Here in London, and in Ontario more generally, there is a severe shortage of clinicians who are willing and able to both track patients’ medications and provide psychotherapy.
This is not an accident. It’s part of our biopsychological machine: it’s built right into Ontario’s funding formula and the emphasis on meds.
The easily predictable shortage matters to us all. But it’s especially pressing for people like me, because my mental health troubles were over-determined.
My Bipolar Disorder is grounded in a genetic predisposition. There are good reasons to believe that there was something atypical about my brain from the get-go. There’s family history. And there were early signs such as an attempted suicide as a pre-teen, along with what I now recognize to have been hypomanic periods in my final years at high school
I also lost my beloved first wife Hamila to cancer in my late 20s after a five-year illness – three surgeries, repeated chemo and radiation therapy, and the slow breakdown of her extraordinary mind and beautiful body. In addition, I suffered pretty severe childhood trauma. (I don’t blog much about that, out of respect for the privacy of others. But one episode illustrates the interplay of the twin factors. When I made an inept attempt to hang myself as a boy, my father found me – and beat me for not appreciating how economically fortunate I was.)
Either factor likely would have required remediation. In the event, their intersection led to my first serious breakdown at 28, about six months after Hamila died. I was unable to care for myself, or even to speak. I just spent hours rocking on the floor in my Boston apartment, in a near catatonic state. (My (mis)adventures with medications began about then.)
Here’s the impact specifically on me of the shortage, looking forward. As this blog attests, talk therapy in the form of DBT has really helped, and it can help still more. However, my condition is almost certain to be chronic and permanent. I’ll likely never be fully functional without powerful medications or brain stimulation. I’ll die taking them. So, I – and folks like me – desperately require multidisciplinary practitioners.
That’s just what our system discourages.
[Correction: I fear that what I wrote suggests both that all practitioners should be multidisciplinary and that all should devote hour-long sessions to their patients. That suggestion would be wrong and unfair. Specialists are very important. And many mental health professional make the hard choice, based on ethical deliberations, that it’s better for them to take on more patients, given the severe shortage of psychiatrists.]
Postscript: My latest homework from Dr. D – to whom I’m very grateful, by the way, for choosing to treat patients at great cost to herself – is to try to disentangle the effects of my early/adult life traumas vs. the effects of my peculiar brain chemistry and circuitry. The aim, in part, is to help tease out the bits of mental illness (tracing from either or both) which I need to “radically accept”. As you can imagine based on the above, it’s going to be a tough nut because of how tightly they interweave. Tips welcome.