What Your Psychiatrist is Thinking
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“I am embarrassed to be here.”
“I really didn’t want to come today.”
“I’m worried you’ll tell me I’m crazy.”
“I should have done this years ago.”
These are some of the most common things patients tell me at the beginning of their first psychiatric visit with me, because, let’s face it: the idea of unpacking your mental health concerns with someone who is, at that very moment, a complete stranger, can be intimidating.
If you’re thinking of visiting a psychiatric provider, but have been dreading making the phone call, or filled with anxiety each time you attempt to fill in the contact form, let me put your mind at ease by going step-by-step through a typical mental health evaluation, of which I complete five or six every day. (Note: Not all psychiatric providers will conduct their evaluations exactly the way I do, but the information gathering process will usually be similar to what I describe here.)
First, I will introduce myself and get a general sense of why you are here and what issues you are interested in treating. I will let you know that I don’t have an agenda for you, and that all choices are yours — it’s your body after all. I will inform you that although I will provide a diagnosis, it’s not the most important thing — we could call your illness spaghetti and meatballs for all I care. What I am concerned with is creating a treatment plan that works for you and helps you feel better.
One thing to remember is that all the questions won’t apply to you. A thorough evaluation, much like the kind a primary care doctor will give during a yearly physical, includes checking in and ruling out a multitude of symptoms and illnesses. While I do own a stethoscope, I probably won’t be listening to your lungs; I’ll be more concerned with how well you are functioning on a day-to-day basis.
I will begin our session by screening for depression, asking you how often you experience sadness, suicidal thoughts, and loneliness. We will talk about mood swings, insomnia, and any history of explosive anger or excessively impulsive behavior that may indicate bipolar disorder.
Next will come questions about anxiety. Do you stay up late at night with ruminating thoughts racing through your mind? Do you worry, to the extent that it interferes with your daily life? Have you ever had a panic attack?
There will be a few questions about psychotic symptoms, which may make you laugh nervously with discomfort, but I ask these to everyone. Have you ever heard voices, or seen things that others didn’t? Have you ever received special messages from a magazine or television, or believed others could read your mind or you could read theirs?
We will talk about your psychiatric history and I will ask if you have ever been prescribed psychotropic medication before or been hospitalized for a mental health reason. I will also ask a few questions about drug use and trauma history. Remember that being as honest as possible with me will allow me to provide you with the best, most informed care. Judgement, shame, and blame are not welcomed guests in my office!
The information you give me helps me to identify a diagnosis and rule out others that may not apply to you. My view on diagnoses, like I mentioned above, is that they’re loose guidelines. Not everyone with depression wants to kill themselves, and not everyone with anxiety has panic attacks. I practice person-centered care, which means that I help patients find what works for them. Ultimately, you know yourself best and without your input, my suggestions are meaningless.
The end of the session is where we discuss medication options, based on a variety of factors — cost, insurance coverage, side effects, and previous reactions to similar medications. If you are uninsured and aren’t sure you can afford medication out of pocket, I’ll refer you to goodrx.com, a site that provides coupons for most medication.
I’ll give you the opportunity to ask questions about side effects, and I’ll also strongly encourage you to contact me before disappearing into the rabbit hole of forums found on the internet. Someone, somewhere, is going to claim that Zoloft made him grow a horn out of his back, and you don’t need that kind of stress in your life.
I’ll ask you how you feel about the diagnosis I have given you, as I have found that dropping a diagnosis like bipolar on someone who is new to mental health can uproot their reality in a major way — it can cause them to view themselves as broken, crazy, or defective. I have heard all of these words come out of recently diagnosed patients, and this is the time that I build my greatest therapeutic rapport with them.
Caring for your mental health is important to your overall quality of life and daily functioning. If you are wondering whether you may be depressed or anxious, check out questionnaires like the PHQ9 and GAD7 that may help you visualize the severity of your symptoms. Though these screeners are not diagnostic, they can be helpful tools to quantify the effect mental illness is having on your day-to-day life.
The last thing I will offer you is this: If you’ve had a bad psychiatric experience, and have been avoiding returning to care, you’re not alone. The field is crawling with crusty old docs just trying to make a buck before retirement.
Medical knowledge doesn’t make anyone an expert on your body, and if you don’t jive with the style of your current provider, feel like you’re not being heard, or simply want a second opinion, find someone new! Even if you’re embarrassed or worried you might be crazy, and especially if you’re feeling hopeless or having thoughts that life is not worth living.
Once you get the help that you need and deserve, you’ll start to feel better. And once you feel better, you can join me, and others, who are fighting to erase the stigma of mental illness worldwide!
This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
