When people dance together, there is a leader and a follower—but both are equally important to the smoothness and flow of the dance. The partners need to be aware of one another and respond to one another. Being in sync is pivotal if the dance is to be successful.
Finding the right doctor, especially when dealing with a physical or mental illness, can be like finding the right dance partner. While the doctor takes the lead in diagnosis and treatment, the patient brings their medical history and lived experience to the partnership. When both doctor and patient listen to and understand one another, this successful communication can lead to a more positive outcome.
I was diagnosed with bipolar disorder in 2006, after a year of many hypomanic episodes and times of deep depression. On my initial visit with a psychiatrist, I was prescribed Lithium, which is often the first medication given to people with a bipolar diagnosis. Many patients respond well to Lithium; I was not one of them. I was constantly thirsty, but otherwise unchanged. I continued to struggle with extended periods of hypomania, alternating with uncontrollable sadness.
After a few months of regular blood work and frustration, I asked for a change of medications, and the doctor prescribed Seroquel. At the time, the antipsychotic drug had been recently approved to treat bipolar disorder—now it is very commonly prescribed. But Seroquel, for me, disastrous side effects, including a significant uptick in my manic feelings.
When I explained all this to my psychiatrist, she merely increased the dosage and said I would likely improve when I reached the correct level of drug in my system. I was terrified of taking more Seroquel, and told her so, but her lack of empathy left me very discouraged. I began to despair of ever feeling like myself again.
On a friend’s recommendation, I made an appointment with another psychiatrist. This time, when I described my reaction to the first two medications, I was heard. I started on daily doses of Abilify and Wellbutrin. Within weeks I was starting to feel better. It took a bit of tweaking, but that combination of the two drugs worked beautifully. It’s been 13 years since I made the change, and it’s still what I take now. I have remained stable for well over a decade, with no manic episodes and no depression. I ask questions during my appointments so that I understand what is going on with my brain. And my psychiatrist treats me with respect and gives me clear answers without oversimplification.
Over the past decade, I have found through research and conversations with other people with bipolar disorder, that my experience is not unique. I have learned that there is a wide variety of reactions to psych meds—some people do extremely well on Lithium or Seroquel, and may respond quite poorly to the meds that work so well for me—and that more than anything, working with the right doctor is key.
The first step in treating mental illness is … well, seeking treatment. A combination of talk therapy and medication has proven very effective, according to the National Alliance on Mental Illness. Some doctors can do both, and in other cases you might want to see a psychiatrist for medication and a different professional for talk therapy. If you don’t know where to turn, you can ask family, friends, or your primary care doctor for recommendations. And if those options aren’t available to you, you can find listings of local doctors online at psychologytoday.com.
Once you find a doctor, you should focus on your first appointment. Philadelphia area psychotherapist Laurie Kennedy says a therapist must make it immediately clear that you are in a safe space.
“It is of utmost importance that the therapist communicates that the therapy room is a nonjudgmental place and a place that has firm ethical boundaries and is confidential,” Kennedy says. “Clinical work will only be effective if and only if boundaries, respect, and a spirit of optimism are initially and directly communicated to the patient.”
Through therapy, patients with mental illness are recalling and recounting incidents that often cause shame and emotional pain. By creating and maintaining a safe, judgment-free zone, the doctor makes sharing possible—and even comfortable.
So once you have found a doctor you feel comfortable with, how do you maximize the potential for a successful “dance” to make sure you end up on the right treatment path?
Dr. Christopher Martin, a psychiatrist at the University of Michigan, says the first step is always being open with your doctor: “The exam given when we meet a patient means a lot, but … a patient, being as open and honest as possible—including providing contacts and permission to gather history from loved ones or prior psychiatrists and hospitals—can make all the difference in the world in terms of getting an accurate diagnosis and appropriate treatment.”
Giving that thorough life story at the first visit is key to getting the right medication and treatment, Dr. Martin explains. “We rarely have tests, imaging, or studies that provide an unequivocal diagnosis,” he says. “While medications can often help with symptoms, they can be ineffective or catastrophic if the doctor doesn’t have the full story.”
Sometimes, as in my case, the relationship stops working. As with medications, a medical professional may be effective for one person, but a poor fit for another. When patients sense that their questions and concerns are not being heard, or if they get the feeling that they are being judged for their behavior—it is time to find a new doctor. Difficult as a switch may be, the patient’s mental health is too important to be compromised.
The reality is that 20% of adults in America live with some kind of mental illness, but with increased medications and therapies, it’s possible for many to live full, productive—and happy—lives. The key is finding the right doctors to help you get there, and that starts with being informed and communicative patients. The dance can be tricky to navigate, but when the dancers have a solid partnership, it can be a wonderful one.