Day: August 26, 2018

pustluk:

so it turns out i’m going back on private insurance in october because pennsylvania medicaid isn’t going to cover any of my transition-related expenses—including hormones. a side effect of this is that (for at least a year) i’m going to have to terminate with my psychiatrist and therapist, an autism specialist with whom i’ve made the only significant progress in my six-year, eight-practitioner mental health campaign.

needless to say, neither of us is thrilled about this, but certain things need to take priority and there’s little we can do to prevent it. at first, she suggested i go back to my old clinic—even if it’s just to touch base every couple weeks—until i walked us through the following:

at best, this clinic will stick me with another intern who i don’t trust and who isn’t equipped to help me. at this point in my life, i am not a client who benefits greatly from talk therapy. my official diagnoses are far outside the anxiety and unipolar depression comfort zone of most practitioners. at best, especially to an intern, this makes me a liability.

imagine i walk in during a real low (to “touch base”). my lows are scary, both to me and to the people who witness them. the only thing a new, inexperienced therapist is going to see is the alphabet soup on my client profile—”oh shit, he got fucked as a kid and doesn’t eat”—and immediately gun for a 302. this has happened to me before, once with a therapist i actually trusted, who attempted to commit me knowing i was about to go on a trip that would ultimately save my life and radically change it for the better.

if i go to inpatient, i lose my job. because i am autistic and inpatient teams don’t know or care to know about autism, i am also unable to gain enough ‘privileges’ to talk to my partner. i am completely isolated from my support network, constantly overstimulated and exhausted, and, when i finally get out, without a livelihood.

i asked my psychiatrist at this point whether any of this seemed unreasonable or paranoid. “no,” she said, “unfortunately it really doesn’t.” we’re now going to try and negotiate a single-case contract with my hypothetical insurance provider, because neither of us is the slightest bit optimistic about any of my other options when it comes to continuity of care.

this is what multidiagnosis is like. this is what it’s like navigating healthcare with autism, with complex PTSD, with complex mood disorders, and god help you with a tentative cluster B diagnosis. success stories without major setbacks are the exception, not the rule, and the exceptions most often occur at the confluence of social privilege and alignment of a client’s problems with the practice du jour of the mental healthcare and pharmaceutical industries.

the idea of a widespread “anti-recovery” movement is tone deaf at best, almost always drenched in privilege, and uncritically marginalizing at worst.