Saturday, November 28, 2009
My diagnostic disaster – part three
The story so far:
In an attempt to save my sanity. I had decided to apply for a part payment of a government allowance. To do this I needed a doctor’s report, and to obtain one I returned to a psychiatrist I had seen eight years earlier. At the time he had diagnosed me with bipolar and unsuccessfully tried to put me on an epilepsy drug. I had left in disgust. Upon returning in the hope of getting a doctor’s report, Dr Field (not his real name) had diagnosed me with ADD.
As I sat in Dr Field’s office trying to absorb the news, he was already back to his old diagnostic tricks. ‘Do you feel stuck in the present?’ he asked. Stuck in the present? I wished I was. I was stuck in the past, stuck in the future – the present was in some ways elusive. But even a preliminary perusal of the literature he’d given me to read on ADD suggested that the picture was far less simple than his question suggested.
‘I want you to go on dexamphetamine’, he said. ‘It’s a stimulant, but it has the opposite effect on people with ADD. It’ll calm you down’.
I was shocked but also stunned at my own naivete. Dr Field loved drugs: why would I think he wouldn’t have found one to treat his latest diagnostic interest?
I tried to explain my reluctance to take a stimulant drug but my efforts were wasted. It was all contrariness and non-compliance as far as he was concerned.
He smiled at me. ‘If you don’t take this drug you won’t get anywhere in life. Are you willing to throw away your entire future?’
In the end we reached an agreement. I would try the drug, and come back and see him again; and he would fill out the report form.
Despite our agreement, I knew I would never take the drug for any length of time; my system was just too sensitive for something so strong. But I was desperate for the report, so decided to try one dose and see how things went. In the unlikely event that the drug didn’t act as a stimulant, I’d take sufficient doses to please Dr Field so he’d fill in the report.
That Saturday, I picked up the prescription. Twelve tablets. How much would this be worth on the black market, I wondered. I joked to myself that perhaps I could go to Fitzroy Street (a street in Melbourne popular with drug dealers) and see if I could sell them.
I took one tablet. Just as I’d thought it would, it made me speedy (did this mean I didn’t have ADD? Who knew?) I rang Simon, a friend who lived close by, and asked him to come over and ‘babysit’ me. We decided to walk through the quaint, gentrified estate near where I live to the haven of Central Park. I was ‘with it’, but very talkative, chatting volubly about some of the meticulously renovated Edwardian houses we passed. Simon later confirmed that I had seemed a bit ‘high’.
I slept very lightly that night, just as if I’d taken a huge dose of caffeine. I wanted my brain back; dexamphetamine and I were fated to part for all time.
By this time I was feeling sheepish and quite manipulative. Why had I gone through this ridiculous farce? What was I trying to prove?
The following week I faced Dr Field once more. If I was manipulative and conniving, I was also honest. ‘I took one tablet’, I told him, ‘and it made me feel very speedy and a bit out of control. So I didn’t take any more. I did try.’
‘Well unfortunately I can’t help you. Counselling without medication won’t work.’
‘But what about the doctor’s report?’ He seemed to have forgotten all about it.
‘Yes – that’s why I came to see you. I’m hoping to be able to get this government payment. But I’ll only be able to get it if the report’s filled out. We spoke about this last time.’
I handed him the form. He scribbled away as I sat in my chair feeling relieved and gladdened. I had looked after myself, gone through the hoops, done everything I needed to do, and now this surreal episode was drawing to a close.
‘There you go.’ He handed me back the form – like so many doctors he had almost illegible writing.
I stood up as I took it from him, gave him my most charming smile. ‘Thanks Dr Field.’
‘Good luck’, he said.
Once on the tram I eagerly pulled out the report from my bag. My heart sank.
‘Oppositional personality features and paranoid attitudes’, I read, ‘given prescription of dexamphetamine but too scared to take it’, and ‘needs medication and counselling but refuses’ (I would have gladly gone for the counselling without the medication, indeed would have done so eight years earlier).
‘Pleasant person but throwing her life away’, was his passing shot.
The report was useless; as a non-compliant patient I didn’t stand a chance of getting the payment.
The story doesn’t end there. I finally saw sense and went to a local GP I had seen intermittently over the years who headed a large clinic. She knew I had anxiety and had at one point prescribed sleeping tablets. She listened to my request and filled out the doctor’s report for me, and needless to say it read quite differently from Dr Field’s version. After many months and much stress, I finally received the part government payment I’d been seeking.
I can’t see myself as a total victim in this story; it was plain dumb of me to go back to Dr Field, to think I could see him on my own terms rather than his. I didn’t enjoy the feeling of trying to manipulate him into filling out the report. But the experience did make me think about psychiatry and the power it brings with it. I now believe that this power has its own inherent psychic dangers – in order to maintain their registration, psychiatrists should be required to undergo some kind of periodic co-counselling with colleagues to ensure they have not succumbed to, say, narcissistic delusions of grandeur or a tendency to over-pathologise.
Dr Field, in his own funny way, could see the damaged part of me better than some other psyches and for this reason I was attracted to him; but he could not see all of me, me in my complexity and entirety. His considerable talents were stymied by his inability to learn anything from his patients, to listen to their narratives, to open his heart to them as well as his mind.