Doctor Without Borders: A Bizarre First Brush With Psychiatry

01/17/2014 05:00 pm ET Updated Dec 06, 2017

Awaiting my first appointment with a psychiatrist, I look down and notice a brochure. "There is no such thing as mental illness anymore," it reads. "There are only physical illnesses of the brain."

Anymore? I wonder. The brochure suggests that mental illnesses were once real, but no longer -- now, they're just illusions. I see the point that the author is trying to make -- that we don't need to mystify mental illness, and that addressing it is simply a matter of biochemistry. But I'm troubled by the metaphysical mistake: If mental illness isn't real now, then it never was.

The language seems exuberant, huckster-ish. I wonder who might have said such a thing -- some large, conservative, professional organization, I hope. Perhaps their marketing people just got carried away.

I look closer. The quote is from the doctor I'm about to see.


On the wall above his couch hangs a framed poster -- a blue silhouette in four poses, beginning in the fetal position and slowly rising to its feet. The picture has a Futurist, Ayn Rand feel -- a schematic, angular optimism that I doubt bears much resemblance to real life.

I never end up sitting on the couch. Instead, the doctor indicates a seat next to his desk and prompts me for a history of my symptoms. He wants incredibly granular detail, and as he scratches out notes, I take him in. He is somehow both slight and dumpy, pants hiked up over a cantalouped front-butt. His face is clean-shaven, save for two rebellious copses of long, wiry whiskers. An extremely long fingernail forms the terminus of his left pointer finger.

By this time, I've seen enough therapists to know that wisdom doesn't always come in pretty vessels. But the doctor's appearance isn't just unattractive; it smells of ignorance, details overlooked, neglect. The brochure floats back into view.


By the end of that first session, we were talking drugs. I would begin with 10 milligrams of Celexa, a selective serotonin reuptake inhibitor (SSRI).

The doctor explained that serotonin is a neurotransmitter, and that its release is associated with well-being and happiness. In people with depression, however, synapses in the brain tend to reabsorb serotonin too quickly. As a result, I wasn't experiencing many good feelings, and when I did, they didn't last very long. In my depressed mood, I was finding it increasingly difficult to deal with the onslaught of OCD-driven intrusive thoughts.

By using an SSRI, the doctor explained, we would cut off something like the bottom 10 percent of my emotional range, and I wouldn't be as likely to fall into such despair. You could think of it like scaffolding, he explained: By providing a supportive platform, the medicine would help create space for me to change my mental habits.

Unfortunately, he added, the medicine would also slice off the top 10 percent of my feelings -- my most joyful and ecstatic moments. I'm sure I asked him why the medicine worked this way, but I'm also sure that I didn't feel much resistance. I was in far too much pain to worry about a slight reduction in the intensity of good feelings which didn't appear very often anyway.

My decision to try medicine hadn't come quickly. In my typical OCD way, I had fretted about it for months: How long had these things been around? Did we really know enough about the long-term effects? What if taking them ended up solving one problem by causing another? What if I gave myself cancer -- then how would I feel? Maybe better to just soldier on. As with my decision to see a therapist a year and a half before, though, the daily pain-grind eventually wore down my resistance.

The first time I filled my prescription, I still wasn't sure I would go ahead. I took the bottles home, placed them on the counter, and stared at them for a moment. And then I realized that I'd already made my decision.

As with anything fearsome, ingesting pills seemed like a big deal until I did it. It was like being afraid of flying and getting on a plane for the first time: Fear no longer made any sense. Things were in motion, processes underway.


People ask if the drugs make a difference, and I don't know what to tell them. I've been taking medicine for a little over 10 years now, and it's hard to remember what things felt like before.

It was hard to tell even at the outset. As we got going, I would meet with my psychiatrist every month or so. Each time, he would ask a battery of questions about the frequency and intensity of my anxieties.

I found these questions profoundly -- even existentially -- confusing: How often was "sometimes"? What was a "moderate" amount of pain? And what would happen if I provided answers that didn't track my feelings perfectly? (To provide me some compass points, the doctor would sometimes tell me how I had answered the question at hand on my previous visit. I was grateful, though I wondered whether this was cheating and would skew the results.)

Each of the possible answers correlated with a point value. After we finished the questionnaire, the doctor would add them up and compare the total to my previous visit. Tiny changes meant a lot to him; if I scored a 29 on one visit and a 27 the next, (lower was better) he took that to mean that the medicine was working.

I don't think he was wrong, exactly; without the numbers, I wouldn't have been able to tell whether I was making any headway at all. My mind was a tight and constricted place -- one panicky, claustrophobic day indistinguishable from the next. Sure, it might not feel much different day to day, but what did I know? I was trying to differentiate between shades of black...

This is an excerpt. The full essay is available for free at The Wheat and Chaff.