PTSD: Something From the Psychiatrist

My new psychiatrist is an integral part of my new mental health team. He has a long Indian last name, so he is called Dr. Uma by everyone. He is so focused, attentive, and precise that I find him alarming,  but I think he is also very good at what he does.

A psychiatrist these days is not the old image. One does not lie on a couch and discuss one’s parents. No. You sit in a chair across the desk and the psychiatrist focuses on your symptoms. Dr. Uma fires questions at me that feel like they are being zapped out of a ray gun. Then he prescribes. I spend only about 20 minutes with Dr. Uma but it is much more intense than spending an hour with my therapist. After an appointment with him, I am shaky and weak, I only wish to lie down quietly and not be looked at for a time.

Two visits ago, Dr. Uma reviewed my medications and radically altered then. I was on a huge dose of seroquel, it did not help, it made me sleepy, it made me gain weight. I hated seroquel. The doctor had me quit the seroquel flat out that day, and prescribed geodon to start titrating up at once.

But before he wrote that prescription, and before I had decided to trust him enough not to kick at a medication change we both knew was going to put me through nearly a month of med Hell, Dr. Uma gave me something else: another diagnosis.

PTSD.

Voodoo doll with large clamp on her head. An image of suffering.
Voodoo Doll Tatto Flash by S. Grice, colored by me.

I guess I should have seen it coming, but, to me, it fell out of a clear blue sky.

To be perfectly honest, I am struggling with my new diagnosis. It feels like I didn’t earn it. PTSD is a warrior’s illness. I think of the soldiers with PTSD, and I feel unworthy to be diagnosed with it. It is true that I hate this (these?) war/s. But I honor and respect the warriors who are there fighting, those who risk their lives to obey orders and to defend their country. They did not make this war. I do not blame them. I would never scorn them. I will always honor our warriors.

Regardless of how I feel about it, the diagnosis is there, and I do think it is accurate. I have the recurring nightmares, I have the flashbacks. I do fall out of the here and now. I am perpetually being startled. If the slightest thing startles me, I jump, scream, and, sadly, if it is bad enough, I’ll wet my pants. And it doesn’t take much. My housemates have modified their behaviors so they don’t inadvertently sneak up on me. I wake from fevered dreams sweating and shaking. I know Dr. Uma is correct, I know I have PTSD…I just was not expecting a new diagnosis at this stage.

The good news is that the worst of the symptoms can be treated. The nightmares in particular can be treated. When Dr. Uma told me that, I nearly wept…not cried…wept. The only thing I can think of that would be better than not having the nightmares would be a letter from Hogwarts.

The bad news is that I have been having chest pain, and Dr. Uma will not prescribe the medications for PTSD until my regular doctor checks me out. I think I just have a touch of bronchitis, after all I live in Pittsburgh and it is Winter, and I smoke like a chimney, and in some bizarre turn of events, I took a little barefoot stroll outside the other night, and the housemates are both sick. So it is probably just bronchitis, but better safe than sorry, I suppose. I see the MD tomorrow.

Of course, there is a lot of anxiety about seeing a doctor for chest pain. Anyone would be nervous. And me? I’m pushing 50, smoke a lot, and my medications for the past 4 years have all had weight gain as a side effect. (And, believe me, I have gained weight!) Therefore, for the first time in my life, I’m also overweight. So I am worried. I’m having quite a few panic attacks, and my insomnia has shifted into high gear.

But if all is well with the MD, I’ll have the new medications, possibly before the end of the week. And new side effects. Since I don’t know the names of the new medications, I can’t research what side effects to expect. So I have stocked my nightstand with the OTC drugs that every psych patient uses to manage side effects. I put fresh sheets on the bed. I washed the two throws I keep at the foot of the bed because with my delightful hot flashes, often getting under the covers is too hot. In short, I am set up for a siege of new medication side effects.

I can not remember ever being so excited about a new medication. The hope of getting rid of the nightmares has filled me with giddy anticipation. The thought of getting a good night’s sleep-I simply have no words for that.

My insomnia is fueled by my fear of the nightmares. Often, I choose to stay awake, just so I don’t have the nightmares. I can stay awake for a couple of days at a time. That is bad for the schizophrenia, and when the schizophrenia is bad, my anxiety goes through the roof. Then my life feels so out of control that the depression kicks in hard from guilt and shame. It is the vicious cycle that creates the cage that is my life. Breaking one link in the chain feels like the start of freedom.

But this is a lot to take in.

The psychiatrist is the shaman of Western mental health. We expect him to divine our ills from the depths of his recorded notes. We expect him to shake his pill bottle rattles. We expect him to heal us body, mind, and spirit. He interprets our dreams. He probes the depths of our consciousness. He has no laboratory tests to guide him save testing blood levels of certain medications and vitamins. We expect him to walk through our damaged psyches and emerge with efficacious treatments. We expect him to fix our irreparable brokenness.

Our expectations of psychiatry are not fair. I try to balance psychiatry with spirituality. I pray daily, and I sit with my prayers waiting for blessings and answers from my Gods. (In my religion, they are called Orishas, but most people are not familiar with that word) My first set of dreadlocks did not take, so I am growing my hair to try again. This is based on an African idea that binding the hair can bind troublesome spirits to help stabilize a person. I am using all the tools my life has laid before me to find the road to wellness. So I try not to have unrealistic expectations of Dr. Uma.

But, right now, I do have unrealistic expectations of Dr. Uma. I daydream that this pill will stop the nightmares in their tracks. I daydream that this pill will break the chains of my illness, and that I will emerge from madness miraculously whole and sound. And I know better. I know it does not work like that. I know my expectations are ridiculous, and that I am about to be disappointed. I know I should be realistic.

But I’m not going to be realistic. These unrealistic expectations are part of my illness, I know that. But they also are my manifestation of hope. And hope is like a ray of sunshine in the darkness where I dwell. I know that, as always, the reality will not live up to my fantasy. But, for now, I choose to hope.