During new patient evaluations, psychiatrists generally have a standard set of questions that are asked to help formulate a diagnosis based on diagnostic criteria and to develop a treatment plan. Every psychiatrist has their own style, but I’ve always been interested in asking patients more open-ended questions if I think it will provide me with a greater understanding of who they are as unique individuals. I also assume that my questions might be a bit different than the norm because I’ve grown accustomed to patients making statements such as “You know, nobody’s ever asked me that before.” Oftentimes, I believe that the art of psychiatry has dwindled down to a checklist which subsequently churns out a diagnosis based on the minimum criteria needed to properly meet billing requirements. Such a practice may lead to a lack of connection in the therapeutic relationship, therefore, I sought to create a series that explores the unspoken thoughts that a person may have when meeting with a psychiatrist. If you would like to contribute to future questions in this series, please email me at freudandfashion@gmail.com.
QUESTION OF THE WEEK:
What goes on in your mind when a new psychiatrist asks if you’re suicidal?
RESPONSES:
It’s been some time since I’ve seen a new psychiatrist; thankfully I’ve been (somewhat) stable and happy with the treatment I’ve been receiving with my current one. But I do remember going through what was round-robin of mental health professionals before I found my current doctor. The situation is horrible, as I’m sure most people who have gone through the same process can testify. Although someone may be a professional who’s gone through years of grad school and training about what may be wrong with me, why would I want to share my darkest, deepest pain to someone I just met? It never felt right.
The two psychiatrists whom I connected with most during my care have been the ones that treated me like a person (and even a friend) first. No, I’m not that textbook case study you read in Psychology 407 back in grad school. Nor am I willing to try new psych medications with the script you’ve given me after our 5 minute visit.
There are no 100% effective cures for mental illness, but you can still treat those living with mental illness like human beings. It’s not that hard.
First thing that springs to mind is: “I can’t tell you I’m suicidal because you’ll hospitalize me and that will just ruin everything I’ve worked so hard for.” (as strange as that sounds…)
However, I always think there’s no point in outright lying to my psychiatrist if I genuinely want to get better. So, usually, I just tell them what I’m thinking, even if it means telling them I’m suicidal. But, I make sure I explain exactly what I’m thinking. Usually my thoughts are more of a passively suicidal nature and I don’t have a concrete plan in mind. My current psychiatrist is well aware of that. I haven’t had suicidal ideation with a plan for quite some time now. The last time was with my first psychiatrist, two years ago. And even then I’d tell her the truth. I only got hospitalized once, when I told her I genuinely couldn’t guarantee that I wasn’t going to do it. I guess the fact that I’m always honest about what goes on in my mind is precisely what has helped me not get hospitalized more than once. I’ve always thought of the patient-psychiatrist relationship as one built on trust. If they can’t trust me then they can’t help me to the best of their capacity and I’d just end up self-sabotaging.
Dana S, medical student (borderlinemed.wordpress.com)
‘I’d never kill myself. Wanting to die to end my misery and actually going through with it are completely different. But that’s probably not the answer you were looking for…’
First thought in my head if asked if I was suicidal would be something sarcastic like this: ‘Would I be sitting here if I was [suicidal]?’ and/or ‘Yes and to be honest, you’re just having a visual hallucination of myself right now.’
Anonymous
What goes on in my mind? Terror yet the need to be honest and tell the psychiatrist if I’m feeling that way. From experience (I was hospitalized several times for suicidal ideation) I know I had to be truthful about feeling suicidal because despite the intense compulsion, I didn’t want to do it and leave my two young daughters without their mom. I needed to be kept safe so I didn’t go through with it and I knew I needed hospitalization. I got better, and if the feelings return I will be honest with my current psychiatrist. I realize that he would most likely place me on a 5150 hold, but I accept that.
Dyane Leshin-Harwood, author of “Birth of a New Brain – Healing from Postpartum Bipolar” (Post Hill Press, 2017). Blog: www.proudlybipolar.wordpress.com, Twitter: @birthofnewbrain
The first thing that comes to mind is that I need to justify why I’m there seeking help at this appointment and I wasn’t really sure how I need to respond. I was asked to rate my suicidal thoughts on a scale of ‘1 to 10’ (1 being the least severe and 10 being the most severe) and thought to myself, ‘do I need to respond with a high number so that I can get the help that I need, or will a low number not make them take me seriously enough?’ I remember feeling like I needed to justify that I needed help and it seemed as if a number was supposed to prove it. I get that a number is supposed to reflect my thoughts and feelings, but I didn’t feel like it was a genuine representation of my situation.
Anonymous, Psychotherapist
Having seen a psychiatrist in the past, I remember feeling anxious about this question because I knew what to expect in an evaluation, even though I didn’t feel suicidal. Fortunately, I knew the psychiatrist came highly recommended, was well-established in the community, and was someone I could trust, but what if I had no choice but to see a random psychiatrist (quite similar to the experiences many of my patients have encountered in the past) who was a novice, unskilled, or didn’t care to take the time to get to know or properly assess me? A psychiatrist’s job is hard and safety is our utmost concern, but building trust and mutual respect in a physician-patient relationship also needs to be a priority.
Vania, Psychiatrist and writer of Freud & Fashion
Photo by Marlon Santos
14 comments
I would love to volunteer in a mental health related field as I want to give back the help that I received when I was really unwell last year.
That would be wonderful! I know there’s crisis line volunteers and I used to volunteer at a shelter for women & children escaping domestic violence. I hope u find an opportunity in your local community 🙂
When I am suicidal it’s written all over my face. No need to ask.
Ok. I have had the same Freudian based, all cash (125.00 for fifteen 175.00 for 25) doctor for seventeen years. I met him when involuntarily hospitalized while on vacation in South Florida for severe and psychotic mania. In the time I’ve known him, I’ve have 8 med fatigues where antidepressant stopped working and we had to try new ones. Bipolar Depression as I experience it is a mixed mood of sorts, Depression/sever anxiety. And I’m suicidal the whole time. Once it lasted for a year while we tried this and that. And sure, I told him I wanted to die But he worked in hospitals for thirty years and he feels it would just screw me up. And to stay out of hospital if I can possibly avoid it.
after twenty five years of being bipolar I, mostly highfuctioning (although I’ve had my days) I now have Tardive Dyskineisa medicated by tranxene/xenazine(benztropine).clozaril. I’m beginning to show insulin resistance (even though I’m slender and exercise)…
The three years during which we searched for symptom control were the worst of my life. I saw fifteen neuros and psychs. Cleveland clinic lady and a few others said it was psychosomatic. Head of National Parkinson’s foundation said “suck it up.” Another doctor spoke to my breasts and his medical report referred to them. They are not that big. After putting me through every test he could think of, he clucked me under the chin, told me to stop taking the benzo that was helping me and said, “I have nothing to offer you.” And he was a movement disorder specialist.
It’s fair to say those three years were characterized by suicidality. It was plain as day. And during that time I also saw some psychiatrists other than my guy, thinking they might have a solution.
I’m telling you all this, Freud, because in your practice you may run across someone like me who can’t take Cogentin or Artane. Clozaril/Xenaxine 12.5x2and Tranxene (similar to Klonopiln) did the trick.
At the request of my publisher, International Bipolar Foundation, I did two friendly, low-key videos reassuring people that they, too can find treatment for this unfortunate and disfiguring side effect. Mine was treatment refractory. If I could find help they can. And if they watch my video and read my blog in IBPF “Move Over, Movement Disorder,” they will know how to get that help.
I’m glad you are in this field. It gives me hope. Here are the links to the videos if you ever want Tardive Vlogs Utube
Part 1: https://www.youtube.com/watch?v=nCOR_YVo-ks
Part 2: https://www.youtube.com/watch?v=TqfEX8jl-Zs
to give them a gtlance.
i appreciate the comment, especially sharing your videos as it can help others struggling with tardive in addition to educating physicians, like myself.
beautiful post, and you whole blog shows your passion for what you do. I hope to be able to write and feel that way when I finish med school & residency.
Thanks so much Jani! What year are you in school? If you have any interest in pursuing psychiatry as a specialty, feel free to email me if u have any ques 🙂
I am a second year and although I find psychiatry interesting, I feel a passion for women’s health and reproduction. I just found your blog but so far I am loving what I have read.
Wonderful! Always go with what you’re passionate about! During my OB/Gyn rotation as an intern, I was always assigned the cases where workup was normal and couldn’t be solved via standard medical treatment, and was amazing how oftentimes exploring possible underlying psychiatric issues actually alleviated some of their presenting physical symptoms 🙂
yeah, it is so wonderful. I like things like that, out of the ordinary and non traditional cases. <3 best of luck and thank you!
I don’t recall having seen a psychiatrist. I can say that thoughts of suicide wanted me to be entertained by them, but I found them not entertaining. I believe that would be my honest answer.
Thanks for contributing your thoughts
I was asked that question when I started seeing my psychiatrist (it made me question what I was doing in the office) , my answer is; “no, I’m grieved, not suicidal, can’t you tell? Every morning I wake up and I make a choice, to be with my wife and surviving children, or to join my son in the grave. I love my family and I could not put them through “that” unending experience of having to lose someone before the time to go”. Now for the darker side, what I’ll call sympathetic suicide, the loss of a second child (sibling) to suicide because of the loss of a first child (non-suicide). In my support group there are a number of families (approximately 25%) that have experienced sympathetic suicides and it scares the beggiebies out of me with 3 surviving children. Most of the suicides were committed with no chance of recovering (firearms, and poisonings), and the parents had no warnings signs (their comments when they look back and “what if”). I believe it may be more effective if the psychiatrist would delay asking “the question” till later on in the conversation with the patient, and probe the situation with a different approach. Maybe it would be beneficial if the sessions were with more than one person instead of 1 on 1. We do that with my daughter on occasion. It has provided some comfort as a parent, and it opens an alternate line of communication with my daughter.
It’s a tough subject!
Hi Bob, great to hear from you…I just saw your other comment on my previous post and had actually been wondering how you’ve been doing! Yes, suicide is a very tough subject. It’s a standard question that we have to ask in an evaluation to assess any risks, but technique and how it’s phrased is very important and varies among clinicians. I’m actually not familiar with sympathetic suicide (I feel like i learn so much from you) and that is a very high rate you mentioned, so I can see how real the fear is for you as a parent. Sounds like you’re doing everything you can to make sure your kids get the support they need. Thanks for your thoughts on this subject. I hope that you and your family are having a good start to your year 🙂
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