When Psychiatrists Disagree

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I’m sitting in my car.  I check my e-mail, then I check the clock. Eleven-thirty a.m. Finally. I dial Dr. X’s number on my cell phone, not really expecting him to pick up. He’s told me to call at this time, but he must still be finishing up with a patient.  I’m just anxious to hear what he thinks and take the next steps.  The phone rings.  Dr. X picks up.

“I have just a few minutes,” he tells me.  “I haven’t heard back from Dr. Z yet.  Tell me what he had to say.”

Dr. Z is the psychiatrist we met just the other week.  He’s the head of adolescent psychiatry at a major university, a close colleague of Dr. X, and someone we consulted with to see if there is something different we can be doing to help Blake.

“He said that he sees Blake as being affected by dysthymic disorder – a constant low level depression.”

“What about his OCD?  Does he disagree with that?”

“He agrees that he has OCD.  He just doesn’t see the OCD as the cause for the depressed mood right now.  He thinks we should change to the other medication I mentioned.  Try a trial for a time-limited period.”

“Here’s the issue,” Dr. X says.  “Dr. Z has always liked that other medication better.  The down side of it is that it can cause greater amounts of anxiety in kids like Blake who already have high anxiety.  The other problem is Blake.  How does he feel about it?”

“He’s willing to give it a try for a time-limited period.  He is doubtful that it will be helpful, but he’s willing to do it.”

“Look, I know Blake’s history and we have to take that into consideration.  Blake has a negative view of the world and he doesn’t have much motivation to change things right now. I’m concerned about putting all our eggs in one basket, putting everything on the hopes that this medication will change things.  If Blake isn’t really on board, and if this medication is a failure – which it is likely to be if he doesn’t want it to work or believe that it can work – then it just becomes more proof that the world isn’t worth it and that he’s right to have the world view he does. He really needs to want to get better.”

My stomach is sinking at this point. This is an issue that’s come up over and over in the past four years. Blake has to want to get better. It doesn’t matter what anyone else wants; it matters what he wants. The truth is that it is still me who cares more than Blake about how his life is going. It’s me who wants to jolt my son into giving a damn about the world.

“I understand what you’re saying,” I  say, as my heart turns into a knot in my throat. “It’s just that I’m the one who has to wake him up every morning – over and over. I’m the one who doesn’t get to work out in the morning, or schedule patients before the afternoon. If I leave the house, he sleeps until three pm.”

Dr. X continues, “I really think that Blake has not experienced the full consequences of his refusal to get better and to join the world. It’s a tough time for this, but it’s important that he feel the consequences of not getting out of bed. I had another patient where the mom finally had to tell the son that she’d changed her life enough for him and she had to go back to work. We call it ‘family accommodation’ when family members change their behavior so that the one who is ill does not have to suffer as much…”

“Dr. X, you know that I know what you’re talking about. I work with this with my own patients and their families all the time. It’s just so hard to know what to do when it’s your own child. You’re telling me that I have to let him experience the consequences of his not getting up and not getting involved in the world.”

“Look, Angie, if Blake is on board and wants to, I’ll order a test to see how he metabolizes medication. That will help us know what medications are or aren’t likely to help him. However, Blake has to really want it. I’ll wait to hear from you about when you’d like to meet. I’ve got to go; that’s my next call.”

I sit in the car, alone in thought, for some time. I had been so hopeful. I’d wanted to put faith in the idea that a medication change could make my son see more that is positive in the world, maybe help him find a little motivation. Now I’ve been brought back down to Earth. I am reminded once again that a key ingredient is Blake. I’m also reminded that I probably make life a little too easy. Do I have the guts to stop waking him up and let him face the consequences? Will he even care? There are definitely no easy answers for me.

A Second Opinion

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Blake, my hubby, and I are crammed into a little couch that was probably only meant to hold two.  I’m halfway on, halfway off.  The psychiatrist in front of us is quietly, methodically having us complete new patient forms.  He’s part of a major university and the forms are in abundance.  The hubby and I are hopefully anticipating that this doctor’s opinion will help us find a way to improve Blake’s mood.  Even more so, we are hoping he will see how devastating Blake’s inability to stay awake is, and that he will think of something that we, and his other doctors, haven’t yet.

Blake is really just along for the ride.  We talked this over at the dinner table last night.

“Frankly, I’m not hopeful at all,” Blake had said.  “I’m not expecting anything.”

So he is here because mom and dad have made the appointment.  Now, as we begin to share the information about our son – how he cannot stay awake in the morning no matter how much he sleeps, how he sees little future for himself, how he believes his life has been a wasted sixteen years – I’m feeling a little foolish.  I watch as the psychiatrist puts his head in his hands, pulling his hair back from his face.  He gets the information he needs from the hubby and I, then he asks to meet alone with Blake.

“Sure,” we both chime when he asks us to leave.  I’m curious if Blake will share more than the vague one or two word answers he has been giving so far.

“I think the psychiatrist thinks we’re nuts,” I half-jokingly say to the hubby.

“He doesn’t think we are nuts. He’s analytical.  He’s just thinking,” the hubby says.

Within minutes we are back in the office.  The psychiatrist explains that he believes Blake has a dysthymic disorder. That is, he is plagued by a low level depression that colors the way he sees the world.  It is punctuated by days or moments that are worse, but it is mostly this low level of depression.  He does not think that Blake’s OCD is the cause for the depression.  He recommends changing medications. He thinks this other one might be more energizing, especially in the morning.

Blake is doubtful.  He doesn’t like medication to begin with. He doesn’t want to try another and have it fail, but he is willing to try on a time-limited basis.  The psychiatrist wants Blake’s psychiatrist to be the one to prescribe.  He invites us to have him call so that they can talk.  We drive home with Blake saying it was just like what he thought.  Nothing earth shattering or even helpful in his mind.  The hubby and I want to believe this can help.  We want more from life for our boy.

I text Blake’s regular psychiatrist and tell him the outcome of this consultation.  He plans to contact the other psychiatrist.  I’m ready to begin the change right away, but I have a nagging thought.  He didn’t say it, but I don’t think Blake’s usual psychiatrist likes this idea. Now I’ll need to wait to see if I’m right.

Brother

One year ago, Michael, my oldest, finished his college applications.  His central application essay was about his experience living with a family member with OCD.  It offered a glimpse, not always very pretty, of our family life and dynamics, and about watching his brother – his beloved friend – slip beyond his grasp.  Today, Michael is home from college, and he gave me permission to share his words:

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“Why won’t you just eat the food?! We bought this chicken especially for you! It’s much more expensive than the regular ones at the store you said you won’t eat!”

Although my mom buys special food for the house, my brother refuses to believe that it is up to his standards. I feel a need to slip out of the room silently. Sometimes I do leave, sometimes, I do not. It doesn’t really matter whether I do or don’t, because the battle follows me, as my mother continues to yell at the top of her lungs, frustrated and hurt to no end that her own child refuses to eat the food she prepared with the hope that tonight he will accept her efforts and eat, without comment. But the food is never right; it is not acceptable enough, it is not clean enough, and it will never be.

The unspoken hope we all share is a faint little flicker: maybe this night will be different. Maybe we can make it through a dinner as a family, and remain intact. At every family meal, an unwelcome guest pokes his head in and disrupts our otherwise normal lives. My fifteen-year-old brother, Blake, has been plagued with terrible, paralyzing Obsessive-Compulsive Disorder (OCD) for as long as I can remember. He calls his OCD “the Kraken” in order to separate it from himself. I call it the uninvited guest that just will not leave.

Not only does this guest break our bread, he breaks our hearts. Although my mom, a PhD anxiety disorder specialist, has educated my dad and me on his disorder, the whole family is still powerless to do anything but watch as my lifelong friend slips farther and farther away, as his stubbornness stops him from getting help. What is written on paper about it is so vastly different from our actual experience with the disorder. I am left with so many questions. Why is my insight so limited, so human that I am able to do nothing to help my brother? Why can’t Blake show the unwanted guest to the door and be the fun-loving, carefree person he is when he is at his best? He is naturally imaginative and whimsical, a perfect improvisation partner, and an excellent Minecrafter. Like the fingertips of Adam and God on the roof of the Sistine Chapel, I see the paradise that could be, were we only to reach a little bit farther, were one more thing how it ought to be. If only I had the power to reach further.