When Psychiatrists Disagree

Image courtesy blackzheep at FreeDigitalPhotos.net

Image courtesy blackzheep at FreeDigitalPhotos.net

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.

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6 thoughts on “When Psychiatrists Disagree

  1. Oh, I feel for you, Angie, these decisions are so tough and as you say, there are no easy answers. Dr. X sounds like a very wise person to me. I have no advice but I will say that when things were really bad for our family, my husband and I would sometimes reach the point where we knew we just had to do something differently, as what we were doing just wasn’t working. Of course it’s the hardest thing in the world to increase your son’s suffering, but if what you’re doing now isn’t working……….then maybe????….oh if only we had a crystal ball. Good luck – however you decide to proceed. I’m sorry things are so rough for you and Blake now.

  2. I can relate. I am a mom of a 17 yr old with OCD and we just had an experience with extreme depression and med changes. Also, I have decided to no longer wake my child and my child will also sleep until 3pm. It is a little different now because the hypersomnia is related to the OCD anxiety and lack of sleep at night. 3 months ago when the depression was worse my child was sleeping around the clock.
    This has been challenging to navigate with school, etc. It is so difficult because you know they need to take responsibility for it long term, but it’s a hard road to watch them crash and burn while they figure out how they will.
    Ultimately we have found a med that worked to treat the depression, but only after I stopped accommodation all the time. That’s just my experience. It’s been rough and I couldn’t do it without our psychiatrist and neurologist. Good Luck!!!

    • You know, it’s amazing how you can feel all alone in a situation and then somebody shares something that makes you realize that someone else CAN relate. Thank you so much for sharing. I really appreciate it. And good luck to you and your child, too!

  3. My heart aches for you. Your experience echoes the struggle my parents have been through with my sister who has borderline personality disorder. And my experience with my husband, in the years when he had that same sleeping pattern as Blake – in his case, to completely avoid the world. I’m hoping mightily for a breakthrough for you.

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