How to get referred to a psychiatrist

First of all, I’m writing from a Canadian health care perspective but it should be similar in western countries where the health system utilizes General Physicians and Specialists.  I believe in th US, it’s got a similar referral system.   I’ve been through the system so I will explain as much detail as possible and provide you with some tips so you can seek help and start recovering.

If you are in an emergency situation, PLEASE go to your nearest emergency hospital for prompt treatment.  I know in major cities, there are emergency mental health hospitals that have psychiatrists onsite to deal with patients. Don’t be afraid of the mental health care system, it’s not what the internet perceives it to be.

General Physicans would be what we called family doctors, it’s usually the first point of contact in the health care system, they are like the handymen.  Psychiatrists are known as specialists because they specialize in mental health issues so you can’t just walk into a specialist’s clinic and expect the doctor to see you.  It just doesn’t work that way.  I know in Asia, at least in China, you normally would see a specialist directly but that’s a whole different health care system over there.

The first step is getting an appointment with your family doctor or physician.  This should be pretty fast, from a day to couple weeks.  Now this is very important especially with mental health issues, I know people tend to tell doctors about symptoms in a way that sounds less crazy because they do not want to be labeled “crazy” and they want the doctors to tell them they are fine.  This is wrong!  You have to be genuine and tell them everything that you are experiencing.  There is no shame and do not afraid, you are there to seek help.  If you want a referral to a psychiatrist, you have to be truthful with your doctors, do not hide any problems.  Some family doctors do overlook mental health issues so if they tell you “oh you’re fine, take some rest”, insist that they refer you to a psychiatrist if you feel like you need to.  Usually they will also perform some basic tests like blood test to make sure no physical issues in your case.

The next step in the process is wait….. a long wait… it took me almost a year and I think that’s the average for psychiatrists.  It’s very unfortunate that the wait time is so long but it is what it is.  The more awareness we raised about mental health issues, the more doctors the system will put into this field.

After months of waiting, you’re finally and excited to see the specialist(psychiatrist).  Same tip again, be genuine and tell him exactly what you are experiencing, don’t hide anything from him.  Remember, he is a doctor, he is trying to help you.  Mental diagnosis is just a label, what difference does it make if he diagnoses you with this or that?  There is no difference, you are still suffering and you will still need treatment.  Label is just a label, remember that.  Don’t read all the horror stories on the internet about how psychiatrists just stuffs you with medication, I’ve never experienced that.  Every one of them I met were nice and understandable.  They never pushed medication on me in any way.

Remember that mental health issues require longer term treatment so it’s important to find a doctor especially when you’re prescribed medication, to follow you up through the whole treatment process.  It’s not like a cold where you see a doctor once and the next time is god knows when.

I hope this helps all of you!

Drug Related DP/DR

Those who are curious, mine was not drug or cannabis induced, I’ve never taken any drugs in my life but I don’t think it matters.  Here is why,  I 100% believe that cannabis is just an external factor that contributes to the internal process that triggers Depersonalization/Derealization.  It is a trigger and trigger in many cases isn’t really important.  Trigger and cause are two very different terms.  Trigger is what starts the process and cause is what’s really happening during the process that causes all of your symptoms.  Prior to all of this happening to me, I had two small episodes of DP/DR which were triggered by fluorescent light, I’ve always had issues with fluorescent light.  When I went to my psychiatrist who specializes in dissociation, he said that fluorescent light is just an external trigger, there must be an internal factor that allows the external trigger to start the process, main thing is stress.

Many drugs are considered dissociative drugs and I’m not sure if cannabis is one of them but I believe cannabis should be one of them.  It’s no surprise that dissociative drugs induce dissociation.  Under normal circumstance, the effects of dissociation wears out when the drug leaves your system, no internal factor in this case.  If cannabis can induce permanent DP/DR then everyone who has taken it would have suffered from this condition.

But then there is the “bad trip”, from my readings at least from the book, “bad trip” tends to happen more during stressful period.  As you can see, there is always that internal factor which in many cases of bad trips is again stress.   So the question is why DP/DR becomes chronic after a “bad trip”?   My theory is that the drug has triggered the protection mechanism of the brain which your brain is already prone to during stressful period.  This is why people can take cannabis for years and not have a bad trip and suddenly one day, a small dose triggers chronic DP/DR.  You can find many examples of this on forums.  The research book I bought “Depersonalization : A New Look at a Neglected Syndrome” has a whole chapter about drug induced DP/DR and the interesting fact is that virtually they found no difference between drug-induced and non-drug induced.

Anyways, the point that I’m trying to get through is that whether your DP/DR was caused by drug or other triggers, it’s not as important as you think.  Like how my psychiatrist says it, the why sometimes is not always clear or important.  But of course, we’re not talking about physical causes that can cause symptoms of DP/DR.  Either way, we are looking for the same treatment and try to get better.

A good analogy to understand this is to take a simple allergy as an example.  Let say you develop skin rashes from drinking alcohol or certain juices.  Alcohol and juice are triggers and immune system reaction is the cause of skin rash.  The treatment would be the same, you would take some kind of antihistamines to reduce the reaction.

The reason why I’m writing this blog is there have been hot discussions of drug related DP/DR and non-drug related DP/DR.  My advice to everyone is DO NOT take drugs, it is not worth it.  I understand sometimes there is peer pressure but your life is much more valuable.

Stay strong people! 

Set a Goal: Now to new year.

I know many of sufferers are excessively browsing the Internet searching for answers and recovery stories, I ‘was’ one of them.  I understand it’s hard not to glue to Google but really they only provide temporary relief.

It’s wonderful time of the year, I know many of you probably can’t feel the atmosphere or feelings of holidays because you are dissociated but that doesn’t mean you can’t feel better.

Make yourself a goal, from today on to the New Year, get off the Internet temporarily and just enjoy the holidays with your family and friends.  If you’re alone, go out to the shopping mall or have walks in your neighborhood.  That’s what I did whenever I felt kind of disconnected, it does bring some normalacy back.

Just do something to distract yourself, whatever that may be.  Ski? Wonderful idea for this time of the year.  Or it can even be sitting at Starbucks for a day and just watch the people, bring a magazine along.  Just go out and do whatever you used to do.  I know how it might feel weird but the more you do this, the better you will be.  Tell your brain that you’re ready for life again, the fog can now be removed since you do not need it anymore.  Remember stress is a killer, by focusing and stressing out about your condition, you are inducing more stress on your brain which will make it worst.

Do it and report back… Trust me, even though you may not be able to feel the holiday time, you will feel better.

Cheers, happy new year in advance.  You guys will all be ok, true warriors!

Books on Depersonalization/Derealization

First of all, there aren’t many out there about Depersonalization/Derealization anyways.  But  I’ve read many and will try to give you a summary on all of them so you do not need to spend the money.  My general advice is that there isn’t anything that you will find in these books that you can’t find on the internet.  It’s wonderful that we live in the technology age where medical information is readily available.  I can’t imagine DP/DR sufferers 20 years ago, I truly feel their pain, perception on mental illness has greatly improved over the recent years too.

My advice to you is not to read a book but speak to a professional psychologist or psychiatrist and begin your recovery journey.  I’m not saying that those books aren’t good but this condition is not a condition that is suitable for self-help.  Behavior does aggravates the symptoms but this condition is more than behaviors, it’s your brain chemicals so speak to a doctor.

Here are some of the books I’ve read so far about Depersonalization and Derealization.

1. Overcoming Depersonalization Disorder

This book is really the only book specifically about DP/DR.  It mainly focuses on different therapies that can benefit DP/DR, for example, Acceptance and Commitment Therapy.  There is a section about treatment from a pharmaceutical approach but it’s limited.

1. Depersonalization – A New Look At a Neglected Syndrome

This is a research book, it basically puts all of the research that have been done by King’s College of London Depersonalization Research Unit.  I have heard that the lead researcher has left and the unit is not in a good state, very unfortunate.  This unit is really one of very very few centers that focuses on Depersonalization Research.  As the title implies, it is a neglected syndrome but it is a lot more common than what people think.  The target audience is really for the medical community, it goes into many theories of DP/DR and why they occurr.  This book also features different case examples and the treatments that went along with them.  It’s a good read but it’s expensive.

1. The Body Keeps the Score

This book mainly focuses on trauma related dissociation, like PTSD which can have Depersonalization and Derealization as symptoms.  It’s an interesting read but not targeted towards DP/DR.

1. At Last A Life

This book is mainly on DP/DR from an anxiety and panic attack perspective.  I think DP/DR can stem from anxiety and panic but there are many other causes.  I didn’t find this book useful.

My book collection on Amazon Kindle

Like I mentioned, everything is available on the internet, the books offer no secret.  I would greatly encourage that you speak to a psychiatrist to begin your treatment journey.  Instead of reading these books, an alternative is go out and live your life.  You can read eveything there is to about DP/DR and gain nothing from it.

There is a light at the end of this tunnel, the world is with you!

Psychiatrist: Journal writing and the subconscious healing

This is the third psychiatrist I’ve seen regarding my condition, I was given a dissociation questionnaire for the first time.  From the questionnaire I can tell you dissociation is a wide spectrum and complicated.  It seems like normal people experience dissociation quite often, it’s just part of the brain.  For example, you’re talking with someone and your mind wanders off into blankness and two minutes later you have no idea what was said.  One of the questions was similar to this and this is actually dissociation but of course it happens time to time with normal people.

My perception of psychiatrists have greatly improved recently because every one of them I’ve met are nice and honest so far.  They DO NOT just give you drugs unless they really feel like they help and they are optional, you are not forced to take any medications.  Please keep that in mind, it’s OK to seek help.

We started with getting to know me, very patient doctor that genuinely wanted to know my background and my culture.  We spent probably 15-20 minutes on my background and my family.  Then we went to the symptoms part, when I described the symptoms that I had experienced, he said they are symptoms of dissociation.  I said not many doctors know much about dissociation and he agreed but he said they should know about it, it is more common than people think.  We then went through the timelines of how my condition started to present in details.  Like all doctors, they are looking for any triggers.

I asked him “I really want to find out what’s going on in my brain and if you have seem anyone like me?”.  He replied “sometimes why is not always clear.”  which is sad but true and it is the limitation of psychiatry in today’s world.  Then I asked “do you think I should do more physical scans?”.  He replied “No, It’s not at the physical structure level, it’s really at the chemical level.”.  Like I mentioned before, we do not have proof or brain scan to proof this, hopeful our kids and grandkids will have access to these technology in the future.

Then he said dissociation is on a spectrum, on the less severe end we have Derealization, then Depersonalization and then others and finally on the severe side we have Dissociative Idenity Disorder.  Derealization is really a brain response to stress at a subconciousness level, a form of protection that your brain shuts down at a subconciousness level.   Another important and interesting thing he mentioned is memory time confusion which is common in dissociation. He said he understands it’s frustrating but use that as motivation to get better.

Then we talked about medication, he mentioned that medications in my case can be used as supporting role to help with anxiety, normally SSRI with a small dose of atypical antipsychotics but he said he wouldn’t give me anything at this point as he felt like I don’t need it.  But the combination is usually used to treat anxiety.  I told him that I have fear for medication and he asked why?  I mentioned that from the forums and internet, they can have severe side effects.  He said this is why sometimes reading too much can be bad.  I think it is very true.  Google lasik eye surgery side effects and it will scare the shit out of you, it is the same for psychiatric medications.  With Internet, there more negative stories than positive stories, there are side effects to everything.  My perception of medication is starting to change for the good, the most important thing is a good doctor that you trust to take care of you long term and not some doctor that you see once and get these type of medications.

Going back to Derealization, he said since it’s at a subconciousness level,  to get to the subconiousness level, we have two therapeutic approaches, hypnosis and journal writing.  Since they do not practice hypnosis clinically  he suggested that I start writing journal, write down every thought, behavior, feeling and actions.  I didn’t understand the logic behind journal writing but google it and you will find many benefits, it gives you access into your subconciousness.  Clearly this doctor knows a thing or two about dissociation.  My support friend who has fully recovered from Derealization indeed kept a journal during his illness, interesting eh?

Then he mentioned an article he read recently about dissociation, he asked “from your research, what’s the most common thing that causes dissociation?”.  I replied “trauma”, then he went on to tell me that he somewhat disagrees, he said genetic predisposition has a huge factor in dissociation and but it’s being overlooked because everyone thinks trauma is the only cause and they don’t focus on other causes.

Anyways you get the point, I think as far as a good psychiatrist with knowledge in dissociation, he is as good as you can.

With that I would like to wish everyone Merry Christmas and happy holidays! Cheers! Get better!

Depersonalization/Derealization – Reading too much is bad.

I’m writing this post to tell you guys why reading too much on this condition is bad.  I understand that you want to be better informed but at the same time, you have to understand that not much is known about this condition and while reading research papers can be interesting but they can also dangerous.

In the past few days, I’ve been feeling a little down and came across this article which made it even worst.  It talks about brain anatomy differences between normal people and Depersonalization/Derealization sufferers.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4275327/

In the conclusion part it states:

“Patients with DPD are characterized by extensive, but circumscribed alterations in brain anatomy rather than large-scale morphological aberrations as seen in patients with schizophrenia. “

Sounds scary isn’t it?  Extensive alterations!  But wait, read the other part of the article.

 

“Owing to the cross-sectional nature of this study, it remains unknown if the observed structural brain differences are best understood as risk factors for the development of DPD or as a result of the disorder.  Future studies should aim at capturing possible neuroplastic adjustments over the course of the disorder, using a longitudinal design and a sample of patients with recent symptom onset.”

Basically what they are saying is that they don’t know if the brain has really been altered as a result of this condition or our brains are different to begin with and those differences are just risk factors.  To study changes or alterations, it has to be over a period of time.  How can they conclude that our brains have been through extensive alterations but in this paragraph says they are really differences and they need to do a long term study to see the neuroplastic adjustments.

Research papers are just research papers and they don’t mean much, they can be completely wrong.   You get the point, because when I saw “extensive changes”, I was a little scared and that will just leave you hopeless.

I’m sure our brains are different than normal brains, no doubt about that.  But scan any psychiatric patient with anxiety, bipolar, anxiety, OCD and the list goes on, you will observe extensive anomalies in the brain.  It doesn’t just take one tiny spot in the brain to cause psychiatric symptoms I think, it is many things at work.

Now stop reading these things, you can be the master of condition and know everything but as long as these research papers haven’t translated into medical papers or training for doctors to provide treatment, you can’t do much about it.   So go out and improve your general well being and beat this beast.

“We human beings are the greatest survivors! We do not give up, we will fight to the last second!”

 

Memory and Time Perception

I still struggle with this up to today, although not as bad as when I first acquired this condition.  I have made good improvements in this area.

So what does this mean?  Let’s go back to pre-DPDR days.  Let say you went to the gym two days ago, as you are recalling the memory two days later, you know exactly which day you actually went to the gym, it just seems naturally clear.  Another example, you called your parent last night and the next morning, you are pretty darn sure you called your parent last night.  Now going back to DP/DR, this clarity and awareness somewhat is extremely fogged up.  Things you did couple hours ago seem like you did them ages ago, you have difficulty telling when a particular memory had happened because it feels so foggy and dreamy.  Sometimes you loose awareness of which day of the week is it, all because of DULL memories.  This is what I mean by memory and time perception and if you think of DPDR as a dream state, it totally makes sense.

Have you ever had these occasions where you’re sleeping deeply in the middle of the night and someone wakes you up and ask you something, you answer and you fall back to sleep.  The next morning, either you forget about that experience or if you do remember, the memory does not feel real, you ask yourself like did it really happened or did it happened in a dream?  Because DPDR sufferers are in a permanent state of this, all aspect of consciousness will have dream like qualities to them.

Another explaination is that memory is formed based on your attachment/interaction with environments and surroundings.  When that connection breaks loose and you become detached from the surroundings, your memory will automatically feel distant as well.  Time, on the other hand is based on your memory and the emotions attached to them, without vivid and emotional memory, your perception of time will automatically be affected.

If a doctor can induce some kind of half awake state on a patient, I bet this patient will describe exactly what we are describing.  Like I said the brain is a lot more complicated than we can possibility imagine but there are a lot of good stories out there about recovery.

My support buddy while I was struggle has fully recovered and he described after 3 years of DPDR and final recovery, at the end he described the recovery as “Rebirth, waking up from a long dream.”  And I will leave it at this.

DP/DR Recovery Tip #3

Like I said there are millions of ways to describe DP/DR.  From my readings and research, we just do not know much about it to really consider it as “disorder”.  When you associate yourself with a real disorder, you fear and you loose hope.  There is no scan to tell you you that you have this disorder, worst of all not many psychiatrists have any trainings on it and research does not have any definite criteria for diagnosis.  DSM just groups of bunch of symptoms together and call it a disorder. I’m not fond of the DSM, just because DP/DR is in the book, it doesn’t mean it’s a proveable and real disorder.  Homosexuality was in the DSM until late eighties, can you believe that?  It’s just a label, nothing more.

Dpselfhelp is just full of people with “similar symptoms” looking for help, simple as that.  Think of it as like the “headache” forum, people come to discuss a condition but the root causes can be totally different.

Think of it as some thing  not working correctly in the brain, maybe it will correct itself over time and heal!  Brain is truely a wonderful organ.

Get off the forum and stop associating yourself with the DP/DR disorder.

DP/DR Recovery Tip #2

Get yourself a gym membership!   This is exactly what did after I got the condition.  Whenever I feel a little down, I would hit the gym alone and work out. 

Physical excercise not only helps with your mood but I think it improves your overall health.  The other good thing about going to the gym is distraction.  It allows you focus on what’s present and not dwell on this condition.  

If you can’t afford a membership, get a sneaker and go out and run!  Do this consistently and you will see yourself improve.

DP/DR Recovery Tip #1

In the past year I find traveling seems to work wonder for distraction, you feel very normal during the trip because of all the new things that you’re seeing.

Like I mentioned, I went to many places in the last two years.  I went to Italy, Spain, France, Greece, Vegas, New York and LA.  My first trip after the onset, I was extremely nervous because I didn’t know how I would feel but my advice to you, just go and have fun.

It doesn’t have to be far, if you have a car, book a hotel and have a road trip.  You will realize that it actually feels pretty good.  Whenever I feel a little down, I would take my family on a small trip and it would take my mind off things. 

Listen to me!  You have one opportunity to live this life.  I know, I know, we have to deal with this sh$t but what’s happened has already happened.  You have choices to make, matter of fact, humans are the only specie that have choices, animals don’t.  Stay home, obsess on forums, suffering and looking for answer that does not exist OR go out, things might feel different but try to live your life to the fullest.  WE humans are survivors and warriors, we do not give up!

Give it a try guys!

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