Reality Check: Everyone Should See A Psych

As part of writing non-consent and gender degradation erotica in a responsible manner, each month I present a Reality Check article, touching base with safety, respect, equity and health in the real-world.  An archive of these articles is also available to all members.

Everyone should see a psych

Everyone should see a psychologist once a year for a checkup, regardless of whether they feel they need it or not.  That *should* be just the done thing. There should be a marking on your calendar. “Oh, it’s August. Time to make an appointment with my GP for a physical health checkup, and with my psych for a mental health checkup.”

If you’re having a hard time of life, it’s almost certain that you need more than just a checkup.

Yes, even you, manly dude who feels like he can tough it out.  *Especially* you. I’m a dom. I’m a dude. I have literally more girls to play with at kink parties than I have time to satisfy.  And I see a psych. If I can, you can.  

Now, I live in Australia, and we have a range of safety nets here that make it easier to see a psych here than it is in some places – and even then, it’s still not cheap or easy.  I know in the US it’s a bit of a nightmare, because wow, you’ve fucked up your healthcare system in some exceptionally special ways.

But there’s a good chance you’re not going to get better on your own. 

Warning signs

Everyone should see a psych. You don’t need to have any warning signs. Just go. Also, people who have warning signs tend to minimise them as an excuse not to seek help. So let me tell you, there is no excuse not to seek help. If you’re 100% healthy, you still need to go see a psych.

That said, there are a bunch of signs that not seeing a psych might be particularly unhealthy for you. Scroll down the list and see if any of them sound familiar. Any one of these by itself is a good reason to pick up the phone and make an appointment today.

• If you’re over 35 and putting on weight.
• If you have a history of being physically or sexually abused.
• If you engage in self-harm or have suicidal thoughts.
• If you are missing work regularly or having trouble leaving the house.
• If you are socially isolated or can’t think of three separate people you could count on to help you out if you were in trouble without making you feel worse than when you started.
• If you’re avoiding some important task, appointment or interaction, and you know there will eventually be consequences for that.
• If you know you have a problem with addiction or:
  • if you are not fully sober on more than two occasions a week; or
  • if you have spent more than $50 on gambling in two consecutive weeks (regardless of if you won anything); or
  • if you’ve used any illegal drug other than cannabis more than once in the last three months, or use cannabis regularly; or
  • if you’re a daily user of painkillers (legally prescribed or otherwise); or
  • if your spending habits or your interaction with any drug, legal or otherwise, are having any negative impact on your work, relationships or life.
• If you have ever been in an abusive relationship, whether as an abuser, a victim, or a regular witness.
• If you have gone an entire week without doing any significant catch-up on the housework, and it’s not the first week within the last two months that that has happened.
• If you have shouted in anger in the last two months.
• If you have, while angry or stressed, punched or thrown something that wasn’t intended to be punched or thrown within the last year.
• If you’ve been in a traffic accident and your behaviour around driving or travelling has changed as a result.
• If you just ended a long-term relationship, had a divorce, transitioned from a long-term job into unemployment, had a business go bankrupt, had a parent, child or partner pass away, or if you or a partner had an abortion or miscarriage.
• If your friends have recently raised concern about your behaviour or health, whether you think that concern is justified or not.
• If you have been arrested for any crime, or are otherwise currently involved in legal proceedings.
• If you do not feel in control of your behaviours around sex, masturbation, or consumption of pornography, or if those behaviours are accompanied by significant feelings of guilt or self-harm.
• If you have been recently diagnosed with a significant disability, chronic illness, life-threatening illness, unplanned sterility, or STD.
• If you’re not regularly getting a full night’s restful sleep.

These aren’t the only warning signs, but I have to stop somewhere.  If any of these sound familiar to you, you NEED to see a psych. The psych might listen to the full context of what’s going on in your life and say, “No, okay, actually you’re all right” – but that’s for them to say, not you.  It’s just like if you have severe chest pain, you call a doctor. Maybe it’s just heartburn, but only an idiot makes a bet on that.  

What to know about seeing a psych

In seeing a psych, you may be assisted by knowing about the following things:

• EAPs exist and you may have access to one: Many workplaces offer an “employee assistance program” as part of their work conditions / workplace agreement / employee contracts / general plan to be a responsible employer.  This will grant you a certain number of free, anonymous appointments with a counsellor and/or psychologist per year, which can be used for any topic, whether work-related or otherwise.  (Anonymous in the sense that the EAP doesn’t tell your employer the names of employees who had appointments.)  
  These appointments may be by phone, in person, or both.  Some volunteer organisations, unions, and professional associations also have these programs.
  Consult your Human Resources area (or coordinator of your organisation) to find out what’s on offer.

• Your GP can help: Your general practitioner SHOULD have basic training in mental health, and be able to assess and recognise symptoms of depression and anxiety.  They can refer you to a good psychologist who meets your needs (or a psychiatrist – see below), and may know which psychologists do and don’t suit your particular personality and issues.  In Australia, a GP can also put you on a “mental health plan”, which is basically a fancy way of saying that you’re qualified for a certain number of discounted psychologist appointments under Medicare, saving you money.
  
• Psychiatrists are not psychologists: Psychiatrists deal in the medicine of the brain.  Their job is to treat physical disease involving the brain using medication.  That’s different from, for example, talking through past trauma and helping you understand the ways it’s affected your behaviour, which is what psychologists do.  A given problem may require help from a psychiatrist or a psychologist or both. Depression, for example, is more likely to occur in people with a history of trauma – so you’d probably want to see a psychologist about that – but regardless of where it comes from, it presents as an actual imbalance of chemicals in your brain and a difficulty in forming seratonin, so it’s very likely that you *do* need medication – specifically antidepressants – to stay healthy and safe.
  
• Counsellors are not psychologists: A counsellor is not a psychologist.  It’s a lower level of qualification in the same general field.  They’re generally not qualified to do deep examinations of trauma, for example.  That doesn’t mean that they’re not worthwhile! They can be great for talking through a specific recent distressing incident, like the loss of a loved one, and can suggest specific strategies for dealing with stress, anxiety, and other immediate impacts of mental health.  They’re also significantly cheaper to access. But if you know you’ve got a *big* issue to deal with, or something in your past that continues to affect you today – or if a counsellor simply hasn’t satisfied you – then don’t just give up. Step up to an appointment with a psych.
  
• Chaplains and priests are not necessarily counsellors OR psychologists: I’m not a fan of organised religion, but many priests *do* do very good work in supporting the mental health of others.  If you’re the sort of person who feels like they might benefit from talking to a priest, go for it. It’s always better to be talking than keeping it to yourself.  But do ask your priest what specific qualifications in mental health they have – get the name of the qualification and where they earned it – if only so you can correctly report what medical care you’ve received if you need to go elsewhere.  It also has consequences for their professional obligations around reporting, keeping of records, professional insurance, and compliance with professional standards and ethics.
  
• You might not get the right psych on the first try: Getting good results from a psych involves feeling like you can trust them, that you are communicating with them effectively, and that your interactions are safe, positive and beneficial.  If you don’t feel like that after your first appointment, try a different psych. (Yes, I know there are cost implications, but if you need a psych then it costs what it costs.) It is okay and normal to try a couple of psychs to find one that feels like a good fit for you.
  
• Different psychs offer different services: There are a range of treatments that psychologists can offer to patients.  Some are big fans of Cognitive Behaviour Therapy, which is focused on being aware of the way you think in the present, and consciously modifying those patterns of thought to have healthy outcomes.  Others like Schema Therapy, which is about looking at how past interactions shape the way we assess and react to the world and to ourselves, and reassessing both the events that cause that reaction, and the way we react in the present.  Others can offer something similar to Freud’s “talking cure” – there are better and more scientific names for the modern versions of this that I can’t recall right at the moment, but they often involve a deep dive and long-form re-analysis of childhood and past trauma to gain catharsis, insight, and allow us to move on from unresolved issues. 
  Not every psych will offer every treatment, or be equally good at them, or even believe them to be effective.  As the patient, you’re ultimately entitled to the treatment you want and which makes you feel like you’re improving, and if you’re finding something to be frustrating or unhelpful, you can request a different approach, or move to a different psych.
  
• It gets worse before it gets better: Engaging with past trauma is upsetting.  It brings it all up to the surface and makes it feel real and immediate.  It is my experience, both personally and with friends, that trauma-related issues can actually get *worse* immediately after starting psych appointments.  You can feel more emotional, more on edge, and like situations are more charged with triggering associations.
  That sucks, and there’s no real way around it.  You need to get better, and the path to doing that involves temporarily getting worse. 
  What you can do is be aware of it, and plan for it, and – importantly – see it through.  Don’t just walk away after one session. Stay the course until it actually does start to get better.
  
• There *are* kink- and poly-friendly psychs: They exist.  I am lucky enough to have one.  That may involve the psych being actively kinky and poly.  It more often just involves them having an open mind and being willing to listen to you explain your life and what it means for you.
  If you are in touch with your local kink community, then someone can almost certainly recommend you an open-minded psych in your area.  (They may still not be the right psych for you, for the reasons above. At the end of the day, it’s more important that you trust them and that they can competently offer you the kind of treatment that you actually need than that they know every detail of your sex life.)
  
• Responsible kinksters see psychs.  It’s just like getting an STD check regularly.  It’s part of fulfilling your obligations to your partners.  Go see a psych. Kink is psychologically intense. The highs are high, the lows are low, and because kinks often come from trauma and taboo, it inevitably interfaces with a lot of pretty deep stuff.  Plus it has all the stresses of relationships generally. If you have a not-fun meltdown in the middle of a scene and your dom or sub suddenly needs to stop everything, deal with their blue balls, and look after you – well, that’s a normal part of kink that everyone needs to be ready to do sometimes, but you could definitely do your partner a favour by being as healthy as possible before the sexy times start – and that means seeing a psych.  

In conclusion

So – go see a psych.

And normalise it.  Feel free to talk about it – especially if you’re a man, talking to men.  It’s just like a GP checkup. Tell your friends to do it. It doesn’t mean you’re “crazy” or your life’s a mess, any more than going to a GP means that you need major surgery – and if you *did* need major surgery, that’s just what you need, and it doesn’t reflect on you as a person.

As always, I’m happy to answer questions on this or any other kink / relationships / sexual health topic either publicly (by an Ask on BDSMLR) or privately by email or private message.

– All These Roadworks
March 2020

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Updated 4 March 2020: A follower on BDSMLR pointed out the following things worth clarifying, which don’t take away from my point, but I’ll include out of fairness.

(1) A psychiatrist is a medical doctor with an extra vocational training and degree in mental health. They can do what any physician does but specialise in mental health.

(2) When I said that “psychologists are real doctors” I meant that they’re a qualified healthcare professional whose skills and expertise are real, high-level, professionally regulated, and run in parallel to a psychiatrist, not at a lower tier. BUT in the technical terminology of the medical fields, they are NOT a medical doctor because their degree is in psychology, not medicine. (Unless they also have a separate degree in medicine.)

Thanks!