Monday, January 29, 2018

Psychiatrists who have "issues"...

Yesterday's post about passive aggressive behavior has led me to remember another anecdote from the late 1990s.  An old friend of mine read yesterday's post and noted that she had the same thoughts my psychologist did about my dad's toilet behaviors being akin to a dog marking its territory.  My friend mistook my psychologist for my psychiatrist, though, and I felt compelled to correct her.  Why?  Because they are two very different men.

I am, to this day, friendly with my former therapist.  He's a Facebook friend, and not of the variety that simply lurks without commenting.  I'm pretty happy to be friends with this guy, mainly because it could be a clue that I'm not as annoying as I think I am.  Of course, therapists do make their livings dealing with annoying people.  I choose to believe that I'm not one of his most annoying former patients.  It makes me feel better.


Quote Investigator says Notorious d.e.b. gets credit for this quote...

I am not friendly with my former psychiatrist.  I didn't like him from the get go.  I am grateful to him for finding me the right medications when I was very depressed and anxious.  I will also grant that he was a competent doctor.  However, he was also a major league asshole who did some real damage to me before I finally decided that it wasn't me who had issues.  It was him.

Yesterday, as Bill and I were driving to a nearby city for a late lunch, I was remembering my "work" with this guy.  I'll call him Dr. Smith.  It's not his real name.  Actually, his real name is common enough that I could probably just use it, but enough people who read this blog actually know me, so it's probably better to preserve his anonymity.

Dr. Smith was an older doctor from the Midwest.  He was tall and had a full beard.  I'd say he was kind of ruggedly handsome, although not really my type.  By the time we crossed paths, he'd been a doctor for several decades, having graduated from medical school in the mid 1960s.  I suspect that when Dr. Smith was a new doctor, he did a lot of talk therapy rather than pushing pills the way psychiatrists tend to do today.  I always got the impression that he missed being a therapist and preferred that to being a drug pusher.  He enjoyed talking and, I suspect, liked the power he had over his patients.  I would say he was one of the most authoritative doctors I have ever seen.  Bear in mind that most of the doctors I've seen have had some affiliation with the military, so I've seen my share of authoritative doctors.  Smith did offer talk therapy, but I think most people saw him for pills.

Our very first meeting consisted of what was called "intake".  I had to go speak to him for over an hour, telling him about my problems.  My therapist had recommended that I talk to the doctor about getting antidepressants, since I was quite depressed and anxious.  Bear in mind that at this point, I had only seen the psychologist a couple of times.

The intake session with the psychiatrist was an expensive appointment because it took up a precious hour of the doctor's time.  Although I remember passing many pleasant hours with my psychologist, the hour I spent with the psychiatrist was rather hellish.  I talked about what had brought me to his office.  I remember being on the edge of tears the whole time.  At one point, he asked me if I didn't think I needed to go on a diet.

I remember being pretty shocked at Smith's very blunt comment about my body.  I mean, yes, I am overweight and have been for years.  But the way he asked me about it was so cold and, frankly, kind of mean.  I remember he said, noting that I was about to burst into tears, "Oh, was I not supposed to mention that?"

What Dr. Smith didn't know... or perhaps he didn't believe after I told him... was that I had spent years obsessing about my body and had actually engaged in eating disordered behaviors as a teenager and college student.  I used to starve myself on a regular basis and engaged in a lot of crazymaking behaviors in an effort to lose weight.  I was still struggling with those issues when I first started seeing him and was living with my parents, who also used to tell me how unattractive I was.

There I was, about to fall apart, and he made this very insensitive comment about my weight.  It wasn't like he wanted to know if that was a symptom of my depression and anxiety, either.  It was more like he thought I was gross to look at.  Then, later in the session, I misspoke and said my parents lived with me and he very coldly said, "No, I think you live with them."  The way he said that made me feel like such a loser, and not in the way he wanted me to be (all that unattractive weight I was carrying around).  It was like he could tell my parents were very disappointed in me and rightfully so.

Then, he said he thought I was probably fat because of sexual abuse in my past.  He said he felt the extra weight was my way of making myself unattractive to men.  For the record, I don't think that's the whole reason why I'm heavier than I'd like to be.  However, I will admit that I've never been very comfortable with sex and I did experience sexual abuse.  If I'm honest, I could probably live the rest of my life without it, although I do love Bill's touch.  I think I have weight issues for many complex reasons.  One of the main ones, though, is the simple fact that I like to eat and drink.

I left Smith's office that day with a prescription for Prozac, after I listened to his very patronizing speech about how I had taken the all important first step to recovery by asking for help.  He had prescribed Prozac because that was the drug my dad was on, and he said that if my dad was having success with it, I probably would too.  Apparently, a tendency toward depression can be genetic and so can the drugs that turn out to be the most effective.  Actually, I don't think my dad did have success with Prozac.  He later switched to Wellbutrin, like I did, and I think that helped him more.  But anyway, I took Prozac for about three months, with the doctor raising the dosage until I was up to 60 milligrams a day, which was a lot.

Although I eventually had what Dr. Smith called a "partial response" to Prozac, it wasn't really helping me that much.  In November of 1998, I had a major meltdown while I was at work.  I can't really describe in detail what happened.  It was kind of like my brain froze or something.  I didn't feel like I could function.  I started crying uncontrollably and had to leave.  I also felt suicidal-- it was like I just went certifiably crazy or something.  It was very scary for me and probably for anyone who witnessed me in that state.  I felt like I was going crazy.  It was probably due to the high dosage of Prozac I was on, because it never happened again after I got off the drug.

I had emergency appointments with both of my shrinks that day.  I remember my therapist asking me what I planned to do with the rest of my afternoon.  I said I was going to go home and read a book.  He said, "I hope you won't be reading any Sylvia Plath."  It was a rather funny comment, but I was too upset to laugh at it.  Then I saw the doctor, who said maybe it was time to consider trying a different antidepressant.  He didn't change my meds that day, but he did the following week.  That was when he prescribed Wellbutrin, which ended up being a life changer.  Wellbutrin also has the added benefit of being energizing.  People often gain weight on antidepressants, but not usually on Wellbutrin.  I'm sure that was another reason he prescribed it.

I remember the actual day my life started to change for the better.  It was December 4, 1998.  I had a purple pill in my hand as I sat at a restaurant in Williamsburg, Virginia.  I took the pill.  Exactly four days later, I woke up and realized I needed to get on with my life.  That was when I decided to go to graduate school.  Somehow, it was like all of the fears and paralysis I had experienced with depression vanished and I soon found myself working to make a move happen.  Wellbutrin probably saved my life.  Within a month, I was applying to graduate schools and getting read to take the GRE.  Within three months, I had acceptance letters to both of the programs to which I had applied.  Several months after that, I finally moved out of my parents' house for the last time.

In the meantime, I still had the occasional meltdown at work because I was waiting tables at a very popular restaurant and the job was very stressful.  I would get abuse from the customers and my co-workers and the work itself was high pressure.  I felt like I was living on adrenaline.  Although I eventually got good at waiting tables, it took several weeks to get the hang of it.  There were a lot of days when I would show up to work feeling like I needed to throw up from the stress.

Dr. Smith, again, would usually take the other person's side whenever I had a conflict.  One time, I came in to see Dr. Smith and told him about how one of the chefs was abusive to me.  I had made a mistake on an order.  Someone had ordered a cheeseburger and, for some reason, the computer didn't automatically sequence burgers as "third courses".  We had to remember to do that manually.  I had forgotten to properly sequence the burger, so I went to tell the chef that I had intended to for the burger to come out with the main courses the rest of the table had ordered.  Instead of simply saying it was okay and making a note of the change, the chef proceeded to yell at me, something that neither of us had time for.  I shrugged and said "Whatever." and the chef called the manager and complained.  Then she also yelled at me and I got really upset.  Actually, I'm surprised they didn't fire me!  But, for whatever reason, I did good enough work and was reliable enough that they didn't.  Twenty years later, I'm still friends with a lot of people from that job.

When I told Dr. Smith about that incident, he asked me if I had apologized to the chef.  I remember saying that I hadn't, because I didn't feel like I did anything wrong.  I simply responded dismissively to the chef's rude, abusive behavior instead of just swallowing it like I always did in the past.  Smith felt that I should have been willing to tolerate the abuse and I owed the chef an apology for not accepting abuse from him.  He was not an advocate.  When I told my therapist the same story, he said, "That chef sounds like a prima donna.  Good for you for standing your ground."  See?  They are two very different men.

In August 1999, I went off to grad school.  For the next few years, I continued to visit the psychiatrist and the therapist quarterly.  I didn't really need either of them that much, but I wanted to continue to take the medication because I didn't want to fall back into depression while I was in graduate school.  Those three years were also pretty stressful and intense.  I wanted to give myself the best chance at success.

I met Bill online when I was in graduate school.  In 2002, six months after I finished my two master's degrees, we got married.  I remember visiting Dr. Smith with a few photos from our wedding.  He looked at them, frowned, and said, "Oh Jenny, don't you think you should lose some weight?"

Again, I was shocked at the sheer bluntness of that comment.  I wasn't depressed at that point.  I had finished grad school and gotten married, but instead of congratulating me for my successes, there he was making more derogatory comments about my body.

He also had a very annoying habit of calling me "kiddo", which I fucking hate.  I remember telling him that I was a thirty year old married woman, not a kid.  I told him I wanted him to stop calling me "kid" or "kiddo".  He said something along the lines of, "I'll always think of you as a 'kid' because I'm so much older than you are."  It seemed to me that the doctor didn't understand that calling me a "kid" when I was having trouble launching into adulthood was belittling.  It was the opposite of empowering, which was what I really needed.  There I was, trying to be strong and act like an adult, and there he was calling me a "kid" and, frankly, treating me like one.

I walked out of that appointment with a prescription for Topamax, which is a mood stabilizer and anti-seizure medication.  It's also been used to treat migraine headaches.  I didn't have any of the problems that Topamax was intended to solve, though.  Dr. Smith had given it to me because of the side effects.  Topamax kills your appetite.  Many people lose weight on it.  Dr. Smith was hoping I would lose weight and that's why he'd prescribed it.  I remember having to explain to pharmacists that I wasn't taking the drug for seizures.  They would routinely tell me that I shouldn't take Wellbutrin if I had seizures, since Wellbutrin can cause seizures in some people.  I was put in the embarrassing position of having to tell pharmacists that I was using the Topamax for an off label purpose.

I took the medication and it did kill my appetite.  In fact, Bill didn't like that I was taking it because I didn't want to cook or eat.  I remember it made anything carbonated taste flat, so I stopped drinking beer and soda (not necessarily a bad thing).  I still didn't lose any significant weight, which seemed to really upset Dr. Smith.  He couldn't understand why I wasn't dropping pounds.  I remember he said, "Maybe your thyroid is bad."  Other times, when I didn't progress the way he thought I should, he'd say things like "Oh, I was hoping you'd be one of my success stories." in a pitying tone of voice.

I finally stopped seeing Dr. Smith in February 2004, because I changed health insurance.  I weaned myself off of the Topamax and Wellbutrin without any ill effects.  Smith had also given me Klonopin for anxiety, but to be honest, I really didn't take it very often because it didn't do anything for me.  I was able to get off of all of the meds without any ill effects.  I suppose I'm pretty lucky.  The only thing that happened was I gained some more weight.

About three years after I saw the shrinks for the last time, I had to request their notes from my sessions.  It was 2007, and Bill and I were planning to move to Germany the first time.  I had to be evaluated for the Exceptional Family Member Program (actually, it turned out I didn't really have to be evaluated, but that's another story).  The EFMP screening required me to present my records to a doctor who would determine if I needed to be in the EFMP, which is a program that allows the powers that be in the military to consider the medical and educational needs of family members before assigning them to a job.  Anyone going OCONUS (outside of the continental USA) is supposed to be evaluated.  Because I had seen a therapist and was on psychiatric medications, the doctor decided I should enroll in EFMP (and again, that's another rant about which I've already written).

Against my better judgment, I decided to read the notes from my sessions.  The ones Dr. Smith had written often included his impressions of my appearance.  I remember in one note, he wrote that my appearance was "garish".  That took me aback, since when I think of a garish appearance, I think of someone who wears a lot of makeup and flashy clothes.  I have never been one to wear a lot of makeup or wear loud colors.  Apparently, that was how he saw me, though-- garish (clownish?).  I was left with the impression that he thought I was mega fat and should be dressed all in black or something.  Actually, at that time in my life, I was buying a lot of clothes because I had lost weight working in the restaurant.

I read other notes in which he noted with apparent disappointment that I wasn't losing any weight.  It was like he was very disappointed that I wasn't slimming down, although just working at the restaurant had effortlessly peeled about thirty-five pounds off of me.  I looked comparatively good, although I have never been as sick as often as I was when I worked at that restaurant.  I was constantly at the doctor's office.  It's the only time in my life that I've ever been close to being hospitalized, aside from when I was a baby and had pneumonia.

I try not to think too much about Dr. Smith these days.  The truth is, I mostly have negative opinions about him.  He was generally negative toward me.  At best, he was very condescending, which is something I can't abide and have less patience for today than I did back then.  However, even though I think he has some of his own "issues", he did find me the right medication which did help me finally get out of my parents' house.  So, for that, I truly am grateful.  But I'm not grateful for the constant comments he made about my appearance, the belittling things he said to me about how I lived my life, and his generally negative and unsupportive attitude toward me.  He was almost as bad as my father.

Moreover, I don't think Dr. Smith focused on my weight because he was concerned about my health or well-being.  I think he just doesn't like overweight women.  It's his personal preference that women be slim and submissive.  My therapist later told me that Dr. Smith was on his third marriage to a woman who was my age.  Somehow, I'm not at all surprised.

I will no longer endure people who treat me badly, especially people I'm paying.  I hate going to doctors because I have had a couple of bad ones who did some harm.  I don't trust them.  This is probably why I've been so riveted to the victim statements made by the athletes who saw Larry Nassar.  They are expressing a lot of the same feelings I have about how my trust in medical people is now greatly diminished.  First, it was because of the terrible experience I had with my very first visit to an OB-GYN and then it was my years of experience with Dr. Smith, who constantly made statements that were belittling and made me feel like there was a lot "wrong" with me, and not just in my head.  Frankly, it was the ultimate mind fuck.

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