Trigger Warning: This post contains mentions of depression and anxiety, as well as descriptions of some symptoms of these conditions, and brief mentions of suicidal ideation. Additionally, the subject of inadequate care from mental health professionals is discussed at length.
I was 11 years old the first time I was sent to see a counselor without my prior knowledge or consent. At age 13, I was sent again under these same circumstances, and then again at age 14. On this third occasion, it was also suggested for the first time that I consider medication. I resented this suggestion, just as I resented being sent to each of these counselors in the first place. No one had asked me if these visits were something I wanted or needed, and the counselors themselves seemed at a loss with what to do about me. They fumbled at my head with their shallow questions and their clichés, and they never seemed to recognize that their actions might in fact be making the situation worse.
These early negative experiences led me to develop a bias against therapy and medication that would last nearly 10 years. During that time I made a commitment to myself: whatever changes were to take place in terms of my mental health, I would meet them on my own—unaided and chemically unaltered. Essentially, I was opting to pursue the DIY approach to mental health.
I held myself to this approach—with mixed results—until my freshman year of college. After I suffered an extended panic attack (lasting about 3 days, total), I sought help from the health center at my school, and from there I was referred to the counseling center. I remember being reluctant about taking this step, even a little hostile. Fortunately, the counselor I was assigned to displayed an enormous amount of patience, agreed to and respected the boundaries I established at the beginning, and treated me as an adult capable of making my own decisions. Gradually I grew to trust and rely on her, and I continued to see her off-and-on throughout my time in college.
This new, positive experience served to dispel my reservations about therapy, but my opposition to medication remained unchanged. My hesitancy was due in part to the stigma surrounding psychiatric medication, but also to fears about potential side effects. The last thing I wanted was to undergo any drastic personality shifts, or to be left feeling enervated and detached from my own reality. Moreover, I felt at the time that medication was largely unnecessary for me. While I still suffered prolonged periods of depression, they had become more intermittent and less severe. Things had improved over all.
I maintained this attitude until, in my final year of college, something in me finally seemed to break. Shortly after graduating I found myself in crisis. My mental state had been deteriorating for the better part of a year, but the combined stress of the rush up to graduation and the sudden loss of structure my life suffered immediately after, along with the deterioration of a significant friendship around the same time, proved to be too much for me. I found myself in an emotional free fall, unable to perform basic self-care, paranoid about the state of nearly all my relationships, and hopeless to a degree that I hadn’t felt in years. Detailed visions of self-harm and suicide dominated my thoughts on a daily basis. Finally, after being advised by friends, teachers, and coworkers that medication might help to ease the distress I was feeling, I decided I was ready to pursue it as an option. I remember very vividly how it felt to come to that decision. Instead of feeling as though I’d failed in some critical way, I was actually relieved—excited, even.
Unfortunately, the process wasn’t as simple as I had hoped it would be. Prior to seeking out care, I made a promise to myself that if I felt at all uncomfortable with the psychiatrist I visited, I would not allow them to prescribe me anything. I wanted to be absolutely certain that the person in charge of meddling with my brain chemistry did in fact have my best interests in mind. Additionally, I tried to brace myself against the reality that even if I could get medication, there was no guarantee that the first thing prescribed to me would be effective. It could take multiple attempts, spanning a period of at least several months, before I found something that worked the way I needed it to. This knowledge made the already intimidating task of seeking help feel even more daunting, and had I not been motivated by the lingering memory of my recent crisis, this probably would have been enough discourage me entirely.
Yet I had made my decision and I intended to follow through with it, so I made an appointment with my first off-campus psychologist (who will be referred to here as Dr. L). Logistically, seeing Dr. L was problematic for several reasons. Unanticipated expenses emerged in the form of transportation costs (bus or cab fare to and from appointments), as well as the loss of wages I had to accept in order to take time out of work when the only available appointments were scheduled during normal business hours. Yet these concrete barriers to accessible mental health care were not nearly as frustrating to me as the obstacles I encountered once my appointments were actually underway.
Right from the start I knew that Dr. L was not a good fit for me, and that his capacity to help me would be limited, at best. When I told him that I was seeking help for depression, he informed me that he wasn’t used to treating depressed patients, and that he specialized in the more “exciting” disorders (his word). This was his idea of a joke, and although I understood his intent, I was still offended by the implication that a patient’s health was more of a concern when it also held some prospect of amusement for him. Dr. L also developed a habit of addressing me as “kiddo” during our sessions, which I felt was infantilizing. At the time that I sought his help, I was a 23-year-old woman, not a child, and being treated as such only made me feel as though nothing I said to him would be taken seriously. Instead of calling him out on this, however, I simply stopped telling him important things—defeating the purpose of therapy entirely. Yet in another instance, I did take it upon myself to explain to him why some of the things he said to me were problematic. During one session he offered his unsolicited opinion that sex should only take place in the context of a committed, monogamous relationship. I later confronted him about this comment and attempted to explain that it had some judgmental implications, especially given that he was speaking to a female patient who has been subjected to a culture of shame and limitation surrounding sex her entire life. Given that Dr. L had been practicing for several decades, I found it especially upsetting that this would not occur to him. Yet I found it even more upsetting that the responsibility to correct his ignorance fell on me: the patient, the untrained person, the one seeking help. Essentially, I was teaching Dr. L how to treat me as a female patient without reproducing and reinforcing the culture of shame that likely contributed to my condition in the first place.
This extra work on my part was both frustrating and exhausting, but I chose to continue with the therapy anyway. I tried not to lose sight of my original goal: to secure medication for myself. In order to do this, I had to wait 3 weeks for Dr. L to refer me to a psychiatrist working for his practice. When I finally had my appointment with this psychiatrist (who I will refer to as Dr. S) it lasted about an hour, and I left in tears and without the prescription I’d set out to get.
Dr. S turned out to be extremely condescending, and throughout the appointment he made a number of insulting remarks. Perhaps the most insulting was made in response to my medical history. When Dr. S asked if I had sought treatment before, I explained to him that I saw a counselor at my college off-and-on for 4 years, even though it was unusual for students to receive help for that length of time. Upon hearing this, he asked me if I thought my college counselor agreed to keep seeing me because I provided her with “entertainment value” (echoing Dr. L’s sentiment about “exciting” disorders). Of course he also failed to understand why I might be upset by this comment or any of the similar comments he made over the course of the appointment, and he interpreted my frustration as me being overly sensitive and unnecessarily hostile. The situation only grew worse from then on, as Dr. S’s attention waned. Toward the end of the hour, he pulled out a medication reference book and began to suggest a prescription for me. I stopped him and asked if before he did so, he might like to know what my symptoms were and how my conditions presented (something he had neglected to ask). At first he tried to tell me that he knew my symptoms because he knew my diagnosis, and I had to point out to him that not everyone suffering from a given condition will experience the exact same set of symptoms. He was visibly annoyed by this, but he agreed to hear me out. Except instead of actually listening, he began to thumb through his book, refusing to make eye contact and doing his best to communicate his annoyance and complete lack of interest.
Yet at the end of all this, he still offered to write me a prescription for antidepressants—which I declined. I left his office in tears and phoned a friend to come pick me up because I didn’t want to make my way home alone. All I could think about was how I had waited 3 weeks for this appointment, taken time out of work, paid a co-pay, endured an hour of casual insults and condescension, and walked away with nothing to show for it. In a way, I was proud of myself for sticking to my original commitment: I did not allow someone I did not trust to take charge of my care. I had stood up for myself and taken an active and assertive approach to my own mental health. But I was also aware that I was only able to do this because I was not in an immediate crisis. Had I been in serious distress, I might have overlooked Dr. S’s problematic behavior and taken the prescription he gave me without asking any serious questions. Looking back on this incident now, I wonder how many people end up accepting substandard care because their situations feel so dire—and the likely answer terrifies me.
This incident reinforced something I had known for a long time: the burden of my own care rests entirely on me, even at times when self-care is too demanding a task for me to undertake alone. As if this were not exhausting enough already, seeking help can introduce additional frustrations. Pursuing professional care can be costly, and the accessibility of that care is a constant concern. And finally, the fear of suffering an experience that only serves to reproduce stigma and trauma, or to create new variations of both, can act as a huge deterrent to the pursuit of care. It is not the responsibility of the patient to guard against their doctor’s prejudices or lack of awareness, nor is it the patient’s duty to educate their doctor to correct moments of ignorance or insensitivity. This extra emotional and mental labor is taxing, and ultimately renders the therapy ineffective as it creates more stress for the patient.
I never scheduled a follow-up appointment with Dr. S, though I did continue to see Dr. L until my health insurance expired later that summer. Since losing my insurance, I have not been able to obtain professional help, though I have also not made any significant attempt to do so. The thought of trying again to pursue professional treatment is too discouraging most of the time, and at the moment I’m not sure I could survive another failed attempt. To compensate, I have returned to my original DIY approach. I manage mostly on my own now, with some support from friends who have also struggled with their mental health in various ways.
Because I struggle primarily with depression, coping for me is less about identifying and managing specific triggers than it is about being mindful of how my depression presents itself. Rarely will a single event or encounter spark a depressive episode; more often my descent into a depressed state will be slow and imperceptible from day to day. The progression downward is always subtle, until one day the accumulated weight of it is crippling. To counter this, I try and monitor even the smallest changes in my mood, and to disrupt them if I begin to feel that they are trending downward. I also try to keep myself physically healthy by eating as well and as regularly as I can, practicing yoga 2-3 days a week, and trying to maintain a regular sleep schedule. When I feel particularly down, I’ll journal, or phone a friend I trust. And all of this works, for the most part.
But there are still days where it’s not enough. I’ll go to yoga and still walk out feeling anxious and afraid. I might try to call a friend, but everyone’s busy, or it’s too late and they’re all asleep. I’ll think about making myself a meal, but I’ll be too nauseous with anxiety to eat. I know that going outside would probably lighten my mood, but I won’t be able to pull myself out of bed. On these days, it doesn’t matter how many candles I light, how much calming tea I drink, or how many hugs and encouraging words I receive. My illness seems to emerge from nowhere in particular, and it never really leaves.
In these moments, I find myself wishing for extra help. I want someone to step in and take over, so I don’t have to be responsible for myself anymore. If I could take something just to minimize my feelings, to take a little of the edge off, I would. DIY mental health care has its limitations, especially for certain disorders. I’m fortunate that it has proved relatively effective for coping with my depression and anxiety, and I appreciate the degree to which this approach allows me to personalize my own care regimen and to practice it whenever and wherever I need to. And I have made progress. When I think about how much I’ve accomplished in the last few years, and how capable I feel now compared to even a few months ago, I know that what I’m doing works. Practicing DIY mental health care is an empowering exercise of my own capacity to heal, to unlearn harmful patterns of thought and behavior, and to take enjoyment from aspects of life that once seemed distant and foreign to me. It is a viable option for care, and one that I continue to rely on.
I just wish it wasn’t my only option. Choice is what’s missing in all of this. Yes, I can wake up every day and choose to practice self-care or not. But I’ve lived the alternative, and in the face of that reality it hardly feels like a true choice. It is a necessity. I must do what I can to manage given my circumstances, and my limited resources. Ideally, I would like my DIY approach to serve as a foundation for care, rather than as a substitute I’ve stretched to try and cover all my needs. But for now, I’ll work with what I have available, and I’ll continue to mark my progress with it, day by day.
About the Author: I am a 24-year-old woman currently living in Brooklyn, NY. I struggle with depression and anxiety, and I’m beginning to use my love for writing and literature to cope with my conditions and to explore the ways in which I can reach out to others who share similar experiences.