A long explanation to a little question:
Since I was first officially diagnosed with depression in late 2003, I have seen both psychiatrists and psychologists.
I've told the story of post-Peace Corps time before (severe depression, some post traumatic stress anxiety, brief hospitalization and then intensive out-patient treatment), but I don't usually tell the story of how I got there. In early October winter was about to hit full force in Mongolia. It had already snowed twice and I was sitting in my ger in Telmen (a small village in the Altai Mountains in the Westernish region of the country) and I knew that I couldn't continue living like I was. I had stopped taking care of myself. Stopped trying to get water, stopped chopping wood, started letting my best friend's family take care of me. Some days, I didn't stop crying. The one year relationship that I had been in had recently ended and I couldn't muster up any reason to continue putting one foot in front of each other.
I went into the capital, Ulaanbaatar, and talked to a very kind Peace Corps Medical Officer from China, who made me dinner and told me that I was young and resilient. She didn't understand why all of the volunteers fought so hard to stay in a country where they were so obviously struggling on a daily basis. She said that life was long and that I would have many, many more opportunities to volunteer and many more adventures. I couldn't comprehend anything that she was saying. All I felt like was a giant failure and a fool. She convinced me that I should go to America for counseling and medication. I was told that if my treatment went well, that I could go back to my village and continue the work that I had started over the last 18 months.
On the plane ride, in the business class section, the head Medical Officer that traveled with me told me that I wouldn't be coming back to Mongolia with Peace Corps. He said that I was considered a risk to myself and others - an unacceptable risk to the U.S. government. When I landed in Washington D.C., I found out that I wouldn't be staying in a hotel. They forced me to check myself into a nearby hospital, in a locked and controlled Psychiatric Unit.
I spent six of my longest days there. I tried to re-adjust to hearing English spoken all around me by watching daytime television and countless movies. I didn't sleep and barely ate. My anxiety was the highest it has ever been and all the rounded spoons and bolted light fixtures made me want to cram something into my eye socket, just to prove that I could. They gave me an EKG and a chest X-ray, saying that it was standard procedure, even though I didn't have any physical problems with my heart or lungs. I was crying so hard when they took me down to be x-rayed (after cautioning me that if I tried to escape, they would call the police) that a nurse cruelly informed me that: "If you can't manage your emotions, we will sedate you." They gave me both an external and internal ultrasound (hello long tube with a camera and a condom!) for some bleeding and pain in my uterus. I had constant headaches and the tell-tale dry mouth associated with starting an anti-depressant.
After discharging me from the hospital, I spent three weeks going to daily therapy sessions with a psychiatrist in Bethesda, Maryland. At the end of our time, he ultimately did recommend me for further Peace Corps service. The Powers-That-Be, however, said that I had lied on my pre-service medical questionaire about previous problems with depression. They told me that if I didn't accept a "medical discharge", that they would possibly pursue legal action against me. I had to drop my fight to go back to my village and it was told to me in hushed tones that I should keep quiet about the deal I was offered. I was never able to say good bye to the people that I had grown so close to.
With a medical termination, I was able to apply for a Worker's Compensation Claim through the government. Basically, I was classified as a "federal employee injured on the job". My claim was accepted, with the restriction that I could only seek psychological counseling from a Ph.D. psychologist or medical psychiatrist. I began seeing a therapist in New Hampshire, who helped me through some of my worst times. She helped me see that even though I had to leave unexpectedly, that I stayed longer than most people would have and had given 18 months of my time and heart to improving the lives of others, even if just a little.
Fast forward four years to present day. I still have a lot of guilt and shame. I don't wake up anymore wondering what country I'm in and how I got there. I don't have as many panic attacks during movies or while reading books. I don't think that I'm in immediate danger all the time, like I used to. I got pregnant, had a child, moved to Texas, the rest...well, you all basically know the rest.
So, yesterday I talked to a psychiatrist who agreed that I was most likely having an interaction between the two medications that I'm on (my seasonal birth control and Z*oloft). She agreed that in addition to therapy, a psychiatrist should oversee my medication managment (to use the correct buzz phrase) as part of an integrated treatment plan. She's supposed to call me today to verify her schedule and finalize our appointment time. Yes, though, you were all right in that it is VERY DIFFICULT to find a psychiatrist that will (A) accept new patients (B) do more than just prescribe pills and leave the 'talking cure' to a therapist and (C) accept Worker's Compensation insurance.
I've been down a long road. This is a curve along the way, not a cliff that my car is creening towards. I can see that. For once, I can actually see that and that feels good.