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Every good mental health professional I've had has understood this. Effective treatment treats the individual, not the diagnosis -- the diagnosis is only to get

Every good mental health professional I've had has understood this. Effective treatment treats the individual, not the diagnosis -- the diagnosis is only to get authotizarion from insurance and government agencies to get the necessary resources. My insurance paid $1500 for psychological testing that "confirmed" my severe ADHD -- which was completely obvious to my psychiatrist, she just wasn't allowed to diagnosis it -- just so I could get authotizarion to try stimulants... and find they didn't work for me at all. Psychiatric diagnosis is at the level of pre-scientific symptom-based diagnosis, for the most part. Imagine if you went to the doctor for a cough and, without any tests, they prescribed a month long course of antibiotics with no idea how effective they would be. A friend of mine was prescribed powerful antipsychotics to "fix" a problem that was actually being caused by another psychiatric medication they had been prescribed earlier to fix something else. Their mental health kept getting worse and worse, and what finally helped was starting a DBT (dialectic behavior therapy) program, and now they're in the process of getting off all those meds that turned out to be more harmful than helpful. We need to stop pretending that a point-scored questionnaire is a scientific way to distinguish a diagnosis, or that we understand the chemistry of the brain well enough that medication can be the first line of defense.

shadowoflight 7y ago
Stop me if this is too personal a question, but: As a fellow adult AD(H)D sufferer who is currently undiagnosed, how did you go about finding a diagnostic center that accepted your insurance? I've been trying to find one, but the list provider by my insurance provider (United HealthCare) is less hopelessly inaccurate, and every online psychiatrist/psychologist directory I've found does not have up-to-date insurance information.
- Rotten194 7y ago
  It was awhile ago, but IIRC I just called around to a bunch of places. The best way to get information unfortunately ¯\_(ツ)_/¯
- Mathnerd314 7y ago
  Insurance providers are required to keep their directories up to date with roughly the past 30 days: https://www.ahip.org/wp-content/uploads/2016/09/The-Provider-Directory-Dilemma-Availity.pdf https://www.ahip.org/wp-content/uploads/2016/09/The-Provider... But there's not much you can do if it's inaccurate besides start looking for another provider. I've written a few scripts to massage my provider's directory into something usable, now lost unfortunately. UnitedHealth is apparently working on a blockchain for provider data: https://cdn2.hubspot.net/hubfs/4801399/18-SYN-001-Synaptic-Website/downloads/Synaptic_Health_Alliance_Blockchain_White_Paper.pdf https://cdn2.hubspot.net/hubfs/4801399/18-SYN-001-Synaptic-W... I guess making a web service is too hard? https://www.managedcaremag.com/archives/2019/7/how-blockchain-has-strange-bedfellows-singing-kumbaya https://www.managedcaremag.com/archives/2019/7/how-blockchai... suggests it's mostly about getting management to sign off.
- letsmakeanewone 7y ago
  I'm a mid-30s engineer in a tech hub and am ~45 days into my Adderall prescription. I decided to seek treatment for ADHD because my inability to focus was having a negative impact on my career and, indirectly, my well being. For context, I've lost more than one job where I've done good work on the interesting parts, but failed to carry my weight on the boring parts to the point where I simply wore out my welcome. I'm trying to start a family and I felt I was beginning to tread a familiar path with my otherwise very understanding and welcoming new boss. This probably varies per provider, per locale, etc, but for me the process was: - Used my insurers website to look up psychiatrists in my area. Had issues with less than great data here also and long appointment waiting times for some, just kept calling around - called and scheduled an appointment - told the psychiatrist that I believed I had ADHD - went through a verbal assessment with the psychiatrist - got blood work and an EKG done - had my psychiatrist look over these results - picked up prescription for first 30 days - come back in for assessments at 3 weeks, 7 weeks, 11 weeks. Can get prescriptions over the phone afterwards For me it has been life changing. There's a stigma within my family about mental health so for a long time I've suspected I had this problem but just tried to discipline myself and stick to a system instead of asking for help. AIUI I use a relatively small amount (10mg in the morning, then either 5mg or 10mg in the afternoon). The biggest differences for me have been a) I start the work that sounds boring in a timely manner instead of putting it off to the last minute, b) when I dig into these boring items, I find that the stuff I considered boring before actually can be interesting too sometimes - and at the very least solving them correctly gives me a little rush of dopamine, and c) I make fewer mistakes on the boring stuff because I'm not rushing through it under self-induced time pressure just trying to accept the first "looks right" explanation.
  - yowlingcat 7y ago
    "I've lost more than one job where I've done good work on the interesting parts, but failed to carry my weight on the boring parts to the point where I simply wore out my welcome. " I experienced this quite a bit earlier on in my career (and still do, to a certain degree), but I eventually arrived at the realization that this had a lot more to do with anxiety for me than with ADHD. For me, the "boring stuff" was either 1) all the little details and maintenance work that needs to be done to bring a project from complete implementation to complete deployment and rollout and 2) things that someone else could probably do better than me, or that I could ask for help with. With respect to 1), I began to realized after working through multiple projects that the thing wasn't really done until it had been used in the wild for a while and I had gone through enough iteration cycles of gradual refinement to know it was in a stable state -- that let me launch things a lot more comfortably and be "okay" with the knowledge that it would never really be done, just good enough, and that I could always come back later and improve it more if needed. With the latter, I used to be a lot worse at asking for help. I found it embarrassing and seemingly a tacit admission of my incompetence. I've also gotten better at that by understanding that productivity gets done through teams, and the more that I ask for help, the more the team is growing and that I'm increasing my own mental context on all the things I otherwise wouldn't know. Asking questions wasn't a sign of my incompetence; it was a sign of my curiosity, and a desire to keep improving. I'm not sure if any of those strike a chord, but if so, these could be things to think through. As an aside, I found that when I worked in unhealthy work environments, these things came up a lot more because I reported to and worked with folks in a low trust environment. This meant that they'd simplify things to saying that I've done "good work on the interesting parts, but failed to carry my weight on the boring parts" when in all actuality, it was painful to do the parts I didn't do -- not just for me, but for everyone. I was just the squeaky wheel. I can't fully tell, but from the way you talk about it, it's possible this is the case with your work environments. It's miraculous how much less prevalent these kinds of issues are in a supportive environment where you're working with not just competent but caring and kind team members and leaders.
- yowlingcat 7y ago
  I've tried in the past to find a provider that accepted my insurance and then given up and just bitten the bullet on paying the out of network premium. To this day, I haven't found a plan (even with expensive, top of the line insurance like I had at a previous job) that had great in-network options.
shkkmo 7y ago
There's been some pretty detailed discussion of exactly these ideas in the past on HN: https://news.ycombinator.com/item?id=19971327 https://news.ycombinator.com/item?id=19971327
gregfjohnson 7y ago
Agreed: in my experience, therapy is intensely personal. It crucially depends on the relationship between a specific patient and a specific therapist. When life forced me out of desperation to seek therapy, I went through three therapists before finding the right one for me. I have been seeing my guy now for several years. Between talk therapy, meds, and a daily meditation practice, my life is substantially better. And, it turns out that my work has improved the lives of my wife and family. I am generally a hell of a lot easier to live with, and am a better approximation to the "sweet old guy" that I want to be as I grow into my later years. When you are in a weakened psychological state, possibly anxious, fearful, conflict-avoidant, passive-aggressive, terrified of conflict or triggering unmanageable reactions from other people, it can be extremely difficult to terminate a relationship with a therapist. The only way I found was to write a brief note, enclose a check for payment in full for the next session and any other financial obligations incurred or committed to, inform the therapist in writing that I was no longer going to be a patient, and skip the last session.
oblib 7y ago
"Their mental health kept getting worse and worse, and what finally helped was starting a DBT (dialectic behavior therapy) program, and now they're in the process of getting off all those meds that turned out to be more harmful than helpful." I'm caring for a family member who's been dealing with serious mental health issues. Hearing voices, not sleeping, crying, screaming and banging and throwing stuff all day and night. It's been tough. I've been attacked twice since they got here. Not quite two weeks ago I insisted they go see a doctor and get some prescription meds to calm them down and help them sleep at night. The doctor prescribed a generic Prozac and some kind of sedative to take at night. They're already doing much better. Sleeping all night and no raging. Still crying a bit, but not near as much, and finally a bit more receptive to the behavior therapy I've been offering. They've been seeing a behavioral therapist once a week for a month now and haven't been very receptive to what they're doing but I think showing them some info on how "dialectical behavior therapy techniques" work might encourage them to engage with their therapist more. So, thank you for sharing that info. I'll be spending some time learning more about that myself now.
- dsego 7y ago
  > Hearing voices, not sleeping, crying, screaming and banging and throwing stuff all day and night. > The doctor prescribed a generic Prozac and some kind of sedative to take at night. I wonder, would this sedative actually be an anti-psychotic drug? As someone who has a family member with mental illness, these symptoms seem like something that would warrant such medication.
  - extra88 7y ago
    Severe sleep deprivation can cause auditory hallucinations and other problems so first trying to help them get sleep to see how it affects their symptoms is a good idea.
    - dsego 7y ago
      Yeah, it's all somehow connected. My sibling's first problems were with sleeping and insomnia, long before the first psychotic breaks (years). Even now it's hard to for them to keep a steady sleeping schedule.

shadowoflight 7y ago

Stop me if this is too personal a question, but: As a fellow adult AD(H)D sufferer who is currently undiagnosed, how did you go about finding a diagnostic center that accepted your insurance? I've been trying to find one, but the list provider by my insurance provider (United HealthCare) is less hopelessly inaccurate, and every online psychiatrist/psychologist directory I've found does not have up-to-date insurance information.

Rotten194 7y ago
It was awhile ago, but IIRC I just called around to a bunch of places. The best way to get information unfortunately ¯\_(ツ)_/¯
Mathnerd314 7y ago
Insurance providers are required to keep their directories up to date with roughly the past 30 days: https://www.ahip.org/wp-content/uploads/2016/09/The-Provider-Directory-Dilemma-Availity.pdf https://www.ahip.org/wp-content/uploads/2016/09/The-Provider... But there's not much you can do if it's inaccurate besides start looking for another provider. I've written a few scripts to massage my provider's directory into something usable, now lost unfortunately. UnitedHealth is apparently working on a blockchain for provider data: https://cdn2.hubspot.net/hubfs/4801399/18-SYN-001-Synaptic-Website/downloads/Synaptic_Health_Alliance_Blockchain_White_Paper.pdf https://cdn2.hubspot.net/hubfs/4801399/18-SYN-001-Synaptic-W... I guess making a web service is too hard? https://www.managedcaremag.com/archives/2019/7/how-blockchain-has-strange-bedfellows-singing-kumbaya https://www.managedcaremag.com/archives/2019/7/how-blockchai... suggests it's mostly about getting management to sign off.
letsmakeanewone 7y ago
I'm a mid-30s engineer in a tech hub and am ~45 days into my Adderall prescription. I decided to seek treatment for ADHD because my inability to focus was having a negative impact on my career and, indirectly, my well being. For context, I've lost more than one job where I've done good work on the interesting parts, but failed to carry my weight on the boring parts to the point where I simply wore out my welcome. I'm trying to start a family and I felt I was beginning to tread a familiar path with my otherwise very understanding and welcoming new boss. This probably varies per provider, per locale, etc, but for me the process was: - Used my insurers website to look up psychiatrists in my area. Had issues with less than great data here also and long appointment waiting times for some, just kept calling around - called and scheduled an appointment - told the psychiatrist that I believed I had ADHD - went through a verbal assessment with the psychiatrist - got blood work and an EKG done - had my psychiatrist look over these results - picked up prescription for first 30 days - come back in for assessments at 3 weeks, 7 weeks, 11 weeks. Can get prescriptions over the phone afterwards For me it has been life changing. There's a stigma within my family about mental health so for a long time I've suspected I had this problem but just tried to discipline myself and stick to a system instead of asking for help. AIUI I use a relatively small amount (10mg in the morning, then either 5mg or 10mg in the afternoon). The biggest differences for me have been a) I start the work that sounds boring in a timely manner instead of putting it off to the last minute, b) when I dig into these boring items, I find that the stuff I considered boring before actually can be interesting too sometimes - and at the very least solving them correctly gives me a little rush of dopamine, and c) I make fewer mistakes on the boring stuff because I'm not rushing through it under self-induced time pressure just trying to accept the first "looks right" explanation.
- yowlingcat 7y ago
  "I've lost more than one job where I've done good work on the interesting parts, but failed to carry my weight on the boring parts to the point where I simply wore out my welcome. " I experienced this quite a bit earlier on in my career (and still do, to a certain degree), but I eventually arrived at the realization that this had a lot more to do with anxiety for me than with ADHD. For me, the "boring stuff" was either 1) all the little details and maintenance work that needs to be done to bring a project from complete implementation to complete deployment and rollout and 2) things that someone else could probably do better than me, or that I could ask for help with. With respect to 1), I began to realized after working through multiple projects that the thing wasn't really done until it had been used in the wild for a while and I had gone through enough iteration cycles of gradual refinement to know it was in a stable state -- that let me launch things a lot more comfortably and be "okay" with the knowledge that it would never really be done, just good enough, and that I could always come back later and improve it more if needed. With the latter, I used to be a lot worse at asking for help. I found it embarrassing and seemingly a tacit admission of my incompetence. I've also gotten better at that by understanding that productivity gets done through teams, and the more that I ask for help, the more the team is growing and that I'm increasing my own mental context on all the things I otherwise wouldn't know. Asking questions wasn't a sign of my incompetence; it was a sign of my curiosity, and a desire to keep improving. I'm not sure if any of those strike a chord, but if so, these could be things to think through. As an aside, I found that when I worked in unhealthy work environments, these things came up a lot more because I reported to and worked with folks in a low trust environment. This meant that they'd simplify things to saying that I've done "good work on the interesting parts, but failed to carry my weight on the boring parts" when in all actuality, it was painful to do the parts I didn't do -- not just for me, but for everyone. I was just the squeaky wheel. I can't fully tell, but from the way you talk about it, it's possible this is the case with your work environments. It's miraculous how much less prevalent these kinds of issues are in a supportive environment where you're working with not just competent but caring and kind team members and leaders.
yowlingcat 7y ago
I've tried in the past to find a provider that accepted my insurance and then given up and just bitten the bullet on paying the out of network premium. To this day, I haven't found a plan (even with expensive, top of the line insurance like I had at a previous job) that had great in-network options.

shkkmo 7y ago

There's been some pretty detailed discussion of exactly these ideas in the past on HN: https://news.ycombinator.com/item?id=19971327 https://news.ycombinator.com/item?id=19971327

gregfjohnson 7y ago

Agreed: in my experience, therapy is intensely personal. It crucially depends on the relationship between a specific patient and a specific therapist. When life forced me out of desperation to seek therapy, I went through three therapists before finding the right one for me. I have been seeing my guy now for several years. Between talk therapy, meds, and a daily meditation practice, my life is substantially better. And, it turns out that my work has improved the lives of my wife and family. I am generally a hell of a lot easier to live with, and am a better approximation to the "sweet old guy" that I want to be as I grow into my later years. When you are in a weakened psychological state, possibly anxious, fearful, conflict-avoidant, passive-aggressive, terrified of conflict or triggering unmanageable reactions from other people, it can be extremely difficult to terminate a relationship with a therapist. The only way I found was to write a brief note, enclose a check for payment in full for the next session and any other financial obligations incurred or committed to, inform the therapist in writing that I was no longer going to be a patient, and skip the last session.

oblib 7y ago

"Their mental health kept getting worse and worse, and what finally helped was starting a DBT (dialectic behavior therapy) program, and now they're in the process of getting off all those meds that turned out to be more harmful than helpful." I'm caring for a family member who's been dealing with serious mental health issues. Hearing voices, not sleeping, crying, screaming and banging and throwing stuff all day and night. It's been tough. I've been attacked twice since they got here. Not quite two weeks ago I insisted they go see a doctor and get some prescription meds to calm them down and help them sleep at night. The doctor prescribed a generic Prozac and some kind of sedative to take at night. They're already doing much better. Sleeping all night and no raging. Still crying a bit, but not near as much, and finally a bit more receptive to the behavior therapy I've been offering. They've been seeing a behavioral therapist once a week for a month now and haven't been very receptive to what they're doing but I think showing them some info on how "dialectical behavior therapy techniques" work might encourage them to engage with their therapist more. So, thank you for sharing that info. I'll be spending some time learning more about that myself now.

dsego 7y ago
> Hearing voices, not sleeping, crying, screaming and banging and throwing stuff all day and night. > The doctor prescribed a generic Prozac and some kind of sedative to take at night. I wonder, would this sedative actually be an anti-psychotic drug? As someone who has a family member with mental illness, these symptoms seem like something that would warrant such medication.
- extra88 7y ago
  Severe sleep deprivation can cause auditory hallucinations and other problems so first trying to help them get sleep to see how it affects their symptoms is a good idea.
  - dsego 7y ago
    Yeah, it's all somehow connected. My sibling's first problems were with sleeping and insomnia, long before the first psychotic breaks (years). Even now it's hard to for them to keep a steady sleeping schedule.