It’s Tuesday noon in Toronto. We now have some 22,000 psychiatrists and related professionals in town at the American Psychiatric Association annual meeting, which ends in two days. We are all here to listen to the experts, and I find that one of the best ways is to simply bowl right up and start a conversation.
The perfect venue for this is poster sessions. Here, at specific times of the day, leading researchers “post” the results of their latest studies on a board. For a patient, this can be a surreal site, as here you can literally find these people standing about like Times Square vendors.
The studies themselves are usually inconsequential to me. They are merely the starting point for me to bombard them with a stream of questions. My notebook and recorder stay in my bag. I’m looking for insights into my illness, not stories.
I see Gary Sachs MD of Harvard hovering about the floor. Two days before, when I found him hovering prior to the start of a symposium, I had asked him about a major NIMH study in which he was the lead investigator. The study involved treating some 4,000 bipolar patients over an extended time, the most ambitious series of clinical trials for this illness ever. The study has been completed, but the results are strictly embargoed. Were there any findings, I asked, that surprised you? Yes, definitely. Any that would change the some aspects in the way you practice? Again, the affirmative.
Now I needed to ask him about the high lithium drop-out rate from a different study that he brought up at that earlier symposium. Basically, the doctors who wrote the prescriptions were flabbergasted to find out that many of their patients weren’t getting them filled. The doctors were out of touch with their patients. No therapeutic alliance had been formed. Dr. Sachs is a huge advocate of psychiatrists constructively engaging their patients in a dialogue.
I preach a similar message from the other side of the street. I’m constantly telling patients we need to engage our psychiatrists. Work with them, badger them, argue with them – more often than not we have to take responsibility for getting the conversation going. Once we’re talking, we can work together on finding the right meds and the right doses.
Later on I bump into Terrence Ketter MD of the Stanford. Dr. Ketter has posted a study that has found that bipolar patients, when they are well, actually have some good things to say about their illness. Creativity, talent, energy, drive, empathy, to mention a few. He tells me of earlier surveys of his that found our population a lot more talented than the general population.
The catch is how to capitalize on our gifts without being flattened by the full destructive force of our illness. Smart meds management, of course. But Dr. Ketter also urged mindfulness, of finely attuning ourselves to subtle changes in mood and behavior and energy. This echoed advice I heard earlier when I ran into Robert Post MD of the NIMH on a bus on our way to a conference venue. Dr. Post is a strong believer in patients keeping life charts. (Go to www.bipolarnews.org for one of Dr. Post’s charts.) Fill in the blanks, spot patterns, take action.
Take home message: yes our illness is severely disabling, but take stock in what makes you special. Yes, bad days happen and relapses are inevitable, but we’re not entirely helpless, either. Watch your mind like a hawk, keep tabs on life changes, and talk to your psychiatrist as if your life depends on it.
This is John McManamy, “live” from the APA annual meeting in Toronto …
How have you engaged your psychiatrist in conversation? Tell us in the message boards.
Published On: May 23, 2006
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