I'm afraid to tell my psychiatrist about my symptoms.
June 27, 2011 9:46 PM   Subscribe

I'm afraid to tell my psychiatrist about my symptoms.

I have a long term history of depression and anxiety. I am in my early 30s. I've never had any problems with psychosis or hallucinations or anything of that sort. I have had a suicide attempt at 23 but have only ever been a danger to myself in the past. I am having a regularly-scheduled checkup with my psychiatrist in 2 days.

For the past month or so, something has just felt "off" in my life. I have had no major changes in my life - heck, not even any minor ones - but I feel like something huge is just about to drop on me, or my life is about to change forever. And it terrifies me. I feel like my life is all a sham, that everyone else knows about all my problems and are deliberately trying to test me, just waiting for me to break. Even that you, reading this right now, secretly know my identity and are talking with others about me behind my back.

I have also become far more paranoid, recording conversations any time I'm alone with someone. This is justified to me because of one person in particular who lies to me, and having been hit on twice in the past by married men and when I told their wives, they wouldn't believe me.

Well, over the past 3 months, I've also had increasingly violent dreams. For an example: 6 months ago if I had a dream where I hit someone, as my arm went towards them, it slowed down as though it was hitting water or something, and never made contact. Now in my dreams, I am successfully able to beat someone over the head with a chair. In addition, an uncomfortable amount of my awake time (always when I am laying in bed unable to sleep) is spent fantasizing about hurting people who have hurt me, by hurting or killing their loved ones. In my mind, they made me suffer so I will make them suffer.

One of my favorite "games" has become "when I rule the world." At night I lay and think about what I will do to everyone who has ever hurt me when I rule the world, and how things will be then. I will exact retribution and never be punished for it.

I know I need help. It's very clear. But I am terrified. I am afraid of terms like "grandiose delusions" and "psychotic breaks." Is my sanity slipping away from me? I am so afraid that people who have in the past only whispered that I am crazy being proven right. I'm scared that the doctor will hear "homicidal fantasies" and immediately lock me up. I'm terrified of being put on antipsychotics that will numb me and I will never feel joy and exuberence again. I feel like my life will end if I'm put on antipsychotics - that it will prove I'm insane and I will never be able to feel anything again.

I guess my main question is: Could I be developing a more serious mental illness at this stage in my life? I mean, aren't I too old to have a disease like, I don't know, schizophrenia? come out of nowhere with no previous symptoms? Wouldn't I have shown some other signs by now? My life was much harder and I was more depressed 10 years ago... why could I cope without wanting to hurt anyone then but not now? Also, is my doctor going to lock me up?

Please note: I am in no danger of actually hurting anyone at this point and I am not going to go to the emergency services at my psychiatric facility unless this changes. I do not want to hurt myself or anyone else. I want to be a good person. I am seeing my psychiatrist in 2 days.
posted by anonymous to Grab Bag (24 answers total) 6 users marked this as a favorite
 
IANAD. But...you need to get an emergency appointment and bring a copy of this post with you. There's a big difference between fantasies about revenge and buying a shotgun. I don't know what's going on but you need someone who will reach into that dark hole and help you climb out...whatever it takes.

I *really* want to hug you. Honestly, even being on antipsychotic meds sounds preferable to the hell you're living through.
posted by guster4lovers at 9:54 PM on June 27, 2011 [1 favorite]


IANAD... but yeah, you can develop MI in later parts of life, and sometimes the MI that you have can deteriorate. Also, you might have been misdiagnosed in the first place - especially if you've kept things from your psychiatrist before. And, if you have certain types of MI -- including depression -- how hard your life is has little to do with your moods.

Anger, violent thoughts, trouble sleeping, delusions of granduer... I'm not going to diagnose you, but these symptoms sound very familiar to me...

Talk to your psychiatrist. You probably won't tell them anything they haven't heard before. I had to tell mine of the time I thought there were cameras in my walls ("they" were out to get me, I just knew it) and a separate time when the entire town of Virginia Beach was conspiring to keep me from working. I was manic then and my psychiatrist would not have been able to help me if I hadn't told him these things. I'm not saying you are now, but your therapist only knows what you tell them. Keeping things from your psychiatrist will only hurt your efforts to get well.

If you say you're not a danger to yourself or others, and you truly believe you're not, then I don't think you'll be locked up - but your visits to the doctor will probably increase until you get these ideations under control.
posted by patheral at 9:59 PM on June 27, 2011 [2 favorites]


sorry to double post, but i missed this the first time... I'm terrified of being put on antipsychotics that will numb me and I will never feel joy and exuberence again. I feel like my life will end if I'm put on antipsychotics - that it will prove I'm insane and I will never be able to feel anything again.

I'm on a mood stabilizer, an anti-depressant, and an anti-psychotic. While I don't have the wild emotions I had before I went on these (kind of the point) I am hardly numb. I'm not the sanest person in the world, but I am far from insane. Please don't let the fear of what might happen keep you from seeking help.
posted by patheral at 10:04 PM on June 27, 2011 [6 favorites]


yes, as other have said, it's terrifically scary, but you simply must risk being honest. you've already written it down. just print it out and bring it with you.
posted by facetious at 10:06 PM on June 27, 2011


We cannot diagnose you but you have made the first step in admitting there is a problem that you would like to fix and now you need to discuss this with your psychiatrist.
posted by mleigh at 10:32 PM on June 27, 2011


If you are honest with your doctor, they can work with you to help you get better. They can, if necessary, adjust medications until they find the type and dosage that works for you, with the least undesirable side effects.
But if you don't tell your doctor the truth, there is a good chance that your symptoms could get worse.
posted by MexicanYenta at 10:38 PM on June 27, 2011


I don't know about hurting other people, but I know that when people confide about wanting to hurt THEMSELVES to a psychiatrist, it has to be very immediate and very concrete plans before the psychiatrist is going to "lock them up". I bet you it is similar for hurting other people.

There is a huge difference between "I imagine killing myself, dream about killing myself, and feel like I want to die" and "I have been planning to kill myself, I have now bought a packet of sleeping pills and I am planning on taking them this evening". The latter is where the psychiatrist is going to intervene against the patient's will.

Likewise there is a huge gulf between, "I dream of hurting people, I fantasize about what revenge I would take if life were completely different, but I am in no danger of actually hurting anyone else at this point and want to be a good person" and "I have been taking revenge on people who have hurt me, and now I have bought a gun and am planning on going after my brother-in-law next".

I strongly feel you should talk to your psych about this at your appointment in two days' time, and I cannot imagine that he/she would react by locking you up or forcing you to take any actions you do not freely consent to. But it WILL help him/her diagnose you more accurately, get you on the right medication, and talk through your fears.
posted by lollusc at 10:38 PM on June 27, 2011


And yes, there are mental illnesses that worsen at around the age you are now. It's not unusual, and they can be successfully treated.
posted by MexicanYenta at 10:39 PM on June 27, 2011


Not being able to tell your doctor IS a symptom. You could start by telling him/her that you're afraid to talk about it.

Otherwise, having violent revenge fantasies that you don't plan on actually doing, or feeling people "know" about you, when you are simultaneously able to tell that it's not reality is unpleasant to reflect on, but not actually something to fear. (Usual disclaimers apply.)
posted by Obscure Reference at 11:59 PM on June 27, 2011 [3 favorites]


Does your psychiatrist have an emergency number? You could write it down and keep it with you in case you need it before your appointment comes 'round. What you're going through is terrifying. Sometimes just having thought about what to do if you can't handle it can help you get through it.


Like people have said: you're aware that you're not thinking straight, you know you don't want to go on a murderous rampage, you haven't gone out and bought guns or something — you're far from the worst your psychiatrist has talked to. They're aware of the distance between fantasy and action.

(I have friends who've described experiences awfully similar to what you talk about, during periods of psychiatric ill-health like manic episodes. Being on psych meds can be a massive PITA, but it has made my friends happier and hasn't made them numb or turned them into a different person. (From the outside, they mostly just seem less stressed-out. Your friends don't know what you're going through right now either.) If the meds you take take the joy out of life that is a problem that the doctor will recognize and want to fix, and if they don't, you have a crap doctor and you're well within your rights to find a doctor who does. You do have a say in your treatment.)

Is my sanity slipping away from me? […] I feel like my life will end if I'm put on antipsychotics - that it will prove I'm insane and I will never be able to feel anything again

There's a reason for the phrase "mental illness" vs "crazy", and that's because illnesses are treatable. Imagine you had pneumonia or a badly broken leg. Until you recovered you'd be unable to cope with your life, you'd need medical care and drugs, you might spend some time in a hospital. Mental illness strikes a lot closer to our sense of who we are than a broken leg does, of course. But it doesn't make you bad or broken, it doesn't define you, it's something you can get help for and get better from.
posted by hattifattener at 12:07 AM on June 28, 2011 [4 favorites]


I feel like my life will end if I'm put on antipsychotics

Some of those are pretty serious drugs, sure, but let's say you are seriously ill. This doesn't sound like a happy, harmless way to be mentally ill -- this is more the sort of sick where you get to spend it getting help, or, not getting help, and instead of seeing a psychiatrist, you see: cops, social workers, prison guards, homeless shelter staff, etc.

You are not too old, 2nd not uncommon, and easily treated. And you've seen the tragically common outcome of no treatment -- angry homeless shouting to themselves in public parks.

I don't think you're as far gone as you think you are; I don't think you're having delusions -- you know you are not ruling the world, and I do not think you're going to be locked up -- but you are experiencing a really miserable amount of paranoia, anxiety, anger.

I don't know how to address the paranoia, but in case it listens to rationality: in the entirety of my experience, what is said about the untreated mentally ill reflects fear and judgment. What is said about the treated is, if not outright admirable, on par with what is said about people with 'pneumonia or a badly broken leg.' If you have decent facilities available to you I'm not sure why you wouldn't want a stint in hospital if it was offered to you; admitting yourself is a pretty big 'Yes, but I am in control of my problems' indicator to the rest of the world. Like going for drug or alcohol rehab. See also: people's thoughts about and gossip behind the backs of alcoholics and drug addicts; there's junkie scum (hide your purse), and there's 'Sober for X years, quite impressive.'

Do try to send an update via a moderator when you've had your appointment -- I do not think you are in need of emergency help with an appointment two days away -- I do agree that printing this question out is exactly the way to go. Vaya con dios, anonymous.
posted by kmennie at 1:42 AM on June 28, 2011 [1 favorite]


Honestly, this could just be a new and thrilling manifestation of anxiety, maybe with a new layer of OCD-related thinking. Fun! It is not necessarily an indication of one of the big, scary psychiatric disorders. Homicidal fantasies are not an a de facto indication that you're a late-blooming sociopath. And just so you know, in your worst case scenario, antipsychotics are really truly and seriously not the end of the world these days. People function and feel on contemporary, well-managed doses of Halodol for example.

You do not pose an immediate danger to yourself or to others, so there is no chance your shrink is going to involuntarily commit you. What you can do, and what the responsible grown up, big-girl pants thing to do is, is discuss this with your psychiatrist. When I am super-anxious about new symptoms, I find it really reassuring to know what the worst case scanrio is ("What happens if I'm having a psychotic break?") and work backwards from there. Knowing how that would play out, what control I have, and what steps we can take now to avoid that outcome, helps everything become much less scary.

Your shrink is on your side. This is going on whether you share it or not; you are not going to be able to address this situation unless you share it. That's what the shrink is there for. Do it in your own best interests.
posted by DarlingBri at 3:06 AM on June 28, 2011 [1 favorite]


The best thing about talking to your psychiatrist about this is that it makes it THEIR problem.

You don't have to worry about fixing it anymore, because a highly trained expert is on the job. Once you put it in your doctor's hands, all you have to do (and can do) is strap in and deal with the symptoms. And to remind yourself as often as possible that the symptoms aren't your personality.

No one ever feels like they failed personally if they catch pneumonia. Feelings of failure and guilt, however, permeate psychiatric illnesses. Don't be fooled---you're sick, you didn't make yourself that way, you can get better.
posted by TheRedArmy at 5:20 AM on June 28, 2011 [4 favorites]


What meds are you on now? Your recent experiences could simply be the result of improper dosages, or drug interactions. If you're a woman (you said married men hit on you, but some married men hit on men) you might also have some hormonal imbalance that's affecting your thinking. I agree with everyone who says show your post to your shrink.
posted by mareli at 5:31 AM on June 28, 2011


I'm pretty sure many people have, at one point or another, had violent fantasies and thoughts of retribution, without the intent to carry it out. I certainly have.

The way you describe it, you don't have any desire to actually hurt anyone, either, just the fear that you might. This sounds to me like someone with obsessive-compulsive tendencies, or at least some form of anxiety over what you fear you could do and what could happen (what if I hurt others? what if I have to be institutionalized?), than someone who poses an actual threat. I'm not a professional, but that would just be my guess, as someone who also has had some experience with obsessive-compulsive tendencies. What you describe also doesn't sound like schizophrenia. (Schizophrenics actually believe their grandiose delusions. Grandiose fantasies, on the other hand, is something everyone indulges in from time to time.)

But again, I'm not a professional. Which is why I think it's in your best interest to talk to someone, who is, in fact, a professional and knows what he's talking about.

I will say that if it is OCD, there are ways to treat it without pills, although your psychiatrist will probably suggest it as a possible supplement to the treatment.

I will also say, I think it's unlikely that you will become institutionalized. But often, for someone affected by OCD, the actual probability is irrelevant as long as there remains just a shadow of a doubt. I might think, "Sure, I probably locked the door, I even remember taking out my keys to lock it, but what if I didn't?" And that line of thinking can go on and on.

So to cut that line short, I will say, yes, it is possible you may be institutionalized. Highly unlikely, would be my guess, but yes, possible. And that's a risk you'll have to take. You can't let what might happen dictate your actions here. If it's deemed necessary that you should be put in an institution in order for you to get better, well, that's that. Or, your psychiatrist will tell you your fears are unfounded, and you'll feel much better for it. Either one could happen. The point is that you owe it to yourself to find out, and tell your psychiatrist everything that he or she needs to know to help you. If you want, you can start just by telling him or her your concerns regarding pills and institutionalization and take it from there. You don't have to say anything you don't want to.

Feel free to memail me if you need to talk over this more.
posted by Busoni at 8:27 AM on June 28, 2011


I only get paranoid like this when hypomanic. If, say, you were also having a hypomanic episode, you might be diagnosed as having something on the bipolar spectrum, as I was. I do not take any antipsychotics, and the meds I do take make me stable and even tempered.
The only way to know is to come clean about your symptoms. I wish I had shared certain things my with old psychiatrist, then maybe I would have had a correct dx sooner.
Good luck!
posted by Biblio at 9:37 AM on June 28, 2011


When I had trouble talking about issues with my therapist, I would usually start with something like, "I want to talk to you about an issue, but I'm afraid to bring it up." A good therapist will work through that fear first and may not even get to what you're afraid to talk about. By working on that outer layer, you can make progress. The goal is to communicate and get help and they're professionals at it.

And yes, you can certainly develop mental illness as an adult. Our brains our plastic and constantly changing. It would be surprising if any of our behaviors were truly set in stone. Behavioral changes can come from physical changes (tumors, for example). Whatever the cause, we all need help in life. Go get some.

As an aside, I, too, have had violent fantasies and imagery. These would happen while I was awake and about. They were unbidden and repugnant, making it difficult to spend time with people. I don't have them anymore and I haven't taking anything stronger than your usual SSRIs.

Be well.
posted by chairface at 12:16 PM on June 28, 2011 [1 favorite]


I'm terrified of being put on antipsychotics that will numb me and I will never feel joy and exuberence again. I feel like my life will end if I'm put on antipsychotics - that it will prove I'm insane and I will never be able to feel anything again.

Even if it were true that being on antipsychotics would make you feel numb and you couldn't feel joy-- it wouldn't change you forever. If you get treatment that you're not happy with, you can always change it. Please try to talk yourself out of these "never again" fears if you can, don't let them scare you out of being honest with your psychiatrist. I'm guessing you know this is irrational, so try to tap into that part of yourself and remind yourself that any kind of treatment that your psychiatrist recommends to you is going to be temporary, not permanent. (And it might be way better than you expect, so it's probably worth a try, since you can always stop if you're not happy with it, right?)

Wishing you all the best, please let us know how it goes.
posted by EmilyClimbs at 3:01 PM on June 28, 2011


Mod note: From the OP:
This morning at about 9am, I got a phone call that my doctor had a family emergency and their next soonest appointment is at the end of September. I said that was absolutely not acceptable and I had to get in sooner. So they put me on a cancellation list in case someone else cancels. I asked to see another doctor; they said all of them are booking out that far. They asked me why don't I come in and see emergency services? I told them I have no health insurance and can't afford it. They transferred me to speak with the emergency services over the phone. I asked why they can't take one of their more stable patients that won't be hurt by waiting until September and let me have their appointment. They said they can't do that. They suggested I call their office in another nearby city, so I did. The appointment I got there is August 25th. So, barring a cancellation, I have to sit on this for another 2 months and hope I don't lose my mind
posted by jessamyn (staff) at 12:05 PM on June 29, 2011


Well, that sucks. Is there a mental health clinic in your area? Mental Health Clinics usually work on a sliding scale an/or free sometimes. Check your local listings and see if there is one available in your area.
posted by patheral at 10:06 PM on June 29, 2011


If you share your location, maybe we can help you figure out lower-cost options or other resources.

Do you feel like things are becoming progressively worse? As much as it sucks and is expensive, please keep in mind that going to see emergency services or some other urgent route may ultimately be the right move for you rather than waiting for two months. (And not only for the sake of your mental health and well-being, although that's the most important thing... but also just in dollars and cents, if it's something you can treat outpatient if you do it now but that could theoretically decline into needing to be hospitalized later, that's going to cost you a whole lot more.)
posted by EmilyClimbs at 1:34 PM on June 30, 2011


Get sleep. Lack of sleep will make things considerably worse much faster. You recognize your paranoia, hold onto that. Are you taking any SSRIs currently or new ones recently? Has your depression increased? The main reason they would hospitalize you is if you needed to be monitored as they adjusted medication. Paranoia can be terrifying, you do not need to endure it and antipsychotics will not end your life. Your doctor should be working with you to find what works for you and you might have to deal with some side effects and adjustments, but you can decide what you find tolerable.
Eat well, get lots of sleep, take care of yourself and see if it helps. If you find you cannot sleep, get help soon. You seem pretty aware of your symptoms, keep track of them. You can get help if you need it before your appointment. If your depression and anxiety have been getting worse, you could be developing altered thinking in relation to them, if you are bipolar or schizoaffective, you probably need more effective medication. If you haven't found sufficient resolution of your symptoms, you could need adjustment in your medications anyway.
Hope you are managing.
posted by provoliminal at 7:23 PM on June 30, 2011


Oh, dear. Hmm. This doctor is not without obligations to you and I'm not sure if making you wait that long, without making other arrangements, really counts as meeting them.

I would fax him with a description of what's going on (fax the post if you don't want to write it out again), and follow up with a phone call; possibly I would make a call prior to the fax as well -- "I will be sending a fax to Dr Daniels for him to read; after I send it I will call back to ask what arrangements he feels are suitable"

If you are ignored/brushed off, the best thing to do is to show up in person. Stay polite! But, of course they can say "We can't give you a 5:30 appointment, the doctor goes home then" when you're on the telephone, but it can be a different story when you are standing right there.
posted by kmennie at 5:52 AM on July 1, 2011


Mod note: From the OP:
If anyone is still checking in here, the doctor was able to get me in today. She said maybe my violent dreams are progress in that I'm no longer holding the anger in but it's coming out in my dreams. I'm oversimplifying here. Also she increased my antidepressant by half and added Abilify. So now it's a wait-and-see.
posted by restless_nomad (staff) at 7:59 PM on July 29, 2011


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