What is the difference, anyway? In short, drugs.
Reading the very funny and very entertaining “Maybe You Should Talk to Someone” book by Lori Gottlieb, (which was fiction, but based on her experiences as both a clinician and a patient,) brought to life for me the notion that psychologists don’t make people happy, but prescriptions do. I came into therapy over six years ago, after a personal breakdown that caused family and friends to intervene on my behalf. I’d been posting cryptic messages on Facebook, while I was contracting at Facebook, and then, I wouldn’t pick up my phone or text messages because I was trying to get some damn sleep.
“Psychologists don’t make people happy, prescriptions do.”
My paraphrasing of a funny quote in the Lori Gottlieb NY Times bestselling book called “Maybe You Should Talk to Someone.”
This perfect storm of sleeplessness, excited-ness, and self-medicating with liquid THC in my tea created what looked to clinicians like a bipolar diagnosis, but after five days in lock-down on a 5150, I went home, literally beside myself. I wouldn’t accept this medical label. I knew in my bones I wasn’t bipolar.
I did, however, take the advice to get some help with whatever my condition was, so I began calling all the psychiatrists on the list that the Mental Health Teaching Hospital (the first in the country, Langley Porter) gave me. There were thirteen shrinks on the list, and over the course of that first week out of the psyche ward, I warily began leaving voicemails for each of them. Only one called me back.
I began seeing Dr. Shirley, educated as both an medical doctor and a psychiatrist, the following week. At the time, I didn’t really know the difference between a psychologist and a psychiatrist, I just knew that this woman was taking new patients, (the supposed reason the twelve other doctors didn’t even bother to call me back) and that I didn’t want to be on an anti-psychotic medication long-term. I was following Dr.’s orders, having been sent home with some Lithium and some $700 Olanzapine. But I was also still self-medicating with my lifelong weed smoking habit. (I did give up the liquid THC tincture, subliminally knowing, that it was THE main culprit.) And while part of me was reluctant to go to therapy, part of me really wanted to begin to understand what was wrong with me.
Of course the first thing that Dr. Shirley wanted to do for me was to refer me to another doctor, one that had decades of experience with schizophrenia and multiple personality disorder. She explained that this other Dr., (who was German and whose first name was Edith, but pronounced Edit,) would see me on a weekly basis, to talk through my issues, but that I would go to Dr. Shirley on a monthly basis, to adjust medications. The distinction was that Edit was a psychologist but Dr. Shirley was a psychiatrist, a shrink who could prescribe me meds. Meds I didn’t want to be on.
And so, I complied, at first.
“I don’t need a team of doctors”
My assertion to my newfound shrink, in our second month of talk therapy.
But after just one visit with Dr. Edith, I refused this course of action. Not only was this other doctor telling me I couldn’t take notes while in her office, (something I did compulsively everywhere I went back then!) she wanted me to lie on the couch, stereotypically. She wanted to direct the conversations, probably asking all sorts of questions about my childhood. She had a thick German accent, and it felt to me like she was a female Sigmund Freud. I was in absolute denial that this woman would be able to help me at all, and I wouldn’t stand for it.
I also stopped taking the olanzapine and lithium, cold turkey. Thankfully, Dr. Shirley, who was new in her private practice after twelve long years of schooling and fellowships and residencies, stuck with me even though she disagreed and warned against with these potentially dangerous actions that I’d already taken. We were still getting to know one another. I trusted her about as far as I could throw her, which would be at least across the room. She didn’t trust me at all, and only had the Langley Porter psychiatric medical records to go on. Records that told of me self-presenting a chief complaint that I was a lead task rabbit in the Facebook hackathon, that I was “here” to see how doctors respond to the various messages they get from all their sources of information. Talk about crazy.
So Lori Gottlieb’s MYSTTS book, and accompanying workbook, are, in short, what I’ve done with Dr. Shirley over the past six and a half years. It’s talk therapy, with yourself. It’s a “courageous edit on your life’s story” as the back-flap of the workbook claims. Dr. Shirley has been kind, and patient, and empathetic, and an excellent active listener. She hasn’t forced any modality on me, and she’s let me lead the conversations, every. single. session. Which for a while, were twice a week. She knew I was not someone who could be told what to do. A patient, or a client, has to come to these very personal realizations about their lives on their own, or else the therapy doesn’t really work. (another declaration of Gottlieb’s book that I know to be true!)
If you’re considering a career, there are plenty of factors to ponder on the differences in these two occupations. But if you’re considering a therapist – and don’t need meds – probably a psychologist will do. Maybe even a counselor, which is to say someone not as educated. Maybe group therapy would be good!? The main distinction and the title of this post, is this ability to prescribe, which only psychiatrists can do. This article from psychology.org is a good primer on it. But this is very tricky business for a person to self-determine, especially when in crisis, and our broken healthcare system in America only exacerbates the issue(s).
I haven’t called it, but perhaps the new 988 hotline can help with this kind of resourcing.