I know you think I'm a hypochondriac, but really, I just don't want you to think I'm crazy...

June 29, 2009 4:23 AM

How to not present as or be a hypo- (or hyper) chondriac at the Doctors? Especially in relation to mental health issues?

How do present yourself objectively to health professionals, when the only way I can present myself, is, of course, entirely subjectively?

Not so bad for physical health problems, but what about the fuzzy, mental health issues?


I have a slight irrational phobia about 'being/seeming "crazy"' so whenever I go to the Dr's, and say, need to talk about my worsening depression symptoms, I can barely get out that there's a problem, zone out on specifics when answering questions, and then desperately & relievedly start babbling about possible health conditions I could have instead (thyroid, iron, PCOs) because they're 'physical', not 'mental', & therefore 'safe' to me, additionally presenting myself as a hypochondriac, which is a very safe/comfortable place to be with my slight phobia, as then the Dr will tell me that 'I'm fine'.
And I walk out, very relieved, until the guilt hits me, because I know I've just subconsciously screwed myself over. But I'm not doing it deliberately, and I'm not aware of the patterns, because they change -
it's very easy to come across vaguely as a drug seeker (despite not smoking or really drinking, I'll start talking about how worried I am about getting addicted to things, or people I know/knew who used Benzo's or ADHD meds recreationally etc if the topic comes up - coincidence? I'm thinking it's less fear of addiction, or just fear of meds?) or hypochondriac.

I have
- Told the Dr I had/have this phobia of being crazy, and my Dr knows I formerly either only half-heartedly sought, or avoided treatment during some long bouts of depression.
- Tried to explain that I'm not presenting myself very objectively (comes across as anxiety, 'You're fine! I think you explain things very clearly...')
- My counsellor, who I see for an hour weekly, wanted me to raise some issues with the Dr. So I even asked her to write me a note instead, and I gave it to the Dr. I even asked if he could talk to the counsellor instead. He was confused, told me they don't usually 'go over the patients head', and it would have been impractical anyway, but... I wish they could just talk to my counsellor/friends/housemates/partners? I'm not objective!
It's only stuff on the level of Depression, Anxiety, and/or ADD, so I'm not screwing anyone else over but myself. :(

And I just can't advocate for myself for medications or disorders I don't really want to have or take. I just always get this feeling of relief followed by a squirmy guilt chaser when I walk out with a 'You're fine!' and realise I've done it again... :P

posted by Elysum to health & fitness (9 comments total)

Bring someone who knows you well enough to corroborate your story to the doctor's office with you.
posted by valkyryn at 4:32 AM on June 29, 2009

When I go to the doctor for a specific problem I write down all the information I want to give him/her: specific symptoms, things I've done to treat the problem, etc., and any questions I have. I know when I get in there I'll forget what I wanted to ask, or omit some important detail about whatever problem I'm experiencing, so having a list or some notes makes me more calm and confident.
posted by LolaGeek at 4:39 AM on June 29, 2009

As a rule, don't talk to a GP about psychological/psychiatric issues.

GPs generally are 1) not extensively trained to recognize or diagnose mental health issues 2) a bit biased against the notion of psychological explanations and treatment 3) more likely to write a prescription for X drug because it's the typical thing you prescribe to a patient when he/she describes Y symptoms and 4)far less likely to be up on current mental health research.

Set up an appointment with a psychologist. With "PhD" or "PsyD" after his/her name (not M-anything). Find someone who will not avoid sending you to a psychiatrist for medication if you need it, but who will not send you for meds if counseling alone will do the trick.
posted by Rykey at 5:13 AM on June 29, 2009 [4 favorites]

Elysum, nobody expects you to be objective. You're expected to present your symptoms clearly, not objectively. You probably are doing fine, and then semi-shooting yourself in the foot.

If you're struggling to do this verbally, then write a letter/list and run it by your counsellor first. Just do a heading for Symptoms of Depression and Symptoms of Anxiety and put bullet points underneath them. Your bullet points should be formatted as simply as possible, like:

* Excessive sleeping
* Listlessness
* Crying (daily)

...etc - obviously with whatever is reflective of your situation. There is no need to timeline or detail these; your PCP will ask questions as needed.

Then (and this is the part that may be hardest for you) make a heading called What I'd Like to Do and put in just three bullet points:

* Eliminate possible physical causes
* Review current counselling
* Consider appropriate medication(s)

Hand it to your doctor and then try very very hard to not do anything but answer questions as succinctly as possible. If you really need to, bring a friend who's only job is to squeeze your hand when you start verbally derailing your goal. When your hand gets squeezed, stop talking.

If it makes you feel better, all of the above is a very rational, non-crazy way to approach your doctor when you have these kinds of issues. S/he will not think you're a whack job.
posted by DarlingBri at 5:56 AM on June 29, 2009 [2 favorites]

Doctors are not going to think anyone is 'crazy'. Because no one is really crazy -- crazy just means 'mental health problems' and the doctor is going to be looking for a diagnosis to give treatment.

But not your GP. I agree with Rykey -- go to a psychiatrist if you need to be prescribed medication. Everyone thinks its OK to go to their GP for psychoactive drugs but that isn't their area of expertise. Go to someone who is up on the literature, knows the drugs and their interactions.

And probably good to stop using the word crazy because it doesn't mean anything. If you want to talk about your depression and anxiety use those terms.
posted by Flying Squirrel at 6:10 AM on June 29, 2009

Unless your insurance requires a referral from a GP, I agree--stop going to that doctor for mental health issues. You can set up an appointment directly with a psychologist or psychiatrist. These doctors are completely used to people walking in and going "I don't know what's wrong with me! But I"m not crazy, I swear!"

You counselor likely has the best of intentions but is not giving you the best advice. Start with your insurance company--you might just need to call them and get approval over the phone for mental health care, or you might just be able to book an appointment, or you might need a referral from a medical doctor, like your GP. If that's the case, you should be able to call your GP and say "I'd like a referral to a psychologist or a psychiatrist, please".
posted by peanut_mcgillicuty at 6:23 AM on June 29, 2009 [1 favorite]

Thank you for the advice... this does help.

Re: Crazy
And, in my effort to cut length,
I didn't distinguish that I used the 'crazy' to refer to my childhood-based phobia, that basically runs along the lines of I'm not going to BE crazy, ACT crazy, or especially let anyone TELL me I'm crazy... (Imagine some actually distubed, abusive adults telling the sane adults they're 'crazy', and you get the childhood background).
Actual 'Mental Health issues? Those are adult concepts and environments I'm totally fine with. Yeah. That's why it's illogical.


Current diagnosis:
Also relevent, I am currently diagnosed with depression.
I trialled 2 anti-depressants last year, but had bad side-effects (dermatitis rash etc) to one, and bad reaction to the other.
After coming off the second, I made major changes to my living, work, and relationship situations, and got a good counsellor. I had a very good improvement, and the Dr agreed that as I was doing so well, I could continue without anti-depressants.
But... things have been going downhill again.
I know I've stopped spinning the plates, and I can see things starting to come crashing down.


Insurance, p-docs and lack of it:
To a couple of posters, it's also relevent that I'm not in the US and I have no insurance or savings (two years ago I did. Funny. :P).
GPs do do most of the mental health stuff here, but at least they get more briefing on being keen on counselling etc.
After a 6 month wait last time, I had a short talk with a Psychiatrist, but I pulled the same shit with him - much worse if anything, and talking 3 times as fast as usual. The speed of my talking worried them, but I didn't otherwise appear visibly anxious (I cover well. To the point where, I suspect they were waiting to see if my fast talking was say, mania or something. Nope, anxious - which I did disclose. But, if I'm smiling and otherwise chatting normally, what are complete strangers supposed to think?).
I was on the upswing by then, though, so - no further action.

I cannot afford to see a psychiatrist or a psychologist on my own (it'd be at least two weeks rent for one appointment). The best I can do is talk to my doctor, and try and get another subsidized referral. I've even seriously considered signing up for some papers at University because I'd have easier access to a psychiatrist etc. But, student loan etc... ? :(


And round to the beginning:
Also, even if I do, I need to cover my issues better with the p-doc. I freaked out and babbled last tim. So this post, with some very helpful responses. Even P-Docs are humans, not telepathic, and though it might not seem like it, I'm actually pretty IQ-smart, which is to say, if I'm really aiming at my foot, I've got a pretty good chance of hitting it without the P-Doc noticing. :P


Darling Bri, yeah, that - that really helps.
I knew writing down stuff, but I have no idea what's really going on with me, so I kept thinking of all the different things that have been suggested (depression, dysthymia, ADHD, anxiety, OCD, blah blah blah) and if I didn't know what it was, then I couldn't know what symptoms to write down or how to frame it, but. Right. Those two. That is less silly. I guess I'll just try and write down really odd/bad thoughts or situations, and check it with the counsellor before seeing Doc.
Hoops. So many hoops!
posted by Elysum at 7:34 AM on June 29, 2009

If you've already been on anti-depressants with this doc than this is all much simpler. Your request is not going to be denied and nobody is going to think you're drug-seeking if you ask for a prescription for Effexor or whatever.

All you need to tell him is that your depression is returning, you're experiencing some debilitating anxiety, and you'd like to look at medications again. Then - and I'm telling you this because this is the point where you seem to be falling over - close your mouth and stop talking.

The reason you don't need to talk anymore is that you do not need to explain this any further. It is a routine, appropriate request and you should not be this worried about making it. S/he will ask questions as needed and if you have a list of symptoms - not experiences, but symptoms - it should all go well.
posted by DarlingBri at 1:09 PM on June 29, 2009

Cupla things -

1) You are not likely as bad off as you think. Most folks who are really bad off do not realize it, and it's got nuttin' to do with IQ. If you are cognizant of your surroundings and recognize your relationship to your surroundings, then you are not on your way to the funny farm. Having a diagnosis does not necessarily mean that you have a mental disorder that rises to the level of problematic. I understand that it feels like you have some major issues, but again, you are likely not as bad off as you think. My job involves telling people this every day, so I'm blunt about it.

2) It is important to be as direct and clinical about it as possible. If your counselor thinks you should try to get meds from your PCP, ask him or her specifically what type of medication you should be asking about and what symptoms are you trying to control? You are correct in anticipating what your PCP thinks. If you go in and say that you are having trouble concentrating at work because of anxiety, there's something to be prescribed for that. If you go in and say you're having trouble with a relationship, there's nothing that can be prescribed for that. If you go in and say that you've been feeling somewhat depressed and would like to see if you can control it pharmacologically, then there's something for that. If you go in and say you're sad because you think you need to get a cat, then well, I'm pretty sure you know where I'm going with this.

You mentioned that you do not want to seem like you are displaying drug seeking behavior. Unless you're asking for opioids, then this is not really a concern. Most folks don't get wellbutrin for the high. Oxycontin, on the other hand, is not indicated to treat depression.

So to summarize, you are probably doing better than most folks - being smart probably means you tend to overanalyze things to a degree. To get some better living through chemistry is appropriate if you have symptoms that can be controlled pharmacologically. Let your PCP know what those are and then you can get on something appropriate.
posted by valentinepig at 1:28 PM on June 29, 2009