I like what several write-ups have to say about distinctions between psychiatrists and kinds of psychotherapists, who may tend to come from training models other than the medical model.

Recent experience, in which I have needed psychotropic drugs (namely Depakote and Seroquel) to bring me back to mundane reality from a chain of events that included a recent bad drug interaction (see Celexa diary for some hints of the back story here) have put me in contact with both my regular therapist, who I've seen almost weekly for over three years, and new contacts with two psychiatrists.

Conversations with my therapist, in which we have reaffirmed my hypersensitivity to drugs (something also confirmed in blood tests at a local psych hospital and in outpatient follow-up) boil down to this:

A key difference between psychiatrists and other therapists is that the psychiatrist tends to come from a reductionist point of view. Rather than deal with a wholistic approach to mental process, wellness and growth, there are specific thought patterns that are pathologized and which are identified as being those we need to treat with drugs.

Now in one sense I agree with the psychiatrist. Without the anti-psychotics I was given in the emergency room who knows how long or even whether I might have come back from where I went? Set aside for the moment that my experience was subjectively closer to a shamanic vision quest than it was to a simple period of "losing touch with reality."

There's little means of defining one separated from the other.

In a sense, I'm certainly grateful my stay in "unreality" (or a real that transcends mundane reality was so brief... I had lots to do back here, it wasn't a good time for a vacation inside my own head. It will be a big adjustment coping with the new addition of a nanny who will be helping me to ensure that my daughters remain safe at all times, even if I do happen to have any kind of relapse.

I've also heard from at least one family member who spend a week in the state I described to him. I have no idea whether I could have stood a week in that state of mind. Most of an afternoon was terrifying enough for me.

But on the other hand, there were images and feelings I was encouraged to downplay (by my longtime therapist), mainly to enable me to get out of the hospital on a reasonable schedule and get to a space where we could start working constructively with images and gifts I got from that brief time in another world (or in the larger world, as I would put it, since that world encompasses ours and many others). A psychiatrist who hadn't known me for three years might tend to frame these gifts more as psychotic ideation or some form of delusional thinking, where I experienced them as religious visions or instances of Jungian archetypes being presented in especially vivid and immediate form. (To be fair, by the time I was released I felt I had an understanding with the hospital's attending psychiatrist that gave due honor to the visions, while recognizing the severe risks that most anyone exposes herself to if she were to choose to remain in that world, or could not find a way out of that world.) I will probably never know whether I found my way out or whether the drugs were the sole factor enabling that escape from the spirit world.

A therapist who has known me a long time could listen and say, yes, this person is back to a baseline where they were before hospitalization... as in touch with "reality" as before... while a reductionist, "reality-based" psychiatrist might have a much harder time of it. Also, for legal and economic reasons, psychiatrists at present tend to spend most of their time and energy pushing psychotropic drugs and frankly, given my sensitivity to such drugs, I frankly hope that recent progress dealing with some major psychic hairballs puts me in a place where fewer (not more) drugs will be needed moving onward from here.

On the other hand, having recently been diagnosed as bipolar on top of pre-existing issues, it may be wishful thinking to imagine that I will be moving away from prescription drugs rather than into more of a dependent relationship with them.