Twelve years ago, I lived in New York, way out in the bowels of Brooklyn. I was free falling into my first major depressive episode as an adult. A paralysis loomed on the horizon and I was desperate to run into the arms of a reputable psychiatrist. There was zero doubt in my mind that now was the time to gain access to anti-depressants and whatever else would be recommended, along with regular talk therapy. I remember my father calling me during this time and saying, “don’t worry, help is on the way”.
My father, who’d been working with the same psychiatrist for many years, some of those years over the phone, asked her to pull a list of names together. The day I was emailed that list was a very good day indeed. I felt one significant step closer to deliverance. We’d decided I should see a man this time since I’d only seen women up until then. Of the ten or so doctors’ names I was given, the only distinguishing information I had was that the guy on the top of the list was the youngest. I started there.
He called me back! In hindsight I realize that that was my second huge hurdle cleared; the first being given that list. I used to run track in middle school, so I like the hurdle metaphor: forgive me, I know it’s overused.
We set up a “consultation”. In NYC, what this means is that I’ll be asked to fork over around $400.00 (at least) for the privilege of being told whether or not the doctor will take me on. At the risk of sounding like a “treatment-resistant” patient, after all the work I’ve done through the years, it bothers me to have to pay a new doctor to give me the familiar, entirely consistent through childhood and adolescence, diagnosis of Major Depressive Disorder.
The other privilege of this 40-minute $400.00 expenditure is an explanation of how much ongoing treatment is going to cost me. The so called ‘nuts and bolts’ or ‘business side’ of things. All the psychiatrists I saw in New York offered sliding scales. I’m sure that makes them feel good about themselves and it is, of course, a good thing to do. But the bottom of that scale is always around $150.00. That’s still out of reach for many of us at $600 a month.
Let’s go back to the fact that I was a very depressed 25 year old. I’d just retired from a modeling career, characterized by ambivalence on my part and far less income than one might imagine. I was dipping my toe into higher education at Borough of Manhattan Community College. The only money I had was from PELL grants and babysitting. Neither of my divorced parents with non-profit careers and 2 other children to care for was in a position to spend hundreds of dollars a month. At the same time, they both–but especially my dad–INSISTED I work with this young doctor, who I think had proposed a discount price of about $250.00 per session, which comes out to $1000 a month. This was so far beyond my means; it felt like a joke.
We were going to have to take the humiliating step of asking a “well-resourced” family friend to fund the treatment. My dad assured her it would be a loan. Turns out that was wishful thinking: it wouldn’t be a loan because he, my father, who had suffered multiple strokes a few years prior, was not regularly employed and soon fell behind in his payments. But that’s another story.
Now, on top of my deep depression, I had a new pressure in my life, which was the awkwardness in my relationship with this family friend who was paying for something so critical to my functioning. Stemming from a feeling I should do something for her in return, we fumbled through dog-walking and baby-sitting arrangements over which I had no right of refusal. I knew she had every right to change her mind at any point, and so my therapeutic relationship felt incredibly tenuous: I lived in constant fear that I’d get cut off from a doctor I’d grown increasingly fond of, or not be able to afford my medication.
Years went by, and while I never was cut off, my relationship with the family friend became increasingly strained. Money is a complicated thing.
When I got my first post-college job, I was able to start paying for the treatment myself at a bigger reduction, a milestone of which I am very proud.
Those years of working, going to school full-time, and being in psychiatric treatment were grueling. Even though money was a constant source of anxiety, I did manage to live my life: I had relationships, formed friendships, and got my degree. The treatment was painful, tedious, electrifying, and everything else worthwhile therapy is. And I did, after many years, feel better.
But it all came at such a cost because neither I nor my parents could afford it. And the truth is that I never would have gotten the help I needed if there hadn’t been someone I could go to for the ask. That kills me.
And as we all know, major depression doesn’t get cured. I’ll always be seeing a doctor from time to time, even if I don’t need the weekly support.
How much better would we all feel knowing really capable psychiatrists in New York, and elsewhere, could be accessed even when you’re living paycheck to paycheck?
Enter Tele-Medicine. This could change everything.
PS: Special thanks to the doctors who gave me the world: money would never have been enough, anyway.