When Prozac first hit the marketplace, I asked my psychotherapist if he thought it could help. “Probably not,” he said, “as it would do nothing for your core abandonment issues.”
My mother committed suicide when I was nine, after years of struggling with alcoholism, an abusive husband, and depression, hence the abandonment reference. As a naïve young woman in the thralls of a bright, charismatic therapist, I assumed he knew what he was talking about.
On the plus side, he listened well and seemed to know me through and through. Much better than the first therapist I saw in college. Our first session was great, providing me with much needed relief, but upon my return, she asked me to remind her of what we had discussed the week before.
None of this is intended to be a whine or a rant, more an observation of the mental health system over the years, as I have experienced it. Mental health is a decidedly tricky business.
So, let’s fast forward to three years ago. A young nurse practitioner, during my annual checkup, asked if I had ever tried Prozac (or fluoxetine, the generic name) for my depression. By this time, I had tried at least five antidepressants over the years, none of which worked.
So, yes to the Prozac! And just like magic, within about six weeks, I was no longer depressed, although maybe just a tad bit too happy. My boyfriend at the time was so startled by the change in me, he said, “I think I liked you better when you were depressed.” And truth is, he was sort of within his rights, as I was guilty of keeping him up a couple nights.
More recently, I have wanted to taper off the Prozac (it’s been keeping me up at night again, making me feel nervous about the long distances I sometimes have to drive). Because I recently moved, I no longer see my NP and my current provider has limited experience with psychiatric medications.
Rightly so, she has recommended I see a psychiatrist. I guess I would love to see one, but the waiting lists are long. So, I looked up how to taper off Prozac on the internet, which tells you how, but that you should only taper with help of a trained professional.
The advice on Medical News Today.com confused me. The article “What to know about fluoxetine withdrawal” says I could experience withdrawal symptoms such as brain zaps, tinnitus, smelling odors that are not actually there (!), etc.
But also stopping could be “particularly unproblematic” because of “an especially long half-life” (i.e., the amount of time it takes for the medications to reduce by half in the body). Whatever! I am doing it anyway.
Daniel Barron, a psychiatrist, wrote recently in TIME Magazine: “I have a problem. I am a psychiatrist in the 21st Century and yet I still evaluate patients the way Freud did a century ago…” And, “the more we fiddle with existing diagnostic framework, the more muddled it becomes.”
I appreciate his honesty.
Understanding what kind of mental illnesses I think I have has taken a long time. My working self-diagnosis is a subclinical bipolar 2 disorder with PTSD and generalized anxiety. Years of reading, participating in therapy, and working as a clinical social worker have led me to this conclusion.
So, given the years it has taken me to know my own mind, imagine the difficulties even the most ethical, seasoned shrinks must have in understanding patients. Barron argues that big data could help.
It doesn’t surprise me that mental health is so seemingly backward (but so much more advanced than when I was young). The brain is complicated. Add to that the stigma of people talking about Mental Illness.
When I was young, I thought about therapy as my anxiety was positively crippling (looking people in the eye would cause a panic attack that included dizziness and once caused me to almost pass out at work; my hands were constantly shaking which limited my choice of occupation, etc.). Yet I would not even consider therapy as I did not want to appear weak.
In a recent article published in The Guardian, Amelia Tait wrote about the possibility of abuse performed by psychotherapists. Ms. Tait references a book by Courtney James, When Therapy Goes Wrong: A Personal Examination of an Unregulated Business, which discusses “…a number of ways in which therapists can be harmful: from inappropriate comments and gas lighting to drinking with clients and telling them they are beyond help.”
This article also references Glenys Parry, from the University of Sheffield, who has written “…a number of papers about therapy risks.” He discusses therapists getting out of their depth, “…working with a complexity and severity of problems that they are not really trained to do.”
I am always hesitant to sound like a victim, which I don’t feel that I am. I could not possibly be a victim as I have made it to age 68, having a lot of fun, interesting experiences along the way, and having raised a successful, kind daughter. But when I did finally go to therapy, I encountered some “therapy abuses” and people practicing out of their expertise.
Here are just a couple of examples, which are not as awful as some I read about in Tait’s article.
#1: In response to complaining about severe headaches (that were later diagnosed as migraines), a Freudian oriented therapist said, “I can’t help it if your vagina is in your forehead.”
#2: This same therapist balanced his checkbook during sessions, saying that it helped him with practicing “evenly suspended attention” (a therapeutic term that describes “…the kind of direction-less listening-removed from theoretical presuppositions and therapeutic goals”, from Wikipedia).
#3: Additionally, he asked me to deliver bumper stickers for him when he was running for city council.
#4: Two handsome, super smart, charismatic male friends (well, former friends) have told me about their female patients being in love with them, in tones that suggested that this adoration boosted their male egos.
#5: Or this, a female therapist said in response to my worries about my arms and legs not looking good enough for a new boyfriend: “I would not know what that is like. Me and my sisters had good arms and legs.”
Of course, synopsizing years of experience with doctors and therapists is a one-sided task. Along the way, I did learn to heal, even getting benefit from the therapists that I have discussed. What I am doing here is pulling stories out of my mind that highlight how difficult the field of Mental Health is, as well as showing that its practice appears to be in its infancy, at least in my opinion.
I hope to highlight some of the difficulties I have experienced mostly as a cautionary tale and also hopefully to provide a little entertainment. In my state, abuses can be reported to a licensing board, which is a relatively new phenomenon compared to the number of years therapists have been practicing here.
Because I think uplifting endings are so important, I want to say that as I write this, I have seemingly successfully tapered off the Prozac after enduring two days of scary vertigo, bad enough that I could not drive and mostly stayed in bed.
As of now, I can feel my familiar negative thinking cropping up, but am anticipating using my own brand of Cognitive Behavioral Therapy (i.e., naming destructive thoughts and reframing them) to the negativity.
My thoughts can go dark easily, so I’m hoping they don’t get too dark. But I strongly feel like I want to trade the oversleeping that comes with my depression (which usually feels like a curse, but right now feels like it would be a blessing) for being wired and sometimes too tired to drive.
And the next time I see my new PCP, I will try again to get a referral to a shrink. But, in a way, I really don’t want to because I feel that this will start the whole process all over again. Honestly, I feel that I have to be a lay physician who heals herself.
Do you carry shame about past issues and emotions? Have you been unable to control your mind? Has seeing a therapist helped or harmed you? Have you ever been in therapy with someone who said or did things that made you uncomfortable? Did you also feel that the therapist had some good qualities and points of view, despite this? Did you talk with the therapist about your discomfort?
Let’s Have a Conversation!