t
see that, then move right along.

7. They imply you are at fault for your illness or shame you in any way, shape, or form. 

I hate that I have to give this warning provided that psychiatrists are supposed to be the “helping professionals” that have the best understanding of mental illness, but unfortunately it’s necessary. If a psychiatrist implicitly or explicitly expresses your mental illness is a choice, your fault or resulting from something you did or did not do — they are not upholding their oath of “do no harm” and you need an immediate exit strategy.

Furthermore, if a psychiatrist makes you feel bad about yourself because you have a mental illness or implies you should be ashamed of your mental illness — that is a dangerous environment to be receiving treatment. Your psychiatrist should unwaveringly be of the mindset that there is nothing you did to “deserve” or “cause” your mental illness and there is nothing shameful about being mentally ill or seeking treatment.

8. They don’t ask for your opinion.

Recently, a psychiatrist asked me to sign a treatment plan he had developed during our initial intake appointment. This would have been appropriate except when we consider that I had no part in creating this plan of action and my opinion about my treatment had been distinctly removed from the evaluation of the plan. No treatment plan can ever be effective without the input and consent of the client. If the psychiatrist isn’t asking you for your personal assessment of the situation or what you’d like to see happen, then they aren’t worth your time.

9. They don’t acknowledge their own fallacy.

We’re all human and we all make mistakes. A psychiatrist may have an advance degree in the study of mental illness, but they are not all-knowing or all-powerful. They will make mistakes at some point or another. The more they can own up to their errors and be humble before you as a client, the more realistic they are about the practice of medicine. Figuring out what psychiatric medications are helpful to a particular person in a given environment is educated guessing at best. It is a process and ongoing negotiation amongst a multitude of factors. Any psychiatrist that portrays themselves or the practice of psychiatry as a concrete answer is not being transparent and you should look elsewhere.

I’m still on the search for my psychiatric match made in heaven, but at least I know what I don’t want. Until I get it sorted out, I’ll take comfort in the fact that I am not alone in my frustrated search and hold the expectation that finding the right practitioner for me will take time and plenty of trial and error.

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Thinkstock photo via openeyed11

Originally published: October 19, 2017
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