Just Sick Enough

When you have a psychiatric diagnosis, there are times when it’s obvious you need help. Other times, it might not be as obvious.

I had to jump through some hoops recently to get seen by a psychiatrist with my new insurance. Among these hoops were multiple rounds of the same questions about the nature and severity of my symptoms.  As I tried to answer as patiently and honestly as possible, I was aware of feeling anxiety about whether I would be deemed “sick enough” to be worthy of care.

You see, although I have been under some form of care for many years, it’s been seven years since the last time I was in a hospital outpatient program and nine years since the last time I was hospitalized outright. I’m only on one relatively benign mood stabilizer.

In recent years, I have been aware of how lucky I am to be where I am. I work hard not to throw this good luck away by falling back into addiction or other self-destructive behavior. But should “doing well” mean I don’t need help any more? Especially with bipolar, where patients are quite likely to float out the door while in a happy place, stop their meds, and wind up in the ER?

So it’s a dance. Be sure to appear “sick enough” to be taken seriously, without appearing so ill that you get a level of intervention you don’t need or want. Be eloquent enough about what goes on in your head to make sure someone knows you aren’t “fixed.”

Why? Why not just have enjoy having fewer appointments and one less thing on your current record? My reason is simple: my condition means that matter how well I am doing, it is possible for me to have a serious episode and need more help. Having a psychiatrist of record means having someone to call for an urgent meds adjustment. In the event of dire need, it means I have a name to give the ER staff.

It’s regrettable that people like me must defend our need to be responsible and prepared for trouble.