## A Tale of Two Psychiatrists

From: andrew cooke <andrew@...>

Date: Sun, 22 Sep 2013 17:17:02 -0300

[Title edited; I can't believe I did that...]

A while back, Paulina got so tired of my shit that she suggested I see a
psychiatrist.  There's a little more context, but that's the basic idea.

And she had a point.  And she helped - she found a guy that spoke english.  So
I went uptown to see an english-speaking psychiatrist.

It was disturbing.

In retrospect, I am not sure that speaking in english was a good idea.  I am
used to having to deal with another language.  It no longer makes me
uncomfortable.  I know what to do, how to handle mistakes.  How to blunder on.

But putting the language aside, he came to the conclusion that I was
depressed.  Actually, he used a different term, but that was the basic idea.
It's apparently common for people with MS, and he's an expert on this (just by
chance).

OK.

So I tried to ask why.  Because I thought I was doing as well as could be
expected.  I didn't think I was depressed.  I've lived with depressed people.
I didn't think I was like that.

Which is where it started to get weird.  Because there were a bunch of
symptoms, but they didn't really fit that well.  And I said they didn't fit
that well.  And he said (and I paraphase, because this was some time ago) that
he didn't believe in those lists, and that I should trust his intuition.

You may be aware that there's a thing called the DSM, that there's a new
version out, and that there has been some discussion about whether or not
that's a good thing.

http://en.wikipedia.org/wiki/DSM-5#Criticism

And I understood my psychiatrist's objection to lists to be part of that
questioning.  Questioning that I had previously thought myself sympathetic to.

But suddenly I was seeing things from a different angle.  Suddenly lists
seemed like a surprisingly useful idea.  Because they are a definition; a
fixed point.  They give you a way to categorise things.  I don't really care
what the name is - you could replace "affective disorder" with "XYZ" and I
wouldn't care.  What I want is something that says: if people are like P then
statistcally Q will help.

That seems like a reasonable way to approach psychiatry to me.  In fact, I
have a hard time seeing how else you can do it.  Intuition doesn't seem that
great an alternative.

So I decided to get an alternative opinion.  I went back to the guy I visited
when I was first diagnosed.

http://www.acooke.org/cute/MyVisittot0.html

It was surprisingly productive.  I explained (in spanish) what my problems
were, what I was worried about.  He described various alternatives.  Together,
we looked at the symptoms - the lists - and saw what might fit.  From that he
suggested that I had been mildly depressed (in reaction to the MS, if you
like), but that I was probably getting better (in particular, that Paulina's
frustration with me was a normal part of that recovery - it's hard living with
someone who is depressed; people tend to start pushing back when the going
gets a little easier).

Everything made sense.  I went home and discussed things with Paulina; she
agreed.  We were all happy.  The lists had helped.

Finally, an argument that the first guy used: that I should follow his advice
because, if I didn't, I would suffer.  Medicating affective disorders in MS
patients improves (reduces) their rate of attacks, apparently.  That's a
strong argument.  If you have MS you're pretty much terrified of your next
outbreak.  So it's a powerful threat, but I am not sure it helps make neutral,
correct, decisions.

Andrew