The patient-psychiatrist relationship: it's a matter of trust

Anita is a SANE Peer Ambassador, mother, vet and writer who lives with Bipolar 1. From her experience of hospital and recovery, she reflects on the importance of a trusting and collaborative relationship with her psychiatrist.  

I don’t clearly remember the first time I met my psychiatrist. I was too sick.

My first encounter with mental illness was sudden and brutal. Psychosis swept in within a week of my first baby’s birth 14 years ago. That episode was the beginning of my bipolar 1 disorder.

On the evening my psychiatrist first met me he had no idea of the person cowering behind the symptoms in front of him. I was incoherent and detached from reality. A chaotic firestorm swept through my head. I said I’d never had a baby. I initially resisted taking the medication offered to me urgently in the sparse Special Care Unit hospital room I’d been moved to.

Fourteen years later I remember a nurse telling me I wouldn’t remember any of this in the morning. While I don’t distinctly remember my psychiatrist on that first night, I did sense him as a tall, calm presence in the room. My first clearer memories of him were laid down several days later.

The firestorm had been extinguished by antipsychotics and I was exhausted and sedated. He told me, with a serious expression, that I had just survived postnatal psychosis.

Not all mental illness requires the care of a psychiatrist, but regardless of who provides mental health care to a patient, trust is crucial.

If the patient doesn’t trust or work well with their mental health care provider, the skill of the provider becomes irrelevant. And what works well for one patient may not work at all for another. I got extremely lucky. The psychiatrist who was on call on the night I experienced my first psychotic episode, turned out to be someone I work with very well.

Over the last 14 years I have learnt what makes our therapeutic relationship a good one. He is always honest, and very direct. As someone who thrives on logic and efficiency this works well for me. We work collaboratively. He lets me make informed decisions about my treatment. He doesn’t let his ego stand in the way of seeking a second opinion if what we are trying isn’t working.

He sugar-coats nothing, but he keeps hope safe when I have none. When he says, “I will get you better I just don’t know how long it will take”. I believe him because so far he has always delivered on that promise. An inherent power imbalance exists between a mental health care provider and their patient. I feel that imbalance creep over me every time I get sick.

When I am well, I am confident with who I am. My 20 years working as a small animal vet makes me comfortable around doctors. I speak their language. I have excellent communication skills and I am not intimidated. But when I experience an episode of bipolar disorder it strips me back to nothing.

My symptoms delete the building blocks of my confidence. My concentration and short-term memory dissolve. My thoughts are so rapid and pressured they may not make their way out of my mouth in a logical order. Attempting to suppress the intense irritability inherent in my manic episodes drains me.

When I get sick I usually need to go into hospital. And with an admission to hospital comes a shedding of the person and the becoming of a patient. Having a mental health care provider who doesn’t take advantage of the power imbalance is essential.

I was hospitalised earlier this year and my psychiatrist was away on holidays. This reminded me how lucky I am to have a trusting relationship with my psychiatrist. You see, one of the covering psychiatrists seemed uncomfortable around me.

I was only seeing him for a week. He invested no effort in finding out who I was beyond the paperwork.

He reprimanded me when I suggested dropping one of my medication doses back to pre-episode levels. This is something my psychiatrist and I do commonly once I am recovering, which I was. And when I asked him (conversationally) what had led him into psychiatry, he refused to answer. He stalked out of the room, offended.

These are only small things, but the stress response this poor communicator induced in my body made me thankful. Thankful that the long-term quality of my care has never been compromised by someone I didn’t trust to see me as more than my symptoms.

Even when I am at my sickest, I always feel as though my psychiatrist sees the person beneath the patient.

Anita has written a powerful memoir about her experiences as a vet, mother, writer and someone who lives with Bipolar 1 Disorder. She shares her experiences of psychosis, mania, and catatonic depression and the hard work that goes into recovering from each episode of illness.

You can find her memoir, Abductions From My Beautiful Life, on Amazon, fishpond and Booktopia.

For more of Anita’s writing, visit her blog Thought Food,where she writes mostly about living a good life with a mental illness.

Where to from here?

• Visit our online forums to chat with others who get it. Share and connect in a safe, anonymous space, with counsellors and peer workers in the background.
• For support contact our free counselling service free counselling service on 1800 187 263 or connect with counsellors online (available Monday to Friday 10am–8pm AEST/AEDT).