not getting the help I need?
May 15, 2011 9:02 AM   Subscribe

Feeling frustrated and confused after dangling ADD diagnosis.

Early twenties, male. Increasingly in the past few years, it has become more and more obvious to me that I have some sort of attention problem. The primary impetuses (impeti?) for finally seeking treatment were the loss of a plum job half a year ago, and my coming entry into graduate school this fall. After a false start (my original appointment four months ago was cancelled at the last minute because they had mistakenly let me schedule during an office holiday - !) I was extremely excited to finally have my evaluation this past week. I traveled from my home to the state I grew up in, because I am independently too poor for health insurance and thus have insurance through one of my parents, but which is only valid for non-emergency care in that state (thanks, US health system!). Before going to my appointment, I read the book "Delivered From Distraction" and was on the verge of tears from recognizing myself so strongly and also from reading something that actually seemed to UNDERSTAND. My family is very supportive of me in general, but tend to be cagey and denialistic about the idea of me having any sort of psychiatric issue, because I am supposed to be the 'not messed up one'; we have a lot of genuinely serious mental illness amongst our relatives. I am outwardly high-functioning-- I graduated from a great school with honors, and I'm headed to another great school with a scholarship-- but people don't really see how much I struggle behind the scenes with basic things and how hollow my successes sometimes feel to me (it feels like I achieved them by coasting and that I could have done so much more of substance if I were more normal). I'm functional on a macro level but so, so dysfunctional on a micro level. Everything major gets done eventually, SOMEHOW, but the amount of struggle, anxiety, inaction, and messed-up steps it takes along the way is just horrible.

Anyway, I went to the psychiatrist's office with high hopes. She sat at a computer and typed down the answers to the vague life questions she asked me. Honestly, I felt like I was at the DMV. A lot of the things she asked me I wanted to go into more detail on, but time seemed a bit short. I felt very uncomfortable with the fact that she went into a lot of personal and troubling things, just as data points-- without addressing them or empathizing with me in any way. For example, she had me go into minor detail about the circumstances of a close relative's suicide; this is something I've never had a serious conversation about with anyone, and to have a stranger ask me to casually mention it and then move on to, I don't know, whether or not I have heart murmurs was really distressing for me. This combined with my revealing of other mental health histories of close relatives made me feel kind of...I don't know, cheap and used? I know that seems like a stupid way to phrase it, but that's really exactly what it felt like -- the same sense of humiliating, unwarranted intimacy as an unwanted sexual encounter. Does this mean I need therapy or something? It had never occurred to me that I needed to talk these things through so much, but it was really apparent that I wanted to work through them, which was well beyond this woman's apparent ability or role. This was my first encounter ever with any sort of psychiatrist or therapist...I guess I thought they had similar approaches. Anyway, after about 35 minutes, she informed me that I had ADD as well as hypomania. This made a lot of sense to me. She also thought I should be trying meds, which, YES, but here's the catch. I'm going back to my current city tomorrow. I'll be back staying with my parents in a week or so, for a week. Then I'll be working abroad for two months. Then I'll be moving to a whole other state for graduate school. Complicated, right? The doctor said she didn't feel comfortable trying out any meds without being able to monitor me (concerns about a stimulant aggravating the hypomania), and recommended I seek help again in my new state in August, bolstered by her already-done diagnosis of ADD. I basically deferred to her, but this is so, so frustrating for me -- to have someone say that I'm not imagining this, I do have a problem, but I'm just going to have to sit on it for a few months. I want to start school off on a good foot. I don't think the doctor understood how hard it was for me to even get it together to make this appointment happen, much less a whole other one while I'm concurrently already moving across the country and juggling seven hundred related balls. I can't even jot a few lines of a fucking email to a friend I've been meaning to contact for months!! As I was leaving my appointment, the next patient was standing in the waiting room, ready to come in. My appointment was exactly 50 minutes. I get that doctors need to see multiple patients, but it was apparent that if I had needed extra scrutiny or to give additional information, there wasn't the time.

I feel really kind of helpless and paralyzed. I felt really let down by having received more understanding and empathy from a book than from a live psychiatric professional. I understand the doctor's concerns, and I don't a priori disagree with her conclusions, but I don't really know what to do with them. Waiting months to get any help feels crushing. Is this how psychiatry is in general, or did I just end up with someone whose style doesn't jibe with mine? It didn't really seem like she gleaned any information from me I couldn't have sent more easily in an email. I don't think the deferred medication trial would bother me if I felt like my problems were being addressed in some, ANY, other way. I'm not just fishing for drugs; in fact, my deep ambivalence about psych meds is partly what made me take so damn long to seek help in the first place. But it's reached the point where the lack of any ability to do anything about my situation is making me want to scream. I feel like I'm trapped in this ADD mind, knowing there's something better and more productive out there.

This came out really rambly, but I guess the TLDR version is: should/(how)can I seek a second opinion in the two weeks left before I leave the country*? And, is this just how psychiatry is? Should I be seeking some alternative form of help?

Thanks for your help, useful advice and compassion.

*NB: I did not plan at any point to take whatever meds while I'm abroad; I just wanted to start the trial before I leave to begin, I don't know, doing SOMETHING, and to not just enter August without having tried anything at all.
posted by anonymous to Health & Fitness (7 answers total) 4 users marked this as a favorite
Any kind of psychiatric or psychological treatment is a process. It's really unfortunate that your life circumstances make getting this kind of treatment (where you meet with the same person on a regular basis) impossible right now, but that's a function of the way your life is right now.

You might want to look into CBT-style behavioral adjustments that are designed for ADD, and that you can try out on your own. And look into how you can get the kind of care you need this fall, when you'll be in the same place for more than a month or two.
posted by MadamM at 9:23 AM on May 15, 2011

Some psychiatrists specialize in psychopharmacology and don't even offer therapy. My guess is that your doctor prefers to only do the psychopharmacological side of psychiatry. What you describe sounds like a medical interview where, as you said, the doctor was gathering information on your past medical history and family history. It also sounds like it was handled clumsily on your doctor's part.

Physicians are people too - sometimes they are socially awkward, pressed for time, distracted, or unaware of the stress you are experiencing. My best advice in these situations (if you have the presence of mind) is to speak up. "I feel like you are digging into some painful emotional experiences here and then glossing over them." It's good for your doctor to get feedback - they can do a better job taking care of you, and you can help them improve their bedside manner.

I'm sorry this experience was so stressful for you, but you are doing a great thing foryourself by seeking out help before school starts.

Do you have a throwaway email address?
posted by abirae at 9:27 AM on May 15, 2011

You went to see this doctor to be screened for ADD not to enter a therapeutic relationship with her. In no way was she there to work through these issues with you. A hard-cap 50 minute hour is 100% to be expected. The misunderstanding there was yours, not hers.

I am unclear if you have an official ADD diagnosis. If you do, you can take that to a local shrink or possibly even your GP, who can write Adderall or Ritalin for you. While therapy for ADD and for life in general is marvellous, if you can get on the drugs it will make ALL the other balls way, way more manageable (assuming the diagnosis is correct and that therefore, the drugs work as intended for you.)
posted by DarlingBri at 9:53 AM on May 15, 2011 [2 favorites]

Does this mean I need therapy or something? It had never occurred to me that I needed to talk these things through so much, but it was really apparent that I wanted to work through them, which was well beyond this woman's apparent ability or role.

I felt really let down by having received more understanding and empathy from a book than from a live psychiatric professional.

It sounds like you want to discuss these issues with a therapist (not a psychiatrist). Psychiatrists diagnose issues, and prescribe medication, but few psychiatrists also provide therapy. It's not that you need a second opinion necessarily. It's that you needed three things: a diagnosis (plus maybe meds), some time to talk through your ADHD frustration and devise strategies going forward, and some time to process and receive empathy for what you experienced in your family (e.g., your relative's suicide). You've now received the diagnosis, so next, search for how to receive the others.

It sounds to me like you're mostly looking for someone who will talk to you -- just plain old "I want to talk through some things out loud with someone who will be a good, caring listener." Someone above recommended CBT, and I want to emphasize that this is a slightly different thing, which might also be valuable, but it is not primarily about someone listening to and understanding your emotions. It might help you create some strategies for dealing with ADHD and also untangling the way that your thoughts about it impact your daily life (e.g., stopping a refrain of "I'm so stupid.") But it would be less helpful in processing your feelings about a past suicide.

Good for you for taking your mental health seriously. Doing this now, while you're young, will allow it to have maximum benefit on your life ahead.
posted by salvia at 10:31 AM on May 15, 2011 [1 favorite]

Sadly, this isn't just how psychiatry is, it's how medicine in general often is. From your perspective, this visit was a Big Deal in your life; it was no easy task for you to get there; you put in a lot of serious preparation. You recognized it as a potential turning point, and your expectations were raised way high. For the doctor, you were routine. She sees this stuff, and much worse, all day, every day, and she only has 50 minutes to fill in all the blanks on the form. Probably, your diagnosis was easy and obvious to her. Your "Very Big Deal" was her "No Big Deal." Maybe she's just not a good fit for you, maybe she was having a bad day, maybe she should be working at the DMV. You invested a lot of hope in this visit, and your hopes were disappointed. It can be a very demoralizing experience; doctors don't appreciate that they can actually cause damage to a patient's health by treating them as a form to fill out.

The flip side is that there are many, many amazing people in medicine who know how to relate to you as a human being in distress; when you meet one of these, you leave the office with more hope than you brought in. Having someone like this on your side can be a constant source of healing.

You're probably also battling against the impression that, on seeing all your impressive accomplishments and very high level of function, many doctors will think you must be just fine and won't take you very seriously. My GP has told me than my coping skills are too damn good for my own good. I'll bet you know what that means, huh?

You feel let down because you were let down. But you don't need to feel paralyzed or helpless, at least not for long. You got the wind knocked out of you, so take a deep breath and try again. You learned a lot from that disapointing visit, so the next one is apt to go better. If you have to delay starting meds for a while, maybe a support group could be of some help to you til then.
posted by Corvid at 1:47 PM on May 15, 2011 [2 favorites]

An assessment isn't therapy, it's more like getting a blood test or an MRI. I like my neurologist precisely because he's not a therapist. If you've been able to function well thus far, you can probably keep going until August. Getting the right dosage and timing of any medication can be tricky, and ADD meds can impact more than just your focus.
So in the meantime, try fish-oil supplements, lots of vigorous exercise, and try to stop dwelling on what you might have acheived had you been taking Ritalin since kindergarten. Now you've got a sort of road map, and you can sort out those coping skills that have served you well so far, and brush up on areas where you might need extra help. For me, it was making lists and checking them twice, getting directions clear before I got in the car, and not over scheduling myself.
My diagnosis changed mylife, but it didn't actually change me--I didn't stop being a jerk in those situation where I'd previously been a jerk, etc. Those changes came later, when I'd figured out how to contend with my non ADD traits.
posted by Ideefixe at 4:55 PM on May 15, 2011 [1 favorite]

Just nthing that this very, very similar to my experience with both of the psychiatrists I've seen. I bitch about them to my therapist, which makes me feel a lot better.
posted by desuetude at 8:19 PM on May 15, 2011

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