By Pamela Siller MD
What is healing?
The healing process is individual and varies from person to person. A young child anxiously awaits a Band-Aid for a boo-boo, which magically cures all ails. A school-age child impatiently waits for an invitation to join the “in-crowd,” which is thought to banish loneliness. A physically ill woman hopes for a clear CT scan and a clean bill of health.
In healthcare, we speak of response, remission, and relapse. Response is considered to be a reduction in symptoms. Remission consists of a return to baseline functioning, albeit, some residual deficits may remain. A relapse refers to symptomatology returning after a period of remission. However, just as every personality is different, no brain is the same. This leads to the many variations in the road to recovery.
Who can help me to heal?
Anyone. Friends, family, and spiritual leaders are the usual first-line responders when one is in physical, spiritual, or emotional pain. However, at times additional help must be sought out. Physicians and other clinicians can often assist in the process of healing.
How long does it take for me to heal?
Most of those who access mental health services do so only when they are in considerable psychic pain. Once an appointment with a health care provider is made, many feel relief as there is now “a light at the end of the tunnel.” However, some patients have the misperception that all will be solved in one visit. Once a psychiatric evaluation is scheduled, frequent questions include, “I should be fine by tomorrow, yes?”; “One pill should take away the depression/anger/tics/compulsions/ hallucinations, right?”; “Once I am back to normal, this will never happen again, correct?” Unfortunately, this is rarely the case.
What can I expect from my psychiatrist?
Education is of utmost importance, especially during the first meeting with the physician/clinician. Explanations of reasonable expectations of the healing process, as well as a basic understanding of the etiology of the patient’s concerns should ideally be provided during the first meeting. Most importantly;
1) In order for healing to take place, a partnership must be formed between the clinician and the patient. Mutual trust must be gained, and a good rapport is imperative. Not every clinician is right for every patient. If a patient does not trust their doctor, sensitive information is frequently withheld, which can lead to treatment failures or adverse outcomes. Doctors must also trust that their patients will report concerns and side effects, as well as be compliant with appointments.
2) Most medications do not take effect immediately. Some, such as benzodiazepines and antipsychotics, can produce a response within the first week. Others, such as antidepressants, can take up to a month to begin to show partial efficacy. Medication dosages frequently need to be titrated, and taken on a daily basis, unless otherwise noted, in order to achieve an appropriate blood level.
3) Medications do not work in a vacuum. Life’s circumstances can and will alter one’s mood and influence feelings. There is no such thing as a “happy pill”.
4) There are no guarantees of efficacy, nor degree of resolution of symptomatology. The physician has many medications which can be considered as keys on a keyring. It is impossible to know at the onset which key will open the door to a particular brain. However, with expertise and knowledge as well as close collaboration with the patient, the appropriate medication is usually soon found.
5) Medications are most efficacious when combined with therapy. When used in times of pain, they assist in lifting the burden of sadness and bring clarity to thoughts, which then allows the patient to utilize coping skills learned in therapy.
6) A support system is not only helpful, it is integral to healing. Most who deny having loved ones they can trust need only to reach out and are frequently surprised by the outpouring of positive emotion that is felt.
Feelings ebb and flow, as do waves in an ocean. At times they are overwhelming and a person may feel as if they are drowning. However, just as all waves recede, so do negative feelings. In times of pain, a minute can feel like an hour, a day can feel like a year. However, there is light at the end of the tunnel. Healing can occur and strength and resilience can be built. The first step is to seek treatment. The next step is to have an open and honest conversation about the process of healing. Lastly, build a lasting partnership with your treatment providers, as they are your partners and allies.
Pamela P. Siller, MD is a Board-Certified Child, Adolescent and Adult Psychiatrist who provides medication management as well as individual and family therapy to children and adults. She maintains a private practice in Great Neck, New York. Dr. Siller is also the Director of Child and Adolescent Psychiatry at the Interborough Developmental and Consultation Center in Brooklyn, and an Assistant Professor of Psychiatry at New York Medical College. Dr. Siller can be reached at 917-841-0663.