This post was originally written in May of 2018. Continue to read to the end for an update from today.
I have been talking a lot about my Avoidant Personality Disorder. Which has made me feel like an ambassador of some kind. But then I started thinking about my diagnosis, which was less than facebook official, and became suddenly wary. (Which ticked my anxiety into high gear ironically—feelings of inadequacy, “I’m a fraud,” blah, blah, blah) I don’t want to go into how I was diagnosed and subsequently medicated (boy, that sounds nefarious) but technically, well, I’ve already mentioned it once before on this very blog so you probably already know… Cutting to the chase, I got my anxiety disorder diagnosed by my general doctor and not a psychiatrist.
Psychiatrist seems more legit, right? That’s what I thought too. So after a confusing series of emails to my doctor, the poor nurse may have thought I was some kind of nut (nothing’s wrong I just need legitimacy. No, I don’t want to hurt myself or others to get it. She wasn’t wrong about the nut part, but that’s not the point) I get an appointment with a counselor. They must deal with worse because she gave me a referral to the same counselor I saw when I first started my meds with very little hubbub. A counselor is like a psychiatrist, right? I think to myself. Either way I don’t want to be too much trouble, so I take it.
Now like I said, this was not the first time I’d met with this woman. This woman sounds like I didn’t like her, that’s not true. I’m just not sure of the protocol when discussing a counselor you’ve seen twice in one year. It’s not polite to name her on the internet, right? Let’s just call her Maureen (her name is not Maureen, repeating that for legalities.)
So Maureen was technically a social worker. When I think of a social worker I think of a poor bedraggled person shouldering the most broken parts of society. Maureen’s posture was way too good for that much shouldering. She had a pleasant smile, straight pin grey hair, and a voice like a metronome set on the slowest meter (which I imagine is calming for a lot of people. Not me. But I was raised by a woman who talks a mile a minute. So much so that the Gilmore Girls seem almost laconic. That’s a bit of an overstatement. After all, the daughter in Gilmore Girls gets a word in every once in a while. Clearly I’m getting all those words in now. Back to what I was saying. What was I saying? Oh right, Maureen.)
So, the appointment comes, and Maureen and I are joined by another nut job. Surprise, it was my son! John was going to watch him. That was the plan. After all, he knew how important this was to me. (What if it turned out that a psychiatrist thought I didn’t have AvPD? This was good news to John, terrifying to me. If I didn’t have AvPD that means I am just an over sensitive pain in the ass, right? Not even a clinical one.) Either way, turns out John has an important lunch meeting and can’t watch him so my two year old is along for the analysis.
It does not start great. This is not Maureen’s fault. The last time I had seen her I had pretty much lied. No, not lied, I deflected. (The truth was that I masked who I really was, but I wouldn’t realize that until much later.) I portrayed myself as a reasonable human being with some social anxiety. Not a problem at all, not like the real problems I’m sure you see everyday. I mean, you’re a social worker. You must see a lot of problems. Please like me. And on and on like that. (My son was there for that one too but he was just one and so merely interested in shiny things. By this point in the second appointment he has already tried to climb her lamp, take the phone off the hook and bite her shoe.) So in between my frustrated and embarrassing attempts to corral my son with my cell phone, she hands me a “mental health plan” based on our last appointment.
I stare at it as she reads it aloud, so slowly that my eyes are about to pop out of my head from the need to speak, to explain why I am there. I interrupt her, still staring at the paper thinking, I can be this person. This person with “social anxiety” and “impaired moods.” That seems simple—but I can’t, that’s not why I am there. So I explain about the Avoidant Personality Disorder, what I spoke about with my regular doctor, about the meds he put me on, about the fact that I wanted to be sure, and that if someone could at least tell me I’m on the right meds or better meds, or at least be sure that the meds are working. (I throw in the part about the diet at some point. Which makes me sound crazy again, but a more pretentious form of crazy.) And then I ask— well, what do you think?
She stares at me for a moment, clutching the paper she had prepared for our meeting. I don’t blame her. It came out pretty fast, and in between moments of dragging my son back to the chair by his overalls. She thinks for a moment putting down the paper and says, “Well, a personality is like a tree.”
What she says from there is technically correct if strangely arbor-centric. It just literally has nothing to do with what I have asked her. It’s also a somewhat canned explanation. I am not a fan of canned explanations. I’ve been on the debate team, I’ve seen behind the curtain, I know what a pivot is—and mostly it’s insincere. But I have to give her a break. I ambushed her after all.
After a moment she asks, “so obviously you feel you avoid things…” in her slow, slow metronome. I raise my own brow.
Is she stalling for time? Does she know actually know what Avoidant Personality Disorder is or did she literally just take the three words I said most and explained them, first personality, then disorder, and now avoidance? Is she analyzing my mental state– phonetically?
So I say, “Well, no. Avoidant Personality Disorder is more about the fear of judgement and criticism, more importantly of deserving that judgement and criticism. It’s not like I am avoiding the outside world, just the majority of people in it,” I pull the little prince’s finger out of the hole in her croc sandals.
She gives me a long explanation about how I need to tell myself that judgements happen. And if it seems like the woman at the grocery store is judging me, I need to accept that and let it go.
I stare at her, feeling incredibly judged. (Not surprisingly, I guess, considering the disorder in question.) What she is saying is not wrong… But… HOLY SHITBALLS, LADY! IF IT WERE THAT EASY I WOULD NOT BE HERE!
At this point, I start to cry. I feel so stupid. She doesn’t think I have it, my big fear is coming true. She even says, “Well, that’s not what I diagnosed you with,” she points at the paper as if relieved to finally be getting back on track. She stops though, confused, and asks, “What’s with the tears?”
The baby groans, as if even he knows this is a stupid thing to ask in a counselor’s office. (Really he just wanted to climb under her desk but the death grip I have on his belt loop has dragged him back yet again, foiled.) Nonetheless I try to explain myself.
“I’ve always assumed that these problems were just character flaws,” I sniff. “When I found out about the disorder. It was like there was a chance that I could be better. I know that I will never be a hundred percent. I know that these thoughts will never be gone. But if there is a chance that you, or a psychiatrist, or someone can give me the right tools, the right meds…. the meds my doctor prescribed me have helped me a lot. And my diet, it’s helped too. But…”
I run out of words.
Maureen goes into another canned speech about cognitive therapy. Once again, she’s not wrong. But I’ve worked myself up so much that the negative thoughts and behavior that cognitive therapy is supposed to combat have just taken over. And now I am suspicious of her. Suspicious that she thinks I am just a drama queen making all this up (there’s that petulant response to perceived criticism. Why did I think I needed a second opinion again?)
Finally, the poor woman, a little slumped now because she clearly does shoulder the broken parts of society, myself included, asks, “Well, would you like a consult with the doctor?” She means the resident psychiatrist all the counselors answer to. She means the psychiatrist that I have clearly decided will have the final answer to what the heck is wrong with me. I can feel myself straighten up as I say, “Uh, yeah. That would be great, thank you.”
She says some other things. Things that looking back I realize were actually insightful. I was just so uncomfortable with her slow speech that I was about to bolt, picking up the kid like a suitcase and walking out the door. She says other things that are less insightful, and some that just keep repeating in my head over and over with the question, “Wait..was that an insult?” so much so that I once again remember that I truly am crazeballs. (Maybe not diagnostically crazeballs, but crazeballs for sure.)
Finally, she sends us out, her posture straightening as she hands me a paper prescribing a consult to the other doctor. I’m his problem now.
Was it worth it? Yes and no.
One of the worst aspects of this disorder is that I grab ahold of the things people say and never let it go. Unfortunately it is usually the negative things that stick the most. But that same tenacity and persistent memory can also be used for good advice. No matter how canned the speech was, Maureen was totally right about cognitive therapy. When moments like that happen, the obsessive bad, you have to confront that negative thought or behavior and assess it for what it is. Her calm slow speech will definitely come back to me just as much as the panic and fear. And maybe that slow meter is the one that might calm me most? Who knows?
It will also be nice to have that second confirmation if the psychiatrist agrees with my Avoidant Personality Disorder.
If he doesn’t…?
The truth is, I know myself the best. And even though my mind is constantly analyzing what other people think they may know about me— I still know me best.
Looking back at this post, several years later, after the psychiatrist that was supposed to be the final arbiter on my identity, misdiagnosed me with Bipolar Disorder, and then put me through side effect hell for over a year… I can only think that I had the right of it from the beginning. Not necessarily the Avoidant Personality Disorder, because it did turn out to be Autism Spectrum Disorder and Inattentive ADHD- both of which are closely related in symptoms to AVPD. But I was right about who I was. I knew who I was. Why I so easily gave my life up to people that I had spent less than an hour with at the time…I don’t know. And that was my big mistake.
My psychiatrist and I got it right in the end, I have the right meds and hopefully the right diagnoses, but only after I demanded that he listen to me. That’s the only way, reader. Your knowledge of your experience has more weight than the DSM. Demand proper help.
That’s another Emily McDowell— “Everything is fine” pill pouch. If you can’t tell, I love sassy typography and stationary. Buy her stuff so that she can make more sassy cards and pouches.