Ask A Patient (Almost) Anything

[Ceke2002]

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I've checked with the mods if this is okay, and I'm assuming that the response I got was a green light to go ahead (if I've misunderstood that, mods please feel free to remove this topic).

Seeing as I've been a guest of these forums for a little over 5 years now, I wanted to do something to contribute in a more concrete way (consider it my way of saying 'thank you for putting up with me for all this time'). So let's kick it AMA (well, almost AMA) Reddit style! Ever been curious about the view from the opposite side of the table, so to speak? Wondered what the experience of therapy or treatment is like for a patient? Want to ask some general questions about what it's like to experience certain symptomology? This is your chance.

Now of course I have no idea if anyone is even going to be interested in participating in this thread, and if the topic dies off or fails to get off the ground at all, it's all good. This is just something I'd like to offer the forum, but there's absolutely no obligation for anyone to join in if they don't wish to.

Before we get started, I do need to set some specific guidelines to be adhered to:

Guidelines For Asking Questions

• The identity of my Psychiatrist shall remain confidential. You may ask me basic questions (age, years of practice, therapies he's trained in) but please do not ask me for a) His name - b) Where he works (or what University he trained at) - c) anything else that could reasonably lead to his identity being uncovered.
• 
  
• I will not answer any questions where it may reasonably lead to anything being misconstrued in terms of my being seen as seeking medical advice on this forum (same goes for how I choose to answer any questions put to me). According to the considerations of the moderators, I need to be strict on this.
• 
  
• By the same token, general questions regarding my diagnosis are fine, but please do not ask me for the ins and outs of a duck's ar5e history of my mental health issues. You are not doing an intake assessment on me, we are not establishing a Doctor/Patient relationship. Same as above, this is something I need to be strict about.
• 
  
• Please note I am only one patient and as such I can only speak from my own experiences . I cannot speak specifically on behalf of anyone but myself, and I certainly cannot tell you how you should treat any patient under your care (generalities based on my own experiences, yes - specific 'how do I...' type questions, no).

Okay, that about covers it I think -the floor's now open.

 

[NontradCA]

What illness do you have and what was going on in your life up until diagnosis/hospitalization?

 

[wholeheartedly]

If you could change one thing about psychiatric from your perspective, what would it be?

 

[Ceke2002]

What illness do you have and what was going on in your life up until diagnosis/hospitalization?

Well my Psychiatrist works less with strict definitions of diagnosis, and more with viewing symptomology as being on a spectrum (treating the person as a whole and not restricting them to a clinicalised point of view, so to speak) - but I am diagnosed with Recurrent Major Depressive Disorder with Psychotic Fx (this was potentially changed to Schizoaffective Disorder at one point, but we went back to the original diagnosis), Anorexia Nervosa (restricting type currently in remission), Generalised Anxiety/Panic Disorder and Adult ADD. Those are my main ones, not all of them were diagnosed by my current Psychiatrist, they are more long standing conditions diagnosed over the years. Apart from that I'm also being treated for some residual Axis II issues (I had a previous diagnosis of BPD, but I no longer meet diagnostic criteria; however, treatment is still continuing because 'no longer meeting diagnostic criteria' does not equal 'cured'), plus I have some OCD tendencies (not severe or interfering with functioning enough to meet the diagnosis) which I'm also getting help with. In regards to my MDD with Psychotic Fx diagnosis, it both is and isn't a set diagnosis for me. Like I said my Psychiatrist works more with treating symptoms and the patient as a whole, and he also works more on the theory of psychotic disorders as being conditions that run along a spectrum. So if you were to consider say something like Schizotypal PD as being on the low end of the scale, and severe Schizophrenia as being on the high end of the scale, I fall somewhere below the middle of the spectrum and MDD with Psychotic Fx would be the diagnosis that best fits my symptomology (I hope I explained that properly).

As for what was happening in my life before diagnosis/hospitalisation. I've never been hospitalised, although it has been strongly suggested on a number of occasions I've never been unwell enough to have been forced in so I've always chosen not to go. In regards to diagnosis, like I said a lot of the diagnosis are long standing conditions that have been diagnosed over a number of years by various Physicians. I have a family history of abuse going back at least a generation (I was emotionally and physically abused for most of my childhood), I also have a strong family history of mental illness (including Schizophrenia, Eating Disorders, Anxiety, Depression and Substance Dependence), add to that some pretty nasty bullying throughout my school years along with what I guess one might call my underlying psychological make up, and I suppose you pretty much have/had a recipe for disaster.

In terms of my current treatment, for a long time I kind of just learnt to manage the symptoms on my own (I did self medicate with drugs in my 20s, but have been clean now for 12 years). The proverbial straw that broke the camels back was when I had rediscovered a passion for creative writing, and my symptoms weren't just interfering with that they were bringing things to a crashing halt. I'd pretty much accepted that my symptoms, when they occurred, would put limitations on me at times, and I'd learnt to deal with that, but to have something I was so passionate about being taken away from me - nope, nada, wasn't going to happen! That's when I met my current Psychiatrist, and I've been in treatment with him for approximately 5 years now. 🙂

 

[Ceke2002]

For a first encounter with a new psychiatrist would you rather the doctor be wearing:

A) white coat
B) suit jacket
C) polo

Would that preference change over longterm?

I'd prefer the Psychiatrist to wear whatever he felt comfortable in, and that wouldn't change over time. I'm more about who someone is as a person/practitioner and less about how they choose to dress. Most of the time I don't even notice what my Psychiatrist is wearing - jeans, shirt and dress shoes sometimes, other times I think he's worn business slacks, it's neither here nor there for me.

 

[Ceke2002]

If you could change one thing about psychiatric from your perspective, what would it be?

Ooh, good question! 👍

I think I'm going to answer this one both specifically and in general.

In general if there was one thing I could change about Psychiatry it would be for Psychiatrists to see their patients more as people who just happen to have certain symptoms and diagnosis, and not just as some interesting textbook analysis sitting in front of them. I know not all Psychiatrists are like that, but I've met a lot who are and it is one thing I'd like to see change more across the board.

Specifically I would really like to see a much better complaints management system and far stiffer penalties for Psychiatrists who abuse the power differential of the therapeutic relationship. I don't know about other countries, but in Australia the system seems to be all over the place, with some Psychiatrists getting off with a rap on the knuckles for abusing patients in their care, and others being jailed for almost the exact same scenario. It's frustrating, and there needs to be more consistent rules and consequences for those who flout the rules in place. Therapy abuse is a serious issue that can have long lasting consequences (I'm speaking from personal experience here), and I think it needs to be taken a lot more seriously (and better handled) when a complaint is made. Right now that doesn't always seem to be the case.

 

[PistolPete]

For you, what differentiates a good psychiatrist from a great one?

 

[Ceke2002]

For you, what differentiates a good psychiatrist from a great one?

Oh wow, that's really hard to answer. I guess it's one of those things that's intangible, like you know when you see/experience it, but putting it into categories or definitions is far more difficult.

I think a good Psychiatrist is one who listens, and empathises, and is prepared to work with and not necessarily just 'dictate to' a patient (depending on diagnosis of course), but for me a 'great' Psychiatrist is the one you really connect with and I don't think that's a quality that can be taught.

Or to put it another way, I had a good Psychiatrist from the outset, but then he become a great Psychiatrist because we began to really connect, and from that connection has come an immensely solid therapeutic bond.

 

[Ceke2002]

What are your thoughts on TMS?

I know what it is, and I've heard anecdotal evidence for and against it, but I don't think I know enough about it to give any sort of realistic opinion.

 

[Frazier]

You describe your story in Post #5 in great detail. From the sound of it, you sought out professional treatment on your own. Is this correct? ...Or were you also guided by someone else (family/friend/PCP/etc) to seek treatment?

Back then (~5 years ago), what led you to a psychiatrist in opposition to some alternative mental health professional?

 

[F0nzie]

Oh cool thread! Psychosis has always interested me. But insight, recollection, and detailed description is almost always lacking. I think defenses may play a role to some extent. What was it like for you? What was it like to talk about it with your Psychiatrist?

 

[Ceke2002]

You describe your story in Post #5 in great detail. From the sound of it, you sought out professional treatment on your own. Is this correct? ...Or were you also guided by someone else (family/friend/PCP/etc) to seek treatment?

Back then (~5 years ago), what led you to a psychiatrist in opposition to some alternative mental health professional?

Yes I did seek out treatment on my own, but I had the support of my husband as well. In terms of choosing a Psychiatrist over someone else, my Psychiatrist actually chose me. It was a case of all the chips just falling into place one after another. For a start my GP at the time realised I had become unstable enough to warrant assessment at an emergency community clinic and arranged for a referral - because my husband and I aren't very well off financially (even with medicare rebates for Psychiatrist and Psychologist visits we still couldn't afford to pay $50 -$60 a session) I may very well have had to accept going without treatment and just plodding along by myself as best I could (which was really not an option in my mind) - then I had a social worker and Psychiatric nurse do a home assessment - that was followed by an in clinic assessment by a registrar (one of the Psychiatric trainees doing their final year). At the time it was determined that while I was clinically unwell, I wasn't unwell enough for them to deal with me as I needed long term treatment and they were a short term emergency stabilisation type set up. I went home, feeling very despondent, the mental health system had let me down again, this sucked, blah blah blah woe is me - and then a day or so later I got a phone call from the same registrar to say that the lead clinician had reviewed me notes, and he was very interested in my case, and would I like to come in for an appointment and have him take me on as a patient in the longer term. I said 'Glory Jesus Hallelujah!', ah, well no, actually I just said 'yes', and that was five years and three clinic moves ago, and he's still my Doctor.

To be honest at the time, for me at least, it wasn't really a case of 'I wanted to see a Psychiatrist', but I felt I 'needed' to see someone and due to financial constraints my options were somewhat limited. Some Psychiatrists do bulk bill (meaning there's no gap fee - which is the set up I have with my Psych now), but those tend to have lengthy waiting lists, so you can end up waiting months for someone you're not even sure is going to be the right clinician for the job - on the other hand you can get heavily discounted Psychology sessions on referral under the medicare scheme, but it's limited to handful of sessions a year, and I knew I needed more than that. Because of my previous abuse in therapy I had a pretty deep seated mistrust of Psychiatrists, male Psychiatrists in particular (my current Psych was the first male Psychiatrist, not counting the registrar who first assessed me, that I've agreed to see in close to 15 years). If I had a choice I would not have opted to see a Psychiatrist at all, I would have gone with anyone else but a Psychiatrist. As it turned out I guess the fates aligned somehow and it turned out my lack of choice became my best choice.

And they all lived happily ever after. 😀 😛

 

[Ceke2002]

Oh cool thread! Psychosis has always interested me. But insight, recollection, and detailed description is almost always lacking. I think defenses may play a role to some extent. What was it like for you? What was it like to talk about it with your Psychiatrist?

Without going into too much detail on the actual content of my hallucinations - definitely recollection and being able to give a detailed description, in the immediate aftermath of an auditory or visual hallucination experience (for me it's within the first 24-48 hours) is next to impossible for me. Five years, and 2 months ago was the first time ever I actually managed to stammer out a very disjointed description of a visual hallucination I'd had earlier in the day - before that about all I could manage was a shake of my head and a shrug of my shoulders. It's not necessarily that I'm feeling defensive, or I don't want to talk about it, or that I'm scared to, or anything like that - it's more that I quite literally can't connect the experience from my brain to my mouth to give voice to it. It's like it's up there in my head, but it's just stuck and I sort of need time to become 'unstuck', if that makes any sense at all. That's for an actual hallucination/psychotic type symptom as well - with 'soft' or 'pseudo hallucinations' caused by other factors, then I'm fine, I can express those in detail straight away. I mean the sort of 'hallucinations' that happen say when someone becomes a bit emotionally disregulated, so they get stressed and/or anxious, and then paranoia creeps in, senses start feeling overloaded, brain starts misinterpreting normal sounds as something else - that sort of thing. Those I can talk about without any trouble, the other sort I can't (but I'm working on being better able to). It's really hard to explain the difference as well, between what I would call an actual hallucination and a 'soft' hallucination. There's just a different quality of feeling to each experience, it's like one 'feels' psychological, and the other 'feels' more like it's a biological process. I know that might sound a bit weird, but I don't know any other way to describe it.

In terms of insight and what it's like to experience a psychotic episode. My first episode was utterly terrifying, which was very closely followed by an overwhelming sense of confusion. I had enough insight to know that something was wrong, but beyond that I had very little to no ability to differentiate between what was reality and what wasn't. That first episode I spent a lot of time just wandering aimlessly around the streets, trying to 'see' reality, and I'd just end up more confused than when I started. I wouldn't wish it on anyone. I did manage to get myself to a Psychiatrist eventually, during one of my better weeks, and again I could talk about my depressive symptoms, anxieties, fears, all that stuff, but when it came to talking about the actual hallucinations I was experiencing, I really struggled - I just managed to give a vague overview (from memory I babbled on a bit about reality breaking apart, and could at least describe the only hallucination I was pretty sure was an hallucination at the time). The entire session was maybe 5-10 minutes on my actual symptoms, less than 5 of those minutes was on any sort of psychotic experience, the rest was a rather drawn out history taking interspersed with long periods of silence for over an hour. Still it was enough for her to rubber stamp with a nice, neat diagnosis of Schizophrenia, and please report the following morning for immediate hospitalisation at the local state mental asylum, by the way we'll be starting you on Largactil. Now as I said I did have just enough insight to know there was something wrong, and I had just enough insight to go 'Oh hell the eff no!' when that particular diagnosis and treatment plan landed in my lap. I pretty much bolted and refused all help after that (fear of stigma, horror stories about draconic treatments in 'asylums', shame, I didn't want to be 'that' crazy - a myriad of reasons). Looking back now I really wish the situation had both been better handled and that I'd been better equipped to handle it, because 6-8 weeks after leaving that Psychiatrist's office I made a near fatal suicide attempt.

By the time I experienced my second and third episodes I'd already been diagnosed with BPD, and was receiving treatment for that in the form of CBT, and although I kept the psychotic symptoms very hush hush (I was still very fearful after my initial experience with almost being chucked into a mental hospital) I slowly began to work out how to use what I was learning in therapy, to help me develop insight into my hallucinations, and so on. After therapy had ended (unfortunately due to lack of finances) I was able to continue taking what I'd learnt and to not only work on my BPD symptoms, but to continue increasing my insight and awareness when I did have a Psychotic Depressive episode. These days it's more of an annoyance, occasionally a hindrance, if things get too bad I take medication otherwise I have a number of things set in place (distractions, reality checking, meditation, ritual prayer, exercise, and so on) that help me manage things until they're better. To be honest these days the one thing I have the most trouble with isn't the hallucinations, it's when my speech is affected - that is more hair pullingly frustrating than anything else and if it goes on for too long it's pretty much the number one thing that will have me jumping up and down shouting 'medication please, now!' (well, not literally). When I say 'speech' being affected I'm obviously talking about stuff like word salad (always fun to respond to someone with complete gibberish), poverty of speech, one of those aphasia thingies that happens (yeah I'm really up on my terminology I know, LOL). My husband is very supportive though, and over the years he's kind of gotten used to me occasionally needing to communicate via charades or just staring blankly at him before coming out with a mouthful of complete nonsense. He teases me about it, we laugh together, it helps take some of the pressure off - the way I look at things you can either laugh or cry and fall in a heap, generally speaking I prefer to laugh. 🙂

 

[Ceke2002]

Just a quick shout out to the mods, I'm trying my best to give well considered, and detailed answers, without crossing the line, but if I happen to slip over, or you feel I have, please feel free to edit and delete away. I really want to make sure this thread stays positive and beneficial.

Cheers and Thanks.

 

[Ceke2002]

For you, what differentiates a good psychiatrist from a great one?

Oh wow, that's really hard to answer. I guess it's one of those things that's intangible, like you know when you see/experience it, but putting it into categories or definitions is far more difficult.

I think a good Psychiatrist is one who listens, and empathises, and is prepared to work with and not necessarily just 'dictate to' a patient (depending on diagnosis of course), but for me a 'great' Psychiatrist is the one you really connect with and I don't think that's a quality that can be taught.

Or to put it another way, I had a good Psychiatrist from the outset, but then he become a great Psychiatrist because we began to really connect, and from that connection has come an immensely solid therapeutic bond.

I know I've already answered this, but I've been thinking about it a little bit more and I think the best way I can really answer the question is to try and explain why my Psychiatrist in particular is a great Psychiatrist for me.

Beyond the connection we've made, and the therapeutic bond we've forged over the years, I've always appreciated the fact that he speaks to me on an equal level. By that I don't mean he talks to me like he would a colleague, but he's never made me feel patronised or like I need to be talked down to because I am a patient (unfortunately some mental health professionals, nurses and other non Physician practitioners included, do sometimes have a bad habit of speaking to a patient like they're explaining stuff to a five year old - I'm mentally ill, not mentally deficient, you can have a normal conversation with me, please and thank you). He's also really good at showing empathy in a way that is appropriate, controlled and balanced - so he doesn't try to rush in and play saviour, but at the same time he doesn't just ignore or brush things aside either - on an emotional level I find that approach comforting, for want of a better word, it's more stable and reliable than having someone trying to rescue me one minute, and then throwing in the towel the next (which has happened in previous therapy encounters and treatment). He's pretty good at picking up on what I need from one session to the next, and is able to allow a session to both unfold organically and to also lead and focus things at the same. Sometimes our sessions are fairly structured, but most of the time we'll just start talking( whatever I feel I need to talk about, stuff he wants to bring the table as well). It's not uncommon at some point for us to end up going off on a tangent and to start having discussions on things like the philosophies of Heraclitus, or the philosophies behind Buddhist and Wiccan teachings, or the works of Joseph Campbell in relation to Jungian Archetypes, but out of that he's usually able to find a thread he can follow back to more direct issues, and then he'll refocus the session, but in a way that doesn't feel like everything's just come to a screeching halt and now I've got mental whiplash because we've suddenly spun track at the last second. He's a Buddhist as well, and he completely respects my own spirituality and shows a genuine interest in it, which is something I really value because it is an intrinsic part of me. Our sessions usually wind down, again typically in an organic fashion, with both of us spending a few minutes just shooting the breeze, talking about music, family and life stuff, funny little anecdotes and experiences we've had - it's a nice way to end things. No matter how free flowing or laid back our sessions get though at no point do our roles shift or change, there is always a clear underlying sense and mutual understanding that he is the Doctor/Therapist and I am the patient and that never changes (nor would I ever want it to, I have plenty of friends both online and off that I can reach out to for support, I don't need him to be another friend, I need him to be my Psychiatrist - and he is, always, and that is pretty much set in stone as it should be).

Aside from all that I also just really respect him as a person. He's a very devoted family man, he clearly adores his wife and children which I must admit I find rather endearing at times (coming from a messed up family myself, I'm always rather endeared when it comes to stable family units); he's both open minded and a free thinker, but still maintains a very core set of morals and values at the heart of everything he does and the way he approaches things - we do actually share a lot of the same core values as well, so I guess that helps us get along in the therapy session also. He is someone I have come to respect and admire a great deal, but again he is not *his first name* my friend, he is Doctor *whatever*, my Psychiatrist.

So that's my Psychiatrist, and that's why I think he's great - so I guess that's what a great as opposed to a good Psychiatrist is to me. 🙂

 

[touchpause13]

Does your psychiatrist do actual therapy with you and if so do you find that helpful? Are you also seeing a psychologist as well?

Thanks for doing this!

 

[Ceke2002]

Does your psychiatrist do actual therapy with you and if so do you find that helpful? Are you also seeing a psychologist as well?

Thanks for doing this!

Yes, he does actual therapy, and no I don't see a Psychologist as well. Our sessions are typically 30-45 minutes, depending on what's been happening and how I'm doing. For the past few years we've had a system in place whereby I email him through quite detailed notes (symptoms, concerns, issues that have arisen, anything I need to talk about etc etc) inbetween sessions, and then he reads through those, makes notes, and once we actually get into session we can just hit the ground running without me having to spend a heap of time explaining what's been going on - so less time having to detail a lot of stuff, more time for actual therapy. 🙂

And you're very welcome. I'm really glad people are liking this thread and participating. Thank you as well. 🙂

 

[smalltownpsych]

Yes, he does actual therapy, and no I don't see a Psychologist as well. Our sessions are typically 30-45 minutes, depending on what's been happening and how I'm doing. For the past few years we've had a system in place whereby I email him through quite detailed notes (symptoms, concerns, issues that have arisen, anything I need to talk about etc etc) inbetween sessions, and then he reads through those, makes notes, and once we actually get into session we can just hit the ground running without me having to spend a heap of time explaining what's been going on - so less time having to detail a lot of stuff, more time for actual therapy. 🙂

And you're very welcome. I'm really glad people are liking this thread and participating. Thank you as well. 🙂

Too many psychiatrists like him and I would be out of business! Great psychotherapy and manage the medications, too.
😱

 

[Ceke2002]

Too many psychiatrists like him and I would be out of business! Great psychotherapy and manage the medications, too.
😱

Yeah I certainly landed well and truly on my feet when he offered to take me on as a patient. I wouldn't be too worried about being out of a job though if too many more of his type arise, he will refer patients to Psychologists if he feels they need a very particular type of therapy he isn't able to offer, or if they have a condition that would be better managed by a Psychologist alone, or even if he feels there's a particular Psychologist the presenting patient would feel more comfortable/work better with. Far as he's concerned, Psychologists are his colleagues, same as another Psychiatrist would be.

 

[Ceke2002]

Does your psychiatrist do actual therapy with you and if so do you find that helpful?

I'm so sorry, I completely forgot to answer the highlighted portion of your question. Yes, yes I do find therapy to be very helpful, absolutely. My Psychiatrist utilises a mix of different modalities in my treatment (ACT, IPT, CBT, MBCT, PsychoDynamic and so on) but the way he works in therapy it's more him guiding me towards my own realisations and connections, rather than just saying 'Oh yes, well symptom X is attributed to condition Y, and that's why you respond with ABC emotional state when *insert whatever scenario* arises'. So if for example I was to go to him and say 'I've realised I have negative response X when confronted with situation Y, and I'd like to understand why I respond that way and how I can change it', he'll usually then go through a number of schools of therapeutic thought related to that particular issue, explain the thinking and rational behind each one, and then based on what he knows about my history he'll narrow it down to a particular suggestion, like 'In theory XYZ in particular it says that ABC responses are related to *insert whatever developmental history*, do you think that's perhaps something you're experiencing when you have these sorts of responses' - and then it's up to me to say 'Hmm, yeah, I think you might be onto something' or 'No, no that doesn't sound right at all' (and then we'll go on to explore the issue further, or he'll just leave it to me to think about some more, depending on how the session is flowing at the time). That is one thing I also really appreciate with him, and something that has definitely helped me to trust him after coming from a previous experience of therapeutic abuse - he always encourages me to question and challenge him, and to never just sit there blindly agreeing with whatever he says. If he's wrong about something, I can speak up and tell him that straight out, and it's not a problem. Being more guided towards being able to make my own realisations and connections as well has been particularly helpful in that even outside of the therapy setting I'm now better able to connect the dots and come to my own conclusions/understanding about particular issues or negative emotional and/or coping patterns, rather than having to wait for someone to hand me a big book of explanations and point to a particular passage. Having regular therapy has allowed me to both grow and develop more as a person, to understand myself both internally and externally (my place in the world, my own internal thought processes, how that all connects to the symptomology I might show, and so on), plus it's also allowed me to minimise my use of medication. 🙂

 

[NontradCA]

Well my Psychiatrist works less with strict definitions of diagnosis, and more with viewing symptomology as being on a spectrum (treating the person as a whole and not restricting them to a clinicalised point of view, so to speak) - but I am diagnosed with Recurrent Major Depressive Disorder with Psychotic Fx (this was potentially changed to Schizoaffective Disorder at one point, but we went back to the original diagnosis), Anorexia Nervosa (restricting type currently in remission), Generalised Anxiety/Panic Disorder and Adult ADD. Those are my main ones, not all of them were diagnosed by my current Psychiatrist, they are more long standing conditions diagnosed over the years. Apart from that I'm also being treated for some residual Axis II issues (I had a previous diagnosis of BPD, but I no longer meet diagnostic criteria; however, treatment is still continuing because 'no longer meeting diagnostic criteria' does not equal 'cured'), plus I have some OCD tendencies (not severe or interfering with functioning enough to meet the diagnosis) which I'm also getting help with. In regards to my MDD with Psychotic Fx diagnosis, it both is and isn't a set diagnosis for me. Like I said my Psychiatrist works more with treating symptoms and the patient as a whole, and he also works more on the theory of psychotic disorders as being conditions that run along a spectrum. So if you were to consider say something like Schizotypal PD as being on the low end of the scale, and severe Schizophrenia as being on the high end of the scale, I fall somewhere below the middle of the spectrum and MDD with Psychotic Fx would be the diagnosis that best fits my symptomology (I hope I explained that properly).

As for what was happening in my life before diagnosis/hospitalisation. I've never been hospitalised, although it has been strongly suggested on a number of occasions I've never been unwell enough to have been forced in so I've always chosen not to go. In regards to diagnosis, like I said a lot of the diagnosis are long standing conditions that have been diagnosed over a number of years by various Physicians. I have a family history of abuse going back at least a generation (I was emotionally and physically abused for most of my childhood), I also have a strong family history of mental illness (including Schizophrenia, Eating Disorders, Anxiety, Depression and Substance Dependence), add to that some pretty nasty bullying throughout my school years along with what I guess one might call my underlying psychological make up, and I suppose you pretty much have/had a recipe for disaster.

In terms of my current treatment, for a long time I kind of just learnt to manage the symptoms on my own (I did self medicate with drugs in my 20s, but have been clean now for 12 years). The proverbial straw that broke the camels back was when I had rediscovered a passion for creative writing, and my symptoms weren't just interfering with that they were bringing things to a crashing halt. I'd pretty much accepted that my symptoms, when they occurred, would put limitations on me at times, and I'd learnt to deal with that, but to have something I was so passionate about being taken away from me - nope, nada, wasn't going to happen! That's when I met my current Psychiatrist, and I've been in treatment with him for approximately 5 years now. 🙂

Thank you for that thorough post, and sorry for the late reply. When you were growing up, or becoming an adult, did you ever consider yourself to be "sick" or have an illness that could be treated by medicine?

 

[Ceke2002]

Thank you for that thorough post, and sorry for the late reply. When you were growing up, or becoming an adult, did you ever consider yourself to be "sick" or have an illness that could be treated by medicine?

With the Anorexia, yes, eventually, but not really with a lot of the other stuff. I developed Anorexia when I was 8 (I did at least know such a thing even existed by the time I was around 9 or 10), but it wasn't really until I was about 11-12 that I first began to think perhaps there was something wrong and my eating patterns and body image and all that stuff wasn't exactly 'normal'. At the time though there was quite a 'be fit, eat healthy, maintain a healthy weight' type push with TV campaigns, and in schools especially, so it became very easy for me to dismiss those first niggling concerns and just tell myself that I was only doing what we were being taught in school, and on the TV (prevention was better than cure, maintain a healthy weight now I won't have to worry about health problems being overweight later on, I'm just on a health kick and looking after my body etc etc - none of which was even remotely true). It wasn't until I was 16, after going back and forth between total denial and continuing niggling back of the mind realisations that something wasn't right (complete with a rather dismissive and disasterous Doctor's appointment earlier on in the piece) that something finally happened and at that point I knew that 'yes I did have a problem, and yes I needed help'. Unfortunately just after entering an outpatient treatment program, denial kicked in again (I figured Anorexia was a teenage disease so once I was an adult dealing with adult responsibilities, like rent and bills, it would somehow just magically disappear - which obviously didn't happen) so it wasn't until I was 32 that I actually made a long term commitment to recovery and treatment (and that was ten years ago).

In terms of the other stuff, I suppose I knew I wasn't like the other kids, and at times I did think 'what's wrong with me, why can't I just be like everyone else', but in terms of thinking I had a problem that could be treated probably the closest to that I ever came was overhearing my Mum talk about my diagnosis of ADHD and how I had to avoid things like red cordial and needed extra discipline. It's hard to explain, I mean looking back now I was clearly showing some very disordered behaviours and thinking as a child, and at the time yeah I suppose there were things I didn't quite understand in terms of my thoughts or behaviours, but at the same time even if I didn't understand why I thought or acted a certain way it didn't really go so far as to have any sort of realisation that 'okay, I have these certain conditions, and I just need help with them'.

 

[hamstergang]

How do you pronounce your username?

 

[softballtennis]

For a first encounter with a new psychiatrist would you rather the doctor be wearing:

A) white coat
B) suit jacket
C) polo

Would that preference change over longterm?

I would prefer a suit jacket or polo.

 

[Ceke2002]

How do you pronounce your username?

Seeker. It's both my initials and my husbands put together, as well as being a stand in for the word 'seeker' (seeker of knowledge, seeker of understanding, seeker of whatever else, etc). 2002 is just the date of my marriage/handfasting - some registrations don't seem to like short usernames like 'Ceke' so I've kind of gotten used to putting the date in as well, and that one seemed appropriate.

My real name is Claire, I don't mind if people use that as well. 🙂

 

[Ceke2002]

Just following on from hamstergang's question, I forgot to mention you guys are more than welcome to ask me personal (so non therapy/symptom related) questions as well if anyone is curious about the person behind the screen name (especially considering I'm not here as a medical professional/med student). Long as it's not anything that's going to contravene the TOS it's all good. 🙂

 

[Ceke2002]

Okay well looks like I've got a few questions from someone via email. Now let's see if I can work out the BB code for quoting stuff on here...oh wait a sec there's a button for that, cool . I'm assuming the person in question wishes to remain anonymous as well so I'll just refer to them as 'Anon' (Anonymous Email Sending Forum Lurker is way too much of a mouthful otherwise 😛).

Hi Ceke (or Claire? which do you prefer?) I hope you don't mind receiving this email. I'm more of a lurker on the SDN forums but I've been following your ask a patient thread with some interest and was wondering if I could ask you a few questions?

Hello Anon (it's 6.30 am here, so 'top of the morning' to you as well ) You may call me whatever you're comfortable with, Ceke or Claire, either is acceptable - No I don't mind receiving an email at all (I added in my secondary online email contact details for this reason, in case anyone who wanted to remain anonymous, or who was more of a lurker wished to participate in the thread without having to post) - Glad you've been enjoying the thread so far - and yes you may absolutely ask me a few questions 👍

By the way, have a 'welcome' smiley in case you ever decide to delurk.

I know some Anorexic patients develop obsessions that revolve around food and cooking. Was that the case with you and if so is cooking something you still enjoy now that you're recovered?

Okay, well first things first, I'm not recovered, I'm 'in recovery' as in I am weight and nutrition restored but I still have some remaining issues I'm continuing to work through, plus I still have to monitor things a bit because the old negative thought patterns and compulsions do have a habit of trying to pop back in every now and then (I keep my Psychiatrist up to date with all of that stuff though, and between us we do manage to get things back on track pretty quickly if there has been a bit of a derailment). I'd say I'm around 75% of the way there, but yeah I still have another 25% or so left to work on. We have a saying in some of the online Eating Disorder support communities - 'Recovery is a journey, not a destination'.

As for the food/cooking obsession stuff, yes I was definitely the classic 'pour over recipe books, cook up a storm, never eat any of it myself' type anorexic. I don't know if I really 'enjoyed' cooking at the time, because it was more just another compulsive behaviour, but yes I do still cook now, and I do (now) enjoy it. Actually it's about the only decent thing that's come from me having Anorexia, I became a damn good cook (even if I do say so myself) . Let's see, so far I've learnt to cook Thai, Vietnamese, Chinese, Tibetan, Nepalese, Indian, Moroccan, Syrian, Iraqi, South African, Algerian, and Mediterranean dishes - next on my list of 'cultural cuisines I must learn to cook' are Malaysian and Korean. 🙂

It's been great to read about your positive experience with your Psychiatrist as well. For some reason I keep picturing him as looking like Travis Stork from The Doctors. Now I'm curious to know what he does look like?

He looks like Travis Stork ...if Travis Stork was a 5'7, slightly built, self admitted nerdy Asian guy with glasses. 🤣

---------

I know you have another, more serious, question for me to answer, Anon, but I think I'm going to leave that one for a separate post (just in case of teal deer 😉)

 

[Ceke2002]

Um yeah, so I included an email contact in my profile in case anyone wanted to contact me anonymously for this thread, and bright spark here has forgotten the password to access my email account. I'm trying to get Yahoo mail to let me change the password, but in typical fashion there seems to be technical difficulties so if anyone has emailed me, I'm not ignoring your question, I just can't read it at the moment.

Anon from above, I know I said I was going to answer your other question in a separate post, and I will, just give me some time because I've kind of been planning out the answer seeing as it is an important and serious topic. I will try and answer it soon though. Sorry

 

[Zenman1]

"Ever been curious about the view from the opposite side of the table, so to speak? Wondered what the experience of therapy or treatment is like for a patient? Want to ask some general questions about what it's like to experience certain symptomology?"

I'm always asking how their therapy (out side of our 30 minute med management/therapy) time is going, and it's usually interesting to hear. I also ask if they are satisfied with current progress and if they want to keep current dose of meds or increase them…basically what do they want…goals, etc..

 

[Ceke2002]

"Ever been curious about the view from the opposite side of the table, so to speak? Wondered what the experience of therapy or treatment is like for a patient? Want to ask some general questions about what it's like to experience certain symptomology?"

I'm always asking how their therapy (out side of our 30 minute med management/therapy) time is going, and it's usually interesting to hear. I also ask if they are satisfied with current progress and if they want to keep current dose of meds or increase them…basically what do they want…goals, etc..

That's great that you take an interest, especially in terms of progress and goal setting, and working with the patient to help facilitate their own improvements in treatment if necessary. I think a lot of patients would really appreciate an approach like that. 🙂

 

[strangeglove]

What does your husband think of your psychiatrist? Do you talk about him at home? Is your psychiatrist in-network for your insurance? What is your experience of the financial side of treatment?

 

[Ceke2002]

What does your husband think of your psychiatrist? Do you talk about him at home? Is your psychiatrist in-network for your insurance? What is your experience of the financial side of treatment?

My husband thinks my Psychiatrist is great, especially considering he's actually helping me which is more than I can say for some of my other experiences of the mental health system. My husband does tend to have a bit of a stereotyped image of Psychiatrists as being very serious and studious looking, whilst scribbling notes and saying 'Hmmm' a lot as well though, so he was a bit taken aback when he came in for part of a session with me and heard my Psychiatrist swear (not that he really cared, we swear in conversation all the time at home, it was just a bit weird to him because of his preconceived ideas of how a Psychiatrist is supposed to look and behave) - but yeah apart from that he's happy I'm seeing someone who's providing me with good help. I do talk about my Psychiatrist at home, I talk about my sessions, what we discussed, and so on. My husband also has a common interest with my Psychiatrist in that my husband is interested in martial arts and combat type sports and defense systems (he's studied a form of Karate in the past, and is currently doing Krav Maga), and my Psychiatrist has an extensive history of martial arts and combat defense/sports training. My Psychiatrist knows all this, he knows I'm totally open with my husband about everything, and he knows my husband is interested in martial arts and so on as well, so sometimes at the end of a session if Kevin (my husband) has something he's wondering about in terms of training then I can ask Dr *last name* and he'll give me an answer or an explanation that I can then pass on.

But yeah, anyway, sorry I'm up at the crack of dawn again, and the coffee is just kicking in so I'm waffling a bit. Suffice to say my husband likes and respects my Psychiatrist, and is grateful to him for the care and help he's given me these past 5 or so years.

In terms of being in network for insurance, I have no idea what that means? (I'm not in the the US, I'm in South Australia, by the way). I'm assuming my Psychiatrist accepts payment through private health funds if that's what a particular patient wishes, I'm actually not sure though, as far as I know he mostly bills through medicare. In terms of my payment arrangements, he bulk bills me, which means I don't have to pay the gap fee for whatever the medicare item code is, which means I don't pay for treatment at all, but he still gets paid himself. Basically the receptionist just swipes my medicare card each visit, and that's it.

From the Medicare Australia Website:

http://www.medicareaustralia.gov.au/provider/medicare/bulk-billing.jsp

"Bulk Billing is when a provider bills Medicare directly for any medical or allied health service that the patient receives.

Where a provider and a patient enter into a bulk billing arrangement, the:

Provider accepts the relevant Medicare benefit as full payment for the service, and
Patient assigns their right to a Medicare benefit to the servicing provider, allowing the benefit to be paid directly to the payee provider

If a practitioner bulk bills for a service, the practitioner undertakes to accept the relevant Medicare benefit as full payment for the service. Additional charges for that service cannot be raised."

 

[Ceke2002]

Well this would explain why I can't reset my flippin' password on Yahoo mail, and the one I have actually remembered isn't working.

http://www.skynews.com.au/business/...ahoo-mail-users-furious-over-disruptions.html

---------

Anon email sending person from earlier, if you're still following (lurking among) this thread, I'm sorry but I won't be able to answer your other question for a little while yet. I currently have a mother in hospital with delirium who's been placed under a mental health act detention order, and I'm about to invoke my enduring power of guardianship until she's been reassessed and deemed fit. So yeah, I'm gonna need some extra time ~ Cheers. 👍

 

[Ibid]

1. Why do some patients find it nearly impossible to cut the apron strings from their psychiatrist?

2. Why do some patients spend so much cash on sessions with a psychiatrist when many on them might as well be shooting the breeze with mystic meg down at fun fair at a much more competitive rate into the bargain?

3. Are some psychiatrists more dependent on their patients than the patients are on them?

4. When the police detain someone in a public place for being a danger to themselves or potentially to the public should that person have a right to silence in front of the psychiatrist called in to assess them? Should they have proper legal representation and not just some sort of mickey mouse advocate before the psychiatrist is allowed to see them?

 

[Ceke2002]

1. Why do some patients find it nearly impossible to cut the apron strings from their psychiatrist?

2. Why do some patients spend so much cash on sessions with a psychiatrist when many on them might as well be shooting the breeze with mystic meg down at fun fair at a much more competitive rate into the bargain?

3. Are some psychiatrists more dependent on their patients than the patients are on them?

4. When the police detain someone in a public place for being a danger to themselves or potentially to the public should that person have a right to silence in front of the psychiatrist called in to assess them? Should they have proper legal representation and not just some sort of mickey mouse advocate before the psychiatrist is allowed to see them?

1) I'm not at the apron string cutting stage myself, but I'm sure when the time comes I'll grieve the loss of a positive force in my life. Although to be honest I'm not actually sure if the apron string will ever be cut, my Psychiatrist has already stated he will be there as long as I need him, and if I have a lengthy period of stability then we can start cutting sessions back, but I'm still welcome to come in and see him once a year or so just to check in and to return to full time therapy if I ever need it. So yeah, I can't really answer that one from my own point of view. For others, I do know people who have previously had bad experiences with Psychiatry, so when they finally find a good one that they can relate to and connect with therapeutically, then they tend to want to cling for dear life (although not literally). Also I do think some patients confuse the therapeutic relationship with an actual relationship, especially in long term therapy, and foster a dependency that way - believing they have a friendship or at least a relationship that is not primarily based within a system of power imbalance, so when termination time comes I guess it feels less like the journey of therapy had come to a close, and more like they've been dumped by their BFF.

2) Maybe because Mystic Meg is a FOS con artist who's advice isn't worth the tea leaves she's reading from? Or maybe some people just assume costlier is better and/or they want to pathologise everything because no one else is hearing them and hey at least the Psychiatrist will sit there and listen (or pretend to, unless they're watching sand art videos on youtube 😉.

3) Wouldn't have the foggiest, perhaps you should ask a Psychiatrist that question. 🙂

4) Why would they detain them in a public place? Do Psychs in the US do kerb side consults? I mean don't the cops like take them to hospital? Why would the person have the right to be silent under law as well, they're not under arrest, they're being detained for their own safety/the safety of others. I mean sure they could choose not to speak to the Psychiatrist, but just personally I find an MSE is far easier when it's not conducted via the age old of art of mime. 😛 (no seriously, detaining a potentially dangerous person in the US means placing them under arrest pending a Psych eval?).

 

[Ibid]

thanks. Re: 4 detaining people in a public place is an arrest just using a particular bit of legislation..... still it is an arrest. Hence the right to silence question. Speaking to a psychiatrist is essentially the same as grassing yourself up to the police to a certain extent. You cant get away from that..... its a legislative fact of life....

And just to be clear if you are arrested/detained for evaluation or whatever you want to call it I assure you..... no you don't have the right to silence. And yes you can end up locked up with a punishment of 30 days to life for being suicidal in a public place.

 

[Ceke2002]

thanks. Re: 4 detaining people in a public place is an arrest just using a particular bit of legislation..... still it is an arrest. Hence the right to silence question. Speaking to a psychiatrist is essentially the same as grassing yourself up to the police to a certain extent. You cant get away from that..... its a legislative fact of life....

And just to be clear if you are arrested/detained for evaluation or whatever you want to call it I assure you..... no you don't have the right to silence. And yes you can end up locked up with a punishment of 30 days to life for being suicidal in a public place.

 

[hamstergang]

And yes you can end up locked up with a punishment of 30 days to life for being suicidal in a public place.

Is this true in every jurisdiction?

 

[Ibid]

Is this true in every jurisdiction?

I'm really just having a dig at the potentially open ended nature of involuntary commitment..... I mean if you dangle yourself off a bridge over the highway and hold up a lot of rush hour traffic your probably going to spend a bit longer in hospital than if you take a couple of extra paracetamol...... im really just kidding...

 

[hamstergang]

I'm really just having a dig

Yeah, I think this is a problem. This is a forum for psychiatry residents. You are not on the road to becoming a psychiatrist, and what you offer this forum is a bunch of anti-psychiatry junk dressed up as facts. You don't belong here, and you're not even usually correct in your criticisms.

 

[Ceke2002]

I'm really just having a dig at the potentially open ended nature of involuntary commitment..... I mean if you dangle yourself off a bridge over the highway and hold up a lot of rush hour traffic your probably going to spend a bit longer in hospital than if you take a couple of extra paracetamol...... im really just kidding...

So my Mother is currently in hospital with a badly broken leg, has gone into a delirium, has refused to consent to medically necessary treatment believes she is being poisoned by the Doctors and Nurses (not to mention the other patients who are hiding machine guns under their beds, and trying to slit her throat at night), believes she has the capacity to escape from the hospital whilst it's surrounded by armed police and is telling me she doesn't care if her leg snaps off she'll find a three wheeler bike to ride. Aaaaaannnddd she shouldn't be involuntarily detained at this point for the protection of her own safety? (which right now she actually is, although she's being reviewed today and yes I've made my wishes clear that I want the Involuntary Inpatient Treatment Order continued until such time as she has full capacity to make informed decisions that don't revolve around Terminator style escape plans through a sea of armed Police Officers).

 

[splik]

You don't belong here, and you're not even usually correct in your criticisms.

I don't think that is very hospitable. Ibid has been posting here longer than you and is well loved (by me at least) for his amusing and provocative posts. and we could do with more brits on this forum i reckon. I don't think it does psychiatry any favors when people get defensive about perfectly legitimate criticisms about the murky side of our field, and we would do well to actively engage in a dialogue with our accusers. Ibid is clearly well-read, in fact for ages I actually thought he was a psychiatrist. He doesn't rant, he isn't antagonist, he doesn't detract, he's not a troll. I don't really see why he shouldn't post here.

 

[Ceke2002]

Yeah, I think this is a problem. This is a forum for psychiatry residents. You are not on the road to becoming a psychiatrist, and what you offer this forum is a bunch of anti-psychiatry junk dressed up as facts. You don't belong here, and you're not even usually correct in your criticisms.

I don't think that is very hospitable. Ibid has been posting here longer than you and is well loved (by me at least) for his amusing and provocative posts. and we could do with more brits on this forum i reckon. I don't think it does psychiatry any favors when people get defensive about perfectly legitimate criticisms about the murky side of our field, and we would do well to actively engage in a dialogue with our accusers. Ibid is clearly well-read, in fact for ages I actually thought he was a psychiatrist. He doesn't rant, he isn't antagonist, he doesn't detract, he's not a troll. I don't really see why he shouldn't post here.

Goddamnit, stop making me agree with both sides of a discussion.

 

[Ceke2002]

I'm really just having a dig at the potentially open ended nature of involuntary commitment..... I mean if you dangle yourself off a bridge over the highway and hold up a lot of rush hour traffic your probably going to spend a bit longer in hospital than if you take a couple of extra paracetamol...... im really just kidding...

So, wait, that thing about Psych patients at risk actually being arrested and processed at the station with criminal charges BEFORE being transported to hospital was just hyperbole? Sorry being detained under the mental health act and being arrested and detained for a criminal charge aren't even close to the same thing to me. I don't know, you seem to have a rather romanticised view of mental illness, it's kind of...weird, sort of.

 

[Ibid]

Yeah, I think this is a problem. This is a forum for psychiatry residents. You are not on the road to becoming a psychiatrist, and what you offer this forum is a bunch of anti-psychiatry junk dressed up as facts. You don't belong here, and you're not even usually correct in your criticisms.

Now... now.... sorry Ive been away watching The dialectics of liberation conference videos on youtube..... can't get enough of Ginsburg in those groovy glasses and Stokely Carmicheal.... boy he gets cross doesn't he....

Anti-psychiatry? David Cooper would be spinning in his grave! Thats just a term of abuse that psychiatrists use about each other..... outside that context it doesn't really mean much..... not to me anyway...

I'll be off shortly but be nice while i'm gone or i'm going to tell the Franz Fannon appreciation society what you said and they will not be pleased I can tell you...... you'll never get a job in Brixton thats for sure..... I'm leaving my fate here in the capable hands of the mods..... thats like gods but with an M..... its a small difference in spellings that makes no difference..... they have the same sort of powers for all practical purposes...... internet life and death is in the hands of the Mods..... mods is the new gods...... thats how it is these days.... on the internet...

 

[Ibid]

I don't think that is very hospitable. Ibid has been posting here longer than you and is well loved (by me at least) for his amusing and provocative posts. and we could do with more brits on this forum i reckon. I don't think it does psychiatry any favors when people get defensive about perfectly legitimate criticisms about the murky side of our field, and we would do well to actively engage in a dialogue with our accusers. Ibid is clearly well-read, in fact for ages I actually thought he was a psychiatrist. He doesn't rant, he isn't antagonist, he doesn't detract, he's not a troll. I don't really see why he shouldn't post here.

Thanks.... I do believe that is all their is..... dialogue... from either side of the lens..... I do wonder how things would have worked out if 300yrs ago lay people had won out and been left to run the asylums how that would have worked out..... if the legal concept on insanity had never been introduced to protect the widows of those who killed themselves from being poverty stricken had never been taken over as a defense for "other" behaviour....... unknowable I suppose and given the cultural power of doctors once they had been employed in asylums I suppose they were always going to end up running the joints....

 

[Ibid]

So, wait, that thing about Psych patients at risk actually being arrested and processed at the station with criminal charges BEFORE being transported to hospital was just hyperbole? Sorry being detained under the mental health act and being arrested and detained for a criminal charge aren't even close to the same thing to me. I don't know, you seem to have a rather romanticised view of mental illness, it's kind of...weird, sort of.

Sorry about your mother..... hope that resolves itself.

In the UK being detained pursuant to 136 of the mental health act is technically an arrest. The police will refer to you as a prisoner until such time as they formally hand you over to health staff. At this point a mental health act assessment will be convened and by this time you will be a patient. Its important to keep in mind that this is a legal rather than a medical setting.

Psychiatry and the criminal justice system for historical rather than logical reasons have become enmeshed..... horribly.

imo it demands public debate about what the purpose of the mental health system is..... thats unlikely to happen because for one thing the public doesn't really want or care to think about the issues. The public mandate is unspoken, to deal with the people who for what ever reason are not going with the program if you like. Its emotive stuff for anyone brave enough to dip their toe in the water and talk about these sorts of things..... people get hurt and feel judged..... understandably.... the conversation gets suppressed..... which if i'm really honest is probably all for the best.... but their is I think also a desire to take a peek behind the curtains every once and a while as well.... and thats probably not a bad thing either.....

bang... right now where is that paper on mitochondrial dna...... that was sooooo interesting......

 

[Ceke2002]

Sorry about your mother..... hope that resolves itself.

In the UK being detained pursuant to 136 of the mental health act is technically an arrest. The police will refer to you as a prisoner until such time as they formally hand you over to health staff. At this point a mental health act assessment will be convened and by this time you will be a patient. Its important to keep in mind that this is a legal rather than a medical setting.

Psychiatry and the criminal justice system for historical rather than logical reasons have become enmeshed..... horribly.

imo it demands public debate about what the purpose of the mental health system is..... thats unlikely to happen because for one thing the public doesn't really want or care to think about the issues. The public mandate is unspoken, to deal with the people who for what ever reason are not going with the program if you like. Its emotive stuff for anyone brave enough to dip their toe in the water and talk about these sorts of things..... people get hurt and feel judged..... understandably.... the conversation gets suppressed..... which if i'm really honest is probably all for the best.... but their is I think also a desire to take a peek behind the curtains every once and a while as well.... and thats probably not a bad thing either.....

bang... right now where is that paper on mitochondrial dna...... that was sooooo interesting......

Thank you for the thoughts regarding my Mother, I'm sure things will be better eventually but with delirum it's hard to tell - she's in and out of lucidity a lot. She has been re-detained, this time under what's known as a Level 2 Inpatient Treatment Order, which is longer than a level one, so she's under the order until January 2nd.

I'd have to go back through the mental health act for South Australia, but I know if someone is arrested for an actual criminal matter (property damage, trespass, theft, whatever else) then of course they are arrested and processed by law, but once the mental health act kicks in it's no longer a matter of law, it's handed over to the health department/guardianship board to take care of. And patients even under the highest levels of detention have rights - the right to appeal their order, the right to seek a second opinion, and so on. Unfortunately a successful appeal isn't always a good thing. The various orders don't just keep people locked up or forced onto medication, they also provide access to social workers, health checks, welfare checks, drug and alcohol counselling - once the order is revoked, at least from the people I've known over the years, the patients tend fall straight through the cracks again and ended up right back where they were with a plethora of health, safety and substance dependence issues. I know one person who challenged his community treatment order, and was successful, who was dead within 2 weeks courtesy of a set of train tracks at night, and a train conductor that didn't see him in time to stop (sliced him in half). I actually had to give statements to the police for entry into the coroner's enquirer at the time, as did a few of us who knew him.

I guess I tend to take more of a middle road with this. I believe in advocating for patient's rights as much as possible, but I also accept there are times when someone does need to be forced to comply with treatment, or detained for their own well being.

 

[Ibid]

Thank you for the thoughts regarding my Mother, I'm sure things will be better eventually but with delirum it's hard to tell - she's in and out of lucidity a lot. She has been re-detained, this time under what's known as a Level 2 Inpatient Treatment Order, which is longer than a level one, so she's under the order until January 2nd.

I'd have to go back through the mental health act for South Australia, but I know if someone is arrested for an actual criminal matter (property damage, trespass, theft, whatever else) then of course they are arrested and processed by law, but once the mental health act kicks in it's no longer a matter of law, it's handed over to the health department/guardianship board to take care of. And patients even under the highest levels of detention have rights - the right to appeal their order, the right to seek a second opinion, and so on. Unfortunately a successful appeal isn't always a good thing. The various orders don't just keep people locked up or forced onto medication, they also provide access to social workers, health checks, welfare checks, drug and alcohol counselling - once the order is revoked, at least from the people I've known over the years, the patients tend fall straight through the cracks again and ended up right back where they were with a plethora of health, safety and substance dependence issues. I know one person who challenged his community treatment order, and was successful, who was dead within 2 weeks courtesy of a set of train tracks at night, and a train conductor that didn't see him in time to stop (sliced him in half). I actually had to give statements to the police for entry into the coroner's enquirer at the time, as did a few of us who knew him.

I guess I tend to take more of a middle road with this. I believe in advocating for patient's rights as much as possible, but I also accept there are times when someone does need to be forced to comply with treatment, or detained for their own well being.

Well sticking with CTO's the trouble as I see it is that they are very hard to challenge.... if one is doing well its used as evidence its working and hence the person should stay on..... if the person is not doing well..... again this is evidence of the need to stay on..... adding in its impossible to know how the person might do with out the CTO. In the UK the OCTET study found they were esssentially a waste of time. The suspicion is that they are really just convenient for staff who want an easy way to recall people to hospital. (treatment can not actually be inforced with them unless a person is recalled, thats little understood)..... the other problem is that they potentially impede the formation of a theraputic alliance because..... well.... why bother ( some people might find this insulting but humans are humans not super humans)

Ultimately they seem to be about adminatrative convenience and managing staff anxiety more than achieving anything useful. Sure the state protects us from ourselves (not just MH law) and from each other all the time..... but who protects us from the state? MH tribunals are a well known joke frankly...... kangaroo courts or some sort of field justice..... harsh but not far from the truth.

I'm instinctively against anything that mitigates against people taking responsibility for themselves. Plenty of people find restrictive regimes helpful..... secure settings get good reports from some people who say that time in those sorts of restrictive secure environments helped them...... that fine and if some one wants to on a CTO or something like it I wouldn't deny them but for the general adult MH population, outside of forensic services..... a CTO is overkill... no one should have to be on one imo.

imo we probably need to do a lot more work on the societal taboo around talking about suicide which you have mentioned. I don't feel that CTO's save lives...... Ive also know the opposite case where someone being recalled killed them selves just before the police arrived to recall them. It cuts both ways..... my solution would be to do with out them..... let the cards fall where they might and just live with it..... my surmise and its only a surmise is we would see people making good choices as often as not and its only my guess.... but fewer suicides.... not more.

 

[Ceke2002]

Well sticking with CTO's the trouble as I see it is that they are very hard to challenge.... if one is doing well its used as evidence its working and hence the person should stay on..... if the person is not doing well..... again this is evidence of the need to stay on..... adding in its impossible to know how the person might do with out the CTO. In the UK the OCTET study found they were esssentially a waste of time. The suspicion is that they are really just convenient for staff who want an easy way to recall people to hospital. (treatment can not actually be inforced with them unless a person is recalled, thats little understood)..... the other problem is that they potentially impede the formation of a theraputic alliance because..... well.... why bother ( some people might find this insulting but humans are humans not super humans)

Ultimately they seem to be about adminatrative convenience and managing staff anxiety more than achieving anything useful. Sure the state protects us from ourselves (not just MH law) and from each other all the time..... but who protects us from the state? MH tribunals are a well known joke frankly...... kangaroo courts or some sort of field justice..... harsh but not far from the truth.

I'm instinctively against anything that mitigates against people taking responsibility for themselves. Plenty of people find restrictive regimes helpful..... secure settings get good reports from some people who say that time in those sorts of restrictive secure environments helped them...... that fine and if some one wants to on a CTO or something like it I wouldn't deny them but for the general adult MH population, outside of forensic services..... a CTO is overkill... no one should have to be on one imo.

imo we probably need to do a lot more work on the societal taboo around talking about suicide which you have mentioned. I don't feel that CTO's save lives...... Ive also know the opposite case where someone being recalled killed them selves just before the police arrived to recall them. It cuts both ways..... my solution would be to do with out them..... let the cards fall where they might and just live with it..... my surmise and its only a surmise is we would see people making good choices as often as not and its only my guess.... but fewer suicides.... not more.

I definitely agree that the stigma against mental illness needs to stop, and that includes society as a whole not being afraid or ashamed to talk about tough issues like suicide. But the trouble is we're not there yet, we're just not at a stage as a society where everyone with mental health issues can expect the sort of close knit community and family support that tends to be afforded to people with other types of illnesses. In cases where a person has no community or family support, often times it's the Doctors, Nurses, Social Workers, etc that become their only support network, and who are the only ones who give enough of a **** to do what has to be done to keep them safe if it's required. I'm not sure what it's like in the UK, although I do know people who have been sectioned under the mental health act there (for some it didn't prevent the ultimate end from happening, for others they've said they might have been p**sed at the time, but they were grateful in the long wrong). Here in South Australia, though, even back in the 90s when I knew a lot of people with various Psychotic disorders who were under treatment and detention orders and the mental health act made it a lot easier to place people under such conditions, it was still pretty difficult for someone to actually be placed on a CTO or an ITO - I mean you had to be trying pretty damned hard to get yourself slapped with one of those. Now they've overhauled the mental health act and the rules and regulations on who can and can't be detained or placed on a CTO are even stricter, plus the patients have a lot more rights and advocacy in place as well.

People sometimes ask me if I would have wanted to be sectioned back in 1991 before I made my suicide attempt. And in hindsight, knowing the life I have now - a wonderful husband, finally receiving proper care and treatment for my mental health issues, having an entire online community support network, the friends I've known for 20 years who have become like family - yes I would have wanted to be sectioned. I might not have been too happy about it at the time, but if it prevented me from losing the chance to have all that I have now, I would have been glad of a section in the end. As it was I did survive the attempt (obviously), but only by a sheer twist of luck/fate - the outcome would have been very different otherwise, considering the method I chose is one associated with a high fatality rate.