Re: Autism doctors?

[Guest guest]

nah wrote:

> My medical doctor wants me to start seeing a psychiatrist for my

> autism.

Umm... why? Autism is not curable. You can't talk therapy someone into

an NT, and you cannot drug someone into an NT. If you have

comorbid/resulting issues, like anxiety, depression, OCD tendencies,

etc., that may warrant a general practitioner to suggest a psychiatrist,

but seeing a shrink for autism makes about as much sense as seeing an

eye doctor because you have blue eyes, to me.

> Lovely. I am doing quite well and do not feel any need to see a

> psychiatrist.

Then there's your answer

> Actually, I agree that I could benefit from someone who could and

> would actually *help* me with some of my issues, help me come up with

> solutions...but I don't really need that, when I can easily ask

> other people online how they handle certain problems.

I am certainly no expert on this, but it seems to me that the kind of

person to do those sort of things would be a therapist, not a

psychiatrist. With managed care, which is what most of it is now, it is

simply too expensive to have psychiatrists doing therapy. Therapy is

time-intensive; therapists (of whatever flavor) are relatively cheap.

Shrinks are more likely to medicate you and send you on your way.

That is certainly the way it is at the mental health place I go to for

my Paxil. I see a psychiatrist once, for 15 minutes, every three

months. They do not pretend to have the resources to have shrinks do

therapy.

> She told me to come

> back for my next appointment in one month, but have seen a

> psychiatrist by then.

Well bully for her! She cannot command you to see a shrink. I would

just tell her NO.

> Problem #1: I do not have an accurate diagnosis; the words " autism "

> and " PPD " litter my medical files, I am sure, as do many other words

> that were incorrect. How can I go to a psychiatrist for autism when

> I don't even have an official diagnosis?

The shrink will be more than happy to write you one. Lots of people

don't have diagnoses when they first see a psychiatrist. Few of them

don't have one when they finish seeing one... there is a trend to define

every personality trait as a mental illness.

> But even if I go to get a DX, and then start seeing this doctor...I

> have no wish to see a psychiatrist that would make things worse. I

> don't want to be told I should fake NT or repress who I really am. I

> don't see why I should have to go see some psychiatrist for a

> neurological condition.

You don't have to.

> I don't see how it can help me any more than

> talking to others of my kind that have more experience, or different

> experiences, than I. I see that going to a psychiatrist may do more

> harm than good.

Very possible. At least you are not walking in there with no idea what

you have... if you did, a shrink may be able to easily convince you that

you have something you do not, and give you inappropriate medications

that may harm you if you keep taking them.

> I am annoyed that when I try to explain autism to

> her, she objects every time with, " I can't treat your autism. " Well,

> I didn't *ask* her to " treat " my autism; I asked only that she

> listen, that she try to understand what it *means* that I am

> autistic, that she understands that I am, yes, intelligent, yes,

> sane, but yes, different, and that these differences do have medical

> implications. I attempt to explain some things to her, and she takes

> them all wrong, and I have to correct her, and I'll say, " No, that's

> not the case, " and she'll reply, " But YOU JUST SAID that it was. "

Dr. is writing a script for you. You can't read it, because it is

written in Doctor Heiroglyphics... but your pharmacist (a person trained

in reading Doctor Heiroglyphics and counting pills) would tell you that

it says " Get a better doctor! "

I think a good rapport between a MD and patient is important. I have a

GP MD now that I really like. I gave him the test results from

Pittsburgh University that had me as autistic, so he knows of that

diagnosis. He has never done anything like tell me he cannot treat my

autism, or tell me I said things I did not say. He listens, takes what

I say seriously, and is not patronizing at all. I have mentioned things

of the sort you have, like how autism affects this or that, and he

listens and considers what I have to say.

I really got lucky to discover him, and the psychiatrist I see, too.

They're both good matches for me. And this experience shows me that you

don't have to put up with a GP like yours.

> There is a big difference between saying, " When I was a child, I used

> to think I may have cystic fibrosis or chronic bronchitis, and I

> have noted similarities between my own lung problems and those of

> Andy Kaufman. I therefore think it wise to test my lungs to make

> sure there is nothing worse than asthma wrong with them. " She thinks

> this means I'm paranoid I have lung cancer. No, I am not *paranoid*

> that I have lung cancer, I just *think there is a faint possibility*

> that I might have lung cancer.

Aargh! Terrible. When I first saw my doctor, I feared that he would do

that to me. If I see a medical problem that seems to match what I have,

I bring the matter to him, and I was afraid that I would get labeled as

a factitious (hypochondiacal) patient. I thought that my revelation of

my HFA diagnosis would make this worse. It did not.

Case in point: I saw this doctor three days ago, for a follow-up to see

how my HDL cholesterol is going. My LDL (bad) cholesterol is very low,

which is surprising since I eat a lot of eggs and red meat. However, my

HDL (good) cholesterol is also low. He is monitoring it to see if

medication can be avoided. Anyway, while I was in there, I reported two

problems to him. First, I have a rapid drumming sound that happens

frequently in my left ear. I can feel it as well as hear it. I thought

it was a tic of one of the muscles in there, but I wanted his opinion.

He suggested that it was a spasm or a tic in the tensor tympani muscle,

which attaches to the malleus, a small bone in the middle ear.

He could have written it off as an auditory hallucination, but he did

not. He looked in my ear, said it looked good, and drew a diagram of

the ear on his marker board, mounted to the wall in the exam room (a

nice touch).

Then I asked him about Marfan syndrome. I read about this when I went

to a tall-person's web site. I do not look like the typical Marfan's

person, but I do have a significant list of traits (arm to height ratio

> 1.05, pectis cavernum, extreme myopia, hyperextensible joints,

scoliosis, unusually tall compared to anyone else in my family, etc), so

I asked him about it. Again, he could have written it off as

hypochondriasis, since I do not " look " Marfan, but he instead asked me

to show him why I thought so. He agreed that I had enough of them to

warrant further investigation, so he wrote a referral to the University

of Arizona Medical Center's genetics lab, to see if I have the genetic

marker for Marfan's.

Any patient needs to have his or her doctor take him or her seriously.

Marfan's can be potentially fatal; it can cause aortic dissection

(that's what killed Ritter) without warning. If I have it, I

should know, so I can go in for periodical echocardiograms, to make sure

the aorta is not bulging. You can't feel it, so the first symptom may

be the dissection-- and that is almost always fatal, because of the time

it takes to get to the hospital and do the emergency surgery. You can

bleed out internally in minutes from a bad aortic dissection.

Imagine that I did have this, and that my doctor did not take it

seriously. You have to have a doctor that will listen.

> I think it would be wise, all things

> considered, to rule it out.

I agree.

> I would not think this, except my

> husband is worried enough about my lungs to *cry* when I tell him I

> think it might be something more serious than asthma, but concluded

> there is no use asking a doctor.

Not this one... but not all are like that.

> So, I ask my doctor and she thinks I'm a hypochondriac. She remarks

> that most people my age do not come in with a sheet of paper with

> everything written out.

So? Most people don't do any number of things. Most people are not

subscribers to this list. Most people don't fly helicopters. Most

people don't live on a diet of nothing but broccoli and oranges. What's

the point?

> I tell

> her that " when I skipped a dose of this medication " I had a certain

> side-effect. She objected that *last time* I said there were no

> problems.

This sounds like a problem with her trying to read too much into what

you said. It reminds me of something that happened that ultimately

helped to skewer the MRI testing I was going to do for the autism

study. On the phone, the MRI tech asked if I had any reason to think I

may have metal fragments in my eyes (the MRI can cause them to move and

cause damage to the eyes), and I thought about it and said no. When I

got there, though, the tech (asking the same series of questions) used a

different phrasing. She asked if I had ever had metal fragments in my

eyes, and I said yes. I was chiseling once, with no goggles (I know...

bad idea) and a piece of aluminum hit me in the eye, but it came right

out when I irrigated it. When I told her that, she cancelled the MRI

testing right then. In order to do it, I would need an X-ray to confirm

that there was no metal in there... and X-rays had to be scheduled well

in advance.

When I related all of this to Dr. , one of the administrators at

the autism study, she said that most people would have interpreted the

first question to mean the same as the second, and they would have

volunteered that. I was amazed... I was asked for an analysis of my

life experiences; I was asked if I had reason to believe I had metal in

my eye. I do not think I do, so I said so. I answered the question she

asked, not the one she wanted the answer to.

It seems to me that this is the same thing that your doctor is doing.

Can you see how the second MRI tech could have said " But you said before

that you had never had metal in your eye, " based on her assumed

interpretation of the question?

> I told her last time one medication mostly

> worked but not all the time, and then this time when I asked if we

> could increase the dose since it didn't work all the time, she

> objected that I'd said it worked last time, and I had to remind her

> that I'd said it usually worked, that it still usually works, but

> that I think I need a little more for it to be really effective.

So she thinks you said it works, and that it does not work, thus

contradicting yourself. And they say that we are the ones with black

and white thinking. (For the record, I understand what you mean, and I

think she would too if she was really listening to you.)

> *sigh* Sorry to go on and on. I just...get so tired of doctors.

> She's the best doctor I've had since childhood. I worry I am being

> too picky; I could probably not find a better doctor.

What?? She sounds frightful. How is she the best, if she won't listen

to your health concerns, orders you go to psychiatrists for things that

are incurable and that you are not having problems with, who belittles

you for doing things that " most people " don't do, who fails to listen to

you, and who considers you a hypochondriac? I have not had a doctor

that BAD in a while.

> And

> yet...there is much to be desired. I don't really want to see a

> psychiatrist, so why is my doctor insisting I need to see one? She

> read my paper and thinks there's something wrong that I am so

> detatched from things like whether I live or die...she doesn't

> understand that this is not depression, just a general, " Meh, I'll

> probably live, but if I don't, then who cares? " to which I have to

> remind myself, " My husband cares and would be very sad, so I need to

> take good care of my health so that I don't die because I don't want

> him to be sad. "

I don't think that idea is off the mark. That does sound like

depression. Depression is not always extreme sadness and feelings of

low worth and such. A chronic low-level depression can manifest as

ambivalence about life like this.

> He reminds me of this by crying and becoming very

> sad whenever I remark I don't think it would matter to him very much

> if I died, or that I may have something really badly wrong, but I

> won't bother looking into it, because who cares?

That sounds like depression too, because you're projecting your own lack

of concern about yourself onto him. You know he would care, because you

have said so... but you still have this inner idea that he really would

not care. I can relate to that rather strongly, as I did that when I

was depressed; I used to think that people that would come to my funeral

would all think to themselves that it was better this way, that they

would not miss me much. I was so convinced of my own lack of worth that

it became a fact in my mind, not just my opinion... and since it was a

fact, I thought everyone else knew it was so too. I think that if it

was really just you being ambivalent, if somehow that was just the way

you were, you would not think that others would not care if you died. I

am no therapist, but I do have some experience with depression, and

depressed people, and this is ringing a bell for sure.

[Guest guest]

nah wrote:

> She told me to come back for my next appointment in

> one month, but have seen a psychiatrist by then.

I've read 's and 's responses to this, and I

agree with them. Now, as for this Doctor, SHE IS NOT

LISTENING ! In fact, it seems that she has a patronizing

attitude. This is what I meant recently when I said that

I wasn't going to allow anyone to treat me like a child,

or as if I were retarded, on the basis of my Dx. How do

you NOT allow this ? Well, you have to stand your ground.

If you believe that she didn't really listen to something,

come right out and say, " You're not really listening. "

Then say it again, slowly, distinctly, and rationally. If

you get all upset, yell, and make a scene, you would only

reinforce her opinion of you as someone without the faculties

to judge whether or not she needs a psychiatrist.

You have valid points to make, make them! But you have to

get her attention first. If she won't listen, you're wasting

your money and your breath.

I know, it can be hard to come up with the words you need

when you need them. For me, it's usually enough to rehearse

what I want to say before I go, and when I hear the key words

to the various subjects, I can let loose with that train of

thought. But 3 X 5 cards would work too. You could just

mark them with a subject, and then a few lines that would

remind you of what you need to say.

Here's one subject: Psych more harm than good?

> But even if I go to get a DX, and then start seeing this

doctor...I have no wish to see a psychiatrist that would make

things worse. I don't want to be told I should fake NT or re-

press who I really am. I don't see why I should have to go see

some psychiatrist for a neurological condition. I don't see how

it can help me any more than talking to others of my kind that

have more experience, or different experiences, than I. I see

that going to a psychiatrist may do more harm than good.

Here's another: Try to understand what autism means.

I am annoyed that when I try to explain autism to her, she objects

every time with, " I can't treat your autism. " Well, I didn't *ask*

her to " treat " my autism; I asked only that she listen, that she try

to understand what it *means* that I am autistic, that she

understands that I am, yes, intelligent, yes, sane, but yes,

different, and that these differences do have medical implications.

I attempt to explain some things to her, and she takes them all

wrong, and I have to correct her, and I'll say, " No, that's not

the case, " and she'll reply, " But YOU JUST SAID that it was. "

And this one: I'm not a hypochondriac, but I do want things

I have reason to worry about checked out.

> So, I ask my doctor and she thinks I'm a hypochondriac. She

remarks that most people my age do not come in with a sheet of

paper with everything written out. I think next time my paper

should include a statement that I communicate better in writing

than through spoken word.

> She's the best doctor I've had since childhood.

All this is based on the assumption that you want to keep

this doctor, (though I don't why you would). If she is not

open to learning and understanding what autism is like for you,

I really think you should get another.

> I worry I am being too picky; I could probably not find a

> better doctor. And yet...there is much to be desired.

You might give this Doctor just one more chance. Go to the

appointment next month, and tell her that you don't need a

psychiatrist; autistic people aren't mentally defective,

just different. What you do need is a Doctor who listens

and understands, and is willing to learn.

> I don't really want to see a psychiatrist, so why is my doctor

insisting I need to see one? She read my paper and thinks there's

something wrong that I am so detached from things like whether I

live or die...she doesn't understand that this is not depression,

just a general, " Meh, I'll probably live, but if I don't, then

who cares? " to which I have to remind myself, " My husband cares

and would be very sad, so I need to take good care of my health

so that I don't die because I don't want him to be sad. " He re-

minds me of this by crying and becoming very sad whenever I remark

I don't think it would matter to him very much if I died, or that

I may have something really badly wrong, but I won't bother look-

ing into it, because who cares?

On the other hand, just thinking about dying, and having a " I

couldn't care less " attitude is a bit morbid, and not far from

" suicidal ideation " , which is planning a more active role. It

couldn't hurt to talk with someone about this, though not nec-

essarily a psychiatrist. There is a better way of looking at

the world and its possibilities than you seem to right now.

Clay

[Guest guest]

Jane,

You mean err, umm... " delegation " (AKA " passing the buck " ) Whatever

happened to " the buck stops here " ?? It's amazing how many people play

this game of passing the " dirty work " onto another who is unknowing of

the situations at hand!!!!! Whenever I see this behavior going on, I

want to scream out & yell!! Not to say I won't accept a REASONABLE

reason. It's " the excuse/blame game " I can't stand!

" Bullshit by any other name still smells the same. "

Wanda

http://community.webtv.net/tikigalharkins/LETSTALKASPERGERS

[Guest guest]

nah,

I agree with the others--this doctor is not right for you at all, and you

should find another one. I'm sure there are doctors out there who would be

much more understanding of you than she is!!

Norah

>

> Reply-To: AutisticSpectrumTreeHouse

> Date: Mon, 26 Jan 2004 11:06:43 -0800 (PST)

> To: AutisticSpectrumTreeHouse

> Subject: Autism doctors?

>

> My medical doctor wants me to start seeing a psychiatrist for my autism.

> Lovely. I am doing quite well and do not feel any need to see a psychiatrist.

> I used to see one when I was much younger (age 5-19) but who needs it now?

>