The CMHT is being shifted around and we’ve got a new consultant psychiatrist. The old one, who I first met when I was 18, used to split his time between the ward and the community (so I knew him both in the community and as an inpatient). He’s now permanently based on the ward, and a new consultant who’s been brought in is based solely in the community. Now that I’ve been diagnosed with Bipolar Disorder, I’m being treated under the ‘Recovery Team’ and the new consultant.
I’ve met him once before- the day I was readmitted to hospital, and I was just a little rude to him, so I was a bit (very) apprehensive about meeting him again. Mum had been singing his praises, telling me he dealt with me that day ‘very professionally’ and that he was very thorough and ‘did what he had to do’. Given that he’d sent me back to hospital, I was a little reluctant to take her word for it that he was a ‘lovely man’…but he was really great.
I apologised when I went in and he said he forgave me, that I wasn’t well. After a few minutes he picked up on my anxiety and said ‘look, really, I don’t hold it against you. Are you nervous about coming here today, or is this typical of you?’ I said it was a bit of both. And for the first time in six years of seeing services, I was asked about my anxiety.
In my CAMHS notes there are references to a diagnosis of anxiety, and it’s always been referred to in supporting letters for things like school and uni, but it’s never appeared on formal correspondence letters between the CMHT and my GP or other services I’ve been referred to. And it’s never really been discussed or addressed or treated, despite it being something I’ve brought up at every appointment I’ve had with a psychiatrist. On a couple of occasions, I was put on medication for it (propranolol and buspirone by my GP and regular psychiatrist respectively), and both times was later taken off it by the old consultant who said both ‘I don’t think you need it’ and ‘I want to streamline your medication’ when I asked him why.
Maybe, it’s because for the first time in years my mood is ‘stable’. Particularly with the psychiatrists I’ve seen in adult services, anxiety has always been brushed to the side, dismissed as something that would get better when my mood did. I remember one psychiatrist waving off my concerns and telling me the quetiapine she was prescribing to help level my moods would ‘take care of it’, while the consultant gave some vague explanation about it being part of the personality disorder I both didn’t have and was never formally diagnosed with. So now that my mood is level, it’s probably easier to explore the anxiety. Which is what the new consultant was interested in doing.
We spent a while talking symtoms, triggers, the things I tend to get anxious about, the things that happen when I’m anxious, both physically and psychologically. Afterwards, he said ‘ok, so diagnosis wise’, which took me by surprise. I’ve kind of learned to go into psychiatrist appointments with limited or zero expectations, because too often I’ve gone in with my list of things to go over, and have come out very disappointed when none of it was addressed. When I saw the CPN a few weeks ago for my discharge review, she too had picked up on my anxiety and was keen for me to bring it up with the doctor, and I honestly wasn’t going to bother because I didn’t think I’d get anywhere. So I was surprised that he both took the time to explore the anxiety (rather than doing the whole ‘nodding to make it look like I’m listening but really I’m not’ kind of thing I felt doctors have always done in the past), and decided it needed treated.
He explained that I have bits of panic disorder, obsessive compulsive disorder and social anxiety. So said he was diagnosing me with Generalised Anxiety Disorder. It wasn’t a complete surprise because ‘anxiety’ is referred to a lot in my notes, but it’s still a little strange to have thought and behavioural patterns I’ve had all my life chalked up to symptoms of several different anxiety disorders. He said we’ve now ‘streamlined’ my medication, as the IP consultant wanted, and have determined it’s not the buspirone that sent me high. So given that I found it really helpful and he’s unwilling to put me on an antidepressant, we can treat the anxiety with buspirone again. For now though, I’ve said I’m happy to try without it. In past year, through a combination of buspirone and anxiety exposure (working in a shop has forced me to challenge a lot of my anxieties), my anxiety has improved a lot, and it’s nowhere near as debilitating as it was during uni…so for now, I’ll see how it goes. He does however, want me to have CBT (cognitive behavioural therapy). As I’m off to uni again in the autumn, he said we probably won’t have time to fit it in before then, but it’s definitely something he wants me to do while I’m there.
He’s going to chase up the CMHT to find out what’s going on with a CPN- he says he wants me to keep seeing the nurse I met for my discharge review/bloods, and said it was particularly important for these first few weeks because the bipolar diagnosis is still New and a Big Thing. He copied my therapist in on his letter and wants us to get the work we’re doing wrapped up before I go to uni. It might be coincidental, but the next day she ended her 4 week silence and offered me an appointment for next week. He’s arranging for the CMHT to post me out a lithium card, is writing me up a supporting letter for a DSA application, and we touched on transferring my care over to another team when I move to uni. He wants to see me again in 4-6 weeks.
So I’m pretty impressed. Usually, I’m in and out in ten minutes, but I was with him for well over half an hour. Often, I leave feeling frustrated and disheartened at the lack of progress, misunderstood, my voice unheard and my concerns, my point of view, ignored. Sometimes I leave in tears. So it was really refreshing to have a productive appointment, a clear plan, to come out feeling listened to and supported. It was really bloody nice to be taken seriously without having to say anything- there were no digs, no invalidating comments, no raise of the eyebrows, and there was no compassion fatigue that has been typical of most of the psychiatrists I’ve seen over the years.
I’d been apprehensive about seeing the new consultant, wary of leaving behind both the old consultant and the psychiatrist I was seeing most regularly, because even though I’d clashed with both of them at times, I’ve known them for years and didn’t want to have to start over with someone new (when you’ve seen a couple dozen different junior doctors/SHOs/trainee psychiatrists/consultants over the years it gets tedious repeating your ‘story’…) But it went well. I liked him and he got shit done.
So maybe change isn’t all bad- we’ll see!