Depression and Doctor Competence

I’m diverting from the purpose of this blog with this particular post.

After the events of the past month plus a post from fellow blogger Mike (his blog here), I  gathered enough guts to share my tuppence concerning an illness that’s very close to me: depression.

Within the past few years, the topic of depression (unipolar, bipolar, postpartum, etc) and other mental illnesses has become the focus of countless news stories, talk-show discussions, social media posts and advertisements. Mass killings and celebrity deaths attributed to suicide seem to have been the trigger.

Jamaica too has been caught up in the wave of talk, and more so after the apparent suicide of one of our local artistes.

Whenever suicide news reaches my ears, I feel empathy for those who’ve taken their lives . . . and then I get annoyed with the medical community and public. Not everyone, mark you. Just those who’ve obviously not taken the time or made the effort to provide genuine and effective care and support to those struggling with mental illness.

I take these public displays of concern with a whole shaker of salt. Let me give you my own history (which is by no means unique).

I’ve struggled with depression since childhood.

As a child, I knew nothing about depression. Clearly, none of the adults around me knew the signs either because with all the trips to the doctor for allergy and motion sickness medicine, the subject of my behaviour wasn’t raised (as far as I can remember).

At home, I was irritable and, later on, rebellious. In school, I was quiet and shy. I also had great difficulty with long-term memory. For the life of me, I couldn’t (and still can’t) remember most of my childhood, just dribs and drabs and one-second scenes with no sound.

But no big deal. Right? I was simply a miserable, quiet child with bad memory.

By the time I entered the seventh grade, I hated school. Apart from the fact that I felt like a social misfit, I struggled to make good grades. Of course, no one noticed.

I just needed to settle down. Right? After all, it was high school and high school was a far cry from prep school. With extra classes and discipline, my life would straighten out.

As poor as my memory is, there’s one thing I do remember: the snide remarks of children and adults.

“Ain’t nobody listening to you.”

“Ain’t nobody going to miss you if you move away.”

“Are you antisocial?”

These were said only once. But when they were said, they stung. My mighty efforts to leave my comfort zone and be sociable had gotten mighty slaps in the face.

By my first or second year of university, I had experienced two clearly depressive episodes. I described them as emotional pits and, like many of us who experience these, I remained silent.

Everybody has down-days. Right?

In my mid-twenties, I had my born-again experience. I made a conscious decision to release past hurts. Because that’s what the church teaches for you to have a peaceful and healthy life. Right?

For maybe a year or two, I felt fine and thought life’s problems were behind me. I was in a permanent job in a section of the island I enjoyed. I had a handful of genuinely caring people around me.

Within months, there was a motor vehicle accident then job redundancy a year later. Two stressful job experiences and a protracted period of unemployment followed.

But I bounced back.

I started going to church, participating in church ministry and throwing my all into a new job. I was awarded with trophies for job performance, year after year, yet buckling under the weight of being a one-woman band in my department on one too many occasions. Staff turnover had been relatively high.

I should mention here that the Human Resource supervisor at this particular job, seeing the immense pressure I was under, took me to lunch one afternoon. She asked me how I was managing. After cautiously sharing my challenges with her, she responded by saying no one cared. And the lunch ended on that brilliant note.

Exhaustion and the stress of the work environment led to my resignation.

As the years passed, health issues, seemingly unrelated, popped up, one by one:

Complete loss of appetite for food.

Inexplicable light-headedness.

Inability to exercise without feeling faint.

Growing apathy.

Brain fog.

Loss of short-term memory.

And there were other symptoms. What ultimately drove me to my doctor, only six years ago, was a feeling of not being able to sense my environment. I felt like I was living in a quiet bubble.

So, back to the public, the medical community and the shaker of salt.

I’ve been to three doctors concerning my mental health: two general practitioners and one specialist.

The first doctor, a general practitioner, made the official diagnosis of depression. When he said it, I wasn’t shocked because the low mood had returned. What surprised me was the physical nature of some of the symptoms.

Either way, I didn’t regard all this as an illness until he backed out his prescription pad.

He prescribed an antidepressant. He checked my iron and thyroid levels to rule out deficiencies. He helped out with medication and encouraged me to ask questions about the medication before taking the first dose. I appreciated his approach.

I would’ve kept the diagnosis to myself had the side effects of the drug not included worsening symptoms of depression and suicidal thoughts. But, good sense prevailed over my deep sense of shame, and I called a close family member on the phone, shared the news, bawled and surrendered to the course of treatment.

Within maybe a month or less, the drug partially took me out of the silent bubble, but corrected nothing else. Regardless, I continued taking it. Because it takes time for these things to really kick in. Right?

Then my dentist told me I needed a root canal to alleviate a sudden tooth pain. At the appointed hour, I offered to show him the medication I was taking. He hushed me up, instructed me to sit in the chair and proceeded to numb my gums. You see, he was also my newest employer (and yes, he knew I had depression).

Days after the procedure, I was back in my doctor’s office, overcome by a heightened state of agitation. He advised me to gradually discontinue the drug. No further treatment was offered. He expected the depression to work itself out. And, honestly, I didn’t mind not being on drugs.

So I gradually discontinued, and my co-worker and I agreed that I was going to beat this thing naturally.

A few months later, relationship issues escalated my depression, and I was back in a doctor’s office. This time, a specialist in a medical centre known in Jamaica for providing quality healthcare services. The visit came at great sacrifice because I was living pay cheque to pay cheque and the fee wasn’t covered by insurance.

This doctor gave me a questionnaire to complete. He reviewed it, called me into his office and put me back on an antidepressant—a different brand. He said he wouldn’t begin talk therapy until I was stable—in another 6 weeks.

He did no blood work and took my word for it that my thyroid was fine and my iron was a little low.

Anxious to start talk therapy (because I had a lot on my mind), I set my next appointment exactly six weeks later.

Well, I don’t think the doctor was looking forward to our meeting as much as I was. He was quite late and appeared very distracted. The only thing of consequence from that session was his suggestion to see a psychiatrist for cognitive behaviour therapy. He didn’t write a referral. I didn’t ask for one. I went to the front desk and made an appointment to see the centre’s psychiatrist.

That appointment would’ve gotten off the ground if they actually had a psychiatrist. Turns out they were planning to hire one, but didn’t. So they threw out my appointment (oh, sorry, they couldn’t find an appointment for me).

Long story short, I eventually stopped taking the medication and didn’t return to the medical centre. No one called to follow up and, frankly, I wasn’t deeply concerned because I couldn’t afford to continue treatment or waste precious money on healthcare providers who didn’t have their act together. Plus, the antidepressant had me nauseous and yawning at my front-desk job. The transient side-effects had become permanent.

Needless to say, I resigned from my job and moved to another parish, my depression at an all-time high, affecting my ability to concentrate. Reading and participation in conversations became difficult, requiring mammoth mental effort.

Three years later, in 2015, after returning from a brief respite overseas, terrible exhaustion and a promise to a relative to visit a doctor led me to a general practitioner’s office near home. By all accounts. this fellow sounded like he’d be thorough. A cousin had gone to him, and he had left no stone unturned in diagnosing her ailment.

How was my experience?

He prescribed 30-days of antidepressants (the same one that made me nauseous and yawn) and gave me a lengthy lecture that insinuated I was depressed because I was pining over things I couldn’t afford . . . like KFC . . . which I rarely eat. When I told him of my experience with the drug, he dismissed it, didn’t bother changing the prescription. He didn’t do any tests either.

I didn’t fill the prescription. If it didn’t cost over J$8000 for a month’s supply (that’s more than US$60) and I was convinced it would work, I would’ve given it more serious consideration.

If I was the feisty sort, I would’ve asked this doctor if he really believed 30-days of antidepressants would make a ding in defeating a thing that’s been plaguing me for 30 years.

I would’ve also asked him, if he thought I could yawn my way through a job interview and still get hired.

I would’ve asked him if he was really going to take my word for it—that I have depression—or earn his fee by actually running his own tests and diagnosing this thing himself.

And I would’ve asked him, “Why prescribe a US$60 drug if you’ve just lectured me on not buying KFC if I can’t afford KFC?”

If I was the only patient with this kind of experience, I probably wouldn’t write this post. But I’ve been a member of an international self-help community for several years. I’ve interacted with persons struggling with various mental disorders: post traumatic stress, anxiety and depressive. These persons are mothers, fathers, senior citizens, college students, single people, married people, Christians, agnostics, employed, unemployed, functional, barely functional, etc. Here’s what I’ve observed:

A number of them are under doctor’s care and are either still very depressed or suicidal.

A few mix their prescription drugs (because many are taking more than one) with alcohol or banned substances to numb the pain that the prescriptions on their own don’t seem to be alleviating.

So here’s my question: If the medical community is getting it right, like they want us to believe in these wonderful, televised interviews in which they strongly encourage people to seek them, then why are so many of us still struggling to find effective healthcare and treatment?

After my experience with these four doctors (dentist included), what is there to convince me to keep seeking medical help?

Depression itself is already exhausting. It depletes your energy and will. How much more of that slim supply of energy do I need to keep expending to find quality professional help? Why should going to a doctor feel like gambling?

In my former career, I learned how to effectively problem solve and analyze results. Why aren’t all our doctors doing this? Why aren’t they thorough in their testing and diligent in strategizing care, patient by patient?

They may say, “It’s going to be too costly.”

To that I say. “Your ineffectiveness is costing me and my family and the society a much greater amount than a battery of appropriate tests.”

Speaking of society, here are another few points worth mentioning insofar as its misconceptions and general attitude towards persons with mental illnesses:

Many of us aren’t dirty and living on the streets. We are right here in your midst, shopping at the same supermarkets, working in the same offices, attending the same schools and living in the same neighbourhoods (in houses, not under the street signs). You’re probably even eating fried chicken and sipping soda with us.

We don’t enjoy being a burden to our families or society. I would dare say that persons with a mental illness crave a normal life and hate being in a day-to-day pit or heightened state of anxiety or anger. It’s mental torture!

Sure you may say “cry out!” and “don’t quit crying out until someone hears.”

Remember the exhaustion issue I mentioned earlier. After a while you get weary of crying out and hearing “don’t get depressed”, “cheer up”, “look to Jesus”, “it will work itself out”, “feel better soon” or worse, utter silence.

When a person is diagnosed with cancer, do doctors provide half-hearted treatment then leave that patient on their own—disease still raging? Does the community isolate them and write them off as antisocial? And does the church chastise them for being weak?

If this isn’t acceptable treatment for a cancer patient, why is it acceptable treatment for someone with PTSD or a depressive disorder or an anxiety disorder or an eating disorder or any other mental disorder? Why are we being driven into a corner to handle our business alone?

To those doctors inviting persons with mental health concerns to seek them: How many of you are caring enough to do a proper diagnosis and comprehensive treatment plan? How many of you are concerned enough to provide follow-up calls to your patients?

To those in the media hosting programs and interviews on mental disorders: Why not be thorough in your presentations? If you’re discussing mental illnesses (as opposed to a specific one), discuss the whole gamut, list all the possible symptoms of each and educate the public in a meaningful way.

To employers: Don’t be like that Human Resource supervisor. Listen to your employees, observe them, challenge yourself to make the work environment a truly healthy (and, by extension, productive) place. Allow them to take their vacation time and to leave work on time, without the fear of a work call disrupting their rest.

To all with disorders, mental health concerns or behaviour concerns: Thank you especially for reading this post to the end. It couldn’t have been easy. Despite my misfortune, I still have a wee bit of fight left in me and my search for effective care continues. Don’t give up!

What are your thoughts? Have you had similar experiences? I would love to hear from you.

Love and peace,
Angie

 

 

Acknowledgement:
Image “Tiger” courtesy of africa at FreeDigitalPhotos.net