EW YORK — In the last four decades, I’ve been to more psychologists and psychiatrists than I can count, from New York to California, from the East Side to the West Side. There have been so many that I’ve no doubt I’m serious competition for Woody Allen — or certainly one of his characters.
The first shrink, when I was a meek 20-something, prescribed lithium, used for manic depression (though no one I’ve seen since has diagnosed me with that), and required weekly blood tests I hated so much that I simply stopped going. The most recent doc is prescribing Prozac, for depression, and Klonopin, for anxiety, in ever-decreasing doses. I see her just a half hour a month. She thinks, as I do, that I’ve talked about myself far too often and for far too long and might benefit from shutting up.
These professionals have accompanied me through my entire adult life, while offering up a medicine chest full of pharmaceuticals: Zoloft, Xanax, Luvox, Ambien, Deplin, Remeron, Oleptro, amphetamine salts.
Have the medications worked? The truth is I don’t precisely know what they’ve done for me, except for a few that had awful side effects. On the lithium, at first, I slept 20 hours at a stretch. Even at the lowest possible dosage, I felt like I had a paper bag over my head. The Xanax, a lightning-fast-acting drug, eventually stops working, and the anxiety comes roaring back at ever shorter intervals.
As for the rest, it’s been so long since I’ve been unmedicated, I no longer have a basis of comparison.
But I do know this: I’m paying a tiny fraction of what I once did — psychiatrists in New York City commonly charge $450 an hour — and maybe I’m happier because I can pay my mortgage.
For whatever reason, I’m now in a place where I feel I can offer advice to others searching for their equilibrium. So here are five suggestions:
Understand that discrimination persists
Despite all the well-meaning talk to the contrary, mental illness continues to be judged by a different standard than physical illness.
I’ve had employers concerned about my competence when they learned of my personal (and family) history — when all around me were untreated alcoholics with bottles of booze in their desk drawers and unexplained absences from work. I had named my problem and was taking care of it, but that seemed a strike against me.
Be prepared to educate your friends
I’ve had friends, otherwise good and loving people, who are ignorant of the difference between chronic depression and the occasional bad day. “Pull yourself up by your bootstraps,’’ was their advice. “Try harder.’’
Surely that would not be the response if I had diabetes or high blood pressure.
Some of these people remain in my life; most don’t. One I asked to read a short book, “Darkness Visible’’ by William Styron, a compelling description of this disease. Was I testing him? Maybe. (He passed.)
Don’t discount the value of talk therapy
Intimate and regular conversation with someone who isn’t a friend or a family member allows you to spare your loved ones stuff they don’t want to hear and may not understand. Within the four walls of a therapist’s office, there’s a safe and private space for the gloom and fearfulness that otherwise can infect “real life’’ interactions.
Another reason talk therapy can be effective: You’re paying dearly for it. How tempting it is to talk about the weather, to entertain the psychiatrist with amusing stories about your week, to come late or simply not show up. But it’s less tempting, for sure, when the meter is running. Waste your appointment or use it well. It’s up to you.
Only a medical doctor has the expertise to prescribe and manage medications, altering the cocktail when what used to work no longer does. These are not medications you can stop or switch easily; they require gradually tapering off one and onto another. (So buy a pill cutter.) Some begin to work instantly and others take weeks. (So be patient.)
And, typically, changing them from time to time improves their efficacy, however onerous the transition.
Don’t commit to the first psychiatrist you see
My selection of providers has been shamefully random, given my skills as a reporter — usually based on a recommendation from a friend or a former doctor. Only once have I had the fortitude to conduct an audition: see several people, pay for each consultation, and then decide. That was in January, following a head injury.
So I made the rounds to a number of providers. I asked questions rather than answered them. I listened, instead of talking. I took notes. My explicit goal was to reduce my medications, perhaps eventually to do without them altogether. My implicit goal was to have a psychiatrist manage that process with a minimum of talk therapy, and to avoid anyone who suggested four times a week analysis, turning me from a human being into a full-time patient.
One of the providers I interviewed said right away, “I think you need less meds, different meds — and to see what it’s like to stop talking after all these years.’’ I went with her.
So far, so good.