Musings on Psych Evals

Since I started my latest all-consuming hobby, reading weight-loss surgery blogs and forums, I've read a lot of concerns people have about psych evals, typically part of the pre-op regime you go through to get approved for surgery.

Now...I'm an open book. Online, in real life, I just don't have many secrets, so it never really occurred to me to be worried about the psych eval. But for posterity's sake, since I hope that one day this blog will be helpful to people considering or undergoing weight loss surgery themselves, I'll tell you my thoughts and experiences.

I went to the same clinic for a psych eval that I had gone to following my divorce. This was the clinic associated with the hospital I'll be having surgery. This clinic would not have been my first choice for the surgical eval, because, well, did I mention it's the same clinic I went to following my divorce?! :) The one that I went to and spilled my guts to a psychiatrist about every dark, sad, awful thought I'd had for the last couple years? Every admission that I did not think I could handle my life anymore, every throw-in-the-towel thought, every awful thing I'd done to my marriage to end it (ok, I didn't really do anything too awful, other than be a stark raving beeyatch to my husband - who, rather than having the cojones to address it, decided to just walk out on an eighteen year marriage - hell, yes, I am still angry!), every awful thing I'd done to myself following the divorce. This clinic, in other words, had SERIOUS DIRT on me.

I had sought out the clinic initially because I was having such a hard time adjusting to life as a single parent, had been so blindsided by my husband's departure, and had been so psychologically beaten and bruised over the last couple years...I decided I must be bi-polar, or borderline personality, or, or, or...

My psychiatrist was so wonderful. He set me right in no time flat. I had gotten divorced, I had been forced into bankruptcy (ex took the credit card debt in the divorce and I took the other stuff, then he bankrupted the credit cards, leaving me with all the non-bankruptable debt and unable to pay the credit card debt). I had lost my "dream job" (ex walked out on me and kids the day before I started new power job, completely, completely unexpected - I battled to keep new job but it is hard to impress people when you have the proverbial rug pulled out from under you and your three kids), I had lost my home (I sold current home and backed out of purchase of larger home when ex left). My kiddos had never been in daycare, my oldest went through horrible anxiety issues causing me to miss an ungodly amount of work, I spent three months unemployed, blah blah blah. I was not mentally ill, I was at the lowest point in my life, and I was having a very, very hard time getting through it. But, he emphasized repeatedly, I *was* getting through it.

Serious dirt. That clinic alone could kill any aspirations of a political career I had ever had, haha (I have no such aspirations).

So, when my surgeon said he was referring me to that clinic, and I could find a different one but this is the one that knows how to do the WLS psych evals, and does them quickly, etc. - I thought, what the heck. My psychiatrist at the clinic was no longer there, so I didn't even have the advantage of someone who knew me and knew I had worked through those issues.

This wasn't ancient history, either. My ex and I separated in March 2009, and I filed for divorce as quickly as the law allowed, and our divorce was final in August 2009.

I had my eval appointment, and it went very well. I am a terribly candid person, so I had no qualms about describing my current state of mind, as compared to the time following the divorce. I have my ups and downs, but all in all, life is pretty good. I had gone off the anti-depressants since I had been to the clinic last, so I had a few months med-free under my belt to further illustrate that I was feeling good.

The psych eval seemed to focus on these key issues: what will you do in place of food? what are your (hopefully reasonable) expectations of the surgery? what sort of support system do you have in place?

That's it, and that's all. The doctor was checking to make sure I had a clear understanding that this was not a magic wand, that my weight issues and the issues that led me to be overweight were not going to go away by themselves. We talked a lot about  how I would spend the time I currently spent eating, why it was that I had gotten so terribly overweight, what I thought post-surgery life would be like.

I explained that I wasn't expecting my 40+ year old body to become my 20-year-old body just because I took off the weight. I think I have reasonable expectations of the surgery, and a reasonable expectation of the amount of hard work I will have to do to maximize its success. I'm aware of the risks and the trade-offs. There is no reversing this surgery, so whatever its results, I've got to be positioned to accept it and make the most of my life. No changies or take-backs!

I think that's all the psychiatrist wanted to hear. I want to say that if I could pass the psych eval, then anyone could, haha, especially given that thick file of mine in the evaluating doctor's hand. But it's more than that - I think I'm proof that if you have good, solid, realistic expectations of the surgery and its risks, as well as what it will and will not do for you, you'll pass the psych eval just fine. So rather than say anyone could pass it because *I* did, I'll say that you shouldn't worry about what demons lurk in your past - if you have dealt with them and are well-positioned to succeed with the surgery, you will not be tripped up by the exam.

Good luck! We've all got our scars from life and none of us are perfect. I have been open with my doctors about my times of crisis, because I wanted to deal with them and move past them! It's nothing to be ashamed of, and as long as you are always working hard to keep life moving forward, your weaknesses won't keep you from achieving your goals.