WHAT EVERY BIPOLAR PATIENT WANTS
HER PSYCHIATRIST TO KNOW
by Ruth Z. Deming, MGPGP
A Talk Presented to Psychiatric Residents at
Thomas Jefferson School of Medicine
January 28, 2004
It all boils down to 2 things: Competency and Relationship.
Know that having a mental illness – or major mental distress – is probably the worst thing that can befall a human being. But, ideally, with medication, therapy and hard work it can be overcome.
You, our psychiatrist, are the single most important person in helping us get better. You have an enormous amount of influence on how we think about ourselves and our illness and our ability to overcome it. Your words mean so much to us that we quote you often. Your image lingers in our mind like a lamp that never goes out.
Medication is the foundation of our getting better. However, it’s only part of the picture. Encourage us to build healthy lives. Much of our instability is due to unhealthy lifestyles, relationships, and job situations.
Know that our psychiatric session begins the moment we enter your office or agency. Everything is either good or bad “therapy” for us, from the receptionist to the décor on your walls. Please make sure you have a friendly receptionist. If not, we’ll tell you about it. (This means we trust you.)
Build a rapport / alliance immediately. Treatment success rests on this. By your body language and your words, let us know you respect us and take us seriously. We also like when you admit you don’t know everything. This will strengthen our alliance and you will be perceived, correctly, as wise.
Non-compliance is a serious problem with us. By establishing an open, non-judgmental attitude, you will encourage us to tell you the truth. This includes our telling you if we’re engaging in bad habits such as drinking or using drugs or altering our meds. (By the way, we hate meds that make us fat or inhibit our sexuality. If at all possible, please steer clear of these.)
Support our strengths and ask us to build on them. Praise us. Many of us have almost non-existent self-esteem and need to hear constant great feedback from you because you mean so much to us. A little praise or showing you care goes a long way to bolster our health!
Rituals: Warm greeting, warm goodbye. Good eye contact. Handshake is nice if that’s your style. Be careful with touching. Could be misinterpreted!
Partner with us – your expertise plus our astute input. Encourage our partnership: A dynamite combination. Don’t allow us to put you on a pedestal. Wecome and encourage our questions. Also, look at each patient as someone you are “helping to shape” into their “best possible self.” Take rightful pride in what you’ve done for us.
Listen carefully. To quote the great physician William Osler: “Listen to the patient.” Importance, again, of good eye contact and body language. Even as you’re writing your notes, reassure us you’re still listening. It’s a “learned art” to do an effective, caring, time-constrained med check.
Make sure we understand your instructions. Misunderstandings often occur. Write things down for us or have us write them down. Also, have us bring in questions and our version of a “mood chart.”
Check with us to make sure you and I are on the same page. No one knows what the other person is thinking unless they talk about it. Also, ask for our feedback. “Does this make sense?” “Am I being helpful to you?”
Recovery is possible. We can reach our potential. Picture successful role models – Kay Jamison, Mike Wallace – and remind us of them. Look at each of us carefully, examine our strengths and nurture us along our path of particular strengths.
Keep in mind that even the worst cases improve. Never give up on us. If you believe that you and I are getting nowhere, don’t hesitate to send us for a consultation. (Many patients are too shy to do this themselves.) Always reassure us we can weather the storm and move on to better times.
It’s often advisable to include family members in treatment if the patient wishes.
Promote use of support system. Reaching out is often very difficult for us. Encourage us to seek out people we can share our problems with. As you know, storytelling is healing. Strongly promote alliance with a support group. It’ll take some of the burden off you. Give the patient an assignment to look up support groups on the net and then have them report back their findings. This will give you both much-needed information.
Please don’t let patient “drop out of life” due to mental illness. Encourage the patient to continue at work or school. Gauge a person’s strength. Work with them to increase their strength and ability to tolerate stress. (We don’t want to lose our talented bipolar people to the sieges of the illness. Let’s keep them in college or in the work force – even if they have to lighten their load.) Okay for them to take time off, but, please, don’t ask them to stop working unless absolutely necessary. It’s the death blow. Going on disability turns us into second class citizens.
Exude a sense of hope and optimism. Sometimes, in difficult times, your belief in our ability to recover is all that sustains us.
Let the patient leave your office feeling fulfilled. And positive and optimistic. Ask us, “Did we take care of everything?” End with positive summary of visit: “You’re doing great” – “You’re weathering this difficult situation with great courage” – “I have confidence we’ll see some good results with this medication change.”
– Learn all you can from the patient. This will be as valuable to you as your textbooks.
– Practice traditional medicine, yes, but keep an eye out for whatever works; integrate traditional with alternative.
– Encourage sublimation – poetry, art, gardening, sewing. Especially helpful for those of us who are angry or stressed. Or who just need to let our innate gifts out of the bag.
– Use your considerable intuition.
– Smile. Laughter is also broadly encouraged.
Ruth Z. Deming, MGPGP
Director, New Directions Support Group, Inc.
PO Box 181
Hatboro, PA 19040