How to Collaborate With Psychiatrists to Self-Determine Care

Having entered the mental health system over 20 years ago, at the age of 10, I have encountered many mental health professionals, all having varying levels of compassion and expertise. Overall, I benefited from an overall high quality of care given that I live in New York City, yet at the same time, more was to be desired.

I can think of my most grim experience: working with a psychiatrist who prescribed me a certain antipsychotic. I gained weight every month, and repeatedly I voiced my concern at appointments:

“Dr. Reynolds? I keep gaining weight. I’m really worried.”

“You need to exercise.”

“But I’m too depressed to exercise.” Thus the conversation ended, then repeated itself the next month. Two and a half years later, I had gained a lot of weight. It was only then that my doctor took me off this medication. The weight gain stopped, but I still remained nearly obese.  It was a miracle I could later motivate myself to lose the weight, but I still now wonder to myself: Did my psychiatrist have any sort of guilt in how his decision so grimly impacted the quality of my life? Why was he so inactive and passive when I voiced my concerns as if my opinion didn’t matter?

It felt like he had created the mess in my life, yet I had to pick up the pieces. All this while simultaneously struggling with schizoaffective disorder. I was so angry and frustrated that my treatment plan seemed to merely be this bumbling train on autopilot, cruising along without any conscious actions to turn here, adjust there, or step back to evaluate on a frequent basis.

This “autopilot” type of psychiatry may be easier for doctors, but patients are the ones who struggle. Consider my experience: Because of my psychiatrist’s… laziness, dare I say, I had to wait around and gain weight before he changed his mind and took me off the medication. If he had noted my changes earlier on and been more proactive, I wouldn’t have had struggled so much. Thankfully, I stopped seeing him for services and was able to lose the weight, but that was no easy task.

My perspectives on psychiatric care radically transformed four years ago when I learned about the “recovery model,” directly countering the mainstream medical model that predominates the system. While the medical model maintains that recovery from mental illness is achieved merely by taking medications to erase symptomatic behavior, the recovery model posits that compliance with a treatment plan is not enough to achieve a satisfying level of existence.  The recovery model upholds that a person should work with treatment providers to self-determine a holistic plan for wellness in addition to (or without) medications, including tools such as having supportive relationships, relaxation techniques such as deep breathing and/or mindful meditation, diet, exercise, a spiritual/religious practice and so forth.

Before learning about the recovery model, I used to go to my psychiatrist thinking that “doctor knows best,” never questioning his decisions. Now that I know this is not the only way, I realize I am not powerless!  I can strongly request to approach my care collaboratively, working together as a team to determine my care. If I do not like a medication I am prescribed, I can voice this concern and have the support of my psychiatrist to try a different one. If ever I am dissatisfied with my psychiatrist’s support, I need not feel guilty or weak, but instead, have the right to leave and find someone better.  

I am in the driver’s seat of my care.

Since adopting this self-empowered approach, I have experienced tremendous recovery in my life. I became brave and optimistic about my future, no longer resigning to the “fact” I would be mentally impaired for the rest of my life. I became more cognizant of the medications I took, really feeling how they reacted with my mind and body. I surrounded myself with better treatment providers, and requested to be put on the medications I knew worked best for me and was obliged.

Profound recovery from mental illness is real. It is important for us to advocate for ourselves in the office of our providers, and providers must also open their minds and respect the personhood of the people they serve. Their expertise should be used to guide and empower, not dictate and control. Quality care is a collaborative process, and we must hold our providers up to this assertive standard.

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