I've been following these inane and hopelessly theoretical discussions
 on psychiatry with increasing annoyance and frustration.  In case you all
 have forgotten, psychiatric patients, those with mental disorders, those with
 aberrant behavior, WHATEVER the heck you want to call them, are PEOPLE!  
This is NOT a purely an existential discussion - it involves a very LARGE
segment of the population, most if not all of whom are suffering.  

     So, in the interests of both infusing the discussion with life, shaking
 things up a bit, and maybe even injecting some reality, I have decided to
 jump into the fire.  (Hey, in S CA who's got a choice anyway?)

     I am a person with a psychiatric disorder.  Technically, according to
current nomenclature, I am a bipolar II with pre{*filter*} of treatment
resistant depression.  I also have a dissociative disorder, probably a
variant of MPD.  No doubt I have a "personality disorder" as well.

     I am also an MD who has practiced both primary care medicine and
psychiatry, so I think I have a pretty unique outlook on things.

    I am quite convinced that I have a disease.  NO ONE would "choose" to
experience the years of hell I have lived through - no one!  I could not even
begin to describe what it is like to wake up every single day of one's life
wishing one were dead.  Or what it is like to go to bed every night not
knowing who you will be in the morning or what the world will be like.  Even
the "highs" cease to be fun because you soon learn that a horrible crash is
imminent - like giving a rat a treat and then shocking it.

     I believe my disease exists at the interface of biology and
"thought/experience".  There is no question that there is a biological or
neurochemical component - as evidenced by my reactions to various substances.
I can also "feel" that there is something wrong with my brain when I am about
to have a major episode.

     I also know that conscious and unconscious "psychological" events can
trigger mood swings or personality switches.  Were Ed McMahon to show up at
my door  with that check for $20 million, I would PROBABLY get transiently
hypomanic UNLESS I were in the midst of a major depression in which case I
would be utterly indifferent.

    I know that I do not choose my aberrant behavior.  I did not choose to
ruin my marriage and several relationships.  I did not choose to destroy my
career.  I did not choose to spend years in bed.  I do not choose to buy
tickets for things I really WANT to do and then deliberately deprive myself
of them by being sick.
    I certainly did not choose to hurt my patients because I, more than most
physicians, KNOW what it is like to be abandoned by a doctor.  I certainly do
not choose the {*filter*} and stigma I must live with constantly.

    Yes, some things I DO choose.  Different personalities are better at
dealing with different situations, and I DO use that.  It's a survival skill.
I suppose I do choose on some level to harm myself, but I don't know why
since there's no rational reason for it except to end the pain which some
would say I CHOSE to experience in the first place!

    In my experience, few of my patients have chosen their behavior.
Sometimes it was thrust upon them and they accepted it.  Sometimes they
merely needed education in other ways of coping.  But I have never seen
anyone who chose a major depression, or schizophrenia, tho some may choose
their symptoms.  But give us a break - EVERYONE more or less chooses their
coping styles.

    As a primary care practitioner, and one who was very committed to
mental health care which most are not, I know I was totally incompetent to
manage major psychiatric illnesses.  Most of my colleagues knew far less than
I, had NO appreciation for psychodynamics or transference-countertransference
and were often quite shockingly abusive to patients who were labelled as
"psych" pts.

     Psychiatrists really ARE specialists, altho imho the training leaves much to be desired.  Psych medicines are difficult to manage, compliance is an
ongoing issue, therapeutic margins are slim and drug interactions complex.
Add that to patients who may or may not be able to accurately report
symptoms, history, problems, etc and a great deal of patience, tolerance,
people skills, AND knowledge of pharmacology and biochemistry and neurology is
required.

      The average HMO FP, no matter how well intentioned, just cannot do this
adequately.

    And for what it's worth, very few experienced psychopharmacologists and
analysts have been able to manage my illness.  Average psychiatrists can't at
all!

    Yes, medications are misused.  The use of neuroleptics to sedate people
to a more manageable level of behavior is improper.  The use of benzos
instead of appropriate psychotherapy is probably also wrong.  But is it any
different than say the use of Zantac instead of getting the patient to stop
drinking, smoking, and working 70 hrs a week?

     There are bad psychiatrists and psychologists and therapists in
abundance.  But that does not invalidate the field or the experiences of
patients with real illnesses.

     I hope this stirs up SOMETHING interesting.  I am willing to answer any
reasonable questions (even personal ones) from any respectful netters.  I
will NOT respond to ad hominem attacks however.

      BTW, if you threaten to come get me and burn me at the stake, I STILL
wouldn't be any more able to work, care for myself or even get out of bed on
a bad day.  I might even be relieved!  So I guess you can't attribute ALL of
this to my being a witch, nor conclude that a simple and inexpensive pyre
would cure me!

    I look forward to responses, either e-mail or public.

                                                  Sylvia  

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Thanks so much for interjecting a note of sanity :) and humanity into this
discussion.  As a sensitive, well-educated person, I too grow quite angry
and impatient with all the spouting about mental illness that is
experientially uninformed and lacking in compassion or common sense.  Since
my background is in philosophy, the fact that ANY proposition can be defended
for quite a long distince with many valid arguments and still not be true
is perhaps more obvious to me than to many.  Of course there are elements of
choice in mental illness.  One choses ones friends, career, etc., and thus
the circumstances in which the illness manifests itself and, to a degree, the
manner in which it does so.  This has nothing to do with whether or not the
illness itself is chosen.

Of course, circumstances impact on one's mental illness, and learning to deal
with one's past, present and future circumstances CAN alter the illness in
some respects.  This is why psychotherapy, in my opinion, has a valid
role to play for nearly everyone who is sufferering from mental illness.  
But except in those cases where the illness is (simple) anxiety about
life choices that is manifesting itself in a neurotic manner,
psychotherapy alone is a short-term paliative at best.  At worst, when
it denies the patient true insight into the biological aspects of their
illness, forcing them to look into their psyche for causes that are in their
brain chemistry, it can actually add to the patient's sense of hopelessness
and dispair as they find that all the sound-sounding advice and analysis
does not make them any better.

I am constantly amazed at how insistant people on both sides of this
fence are at pinpointing a univocal (one-sided) causality for mental
illness.  The fact that multiple determinations may be involved, in
complex interrelationship, seems to create great discomfort and anxiety
for both the rigid medical model psychiatrists and the hard-core
advocates of psychotherapy.  

As a sufferer from panic disorder and major depressive disorder of an
atypical nature, I know that traditional psychotherapy, cognative
techniques and medication have each played an important role in
preserving and improving my life.  I also know that all attempts to
convince me that the causes of my illness are purely inter-psychic have
simply made me worse.

Most people have some kind of ailment, whether minor or major.  Why is it
that we would find the suggestion that, say, diabeties is primarily
rooted in the psyche or "the soul" hopelessly outmoded and cruel, and are
yet so willing to make the same argument in the cases of even the most
severe mental illnesses with the most obvious somatic components?

Michael

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______________________________________________________________________

Executive Director, Gay & {*filter*} Resource Center
4211 Grand Avenue  Des Moines, IA  50312    (515) 279-2110