I was going to wait until the psychiatrist sent her report to my Dr before saying how it went but ok here's my report.
First of all
@WillowJ I am quite happy to accept that my view of the psychiatric profession regarding CFS has been negatively affected by being exposed to so many of the "other kind of story" - in fact that's the only kind of story I've heard so far, from CFS patients, my internet research and the books I've read.
I know at least 4 people from 2 CFS self-help groups in my area who, after suffering from CFS for years and facing severe financial difficulties, have had to give up and accept a (wrong) diagnosis of depression just so that they can finally have their disability pensions approved (or half-approved). One of them even went on a rehab for depressed people where she was made to do sport and crashed so badly they sent her home. It was of course further evidence of depression. These are people I know who have been to Drs and psychiatrists in my area, so I was, to say the least, in a cautious frame of mind about psychiatrists.
I was also resentful of having to see a psychiatrist at all before I am allowed to present myself to the Immunology clinic in Berlin. According to the IOM report CFS should no longer be a diagnosis of exclusion - if it is, what happens to people who have psychiatric issues AND have CFS?
I know I may come across as paranoid, but I'm walking a very fine line here. In Germany CFS is classified in official guidelines for health insurance companies and social services as psychosomatic, so a diagnosis of CFS is often taken as confirmation that you have a psychiatric illness, and I've had to think very carefully about whether I even want the diagnosis, for many months I decided that I didn't. I have now decided to go for it, but if I ever have to claim benefits I will probably have a court battle on my hands that goes at least to one appeal, or have to accept a psychosomatic diagnosis and go on inappropriate rehab which will make my health worse before my claims are approved.
I've decided to go for the diagnosis because claiming benefits isn't part of my plan and I'm still hopeful that I can carry on working and managing / stabilising my symptoms by pacing. Plus I would like to deal with Drs who understand what I've got, and when I have to tell other people it will be easier and more credible to say "I have an immune system disorder diagnosed by the University hospital in Berlin" than "I've got CFS, it's a self-diagnosis". I just don't need the funny looks any more. I want my Cytokines and V02max measured so I can print the numbers on a T-Shirt.
Anyway, to start right at the beginning, my Dr gave me a list of 3 psychiatrists he recommended. I went to all of their websites and, by looking at the therapies they said they offered, chose the one that was the most "school medicine", or at least didn't advertise any quack therapies on their website (two of them did). I also went to Dr review websites, where a complaint from a patient confirmed that I had chosen the right Dr - "as soon as she has exhausted textbook medicine she has nothing to offer". Just what I was looking for.
I also stopped my Dr from writing "CFS clinic in Berlin" on the prescription to the psychiatrist and asked him to write "immunology clinic" instead, which he did. CFS is a dangerous word in Germany, see above.
My appointment was at 08:30. I have between two and three hours after getting up in the morning before I have to lie down again, so I was able to ring on the doorbell symptom free, bright-eyed and bushy-tailed. I was 20 minutes early.
I had to fill in a form about previous medical issues, mine and in my family. There are hardly any, but I put down the few I could think of (thyroid etc).
The psychiatrist was a pleasant, no-nonsense elderly lady who ushered me down the corridor into her room (making sure I walked in front for some reason - so I didn't attack her from behind with my concealed axe?).
She asked what brought me to her. I said that for the last 18 months I had been feeling tired after sport, that I would like to present myself to the immunology clinic in Berlin, and that before doing so I was working with my Dr through a list of conditions I needed to exclude. I then put the list in front of her, so that she could see that a psychiatric condition was just one of 8 other, more physical, things to be checked (others were sleep screening, Lyme, gastro blah blah etc). I was hoping to minimise the significance of my visit to her.
I think it helped that I was there because I wanted to further investigate my complaint, not because she was checking my claim for disability benefit or early retirement. I don't think she was at all familiar with CFS. I handed her the 7-page info document for doctors from the clinic in Berlin. She handed it back.
She asked what I meant by tired after sport. I described a 2-hour crash. I omitted to describe a 6-week crash. She asked if I had headaches, I said yes and described them accurately, pressure headaches in my forehead. She asked if I had stomach trouble, or trouble sleeping, I said occasionally, when I had overdone physical exertion, otherwise not really. I used the phrases "sport" and "physical exertion" (and even "post exertional malaise" at one point, but she didn't pick up on it) and left it at that. She didn't ask for further details so I didn't have to decide whether to tell her that physical exertion that leaves me exhausted also includes walking upstairs, carrying a shopping bag etc. or that I have to lie down at least twice during the day. I probably wouldn't have mentioned any of that to her if asked, why should I give her the ammunition to make a false diagnosis when my priority is to get to Berlin where they have doctors who understand CFS?
She asked about my job, I told her that I teach about 20-25 hours a week, plus 10 hours lesson preparation, I don't find it over-burdensome, really enjoy it, and don't teach at the weekends (all true).
She asked about my children (13, 17 and 18) to which she replied "Oh, they're grown up then" and moved on.
She asked about my marriage, was everything ok? I said that my wife and I had been together 25 years and got on fine (also true).
She asked if anything had been bothering me lately. I said no. (true - apart from my health and having to see her obviously).
She examined me physically by taking my blood pressure, whacking me in the knees with a hammer, tickling my feet and making me pull funny faces.
She said she would be sending her report to my Dr. I didn't ask what she was going to write because I didn't want to appear paranoid or anxious and I'll find out soon enough anyway. She wished me good luck with my further examinations, and we said our goodbyes. Whole thing lasted 15 minutes. I think it went well. She asked me the questions she had to but wasn't pushy, I don't think she's heard about CFS, I wasn't making a claim, she didn't seem to have an agenda or an axe to grind either way.
Thanks to everyone for their advice, support and listening.
let's hope it's a skilled, respectful and compassionate psychiatrist.
