Psychiatrists, Psychologists and Councillors

Oh MY!!

One of the scariest things about Tourette syndrome is getting the diagnosis (DX) in the first place. Although it usually wonderful to know that your condition has a legitimate cause, getting to a DX can be very troublesome. It can also be quite scary if you don't know who you are seeing or what they do.
The general rule of Tourette specialists seems to be:
See a Neurologist for a DIAGNOSIS
See a Psychiatrist for ASSOCIATED CONDITIONS and ONGOING SUPPORT
See a relevant Councillor for INTEGRATION WORK

Neurologist

Neurologists are, without a doubt, the specialist you visit to get a DX. It can take a psychiatrist years to see Tourette syndrome, a neurologist will recognise it in two seconds (unless you are currently suffering from doctor's room syndrome). A neurologist will sit you down and listen to your concerns. He will test a few basic reflexes, tap this, squeeze that, and get you to flex your ankles. If he's convinced of a history of tics he will then say that he believes you have Tourette syndrome, but go and get these tests done just to make sure.

There are no tests FOR Tourette syndrome, but there are lots AGAINST. For diagnostic purposes you are likely to need about three blood samples taken to test for Huntington's chorea, copper deficiency and something else which I can't remember at the moment. You will then, most likely, need a MRI to make sure there is no brain damage present.
There are two ways to look at MRI's...they can be silly and very boring, or they can be terrifying. If you are afraid of confined spaces, don't have one! they are not absolutely necessary and will just be uncomfortable. The general process for a Magnetic Resonance Imaging test is you will lie down on a table near a large white donut thing. They will put a pillow under your head, a blanket to keep you warm, and a little button (like a projector lead) to press if you get stressed. They will then slide a small cage over your head. This will only just fit past your nose...it's very small. On the cage they tend to have mirrors so you can see the nurse at all times, just to reassure you. The bed then slides into the donut and your caged head sits in the middle - nothing but cream plastic to see. The machine will then make beeps and clicks for 20 seconds. The nurse will ask if you are alright and if you are the machine will start again for 30 seconds. This happens a couple of times, the scan getting longer each time. The clicks are a bit odd, but not worrying...at least not to me.
Once the tests come back they will (if you have Tourette syndrome) be negative. You can breathe a sigh of relief that you don't have to be on copper injections for the rest of your life, and you can then discuss medication if necessary. Neurologists are good at the initial setting of medication for Tourette's, but if you need something else as well (e.g. antidepressant) then you'll need to go somewhere else.

Psychiatrist

In some countries, seeing a "therapist" is becoming an upper-class trend. This sort of therapy is usually not treating any deep seated problems, it's more to pay someone to listen to you whine. We see this sort of thing all the time on U.S. sitcoms. A psychiatrist, either a young blonde female or a grey haired male sit with a pad of paper while you sit on a leather couch and do all the talking. Those who expect psychiatry to be like this may be alright with visiting one. Those people who still hold with the image of grey dirty corridors of a Mental Hospital with men in white coats striding down them may be terrified.

The truth is, of course, a combination of these and it depends on the type of psychiatrist you visit. Some of them reside in psychiatric hospitals, some in normal hospitals, and others in private homes or small clinics. Generally (except for the psychiatric hospitals) psychiatrists hang around with other specialists, like dentists, so that you can pretend you are just there to have your cavities filled.

Although the rooms range in size from a broom closet with a bed in the corner to a room that would scare agoraphobics there are a few things you can usually expect to see. There is always a desk. It usually faces the wall and will be used to rest a phone and some piles of paper on. There are chairs, mostly big padded ones (often leather). There's usually three or four chairs in the room, one is clearly the doctor's. You may take your pick of the others. (They will watch which chair you sit in. I played with a psychiatrist's mind once by sitting in a different chair every week.) You do not have to accept any chair where it is. Feel free to move them around until you feel comfortable.
The rooms in hospitals are often the smaller ones and will have hospital beds and blood pressure machines in them...these are not used in psychiatry.
I have never come across a psychiatrist's office with a couch/bed.

When you walk in the first time, the doctor will have a manila folder and be sitting close to his/her desk. They will spend the entire first session asking questions and writing the answers down. The questions will be about your medical history, for example:
Have you ever had any operations?
Where did you go to school?
Why are you seeing me today?
Do you have any brothers? Sisters?

The first session is the only time you will hear him ask closed yes/no questions.

The second session, or the third depending on how much information they got out of you the first time, the folder is gone. The psychiatrist will sit facing you and will look at you. Do not expect him to say anything. Sometimes they will ask a question in order to start a conversation, but it's usually something like "what are you thinking about now?". The idea is you walk in, sit down, and don't stop talking until the hour is up. Talk about ANYTHING. You may think that discussing the clay monster you made in Kindergarten is stupid, but these people are interested in everything. When you hit on a good topic suddenly you won't be able to speak. The doctor will leap in and encourage you to talk more about point A or elaborate on point B. They will also (I'm afraid) talk like Eliza.

(I don't know if any of you remember Eliza. Back when computers used Basic and didn't have colour, there was a program called Eliza the virtual psychiatrist. You would type in a phrase and she would rearrange it into one of four questions or statements. For example, if you said "I am..." or "I feel..." she would say "Did you come to me because you are/feel...." and if you mentioned the word "you" she would say "This is not about me." You could get some great answers from her:
"Eliza, I am a fish"
"Why do you think you are a fish?"
"Because I am"
"Did you come to me because you are?"
"No, I came to you because I am a fish"
"Why do you say that?"
"Because I am, you moron!"
"Does it bother you that I am a moron?"
"Shut up!"
"Tell me more about "shut up!""
and so on...)

Talk to Eliza Here!
(Warning, this version still has a few bugs.)

Luckily real live psychiatrists are a bit more logical than that. But they will say things like. "I get the feeling that there is some aggression behind what you are saying...what are you angry at, do you think?"

As for the medication side of it, this will be sorted out very quickly. Psychiatrists are very sensitive to what you want when it comes to medication. If you go in and say "The tics are driving me mad! I can't live with them! Dose me up!!" they will generally prescribe higher doses than if you admit you hate feeling drugged, but you suppose you need some meds. Personally I find it is always a good idea to state your true feelings about medication because once you are on a dose you really have to push to get it changed.

Councilors

Psychologists are different from Psychiatrists. The major difference is that while a psychiatrist is a graduate of medical school and can prescribe drugs, a psychologist is not. Psychologists work instead with behavior modification, or in other words, habits. Psychology works in a few different ways.
One way uses reinforcement or Classical conditioning. If you've ever heard of Pascal's dog, you'll know what this is. Pascal discovered that if you rang a bell just before you gave a dog food for long enough, then you could make the dog hungry just by ringing the bell. The dog eventually associated the bell with food. This is done in humans with things like nail biting - an bitter tasting liquid is spread over the nails so that every time the person bites them they get an awful taste. Eventually the person associates the bitter taste with biting their nails and will stop. This can be done in useful ways with conditions such as depression or social phobia. You could reward yourself every time you complete an essay for school, for example, by watching TV for half an hour.
A second way is practiced quite frequently with phobias and anxiety. It's called exposure and it introduces a person to the thing they fear gradually. A person who is scared of dogs could be put in a room 10 meters away from a stuffed dog until they get used to it being there. Then they are moved gradually closer until they are touching the stuffed dog. The process will then be repeated with a real dog. This is not a quick method, it can take months to work but it's generally very effective. The method can also be used to help those with agoraphobia or social phobia. The fear associated with a certain activity is rated by the sufferer and they then start out doing the least scary activity on the list once a week. After they get more comfortable with this, they move up the list.
Psychologists are also good with Obsessive Compulsive disorder. They can use Classical conditioning or substitution methods to stop annoying or painful compulsions. They also teach a thought stopping method to stop obsessions. The process goes like this:
First you must think of a calm place or a happy thought. Picture it in as much detail as you can manage. Once you have it firmly in your mind, think about something else then speak out loud "STOP!" forcefully and think of the peaceful scene again. This takes a lot of practice, but eventually you will be able to stop any obsession or even mental tic by saying "stop" and thinking of that scene. Do not change scenes, use the same one everyday. Psychologists are probably the worst people to come to to get a diagnosis of Tourette syndrome. It is almost a good idea not to mention that you have Tourette syndrome to a psychologist as they will attempt to stop your tics by substitution. This doesn't work, substitution moves tics around, but it doesn't stop them.
In an attempt to get a diagnosis my psychologist did an IQ test on me, and I must say that did a fat lot of good!