While thinking back on my experiences as a therapist who specializes in working with people living with HIV, it’s rewarding to think of how so many clients have made such dramatic improvements in their lives once they accessed mental health services as well as good medical care. They were able to overcome any fears of seeking out mental health treatment and learned how to cope with their particular situations. Many of them didn’t know that help was available, and they suffered in silence for a long time. Some of them got medical care for HIV relatively easily, and our work in therapy addressed their emotional concerns. But for others, they were suffering from more severe psychiatric disorders, and they didn’t realize that some of the symptoms they were experiencing came from having well-defined psychiatric disorders that have names and proven treatment remedies. They thought they were the only ones with the symptoms, and they didn’t know others had the same experience or that there was an explanation for what was happening to them.
One client, Tim, had been living with HIV for about 5 years and on medication achieved an undetectable viral load and was feeling pretty good, physically. But he had been laid off from a job during an economic downturn, and came to me for treatment of his depression following prolonged unemployment. But soon after I started working with him, I noticed that Tim would often run late for his appointments with me. When I asked about this, he explained he often ran late for all kinds of appointments because he felt “compelled” by an uncontrollable urge to clean his tennis shoes to be sparkling white, like new, before he left the house. He felt that if he left home without his shoes being spotlessly clean, some vague catastrophe would happen to him or someone he loved. He described other ritualistic “habits” he had, like counting the number of pairs of socks he owned each morning and lining up his belongings in a certain order at all times. He was bothered by how much time these counting, cleaning, arranging, and “checking” rituals took, and he even knew on some level that they were unnecessary, irrational, or even embarrassing, but he still felt compelled to do them. He felt like he was the only one in the world who felt like a slave to these rituals, and wanted to be free of the compulsion to do them. What Tim didn’t know was that he was suffering from a disorder called Obsessive-Compulsive Disorder (OCD), which is treatable with medication and psychotherapy, often with very good results that reduce the compulsions or help someone to cope with them.
After I referred Tim to a psychiatrist who was familiar with treating people with HIV, he was given a type of antidepressant medication that helped him, but he was sure to tell both his HIV specialist doctor and his psychiatrist about what medications each was prescribing for him, to reduce the chance of harmful drug-drug interactions. Sometimes psychiatric meds and HIV meds can mix just fine; other times, they can have interactions that can be dangerous (like with Kaletra or Ritonavir). The same can be true for someone using recreational or “street” drugs. Being sure to tell every doctor what meds other doctors have prescribed for you is critical, along with talking frankly about any other substances used, including “just” herbal supplements.
Another client, Brian, is now older but described how when he was a young boy about 7 years old, he felt compelled to pull strands of his hair out of his scalp. He eventually developed small bald spots on his head and his parents grew concerned that he might have a brain tumor until they realized Brian was pulling the hairs himself. He couldn’t explain why he did it, he just did it as a vague form of tension relief in response to emotional pressures. He, too, felt alone, isolated, and “weird”, and moved his hair around like a middle-aged balding man to try to cover the bare spot, but occasionally other kids would notice and ask him or tease him about it. What Brian and his parents didn’t know until much later was that Brian had a disorder called Trichotillomania, also a psychiatric disorder that, like OCD, deals with uncontrollable impulses but occurs often in young children aged 5-8. His parents were so focused on his treatment for HIV that the “other problem” of the missing hair went unnoticed for quite a while before he was eventually stabilized with his HIV enough to get additional kinds of treatment.
Still other clients have sought help after a long period of hearing voices, “seeing things”, feeling paranoid, experiencing deep depression or manic highs, or a combination of these. These symptoms can happen as a part of severe depression, bipolar disorder (“manic-depression”) or schizophrenia. (People often misuse the term “schizophrenic” for someone with multiple personalities, when it really means someone who has a mental illness that is characterized by hallucinations and delusions). Since HIV meds like Sustiva can cause central nervous system side-effects, sometimes it takes some careful analysis over time to see what might be a passing side effect or a temporary emotional disturbance, and what is a true psychiatric disorder that needs medication. The important thing in making those distinctions is to talk about what’s going on with a doctor, therapist, and psychiatrist who are familiar with both HIV and psychiatric issues.
Sadly, too often people are held back by cultural or family messages that attach a stigma to seeing a mental health professional, causing them to not get the help they need. Some families like to “keep things private”, fear “being put away”, fear being labeled “crazy”, or feel that a “real man” (or woman) solves their problems on their own. But think about it – if you had a broken leg, you wouldn’t think twice about going to see an orthopedist and getting a cast, or breaking a tooth and going to see the dentist. If you need or want help for something that might be a psychiatric disorder, stigma shouldn’t stand in the way. You deserve to have relief from your symptoms. Television and movies have done a lot to reinforce stigma of mental health services, with works such as “Psycho” or “Frances”. Overcoming the stigma and bravely agreeing to be evaluated by a mental health professional is often the first step to freedom from debilitating symptoms.
If you are experiencing emotional difficulty, or if you do, see, hear, or feel things that you think are unusual that bother you or interfere with functioning at work, at home, or at school, talk to your primary medical doctor about a possible referral to a psychiatrist. Unfortunately, just because you’re dealing with HIV doesn’t mean other disorders don’t need attention as well, that can exist along side of – and maybe not even be related to – living with HIV. A psychiatrist won’t “put you away for being crazy” except to keep you safe if you’re about to seriously harm yourself or others, but they can help you out of a mental prison where you’ve long ago “done your time”. When you’re dealing with HIV, taking care of yourself means taking care of the whole you, even if that means getting treatment for other disorders that are happening at the same time.