In April of 2020, I met with a general medicine doctor here in town and laid out my case for why she should serve as my medication-dispensing physician going forward.
To her credit, she agreed.
I laid out my case to her while wearing a mask after many hours of worrying about whether or not I would be seen as a drug seeker. As usual, I was concerned that my mental health history might seem daunting, a project she wouldn’t want to take on in the midst of, y’know, a burgeoning pandemic. To this end, I almost canceled the appointment and didn’t ask because of this.
Everyone who knew about the dilemma told me to go. Sheesh. You go off your meds ONE time and create hell on earth and all of a sudden, everyone wants to make sure that doesn’t happen again.
Meds Affect More than Brain Chemistry
There are lots of different life elements to being on medications that keep you stable. They range in importance, but if you are missing any one of them, the effects can bleed into each other. We can create our own little Maslow’s Medication Hierarchy if we’d like. That dude occasionally knew what was up.
Physiological
The treatment of mental illness in the United States literally fails on step one. Food, shelter, water, air, sleep clothing… In every nook and cranny, there are people missing one or three of these things on a regular basis. If we try to help, people scream socialism to make sure that this level must be earned because (and try to stay with me on the logic here) people won’t appreciate these things if they don’t find a way to get them on their own. This philosophy is bullshit from start to finish which, with even the barest modicum of empathy, people know.
To be on medications that keep you stable, you need a routine. I take two medications with breakfast, one at 2 p.m., and two at night. I get them from the cupboard, my backpack, and my nightstand.
Because I have a cupboard, a backpack, and a nightstand.
Expecting someone who is missing any of these elements to manage a medication regimen is like asking your dog to do your laundry. Sure, there is probably a very well-trained pup somewhere with gigantic buttons on a washer/dryer who can do this. But my dogs are only interested in laundry insofar as stealing our socks and taking them outside.
Safety
May I interest you in some personal security, employment, resources, health, or property?
Meds are often considered a luxury around here. It’s why they’re advertised. “Ask your doctor,” they say, which only requires that you have TV/computer to see the ad and a doctor to ask. We can never forget the “Depression hurts everyone” campaign, a slogan that passed through more than ten people to get approved. Statistically, one of those people should have dealt with depression. Statistically, one of them should have said, “Hey – so – good idea here but depression often causes people to feel an irrational sense of guilt for causing others pain so maybe we should modify that saying just a bit.”
Except then someone said, “Okay! We’ll just have a little dark cloud follow around an egg-shaped sad face to hammer home the burden depressed people are!”
I digress. But stability and consistency with medications help individuals obtain and retain each of these elements. The most personally secure I ever feel is when I have easy access to the medication regimen I need. Any disruption to this causes insecurity in almost every facet of my life.
And that’s just access. Not the medications themselves.
Love and belonging
An individual needs absolute unwavering support from loved ones to believe their medication regimen is worthwhile. Any doubt – any indication that you believe medications are unnecessary or (much worse) wrong – removes self-assurance for the medicated individual. Feedback on the meds themselves is fine. Your loved one starts a new one and suddenly, she wants to go tubing on the lake in late September when it’s 49 degrees outside because it’s the only thing that makes her feel alive? Yeah, you might want to mention that you observe some concerning signs about the recent medication addition.
Here’s the thing: A person trying to decide the role medications play in their lives does not benefit from also questioning what role YOU play in their life, too.
Esteem
The humanity of being on meds gets all wrapped up in the stigma, the secrecy, and the variability of how things are going. A slight shift in the focus from being “weak” for needing the meds to the focus on becoming “strong” with their aid can be helpful. Reducing the secrecy related to being on them is also helpful.
Sometimes I imagine a world where we all just tell each other the actual state of things instead of hammering home that <this long list> is private and should be kept to ourselves. Are there some things that fall into that category? Sure. Is the fact that someone takes a medication of any kind one of them? Probably not.
I take an allergy pill, a multivitamin, and an antidepressant in the mornings. Why are two of these perfectly fine and the third is gasp worthy? Bupropion dwarfs the other two in importance. (I might argue for the allergy meds after my trip through Alabama where the pollen was visible and could be moved with a shovel). So what?
I also fully believe that “So what” is one of the most important beliefs to help with esteem. Very effective.
Self-actualization
Some of us with chronic conditions that will require meds assistance probably forever. Self-actualization comes with the merging of who we think we are with who we actually are. The second step requires understanding the role meds play in this. And when you are able to “lock in” on a regimen that works… and develop a routine that works… and you get these elements in line? That’s the sweet spot.
The other side of self-actualization is noting that you are not attempting to assimilate into “normal.” You’re simply looking for your version of “functioning” and “thriving,” whatever that might be.
Also – Maslow fully believed that a person had to have a good sense of humor about themselves to be truly self-actualized. In this case, I should be a deity.
Meds Shouldn’t Be This Hard to Obtain
The purpose for all of this is to express my frustration at finding yet another provider. I had my every-three-month 15-minute appointment with my psychiatric nurse practitioner today. He is being relocated so I will have to start all over with a new one. Because I intentionally sought services from an actual clinic, they have a replacement for me to go to if I want to.
This is the revolving door of psychiatry services that exists pretty much everywhere. I ran out of a medication two days ago. Subsequently, I was doing a piecemeal job with very old prescriptions to reach 1/4 my usual dose. I knew I had this appointment and figured I could make it work. And I did. No one really needs a good attention span or the ability to concentrate anyway. They, too, are just luxuries.
My appointments with these providers cost around $200 per 30 minutes. Insurance covers none of them. My session consists of telling this person that everything is the same because I have been on the same medication regimen for four years with very minimal episodes. They say, “That’s good.” Then they send in the medication refills for the next three months and for 90 days, I don’t have to be concerned about having access to my necessary treatment. At the end of 90 days, each time, I basically have to hope I can track down someone to call them in.
In four years, I have had to reach out to at least six random providers to see if they will refill them because whoever did the last batch is no longer available.
Here’s the thing: I have the physiological, safety, love, esteem, and self-actualization to do this. And I am often at wit’s end, concerned/embarrassed that I can’t find anyone to fill them, and these are the things that make me feel like I am drug seeking even though I am only asking for the exact same pills I’ve been on consistently for years. The point of reaching the “maintenance” stage of mental illness is to not have to do this anymore.
But I always think of the people who do not have the privilege that I do in any of these elements. This is how people just quit. Or they stockpile for fear of not being able to get any when they need them. This leads to disjointed amounts and sporadic use, which undermines their efficacy greatly. Not to mention the potential for overdosing.
I am thankful I have my physician in place. I will try to maintain with a psych NP so that the pressure doesn’t fall only on her. But the knowledge that I can simply request a refill with her nursing staff and the prescriptions will be ready in less than an hour is like the weirdest but most comfortable blanket on earth.
There is no blame here except on the meta level of “how we as a society treat mental illness.” It is just a ridiculous experience that mightily takes a toll on everyone involved.
I guess the slogan is “Difficulty obtaining med refills hurts everyone.” Someone get the sad egg ready to roll.
Difficulty obtaining med refills does hurt everyone! It’s not my personal hell but in our household we hold our breath every month that my partner ‘s doctor calls in his meds, or that at least he’ll get a return phone call letting him know if his doctor is still there. And he/we are the lucky ones with resources, time, and energy to actually track this down every month and weather the storms when it doesn’t work out. Basically in a very wordy way I’m just saying thanks for sharing, it was a good read!. And I’m sorry you deal with this, that sucks. And I’m glad you got tour meds.