The Insane Guide to Living With Mental Illness: The Psychiatric Appointment

Well, it’s been a while since I’ve written an Insane Guide! Previously on the Insane Guide to Living with Mental Illness, we’ve had fun with depression, a trip to mania, the joy of psychosis and the hell of the mixed episode.

Here is the Insane Guide to meeting your own personal God: The Psychiatrist.

I don’t have anything against psychiatrists. I like the one I see. But some make completely arbitrary decisions when it comes to mental illness. The thing is, you have to tell them everything to get the proper help. I think most of my readers have been misdiagnosed at one point or another.

And they are a fairly prejudiced bunch, mostly rather old school when being mentally ill meant something else.

The first trip to the psychiatrist feels somewhat like visiting the headmaster’s office. You may recognise these panicked tics: sweaty palms, quickened heart beat, shamefully averted gaze and aimless mumbling. You may have been sent there by a GP or you might be there off your own steam. Either way, it’s your job, nay, your duty to accurately relate just how nuts you are and get adequate treatment for it.

Psychiatrists are like dogs; they smell fear. If they see you’re afraid, they’ll pounce. “Do I make you nervous?” they’ll ask, with fingers arched upon the bridge of their nose. Just smile and shake your head.

The problem is that the stress of actually visiting the doctor can kick you into a bland organisational mode and, if you’re like me, you might just be, well, fine on the day, even if the day before you were measuring lengths of ropes. “Fine” doesn’t get treatment. You have to be your very worst in order to be taken seriously. That in itself is a weird type of pressure and it’s difficult not to feel as though your tongue is a dumb dead weight in your head.

The psychiatrist has the power to officially overrule any feelings you may have about yourself. If you don’t feel well, if you don’t show it, then, you are well. The hour is not the time for stoicism.

So! Here are some tips to coping with the psychiatric appointment. Enjoy!

1. Look Like Shit

Everybody knows that Mentalists don’t know how to take a brush to their teeth and hair. Even if, in fact, you haven’t done so for a week, don’t let social graces impose upon the day of the psychiatric appointment. You may want to tart yourself up a bit for the sake of politeness, but mental people don’t care about their appearance, and if you do, then you don’t have any mental problems at all and the psychiatrist will know that.

Dribble some, neglect to use deodorant, throw on your most stained slacks and, if you must wear make up, apply it with the skill of a drunken two year old.

If you have Body Dysmorphic Disorder and are pathologically terrified of leaving the house looking anything less than perfect, remember to leave at least an hour before you head off to your appointment to have your panic attack. Don’t let your panic attack infringe upon the psychiatrist’s precious time. And also remember that BDD is just Latin for “vain”.

2. If You Feel Like Not Feeling, Fake It

Depression makes you cry. You’re not depressed if you don’t cry. If you sit in front of that chair as an emotionless automaton, the psychiatrist will know that you’re lying about any depressive feelings that you have.

If you feel particularly numb and even the thought of your whole family dying painfully doesn’t squeeze out the required tears, then discretely pinch yourself- hard. You should be crying in no time and then the psychiatrist will know that you’re really sad.

3. Suicidal? If you don’t have a “plan”, no you’re not.

An old psychiatric trick is to ask if you have a “plan” for suicide. If you do, well, that’s just great. If you don’t, you’re not suicidal. So get over it.

4. Never, ever suggest a diagnosis.

Psychiatrists get really pissy with patients who think they know better. So even if you’ve swinging from the ceilings and throwing your clothes out the window, and then attempting to swing from the ceiling in an entirely different manner, don’t suggest that you know what’s wrong with you. You’re a civilian and you didn’t go through medical school so you know nothing about mental illness.

Knowing what ails you also indicates that you have some insight into your condition. If you have insight, you’re not ill.

5. Conversely, if you’re a woman who self harms, expect…

…to be diagnosed with Borderline Personality Disorder. Despite not fitting any other diagnostic criteria.

(sometimes this diagnosis is correct, and it’s quite a serious mental disorder. But myself and others have been diagnosed with this or “traits” on the basis of self harm. My traits diagnosis (comorbid with bipolar disorder) was trashed by another doctor, but I know quite a few women whose diagnosis was not. Remember kids- self harm and suicide is not always an impulsive decision.)

6. DON’T JOKE.

NEVER try to be funny around a psychiatrist. THIS IS SERIOUS BUSINESS. If you try to crack a joke they will think you’re “covering” for something. (Or in my case, I was told that I “minimised” stuff, due to my hilarious regaling of The Time I Tried to Top Myself Twice in One Day. Lithium, then attempting to hang myself. Went pathetically wrong. Had neckache and was sick for a few days. Pish, it was funny. Okay, not to my friends, but it was to me).

7. Bring somebody with you.

This is always a good idea. Under the unblinking eye, it’s natural to get a bit of stage fright and clam up. After all, even though we want to know what’s wrong, the reality of it being confirmed is horrible.

And there are all those lovely little things about you that you don’t really know. It’s pretty much impossible to convey that you’ve ever suffered from psychosis because, by its nature, you tend to either forget those experiences or still not realise they were psychotic experiences. Bring somebody who knows you along who can tell the doctor everything you’re too afraid to/don’t remember/don’t realise is a problem.

It might be funny if you bring your “imaginary friend” along.

8. Remember the golden rule of diagnosis: how much does this fuck up your life?

Bear in mind your absolute worst days when you talk to the psychiatrist. And keep this scale in mind: 0- doesn’t fuck up my life to 10, has totally destroyed my life. If you’re below a 5, then you’ll be booted out of the office. Anything above a 5, you might get listened to. Mental illness, by definition, is a persuasive pattern of thinking, behaviour and cognitive impairment that interferes with your everyday functioning.

The psychiatrist may not agree with you so just go, “Booga booga!” in their face.

9. Prepare for nothing to really happen.

After you’ve poured your guts out, you might expect the doctor to stand up, bathed in light, and to tell you exactly what’s wrong with you and how it can be fixed.

So prepare for the exact opposite; standing up, shaking your hand and saying they’ll see you in a month. At the end of the day, sometimes psychiatrists don’t really want to tell you what they think. If you absolutely want, need, desire his thoughts, then ask for them.

If he still doesn’t give you his thoughts, punch them in the crotch. You’ll get a mouthful then.

I hope at least a few of you sniggered at the innuendo there.

In your endo.

Have fun.