Mental health, after postpartum “ends,” becomes a rough path. The only thing rougher is trying to leave the path and walk alone. I don’t recommend trying to walk alone. I’ve been seeing doctors and therapists since I was twenty-years-old, and the darkest times in my life have been before therapy and between therapists. I’m also a bit of an expert, now, in what to expect when seeing a new psychiatrist. I have been lucky, in that I’ve only ever had to see three, regularly, in ten years. The first appointment is always the same: I describe what I feel, how strongly I feel it, and I answer the very same questions, every time, about when it all began. Each doctor has had to determine for him/herself whether my previously recorded diagnoses were correct, so I don’t blame them, even if it’s no fun for me. (I did get pretty short-tempered with the 100,000 people who questioned me during my stay in the psych ward, at age 21, but I was suicidal, and answering the same questions 100,000 times. After my stay was over, I went happily back to my regular doctor!) Their first questions always have to do with what, exactly, I’m feeling, and how strongly I’m feeling it. Am I in danger? No? Let’s move on…

The next series of questions has to do with when I began feeling this way. Does this sound familiar to those of you who have seen a psychiatrist or other doctor, about your mental health? Have you wondered why they get so focused on when it all began? If you’ve experienced a perinatal mood or anxiety disorder, it’s obvious that the “when” is important! It’s in the name, after all. [Side note: the book doctors are supposed to use to diagnose PMAD gives us four weeks, postpartum, to experience symptoms. Four. I barely even remember my first four weeks postpartum. Doctors can and do fudge this, if they think it’s PMAD, because there’s a big lobby to get four weeks extended to six months.] The name of the diagnosis matters, because it can determine the medicines available to you, or even the number of sessions your insurance company is willing to “give” you with a therapist, or how many weeks you have to use up those sessions. 

What happens, though, if it’s been six months, or six years, and you don’t feel that you’ve “recovered” from what feels really similar to whatever got you that PMAD diagnosis in the first place? Well, a whole new world of possibilities and recommendations opens up. It can be a very scary world, because we may not have the words to communicate exactly what we’re feeling, and doctors use our symptoms to decide our treatments. This is a very subjective, delicate process. The process can take a long time. It can be discouraging. If you’ve heard the standard diagnostic questions as many times as I’ve heard them, you start to see a pattern. I can hear it, these days–the psychosis questions (Do I see things that aren’t there? Talk to people who have died? No? We can move on…) and the bipolar questions (Do I stay awake all night, without feeling tired? No? We can move on…) and the depression questions and the anxiety questions. There are also panic questions. Yes, indeed, panic is different from anxiety. Again, all of this matters, because our symptoms determine our doctors’ options for what they can write on forms and prescription pads, whether we’re eligible to participate in studies or drug trials, and, again, how our insurance companies treat our claim forms.

At this point, I’m usually given the most general of anxiety diagnoses, and I don’t often ask what my diagnosis actually is, because when it comes to anxiety, the names of the diagnoses simply match the descriptions of what I feel. Generalized Anxiety? Anxiety in general. Social Anxiety? Anxiety centered primarily around social situations, but not present in general. Panic Disorder? Panic attacks that occur at random, which is a special kind of fun that doesn’t have any discernible source, different from anxiety attacks caused by a known trigger that anyone would reasonable feel some anxiety about. You get the idea. The “disorder” part only comes in because it’s stronger and more difficult/impossible to deal with than what your average person experience–everyone experiences anxiety. In a bizarre way, I’m lucky. My symptoms are fairly clear-cut, if exhausting and painful, and I respond well to medication, with few side effects. If that doesn’t happen, you may find yourself on a long, hard road. At that point, doctors and patients need to work together closely, and trust each other, if it becomes unclear why symptoms last a long time, or why they aren’t easing up more with therapy and/or medication; symptoms are all we’ve got to go on, after all.

Good doctors and your more knowledgeable and patient loved ones can help a lot, if you find yourself trying a series of medications that seem to be all side-effects and no relief, or if you keep hearing that no one knows what’s “wrong.” This seems especially common with depression and bipolar, which just don’t appear with specific, consistent symptoms, the way anxiety and psychosis, do. A good health care provider will focus more on what helps you than on telling you what to call this experience. If the medication that helps you is usually prescribed to bipolar patients, then your doctor may write a number on a piece of paper that says “bipolar,” but you might not feel like you fit the standard description. That’s ok!

An insight that really helped me change my perspective on all of this has to do with this symptom-based, “do you respond to lithium/Zoloft/Ativan?” method: asking a patient and doctor to figure out exactly what symptoms are relevant, and how strong they are, is similar to what doctors used to do, when they were treating patients whose bodies were ill, before we knew about bacteria, viruses, and other things that we can measure and see. I certainly hope that a doctor has never described the “nature” of your fever, but that’s how it used to work, before we knew how to take someone’s temperature and what caused our bodies to get fevers. Because the brain is so darn hard to get a good look at, we have to look at all these other things that seem related to what’s going on in there. But we don’t know much of anything. Those brain scans the media loves to show us really only show where the blood is going. We can guess at what that means, and our guesses seem pretty good, but we don’t know in the same way that we know that somewhere around 98.6 degrees fahrenheit is a healthy body temperature. In other words: some sort of “meter,” like a thermometer, for brain chemistry would come in really handy, but we are nowhere near that place.

I don’t mean to sound discouraging; I mean to send out patience and a forgiving attitude, especially towards yourselves. You may encounter doctors who cling to the current system, in the same way that doctors once felt certain that figuring out what kind of fever you had was the absolute best way to figure out what kind of illness you had. They are doing their very best with the tools given to them, but you may want to look for someone who understands that the tools available have limitations. If you hear some scary names used to describe you, please don’t feel like those words have determined your fate. The scary names may change, and after all, they are really just medicine’s best attempt to describe the kinds of symptoms they, and you, can describe. Make sure that they, and you, keep your eyes on the prize: do you feel better than you did, before the most recent change?

I sometimes envy Warrior Moms who are given a clear-cut PMAD diagnosis, because they have an end in sight. Of course, it’s not that simple. I’m sure the women who have changed medications, a long and grueling process, envy my tolerance and responsiveness to meds. My very first therapist (coincidentally, she wasn’t a prescribing doc) told me something that I repeat, often: I walk a path. The path isn’t coming from anywhere, and it’s not going anywhere. Sometimes, I don’t walk on that path. My care providers and I work to get me back on to the path simply because it is easier to walk, there, than it is to walk across the ground that isn’t so smooth. I may never reach a point where I don’t have to think about that path. It may always take some work, from me, to stay on it. I might always need medication to smooth my way.

None of us will reach a destination called Finished. Whether or not someone writes a number on a form to send to an insurance company to get us medical treatment for how we feel, we are always going to have ups and downs. When will we get “better”? If we are asking about feeling better than we used to feel, then maybe the answer is: soon! But if we are asking about being completely healed, perfect, and never afraid or sad, ever again, well: never. The path is just not going to any destination, let alone destinations like Perfect and Finished and All Done.

Photo by Jonas Eriksson via Unsplash