People often ask me “How do I know if I should see a professional?”, and the best answer I can give is “If you’re asking that question, you should probably see a professional.”
Okay, here’s a slightly less smartass answer: persistence. Does your condition persist? Everyone has good and bad days. Everyone has things in their life that go wrong and put them into a funk. For me, I realized that I needed to see someone when I looked back on my life and realized that my depression persisted despite all else. There were good days here and there, but the dominate theme in my life was a crippling, lethargic despair.
Aaron Swartz put it well:
Surely there have been times when you’ve been sad. Perhaps a loved one has abandoned you or a plan has gone horribly awry. Your face falls. Perhaps you cry. You feel worthless. You wonder whether it’s worth going on. Everything you think about seems bleak — the things you’ve done, the things you hope to do, the people around you. You want to lie in bed and keep the lights off.
Depressed mood is like that, only it doesn’t come for any reason and it doesn’t go for any either. Go outside and get some fresh air or cuddle with a loved one and you don’t feel any better, only more upset at being unable to feel the joy that everyone else seems to feel. Everything gets colored by the sadness.
Setting up that first appointment is a huge hurdle. There’s a reason why they say “denial is the first step.” To make that call, you’ve got to admit that something’s wrong and that you can’t fix it on your own. That step took me years. Please learn from my mistake and don’t wait until things are so bad that you have no other choice.
You’re going to feel shame for setting an appointment with a mental health professional. In the words of Marcellus Wallace, “you fight through that shit.” You should feel exactly as ashamed to see a psychiatrist or a therapist as you would feel seeing a cardiologist or endocrinologist.
I’ve had experience with two kinds of mental health professionals: a therapist and a psychiatrist. A therapist has at least a masters degree. They’re not doctors, so they can’t give you drugs. They’re going to talk to you, or rather, they’re going to get you to talk to them. They are professional listeners. Don’t worry about what you’re going to say — they’ll take care of that.
A psychiatrist is a doctor. They went to medical school and then spent a few more years specializing in brain stuff. They’ll ask you a bunch of questions and, if appropriate, give you a prescription for some drugs or a referral to a specialist who can better serve you.
Some people are reluctant to take drugs and prefer to start off with a therapist. I was, and I did. And that’s cool — therapists see this stuff all the time, so they can help you decide if seeing a psych would be appropriate and make a referral for you.
I think of it like this: my psychiatrist and my therapist both help me run the marathon of life despite my injury. The psych is the doctor who set my broken leg. The therapist is the trainer who I checkin with weekly to improve my workouts. Both have had a profound impact on my life, though if I had to choose one or the other, in my specific case, I’d take the doctor and the healthy leg.
So how do you find a psychiatrist or a therapist?
Ideally, you’d get a referral, but that can be hard to get from friends since we typically don’t broadcast that we’re seeing someone (below is the contact info for the people I see in Chicago).1 Also, ask your general practitioner. If you don’t have one, ask a friend for the number to their general practitioner, call their office and ask for a referral.
If you can’t get a referral, you’re going to have to go online. This is going to be a pain in the ass. In my opinion, no one has designed a site that doesn’t cause an acute case of analysis paralysis at a time when you’re already in a precarious mental condition. But, here are three sites that are Yelp for medical practitioners:
If you have insurance, you may want to check your their website or call the number on the back of your insurance card for providers that fall under your coverage. Their websites blow more than the ones above, but at least it narrows the list down a bit.
If you don’t have insurance, many providers operate on a sliding scale for those who pay cash. There may also be free mental health clinics in your city. Don’t give up just because you’re uninsured. It will be harder, but there is a way to get help, and it might be the highest return on any investment you make all year — your brain dictates your earning potential.
Seeing anyone is better than seeing no one. But, if you’re looking at a list of twenty names, it’s easy to get overwhelmed and put it off for another day or year. Here are some questions that might help narrow down the options:
- Do you feel more comfortable spilling your guts to a man or a woman?
- Who takes your insurance?
- Who specializes in the condition that you think you might have?
- Who is closest to your home or work? (if you have to trek across town to go to this appointment that you really don’t want to go to anyway, you’re not going to make it.)
- Who keeps after-hours office hours?
If there are profile pictures, pick the person who seems the most trustworthy… seriously. I know, it’s a shitty qualifier. But we need something to get you past the paralysis analysis and your success with this person will depend non-trivially on how much you trust them. A lot of trust is based on first impressions, so…
In general, mental health professionals are more technophobic than you — they aren’t speedy on email, and they prefer to talk on the phone. If you get a really good one, they might text you. You’re going to have to play telephone tag. You may want to enlist a friend to keep you accountable through this process. You may even want to see if a friend will help you narrow down the options, make the call, then hold the phone up to your ear. If you don’t have anyone you feel comfortable asking for that, email me.
Stick with it. It’s worth it. Set that first appointment, commit to getting there, then decide if you want to go back. You have a pretty good idea where your current trajectory leads you. Making that first appointment is one of those life events that has the potential to nudge you onto an entirely different track.