Does this sound like a psychiatrist who isn’t trauma-informed and is it reasonable to seek someone else?

[erik]

I’m asking here because I’m worried my care may not be trauma-informed. I’ve been diagnosed with CPTSD, depression, dissociation, and I experience constant fatigue. I used to work part-time, but over time my fatigue worsened to the point where I couldn’t continue, and I’m now on full disability.

I’ve tried multiple antidepressants and anti-anxiety medications, but they’ve had little effect. Trauma has barely come up in my sessions, even though CPTSD is a formal diagnosis.

During the day I mostly use the internet for distraction, both because I feel too depressed and exhausted to be active and because it helps me cope with mental pain. If I’m not distracted, I easily get panic and emotional flashbacks.

My psychiatrist has suggested that I might have mild, undiagnosed autism and that I’m stuck in rigid behavior, which he believes explains why I don’t do much besides using the computer. This doesn’t seem correct to me, I feel more exhausted, unmotivated, and driven to distract myself. He prescribed a medication for “rigid behavior” and said he was sure it would change my life a lot, but it had no effect.

He also thought my exhaustion might be a medication side effect, but changing medications didn’t help. I’ve wondered whether my fatigue could be trauma-related, especially given physical symptoms like a very low heart rate and muscle shaking, but he has never brought up this as a possibility or medications for CPTSD.

He now wants me to return to work and think it will help, even though I've said that I feel just as exhausted.

Does this sound like a lack of trauma-informed care and would it be reasonable to push back or seek a different psychiatrist?

Thank you for reading, I really appreciate any perspectives.

 

[Movingforward10]

Is it easy to get a second opinion?

I don't feel qualified to answer your question. But my experience of the medical professionals (bearing in mind I have never had an appointment with a psychiatrist) is that they are very medical model minded and not trauma informed at all.

What I'm hearing is that you don't feel heard and that the treatment plan he has put together isn't working for you. So a second opinion, a the very least, sounds a really good option.

 

[Ed1905]

Everybody on here should try med called Hypovase , it worked very well for me but never stop taking it suddenly , you must do it very slowly to begin with and come off it very slowly. I have experience of coming off it suddenly and you do not want to know how I felt for 2months! It was my doctor who told me to stop it, but I’m stabilising now after a slow reintroduction!

 

[OM_™]

During the day I mostly use the internet for distraction, both because I feel too depressed and exhausted to be active and because it helps me cope with mental pain. If I’m not distracted, I easily get panic and emotional flashbacks.

Ditto: Do you also find yourself unable to speak and question their authority?

I am a nearly 70yo male and have had a male psychologist, female hypnotherapist, another 2 female psychologists, a female counsellor; now onto my second psychiatrist. It's OK to get a second opinion.

Because I was sexually abused by a man, I am uncomfortable talking about intimate details with male psychologists — my first psychologist was male — and basically told me to "man-up" (my words, not his) and my last session ended with him saying, "So you were abused as child, that was the past. You are here with your beautiful young wife; are you going to walk around as a cripple all your life, limping and saying to people, "Look, I have a broken leg!" He never addressed my nightmares and frequent anxiety attacks. If I was female, they would have called it rape, but as an 8 to 12yo hyper-sexualised boy with an easily aroused penis, I must have enjoyed it.

Sometimes, after visiting my psychiatrist and feeling like crap, I would describe my feelings to the private AI Doctors on MyPTSD and found it quite useful as they gave me responses that I had not considered to take to my next psychiatric session.

FYI: I have been officially diagnosed with MDD, CPTSD, ADHD and OCD. As a survivor, that's quite a collection of acronyms.

 

[Resilientbibliophile]

Greetings and no claim to ultimate authority as I write this...

Similar profile here in relation to CPTSD, disassociation, a deep reluctance if you will to engage others in public (and work) environments where I just feel wholly uncompetitive and too dysfunctional to hide or mask my despair for any great length of time, etc. Ugh - the continual search for agreeable social (and professional) circumstance where I might better contribute, be at peace with the stated mission, and not necessarily be at war with all I observe, overhear, and fitfully react to. Sometimes grimly determined here, but usually just empty faced and grim...

By design a bit of tension is good within psych. care environment if a certain baseline trust and mutual respect exists between parties given one is presumably wishing for improved function and a better quality of life, hence stasis or just tacit agreement not to contemplate change isn't strictly good either. Variations on the theme of what do you want and how to get there are suggested. If a caregiver in some sense isn't pushing me, the greater fear here is that I'm just so many billable hours and that I've lost their interest and respect which is an awful circumstance to contemplate. Even a succession of quite gutting defeats for experiments made may translate into greater acceptance and a more battle tested understanding of limits of what one can do for having intelligently risked this and that. It's something...

Yes - quietly explore your options in relation to seeking what might be more effective care if such can be secured, although be ready if in an immediate sense that it may not or that establishing some path to a different care situation might take time. Certainly don't burn bridges to the extent of rashly letting fly frustrations with a therapist, appreciating that it may be necessary to spell out in a dignified and controlled fashion specific concerns consistent with being heard and influencing for the better whatever dynamic has been worked up to date. Like any relationship, endeavor to lean in and invest so that possibilities to elaborate and refine understanding between parties is explored to the full. Sometimes too one will just come up against hard limits and register that the extent of things has been wholly investigated and explored - and thereby be prompted to redirect one's energies in a new direction.

Just guessing here, but I suspect the therapist might be a bit young, perhaps new to the field (or just shifting careers midstream and slowly coming up to speed), or comparatively untouched by trauma consistent with running up against empathetic barriers to afford you more than they do. It can happen where one is situationally invalidated by not by those necessarily evil, but rather just out of their depth and/or clueless. Some therapists harbor greater developmental potential that might be cultivated and matured out in a two-way street sense - but others no so much. It happens too that cost of care may be closely tied to the quality of care availed, but then we each seek the best fit wherever we might seek or discover such.

If it helps, across what would pass for my 'care career' concerning what has been tried, usually I've found myself in the role of almost instructing and certainly coaching my therapist (or whomever might be on the scene) concerning the experience of PTSD given many a practitioner has a definition of such in their head, although it seems few have actually been hobbled by the day-to-day effects of living with the same. A single explanation and linkage to a particular occurrence doesn't usually suffice, but rather careful and controlled reiteration of what becomes a predictable linkage of cause and effect to stressors and triggers may break through to a caregiver - eventually and consistent with building respect and trust both; i.e. the therapist observes the patterns and behavior one evidences, slowly recalls the framework afforded as to why it might be so, and understanding improves. Writers of books on the topic of PTSD sometimes fall into the same habit of frontloading descriptions and/or the parameters of what PTSD is to the extent of affording the reader a tangible definition and confirmation of what's going on, but then affording maybe 20% of the overall presentation to referral to caregivers who (somehow) possess sophisticated expertise not explicated in the text consistent with bringing forth a cure or release which is overstating matters.

For the passage of many years and for interacting with many care providers, in a manner of speaking I expect/demand more of myself for almost working up a personal owner's/operating manual concerning what it is I can do and what I shouldn't strictly risk, this teamed to reduced expectations concerning just how much or how skilled care is really going to be availed me given the persistent and endlessly elaborated upon awful memories present upon my mental hard drive. Not exactly 'racing for the cure' here, expecting life long struggle and imperfect containment of much unpleasantness and sometimes fitful adaptations to circumstance based upon very deeply set habits and proclivities. I wish you well looking forward...

 

[erik]

Is it easy to get a second opinion?

I don't feel qualified to answer your question. But my experience of the medical professionals (bearing in mind I have never had an appointment with a psychiatrist) is that they are very medical model minded and not trauma informed at all.

What I'm hearing is that you don't feel heard and that the treatment plan he has put together isn't working for you. So a second opinion, a the very least, sounds a really good option.

I don't know, but I'll ask and see what can be done.

Ditto: Do you also find yourself unable to speak and question their authority?

I am a nearly 70yo male and have had a male psychologist, female hypnotherapist, another 2 female psychologists, a female counsellor; now onto my second psychiatrist. It's OK to get a second opinion.

Because I was sexually abused by a man, I am uncomfortable talking about intimate details with male psychologists — my first psychologist was male — and basically told me to "man-up" (my words, not his) and my last session ended with him saying, "So you were abused as child, that was the past. You are here with your beautiful young wife; are you going to walk around as a cripple all your life, limping and saying to people, "Look, I have a broken leg!" He never addressed my nightmares and frequent anxiety attacks. If I was female, they would have called it rape, but as an 8 to 12yo hyper-sexualised boy with an easily aroused penis, I must have enjoyed it.

Sometimes, after visiting my psychiatrist and feeling like crap, I would describe my feelings to the private AI Doctors on MyPTSD and found it quite useful as they gave me responses that I had not considered to take to my next psychiatric session.

FYI: I have been officially diagnosed with MDD, CPTSD, ADHD and OCD. As a survivor, that's quite a collection of acronyms.

Sorry, that doctor treated you very badly. My current psychiatrist seemed to try to shame me for not having worked much during our first session.

He often asks me what I think about what he has said, but it feels like it might be only performative. I'm pretty sure I'm stuck in the freeze shutdown/flop state. I only know a little, but my exhaustion, depersonalisation, brain fog, shaking and stiff muscles and abormally low heart rate are typical symptoms I believe.

I told him I've read a little about dorsal vagal shutdown and wonder if that's what's going on. He said that's impossible since people can only be in such a state for a few days and moved on to another topic. Even if I used the wrong medical terms, he seems to completely dismiss that trauma and freeze might have anything to do with my symptoms, which I feel is strange, especially since I was diagnosed with CPTSD.

Greetings and no claim to ultimate authority as I write this...

Similar profile here in relation to CPTSD, disassociation, a deep reluctance if you will to engage others in public (and work) environments where I just feel wholly uncompetitive and too dysfunctional to hide or mask my despair for any great length of time, etc. Ugh - the continual search for agreeable social (and professional) circumstance where I might better contribute, be at peace with the stated mission, and not necessarily be at war with all I observe, overhear, and fitfully react to. Sometimes grimly determined here, but usually just empty faced and grim...

By design a bit of tension is good within psych. care environment if a certain baseline trust and mutual respect exists between parties given one is presumably wishing for improved function and a better quality of life, hence stasis or just tacit agreement not to contemplate change isn't strictly good either. Variations on the theme of what do you want and how to get there are suggested. If a caregiver in some sense isn't pushing me, the greater fear here is that I'm just so many billable hours and that I've lost their interest and respect which is an awful circumstance to contemplate. Even a succession of quite gutting defeats for experiments made may translate into greater acceptance and a more battle tested understanding of limits of what one can do for having intelligently risked this and that. It's something...

Yes - quietly explore your options in relation to seeking what might be more effective care if such can be secured, although be ready if in an immediate sense that it may not or that establishing some path to a different care situation might take time. Certainly don't burn bridges to the extent of rashly letting fly frustrations with a therapist, appreciating that it may be necessary to spell out in a dignified and controlled fashion specific concerns consistent with being heard and influencing for the better whatever dynamic has been worked up to date. Like any relationship, endeavor to lean in and invest so that possibilities to elaborate and refine understanding between parties is explored to the full. Sometimes too one will just come up against hard limits and register that the extent of things has been wholly investigated and explored - and thereby be prompted to redirect one's energies in a new direction.

Just guessing here, but I suspect the therapist might be a bit young, perhaps new to the field (or just shifting careers midstream and slowly coming up to speed), or comparatively untouched by trauma consistent with running up against empathetic barriers to afford you more than they do. It can happen where one is situationally invalidated by not by those necessarily evil, but rather just out of their depth and/or clueless. Some therapists harbor greater developmental potential that might be cultivated and matured out in a two-way street sense - but others no so much. It happens too that cost of care may be closely tied to the quality of care availed, but then we each seek the best fit wherever we might seek or discover such.

If it helps, across what would pass for my 'care career' concerning what has been tried, usually I've found myself in the role of almost instructing and certainly coaching my therapist (or whomever might be on the scene) concerning the experience of PTSD given many a practitioner has a definition of such in their head, although it seems few have actually been hobbled by the day-to-day effects of living with the same. A single explanation and linkage to a particular occurrence doesn't usually suffice, but rather careful and controlled reiteration of what becomes a predictable linkage of cause and effect to stressors and triggers may break through to a caregiver - eventually and consistent with building respect and trust both; i.e. the therapist observes the patterns and behavior one evidences, slowly recalls the framework afforded as to why it might be so, and understanding improves. Writers of books on the topic of PTSD sometimes fall into the same habit of frontloading descriptions and/or the parameters of what PTSD is to the extent of affording the reader a tangible definition and confirmation of what's going on, but then affording maybe 20% of the overall presentation to referral to caregivers who (somehow) possess sophisticated expertise not explicated in the text consistent with bringing forth a cure or release which is overstating matters.

For the passage of many years and for interacting with many care providers, in a manner of speaking I expect/demand more of myself for almost working up a personal owner's/operating manual concerning what it is I can do and what I shouldn't strictly risk, this teamed to reduced expectations concerning just how much or how skilled care is really going to be availed me given the persistent and endlessly elaborated upon awful memories present upon my mental hard drive. Not exactly 'racing for the cure' here, expecting life long struggle and imperfect containment of much unpleasantness and sometimes fitful adaptations to circumstance based upon very deeply set habits and proclivities. I wish you well looking forward...

Thank you for the feedback.

 

[Muttly]

There's nothing wrong with seeking a second opinion. I'm curious if your psychiatrist is someone who is skilled in talk therapy. Depending on where you are, some psychiatrists are more skilled and focused on medical (primarily medications) management.

Have you talked to him about the concerns you have over how the treatment is going?

 

[erik]

There's nothing wrong with seeking a second opinion. I'm curious if your psychiatrist is someone who is skilled in talk therapy. Depending on where you are, some psychiatrists are more skilled and focused on medical (primarily medications) management.

Have you talked to him about the concerns you have over how the treatment is going?

Not directly but I told the nurse who calls me regularly to ask him if he's familiar with the dissociative "freeze shutdown"/"flop" state, and that people with trauma can be stuck in such a state for a long time, and not just days, and that since I'm diagnosed with CPTSD and dissociation, if he has considered that I may be stuck in such a state and that it is causing my fatigue.

I said to the nurse that I know that these are not medically correct terms, but I don't know if there are any other terms used for it. I'm worried I did a bad job sounding serious because of this and will not be taken seriously. The nurse said that I should accept my doctor's opinion as correct.

 

[Movingforward10]

The nurse said that I should accept my doctor's opinion as correct.

I think medical professionals like nurses will be guided by the doctors. They are all very medical model minded.
You are and should question what you're being told to see if it fits for you.
Being told to accept someone else's opinion just like that isn't helpful in my view.

 

[erik]

I think medical professionals like nurses will be guided by the doctors. They are all very medical model minded.
You are and should question what you're being told to see if it fits for you.
Being told to accept someone else's opinion just like that isn't helpful in my view.

Thank you and everyone else who have replied for your support, it helps me feel more confident I'm doing the right thing. It's hard for me to stand up for my opinions, so it helps a lot.