Fibromyalgia and chronic fatigue syndrome are not psychological illnesses, contrary to the misconceptions and even accusations of many. Because a lot of us have been told we're "just depressed" or that we're hypochondriacs, whiners, or lunatics, it's normal to bristle at the very thought of seeing a psychiatrist. In my opinion, that's something we, as individuals and a community, need to get over.
Is mental help a front-line treatment? No. Is it something we all need? No. But a lot of people do benefit from it, and a lot more could.
I recently spoke to Dr. Leslie Arnold, who's a psychiatrist specializing in the impact of chronic pain. She agreed with me that mental-health providers aren't equipped to diagnose and treat these conditions but added, "There is a very important role for mental-health providers."
Understanding, Help & Coping Skills
So if we're not crazy and our myriad symptoms have physical causes, why would we get mental help? The same reason that anyone with a chronic, debilitating illness would. How many comments have people left here about losing everything to their illness? We lose jobs, friends, spouses, homes . . . we can even lose ourselves, our independence and our self-respect. That's hard, and often we have no one around who truly understands. Even if we do have a good support system, we don't want to burden those wonderful people with constant rants about how hard life is for us.
Psychiatrists, psychologists and other mental health workers are there to listen to your problems and complaints and possibly give you more constructive ways of dealing with them. Studies show that those of us who have (or develop) good coping skills and find acceptance of our illness are more likely to find effective treatments and end up feeling better down the road. If you can't get there yourself, a professional may be able to help.
Managing Comorbidities & Medications
We're prone to anxiety, and depression is a risk for anyone with a chronic illness. Primary care providers aren't really trained to deal with these problems, while mental-health providers are. They may be able to help with both the physical and emotional aspects of depression.
"Not everybody would necessarily need that, but there is a subset that has a lot of [psychological] stressers," Dr. Arnold said.
Many of us take anti-anxiety drugs and anti-depressants (even if we're not depressed); psychiatrists have more experience with these drugs that most other doctors, so they may be better equipped to help you manage them, change your dosage, recognize side effects, wean off, etc. They may also be able to suggest medication changes that you can then discuss with your regular doctor.
More Time
One complaint I frequently hear about doctors is that they don't take enough time to listen to what's going on. I've had a lot of people tell me they also wish they could find a doctor with more compassion. Sadly, the reality of our health-care system is that most doctors have precious few minutes to spend with us. Mental-health workers generally have a lot more time and are willing to listen to the full breadth of your symptoms. A psychiatrist is also a medical doctor, and they just might understand your neurological and cognitive problems a lot better than a primary care provider.
Certainly, psychological help isn't going to "cure" us, or alleviate our symptoms. However, it could help us deal better with having an illness and with making beneficial changes. Consider these questions:
- Do you have problems with anxiety or depression?
- Do you feel alone and have no one to talk to?
- Do you wish your doctor took more time and showed more compassion?
- Could you use help managing your medications?
- Is stress making your illness worse?
- Could your coping skills be better?
If you find yourself saying "yes" to a lot of those, it might be something to consider. If you said "no" to all or most of them, it's probably not something that you need.
Have you seen a mental-health provider for problems related to fibromyalgia or chronic fatigue syndrome? Did it help? How important has it been to you? What's made the biggest difference? Leave your comments below!
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I am a FM, Hashimoto tryroiditis, n GERD sufferer n have been seeing a phychiatrist for two months. This was suggested by by the ENT physician who thought I was depressed.
The phychiatrist took me off Zoloft n put me on Remeron.
Today, when I told him I had weaned myself from Lexotan, he asked me to consider Topomax to help with the myofarcial pain while I undergo physiotherapy, including accupuncture.
I do hope to conquer this and am gathering data to introduce my family and friends to fibromyalgia. It is very painful and very hard to convince people that you are not mental.
Elly, Your post was very interesting. I have been wondering if my transition off of 200mg of Topamax daily back in January 09 was related to the flare and later diagnosis of my FM symptoms. I had mentioned to my pharmacist boyfriend that I thought there was some relationship, but couldn’t find many details supporting the use of Topamax for pain. I think it was working very well for me and I didn’t even know it! I hope you have luck with it and get some relief. Let us know your experience with acupuncture too… I’m considering that myself. Oh yeah, another of the “benefits” or side-effects of Topamax is loss of appetite.. they’re currently researching the use of Topamax in combo with another drug as a diet aid. I never noticed much of this effect, but you might. Lisa
Actually, there is no reason to see a psychiatrist for therapy. Very few are trained to give therapy and they are far too expensive. A family therapist is less expensive and far better trained in the area of therapeutic assistance. The difference is they cannot prescribe drugs because unlike psychiatrists they are not an MD.
A compassionate and knowledgeable psychotherapist can help you deal with the very real losses experienced by all patients with severe chronic diseases of any kind.
However, you are the consumer. If a therapist or doctor increases your feelings of stigmatization, brushes aside your physical concerns, falsifies your records, or insists you are depressed or anxious when you know darn well you are not – stand up and walk out immediately and don’t go back. As immunologist, CFS clinician and psychiatrist Dr. Nancy Klimas said in the New York Times patients often go in with CFS and come out with PTSD.
Find someone who is factually informed and ethical. And if you find one make sure a put them on the Co-Cure list of good doctors – they are far and few between.
Stigmatization by anyone, particularly someone who is charged first with do no harm is appallingly unacceptable and some might say even immoral.
Fight back, but don’t let anger, no matter how justifiable, rule/ruin your life. Find a way to live laugh and love because life is short no matter what your circumstances are.
Adrienne, please correct this error, it’s important: “A psychologist is also a medical doctor.”
A psychologist is NOT a medical doctor (=MD). A psychologist is, at most, a PhD (like any other non-medical professional with a doctorate).
As a CFS patient I’ve had a lot of problems with psychologists because they are *not* MDs. It seems to come down to an issue that many psychologists are just not very good at thinking scientifically (obviously they don’t have the rigorous science training of MDs).
One big result of their weak science training or aversion to science (or aversion to standard rules of evidence, and dare I say, logic) is that psychologists seem to chronically attribute almost every physiological symptom you mention to emotion or somatization (even symptoms of other common physical diseases, like asthma, heart disease, diabetes, you name it).
Totally infuriating, and patients with CFS or FM have suffered far too much of this dangerous b.s.
On the other side, a lot of psychiatrists don’t do talk therapy any more and only want to throw drugs at you. That is not helpful either.
In my experience, best are the psychiatrists – real MDs – who still do supportive talk therapy. And yes, you will have a lot more time to talk through your physical symptoms of CFS or FM with them too – kind of like having a second GP.
Guide Response: Sorry about my error — I meant to say that psychiatrists are medical doctors, not psychologists. It’s been corrected in the post.
I am lucky to be at a great university where my graduate student insurance covers me for fabulous doctors, including my neuro-psychologist. He studies rheumatology and thus is very learned on chronic pain conditions. I often walk out of the office not knowing what I got out of it, but feeling a little better. When I have hard times at home I remember some of the nuggets of wisdom.
He’s there for me when I cannot talk to my family because they are all burdened by their own problems. There may not be answers, but at least you can come out of it feeling as if you have a little more control about how to feel about your life and your condition.
i’ve been lucky to have medicare so i see both a psychiatrist, sleep specialist, and a psychologist who specializes in chronic illness, patients with. they’ve both been instrumental in my recovery, such as it is. the psychiatrist prescribes xyrem for me so that i do get good sleep, and a cpap system for deeper sleep. the psychologist has helped me adapt to the limits in my life and supports me in my quest for energy and health. i also have a pain specialist who is very important in keeping me balanced out chemically. i wish all fibro sufferers could have the kind of support i, as a sr., have.
I was just recently diagnosed with FM after years of a number of different diagnosies. Finaly an answer! I too have run into the people that don’t believe me and I have felt so much guilt and shame. I am a single mother of two absolutely amazing kids and I can’t take them places or play with them much. I am very nurturing and loving, but I know they need more activity, especialy since both are intellectually gifted and need constant stimulation. We are lucky enough to have my parents very involved and they do get to do fun activities with them. My family doctor has started me on Prozac for the FM. Is this a common treatment for FM? My main point is though, that I want to see a therapist so I can deal with the guilt of not being “normal” and my shame with wondering if everyone thinks I just complain and I’m lazy, but considering that I can barely take my daughter to school, how do I go to scheduled therapy appointments? I’m sorry for the long winded comment, but I have not talked to anyone else with this condition and I know only you guys will understand. It is a great relief to read comments and letters and say to myself “I know exactly what you mean”!
For the record, I am only 28. It is very difficult to see friends my age run around all day, everyday and do normal young people things or witness people twice my age or more, go to work everyday and travel when I can’t even do a load of laundry. I haven’t worked since I was a teenager and even then I only worked part-time. I think I need a lot of good advice, but I don’t know how to get myself to go to an appointment. I am so tired of forcing myself to do things and ultimately failing anyway. All advice is greatly appreciated. Thank you!
A psychiatrist recently told me–in conversation, not treatment–that she and her colleagues are learning more about FM as more and more patients are referred to them by MD’s in other specialties who don’t have an answer. As posts to this site attest, many FM patients are helped by antidepressants (usually in smaller doses than are prescribed for depression); psychiatrists understand these medications better than other specialists. Don’t assume that a referral to a psychiatrist means “it’s all in your head.” As with any other doctor, it’s important to find the right one, but it seems that an increasing number of psychiatrists are learning how to help FM patients.
There were a few really good points made in this article and in the comments, but there were a few misconceptions, too.
Just to clarify the differences:
PSYCHIATRIST – an MD who specializes in psychiatry (in most cases, such a Dr is there to prescribe & manage meds…very rarely does he/she do much in the way of talk therapy, and he/she gets very little to no training to do so….usually appts are scheduled to last 10 – 15 minutes at the most – except for the initial one ….additionally, these are usually the most expensive to see….of course, there are exceptions who are available for “talk” therapy and who may even be good at it despite the lack of training)
PSYCHOLOGIST – not an MD, but IS a doctor (either a PhD, a PsyD, or an EdD) (this title is not “at most a dr” as someone stated – to hold the title a person has to have achieved a doctoral degree in a psych field)
….usually the type of doctoral degree will tell you if the psychologist is more interested in academics – PhD (studying and teaching, not as often counseling);
counseling and supervising other counselors, and possibly teaching them, too- EdD;
or clinical work – PsyD (usually dealing with more severe types of phych issues and often in a hospital setting) …PsyD’s are increasingly working in counseling settings, though, and in supervising and teaching other counselors, as well, though, due to their training, they will tend to look at things thru a clinical viewpoint
SOCIAL WORKERS and COUNSELORS – most have masters degrees that focus predominantly on counseling, & they often also can help clients to find additional resources in their communities (support grps, financial help, etc)
….usually they cost less and their training is more conducive to the type of “talk” therapy that many of us might find helpful – they tend to be more open to new ideas (partially bc they are required to do more continuing ed on a regular basis), and to be empathetic listeners, as well as good at assisting clients to change behaviors to better manage their illness (this is not saying that they think that FM and CFS are in people’s heads – just that they can be good at giving clients tools to deal with their illnesses, like pacing….and they can help with the feelings that come up when trying to make lifestyle changes to accommodate illness, and at helping people to deal with the grief that comes from all the illness associated losses)
LIFE COACHES – no degree or licensure required, therefor probably not covered by insurance and training may or may not be much….this is not to say that there are not some good ones out there, but they are not regulated at all, so they can be hit or miss (and more likely miss, unless they are counselors in addition to being life coaches; with the degree and the licensure required to be a counselor)
Of course, there are exceptions to all of these as far as who would be the best for which situation, but in general, if you are looking for meds, a psychiatrist is the only choice with a specialty in psychology, and if you are looking for someone to talk to and possibly to learn some good coping skills and tools for managing your illness, then a social worker or counselor would be best.
Rachel, I’m in my 30’s and I can totally understand what you mean. I think that you would probably benefit greatly from having a counselor to talk to, if you find the rt one. A support grp would be another possible avenue for talking and support (duh! could I state the obvious a bit better?!) and sometimes support grps also offer education and helpful ideas for dealing with FM.
If you think that going to both, or either, would be too much, though, it might be possible for you to find a counselor who would be willing to have phone sessions when you feel unable to go into the office…..some even do online sessions, but I think those can get tricky (as it is often easy to misinterpret what someone is saying or the tone in which it is being said, etc when online).
There are some good online support grps, too, but I do think that it is good to have some kind of in-person (or at least on the phone) support.
Here is how the doctor situation is for me. I have a psychiatrist I see for the anxiety/depression I have and medication(s) he has given me. The first visit was about 1 hour long so he could gather all information he needed about me and start me on any medications he thought I needed. I have a rheumatologist I see for the fibromyalgia & chronic fatigue and see her every three months. She is very empathetic and compassionate and I am very grateful for her. She gives me the medications for both illnesses which are cymbalta, provigil & topomax. We have worked on different medications for five years now and for the last four months these three seem to work okay for now. Lyrica worked so well for about three months, I felt like me again, but that was short lived and then no longer worked. Then I have a social worker I see for therapy/counseling. I go to a fibro/cfs support group once a month and talk to some of the people from the group there sometimes during the month. As we all know everything takes energy so we all try to save what we can and when we need that extra boost or support we call or email one another. I also attended a group that my psychiatrist recommended for mindfulness for ten weeks. It was wonderful and wish it was still going. I am going to present to our fibro group to possibly meet and work on this and see what they think because just the little I have learned has me interested and I have already put in use some of the techniques they taught. It is basically about staying in the present moment and when we do we can work on the pain, negativity, lack of energy, etc. I just need to keep at it.
The bottom line is this for me, I am a Type A person, which I think most of us are or were. These illnesses I have had taken my life from me. I can choose to allow them to take my life totally and have control over me or I can take the control back and still live my life the way I want but just in a much different way and manner. It is very tough for me and I am just now going through my grieving process over losing the life I have had. I have been unemployed since 9/08, decided to file for SS disability last December, was turned down once and am now waiting for the next answer. I am used to taking care of myself financially and have been very independant all my life. My husband did not like it much but dealk with it. I made great money and now I don’t but money is not what I want. I want to feel good about life and living and have no pain. Now I can do something for sure about the first two things as I do have complete control over them and the pain, well, there are many things I can do to help with that too to help eliminate its intensity. I take warm epsom salt soaks, stretch with dvd’s, go to arthritis water aerobics twice a week, and pace, pace, pace myself. Basically I just try to make lemonade out of the lemons. Because if I keep thinking and talking about how bad I feel, well guess what?? I am going to keep feeling bad. At least if I am up and trying to live life then at least I am a human being and not just being a lump like a could be. There are just so many things I have learned to do to take care of myself and that have helped, but let me assure you…I still have tons of pain and there are days that I just wish I were not here because then the pain would be gone, but I keep going in spite of it because I am a fighter and I love life and will keep making this darned ole lemonade and pacing myself. 
Merry Christmas to everyone and please take care.
It is both interesting and encouraging to discover that there are so many other people “out there ” suffering the same as I do. I follow these pages regularly and find that my problems aren’t specific to me alone.
I had what was then termed a “nervous breakdown” in 1978, I’ve had glandular fever twice, which I’m told is quite rare. I HATE psychiatrists with a passion as for some reason the ” male ” ones deem all female depressive events as sexually orientated. Why should I get depressed when I was over worked and never had time for a sex life anyway ???. I was put into a psychiatric unit and had the most frightening experience of my life. I was treated worse than a criminal. the best thing that happened to me was a brilliant clinical psychologist who treated my as a PERSON. He believed everything I said and taught me how to do relaxation exercises. There is/was no quick fix!!! I have depressio problems now but have an understanding GP who sees me as often as she can. Unfortunately my case is far from simple. I suffer from OA, Fibromyalgia, CFS, Acid reflux, HVS, psoriasis, Excema, Insomnia, + other ailments including depression. I can’t take any pain relief other than paracetamol, can’t take PPi’s or H2 antagonists and am multidrug sensitive. This makes life difficult. i had half of my thyroid gland removed 2 years ago and now have elevated parathyroid levels , so it looks like more surgery is on the cards.I’m waiting to see a specialist in CFS who is also one of the UK’s top endocrinologists as well . Do any of you on the comments board live in the Uk as I’d willingly email any of you who cares to chat ?? With a triple whammy for depression , and close relatives who don’t understand and don’t try to life is very difficult. I’m sure lots of you will empathise with how I feel
I saw a cognitive behavior psychologist who listed as one of her specialties, “Chronic illness”… or was it “Chronic Pain” — I can’t remember. Man, tho, was I lucky to find her! She’s a migraine sufferer and she was just so compassionate and helpful. She understood the complexities of living with pain and even though she hadn’t known much about fibromyalgia, when I gave her information, she drank it in and was able to use it to help me.
She helped convince my landlord to let me have a pet, because I was lonely and feeling like I was “stuck inside” more than I ever would have chosen to be. I mean, I still *do* work but every evening, it’s the same drill. I used to come home to an empty apartment and just feel like the routine wasn’t satisfying my emotional needs. Coming home to a pet felt so different. I look forward to getting in the door, now.
My therapist helped me communicate with a difficult doctor. SHE spoke with him to find out what his expectations of HER were after he was bad-mouthing her. He was awfully unprofessional in talking with me. My therapist understood the situation, and understood when I said that he was aggressive and difficult to talk to. She helped me deal with him and eventually, I made the decision to find a new doctor. It was a big decision. Well, after I found a new doctor, I ended up discontinuing therapy. The old doctor was causing a lot of my upset and I was spending so many appointments talking about HIM… when he was gone, we didn’t have much to talk about!!!!
She and I spent some time talking about my work situation — comments that co-workers would make that were hard for me.
She did help me set some goals and monitor my symptoms better. I will go back to her in the future if I have any other troubles.