The past weeks I've really looked at the conditions I was in dealing with anxiety. So I spent time in the hospital; time taking different medications; time writhing on the floor of my bedroom in panic; and time trying to just get through the day. Eventually I'd move on from those experiences, and I started that movement almost as soon as I got out of the emergency room although it was way too difficult to get to doctors who could help me.
This week I'm going to look at the process and difficulties I had setting up two different doctors appointments. For the record, I think that the medical bureaucracy in America is totally a shambles. The systems in place for getting care really does not serve people in my situation well, and I had a ton of advantages in navigating the system:
For one thing I was in Minnesota, which has one of the most all encompassing medical industries in the country. Like you can't throw a rock in Minneapolis without hitting a hospital, but doctors were hard to contact and offices were far flung enough to be problematic.
Additionally, I had insurance through a parent's work. It's not the greatest plan in the world, but I had it and I didn't have to pay for the insurance although I got the bills. The insurance company was helpful and for some reason insurance at all is a bit of a luxury in America so I was fortunate in that regard. Just for the record, I've been on Obamacare in the past and it's so important to have that.
And I had my family, many of whom work in health care in some way or another. And I was in touch with them throughout the process of finding care. That's a huge help. All these things also really inclined me to stay in Minneapolis at the time too. That didn't workout in the end, but I had support every step of the way through care. And I'm naturally pretty good at navigating systems like this so even with other difficulties, I could've been in my element but it still wasn't easy.
The point is there were places to go where I was, there was a company that was going to cover part of my care, and I could call my cousin when I was struggling with making very course grain decisions which were hard for me at the time. So this is one of those important features of dealing with mental health in America, it's unreasonably difficult especially for the person dealing with their mental health.
Initially I thought, since I hadn't been out of school for more than a year, I could at least start by going by student health services. After all, I'd gotten tested for mono there just a few months earlier after graduating. But it was 2016 and I guess that was when the University decided to kick me out of their health system--although I could still use their useless career services office and the library.
So February 19, 2016 was unseasonably warm. Upper 30s and drizzling in Minneapolis. I walked over to student health services early, before work, and just walked up to the desk. When they asked about who I was or whatever, they told me they couldn't help. That's real bummer when you basically see yourself as in a place where people are there to help you and you're asking for help. That dashed the notion that doing this very simple thing--seeing a doctor--would be as easy as walking into the building where the doctors are.
Needless to say, facing a setback in that state of affairs is devastating. I went to an auditorium on campus and thought about how the effort to end it all would be less than picking up the phone just to get buffeted around and told that there was no help available. Making that call took like an hour to just get around to. But eventually I started making calls and walking to work. I was very attached to my phone and my notebook that morning.
An hour or two after the failure at student health services I had the above notes together. But I was really just barely holding it together. I fielded a few more calls from clinics and offices which got stuck on the Post-It's.
On a personal note, I'd like to comment on the degree of organization and planning that was going on here. I'm frankly amazed looking at these notes that they are as organized as they are. So I'd like to clarify a few details about my experience dealing with anxiety:
First, specific to these days, getting through the calls and scribbling these notes down was basically all I was able to do. And it was hard to start. I wanted to just see a doctor, when that didn't work I felt pretty fatalistic about the whole day. I plugged away for a few hours doing research and writing notes. But before I did that I was thinking about bridges and jumping off of them.
Second, in general about my experience with anxiety, I was resistant to dealing with anxiety, or taking medication, or probably even acknowledging the problem. The reason I was resistant to change was because the fuel of anxiety is very compelling for putting notes like this together, agonizing over details and perfection. I definitely made notes and calendars and even some creative work with the force of anxiety behind me.
Now I can't speak for all neurosis or all people who struggle with mental health, but I'm confident in saying that frequently dealing with mental health is as difficult for people because it has some attractive qualities as much as it is difficult to deal with because it's harmful to the individual. I felt like anxiety was frequently what let me get better work done, and I still don't think I'm totally wrong about that.
Bipolars sometimes forego medication because manic episodes can be euphoric; alcoholics will relapse because drinking is part of how they get through the day and how they understand themselves and contextualize their relationships with others. Some of the activity of depressives, I hesitate to posit, is sometimes attractive to an interpretation of some alternative course of action to an individual dealing with depression. Certainly, because mental health permeates your experience of the world, it can be deeply tied to identity and I like some of my anxious energy and have some belief that there are good features of my life which seem only to be possible as a result of having that feature of my psychology.
Regardless of if having anxiety made it possible to effectively deal with my anxiety, by the end of February 19, 2016 I had two doctor's appointments set up. First was with a GP the following Monday, second was with a psychiatrist in March.
Meeting with the GP was pretty straightforward but it's not like a good time or anything. Doctor's offices kind of suck. The questions on paperwork about my own health history and my familial health history made me feel all kinds of ignorant and self conscious.
Basically, though, the GP felt confident in writing a new prescription for the lorazepam I was taking on an as needed basis. She also put me on sertraline, brandname Zoloft, a drug she said she'd "had success with for other patients with anxiety and depression." And that's really about it. Like any doctor I've talked with about Zoloft the GP talked about the caution and acclimation period to this drug. I started at half a tab every day for two weeks and then came up to a full tab after that. Zoloft takes about three to four weeks for the effects to be felt.
Zoloft gets prescribed left and right like it's the cure to the common neurosis. And it kinda is. It works for depression, it works for anxiety, generalized, social, panic disorder, it works for OCD. But the way it works is by setting a new baseline for serotonin re-uptake in the brain. People can feel "flatlined" on it, like there's no up or down. That's true, but for me that was a really positive feeling. By taking away my body's regulation of it's own serotonin the rollercoaster was gone.
So I was glad to have something working for me after meeting with GP. Only the lorazepam gave me any relief for a few weeks as I came up on Zoloft. It was suddenly obvious when this drug was working too, but it did take weeks and the increased dose. But when you realize that 41 million Americans take Zoloft and you sort of figure all these people are dazedly smoothing out the wrinkles in their emotions, I wonder what we really do with this blunt instrument of psychiatric stability.
I don't take Zoloft anymore.
Seeing the psychiatrist was not as straightforward. I had a very early morning meeting. I was going to have to go to a clinic that was miles away. I was resolved to bike to Edina, and it wouldn't have been that bad 13 miles 50 degree weather. But I got a little worried about biking in a light rain and not making it back to work on time. So I took an expensive Uber out there.
There was a lot of paperwork before the appointment. I brought it with me. There was more when I was there. And some of this stuff asks you to rate how you're doing on a scale and you can just tell that the higher the number the worse you are. Going about inpatient work like this almost makes you feel like you're in deep shit. It's like you got called down to some middle school principle's office for adults. I told myself it was better to just be honest.
They got some vital information like hight and weight for their records too. Then it's just a very impersonal interview. Talking to a psychiatrist just doesn't seem like the right way to go about dealing with mental health. Even talking to a really good doctor like I did, I wondered what could this person get from just asking a few pro forma questions that my therapist didn't already have a better grasp on. But moving forward through anxiety in this health system really requires a broad effort of people and approaches which is distressing in it's own right.
The truth is doctors are kind of like plumbers and psychiatrists are working on a very limited set of "if... then..." propositions that lead them to their eventual diagnosis and prescription. There's also something about talking so briefly with a person about substances that will change the way you feel that seems like talking to a two-bit dealer just with an office. I can never shake the Trainspotting feeling I'm in a psychiatrist's office--a feeling that the doctor is saying "this is some good shit, man, try it" because I was often left to just sign on with something like "oh yeah, Klonopin sounds good to me."
So March 15, 2015 I was taking Zoloft and Klonopin which is a pretty standard prescription for generalized anxiety. But it's hard to jump through all these hoops and I was a good jumper. It's weird that the medical industrial system is spread thin on patients. It's spread thin not just in the sense that getting to a doctor isn't easy even in terms of location--not everyone can Uber over the psychiatrist, that's a pain in itself--but who you see is just going to be less than the most helpful. In a sense the doctor is barely as helpful as a good friend, but they can write prescriptions which can help.
I don't want to catastrophize too much. It was paramount that I get help with my mental health. And I got it. Getting help was so much the right decision. Struggling is not right. I went through the next six months on the wave of medications and doctor visits that started on February 19, 2016 and occasionally still occur. But there's a framework for providing care and understanding the problems of people struggling with mental health that just isn't fleshed out enough for patients seeking help.
These are problems I could talk about at length another time.