[New post] Getting Mental Health Help – Part 2 (A Personal Blog)
Rebecca Jo Anthony posted: " Getting mental health help is hard when you need mental health help. This is Part 2 of a personal series where I'm talking about my experience seeking professional help, the events leading up to it, and the difficulties, particularly the difficulty "
Getting mental health help is hard when you need mental health help.
This is Part 2 of a personal series where I'm talking about my experience seeking professional help, the events leading up to it, and the difficulties, particularly the difficulty of not having the help before going through all these steps.
(How am I supposed to go through the process of finding the right psychiatrist, much less calling their office to ask for an appointment, when I already struggle with ADHD executive dysfunction, which makes it hard to plan ahead or do new tasks, Bipolar highs and lows, which cause constant switches between the "I'm too tired to ask for help" and the "I can do everything without help" extremes, and social anxiety?)
Going through the big task of seeking out help from a mental health professional, without having help first, feels like a paradox. The same one as "How do you make coffee in the morning without having coffee first?"
I was diagnosed with ADHD as a child (although back then, they were calling it A.D.D. The most recent DSM dropped the separate label and calls the whole spectrum ADHD), and at some point, with Generalized Anxiety Disorder and Adjustment Anxiety Disorder (I don't remember when the anxiety diagnoses happened, but I know they're in my medical records.) As an adult, I was also diagnosed with Bipolar type 1.
Of those issues, the one that has seemed to cause me the most difficulty was the ADHD.
Although I have it, I didn't grow up knowing much about it. It took a lot of hyperfixated research as an adult, and hearing stories from others with ADHD, to learn that it affects my daily life in a lot more ways than I knew before. I used to think it was just about the attention deficit, but that name is misleading. (I talked about this particular subject more in older posts: - Common ADHD Myths, and - Beyond Inattention and Hyperactivity: An Expansion on ADHD Traits) It turns out there is a lot more to the ADHD experience. And every time I learned something new, I thought, "That explains a lot!" The journey was incredibly validating.
Having learned more about ADHD, I also learned a lot of hacks to accommodate and cope with my own symptoms. But, I wished I could also have been medicated for extra help, too.
Unfortunately, I went a lot of years without any professional treatment of my ADHD, for a lot of reasons. Some of the reasons were financial barriers. Some of the reasons were fear-based. Some of the reasons were part of my internal narrative about how I didn't have it bad enough to need the help. Some of the reasons were simply part of having ADHD, such as not having the motivation or attention span to follow through on the daunting process of seeking help.
Without rehashing the entire story I told in my last post, I'll just give the extremely short overview of what happened with those reasons: I eventually got health insurance, and then an HSA, which removed the financial barrier. It was proven to me, over and over again, that ADHD was causing me enough distress that I could no longer say I "didn't have it bad enough." The only reasons left were fear and the ADHD symptoms that made the daunting process look even bigger than it was.
It took a long time, but after lots of overthinking, research, and help from my spouse, I finally decided to try to get professional help.
When I went searching for a local psychiatrist who treats ADHD and had openings for new patients, I opted for the only one who had an appointment scheduler on their website, because it meant I wouldn't have to make a phone call. As a person with the particular type of anxiety that makes it difficult to communicate over the phone, I go for options that allow me to avoid phone calls as often as possible. I filled out the form, received an email titled "Your Appointment is Confirmed," and breathed a sigh of relief, knowing that the big hurdle of setting up the first appointment was finally cleared.
It was a bit of a jumpscare then, to get a voicemail the next day from that office, stating there were some questions about my upcoming appointment, and telling me to call back to confirm my appointment. Apparently "Your Appointment is Confirmed" didn't mean what I thought it did?
I spent an embarrassingly long time convincing myself to dial the phone number. I practiced saying "hello" out loud, just in case I forgot how to talk once the call started.
When I finally called, I ended up having to answer a bunch of questions I'd already answered online, including what the reason for my appointment request was. I answered that I was primarily seeking treatment for ADHD. The secretary asked, "Is that something you have, diagnosed, or are you just looking into it?" I shouldn't have felt insulted by that question, but part of me wondered if they were trying to screen out "real" cases from those who saw some "ADHD Bingo" post on Tumblr and self-diagnosed. I explained that I had been diagnosed with A.D.D., back before the DSM had been revised to label both as ADHD. Then she asked, "What year were you diagnosed?" I wasn't prepared for that question. What year? I can't remember what I ate for lunch two days ago. How would I remember the year? I didn't want to leave the call in silence for too long, so I repeated several "Umm"s while I did quick, panicked math based on how old I thought I was at the time of diagnosis (I'm not even sure I remember what age accurately). Eventually, I settled on saying, "I don't know, exactly. It might have been 2003? or maybe 2004." She informed me that, because it had been so long, I would probably have to be assessed again after my intake appointment. While she listed details about how the assessment would happen and how much it would cost, I zoned out, worrying about where this was going. Why do I need another assessment? Does this psychiatrist specialize in children? Is this one of the places that believe kids "outgrow" ADHD symptoms? Having engaged a lot in ADHD communities online, I've heard plenty of horror stories about how much harder it is to be taken seriously for an ADHD diagnosis as an adult than as a kid.
Somehow, I managed to get through the rest of the call and get my appointment confirmed.
In the following days leading up to the first appointment, I experienced some fresh, new anxiety. It had never occurred to me that I might need to be re-tested for ADHD when I already had a diagnosis. Of course, I wondered whether I would still meet the diagnostic criteria. I knew, from my own experience, that I had all the symptoms and difficulties associated with ADHD, but still, knowing that whether I could seek treatment as an adult was up to the opinion of a new person I'd never met before made me question myself.
Every day, I asked, "What if they don't think I have ADHD? ...or what if I think I have it, but I'm wrong? What if I'm just lazy?"
My spouse, Josh, always answered reassuringly, "That's what people with ADHD think." Although probably a true statement, it wasn't the most convincing. (Sorry, Josh.)
On one of those days, I ended the day with an emotional meltdown that rivaled the "ketchup incident" I wrote about in part 1. This time, the crying and self-guilt-trip spiraling were about the upcoming appointment, and my worry that it was going to be a waste of time and money, and that even seeking help was overdramatic and attention-seeking, and how dare I?
Josh listened patiently, and of course told me that it was not a waste, and reminded me that I was struggling and needed help, and that ADHD medication would be a big help.
At some point during the conversation, I said, "but we can't just throw money at my problems."
I realized after saying it, how degrading it was to put it that way.
Would paying for a cast on a broken leg be throwing money at a problem? Would paying for chemo for cancer be throwing money at a problem? Would paying the heating bill to avoid being cold in the winter be throwing money at a problem? Maybe, but no one would argue that those are valid, needed expenses.
The last time I'd used the phrase "throwing money at the problem," it had been in reference to people who actually were spending money frivolously, on delaying dealing with a problem they didn't want to face. So obviously, when I also used this phrase against myself, it was in a condescending way. Part of me believed seeking help was "throwing money at the problem" in a lazy way.
Until now, I used to have so many excuses to not seek help...
lack of insurance
it costs too much
the rest of my family needs it more
I don't have time
...Reflecting back on all the excuses, I realize there was a major one I was avoiding listing:
"I'm not worth it."
I've been holding so much shame about my mental health, and my inability to overcome all the obstacles with sheer force, building up so many stories of not being good enough, that I'd convinced myself that seeking professional mental health help would be "throwing money at the problem," aka another failure.
That feeling of failure and my criticism of how "wasteful" I was being was compounded by the anxiety about having to get re-diagnosed. I have imposter syndrome about almost everything I do, so of course I worried that I might get denied the re-diagnosis, that the original A.D.D. diagnosis was a mistake, that all the symptoms I thought I had were all in my head and a cover up for laziness and a bad personality. And if I have to find all that out, this appointment and assessment will have been a waste of time and money.
(By the way, saying "it's all in your head" about mental health and/or neurodiversity related symptoms is ironic, considering the disorder is literally in the brain, which is in the head.)
Fast forward to my first appointment with the psychiatrist:
The intake was a Zoom call. I had Josh with me, to help me remember the issues I wanted to bring up, in case I was too nervous to remember.
The psychiatrist was very friendly and asked a lot of good questions.
She agreed right away with my previous diagnosis of Bipolar, and explained that it is common to have both Bipolar and ADHD, in fact "They often go hand in hand," she said of her experience with other patients.
She went on to explain that the ADHD (which yes, I would have to be re-assessed for), could not be treated with medication until I was treating my Bipolar with medication first. ADHD is most often treated with stimulant-based medications, and being on a prescription-strength stimulant drug if a manic phase happened, would be dangerous. It made sense.
We scheduled an in-person appointment for the ADHD assessment, and for DNA testing (to make sure the safest possible Bipolar medication is prescribed). I had a week in between these appointments to keep worrying.
When I arrived for the assessment, I was shown how to take the TOVA test. This was new to me. (Although the test has apparently existed as a diagnostic tool for ADHD since before I was born, many doctors do not use it, so I had not taken this test before.) The test consists of sitting in a chair, in a silent room, holding a button, staring at a screen, waiting for one of two possible shapes to flash across the screen. The person being assessed is to press the button whenever one of those shapes appears, and avoid pressing it when the other appears. This task is harder than it sounds, because the two shapes are very similar, are only shown for a fraction of a second at a time, and the test spends several minutes at a time lulling the test-taker almost to sleep, by showing the wrong shape over and over, until it's almost impossible to not miss when the correct shape is shown. (Or maybe it's only impossible for those with ADHD.)
A week after this, I had the follow-up appointment, in which I was supposed to hear the results of my TOVA test. However, when bringing it up, all the psychiatrist said was, "Your score's validity was called into question by the TOVA people, so we are going to have to have you retake that sometime," before she moved on to discussing Bipolar treatment options.
As you can imagine, hearing "validity called into question," gave me a fresh, spicy wave of that imposter syndrome. There was no elaboration offered on what that meant, so I'm left wondering what was wrong with the test, and waiting even longer than I originally thought I would before I'll find out if I can get re-diagnosed with ADHD.
Until then, I am now taking a low dose of a mood-stabilizer. Time will tell how this goes.
I suppose this means that this story will have a part 3 sometime in the future.
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