Scared of the psychiatrist

Today was the day that I always dread: the day of a psychiatrist appointment. I know I should feel really happy that I am getting seen by someone there to help me. I am lucky enough to have a really great psychiatrist that listens to what I say and takes me seriously. I am grateful, I really am. But, as usual, I am also full of worries about the appointment.

Will I be able to get across what has been happening to me? This is a big concern. I have a tendency to forget all the really bad stuff because it was so awful I have half erased it from my mind. I have to look back at my diary entries to work out how I was feeling and what episode I was having. Reading back through some of my behaviours is really distressing. I like to think that I am a good person, but sometimes I haven’t acted in the best way. I hurt the people closest to me when I am ill and that is not okay. They deserve better.

Even when I have read through my diary and identified the episodes, it is really hard to explain to a psychiatrist the sheer enormity and horror of what has happened. Each time I have a manic, depressed or anxious episode, I feel like another layer of my personality has been soldered off. The episodes are so painful, so sudden and so disconcerting that I feel like I lose a little of myself each time. I know that I used to be this enthusiastic but stable person with a strong sense of self. Now I just feel lost. I'm unsure of who I am, how I have changed and what I want from life. I can feel myself slide further and further away under the weight of the illness. The thought that I might lose myself completely is with me all the time.

Another worry I have is that I will come across too ill or not ill enough. I don't want them to get the wrong idea that I am completely fine because I am acting fine. I also don't want to tell them some of the more embarrassing stuff in case they think I am much more ill than I am. Yes it is hard to tell even a psychiatrist about why you feel the need to slice up your body, rock back and forth in the foetal position and make strange animal noises. I don't want to be hospitalised under any circumstances. 

My next worry is so petty and ridiculous that I feel silly even putting it down in writing. The thing Is that I really want my psychiatrist to like me. I want everybody to like me really. I always have done. I admit it. I am a people pleaser through and through. It’s lucky that I have some very strong opinions on matters moral and political. If I didn’t, I would probably abandon them all under the desire to please those around me. Shameful I know.

I want my psychiatrist to like me so that I feel affirmed as a person. I want them to like me so they will care about me and, in doing so, will be better placed in trying to treat me. Most of all, I want them to like me because I like them and have opened up to them. I don’t want to feel rejected. Of course, none of this should matter. They are expecting to see unwell people that need treatment and as professionals they should treat you the same whether or not they like you. 

But I can’t stop caring! What makes this all the more ridiculous is that in my bid to be liked I often come across as this really well adjusted, lively person. Obviously there are times when I am too ill to pretend, but I have to be pretty damn sick for that to happen. I always wear the mask. It’s automatic. I am not doing myself any favours by pretending but there you go.

On a related note, I feel panicked about seeing the psychiatrist in case I run out of stuff to say. I am not that talkative these days since I have been more anxious. I worry that it will take two minutes to say what I can think of and then there will be silence. I won’t know what to say or how to say it. I could divulge every single feeling I have had over the past few months but I tend to summarise it all in a paragraph. It is not really my place to keep the conversation going, but (like in all social situations) I fear the awkward silence.

My final worry, which is more of a reasonable one I think, is that there will come a point when there is nothing me they can do for me. I have tried so many medications now: a number of antidepressants, anticonvulsants and antipsychotics. They all have their side effects which are hard to stomach. There has been no miracle cure and I am not even sure if any of them have worked. I still have episodes of illness regularly. At least they get me to sleep which is obviously helpful. The only thing left for me to try now is lithium. If that doesn’t work there are no other medications. I don’t know what my psychiatrist would do then. They can’t exactly admit to you that they are out of options. But I have done my research. There is nothing else left. There is only so much they can do.

On a more positive note, the appointment went okay despite all my worries. My psychiatrist has put me on pregabalin for the panic disorder and wants to put me on lithium next time I see them. I will be seeing them in a month’s time to discuss going on lithium. Now I have a new thing to worry about for next time: should I go on lithium? Should I risk the side effects, have to deal with all the blood tests and worry about the effect it might have on a baby if I become pregnant?