I think with psychiatric appointments, all you can do is be honest. Physically, my health is okay, so I don’t have much to compare it to, but looking at my family members and treatment they’ve received for physical complaints, mental health treatment seems patchy. I've seen excellent doctors and nurses and some that made me weep. One of the hardest things is having to fight, when you don’t have the energy and when you’re doubting your validity. When people cancel your appointments without telling you, when they don't return your calls, etc, it doesn’t exactly encourage you to stay in contact with them. When you drag yourself to the appointment, trying your hardest to explain what’s been happening, and the doctor silently thumbs their copy of the BNF before apparently picking a drug at random. And then they send you a copy of their report which mostly focuses on what you were wearing and if you can make appropriate eye contact. Outside of my appointment, I am not honest. I am excellent at bluffing. Most of my friends know that I have some mental health difficulties, but I'm rarely explicit. My current employers found out when I had to take time off work in February and I'm lucky that they have been supportive. They've been flexible when I've needed to take time off for appointments, they let me work reduced hours for a couple of months and most importantly, my manager has appeared completely unphased by it, treating me in the same way as she does my colleagues with physical health conditions. But outside of my managers and HR, I haven't disclosed to anyone else. Some of my colleagues are weird about mental illness. I work for a charity and sometimes. when a case comes up the involved mental illness, it is spoken about in hushed tones, like it is the most awful thing that could happen to a person. One colleague once stated that she is constantly afraid of being stabbed on the tube by someone with a mental illness and really, she feels 'they' (particularly people who have been in a psychiatric hospital) should be on a register, like sex offenders, so you know who is in your neighbourhood. Or electronically tagged, (I'm serious). I think about telling her that I've been in one, that I am sitting there, across the desk, not killing anyone. And to be fair, I have plenty of colleagues who don't think like this, and who actively try to rebuff the bizarre and ignorant comments.
Here is the next post in my mental health feature written by the lovely Ruby Tuesday, she is a wonderful blogger on her personal experience of mental health and you can read her work here.
Ruby has had mental health problems for thirteen years, which were initially attributed to depression, but more recently to bipolar. She says she has many more down times than up times but continues to believe that a good cup of tea will always help at least a little bit. She is rarely seen without a cardigan and feels wonky if she leaves the house without a book in her bag.
Between incomprehensible and incoherent sits the madhouse. I am not in the madhouse."
-Jack Kerouac to Carl Solomon.
A colleague of mine has been suffering from severe stomach pains for months. Her GP ran some tests, which all came back negative and he told her it was all in her head. Every time she went back saying that she'd had another pain-filled episode, it was labelled as stress, psychosomatic, lack of sleep. Eventually he referred her for an ultrasound. The scan showed that she has a massive ovarian cyst that is squishing the organs around it. She was jubilant when she told us. She said, "I'm so relieved I'm not mental, that there is actually something there and I wasn't making it all up".
I’ve come to realise that I am jealous of this colleague. That I am never going to have that eureka moment. That this will always be in my head. That I will never have a scan at which someone can point at and declare "that's what's wrong!" and therefore know how to fix it.
I am sick of the subjectivity of mental illness.
In my experience of it, treatment depends on (a) my ability to describe what's going on and (b) the other person's approach to understanding what I'm saying. This means that it is open to so much interpretation and distortion. It also means that after 13 or so years of this, my own thoughts and understanding and have been so looped and twisted that I find it difficult to trust what I feel. It depends so much on the theories and tactics that my professionals choose to adopt.
The treatment of my mental health condition has lacked consistency and there are many factors to blame for this. I’ve moved around the country a lot. Historically I've only presented to a doctor when things were truly awful; the good times were fantastic and therefore had no place in the clinician’s room. Only relaying the bad times meant that I was diagnosed with depression - depression that came in like a storm for months at a time and then blew away without warning or explanation. Each time I crashed, I had to go through the sluggish referral process to get help again.
Two years ago, a doctor first mentioned bipolar. He was a newish consultant (tip: get them whilst they’re young and enthusiastic) and he'd seen me several times. The suggestion was tentatively pressed towards me as I fidgeted in the threadbare chair. I went to an aquafit class afterwards, bobbing about in the water thinking, really? REALLY? I was quite terrified. I could hear my mum’s words from several months ago echoing – how depression was one thing, but thank goodness I didn't have something like bipolar or schizophrenia, because then things would be really awful. I kept quiet and took the mood stabilisers, trying not to think about what the diagnosis could mean.
I moved again last summer, whilst entrenched in a down period. My new consultant preached that really there’s no such thing as depression and everyone is a dot on a scale of moods and yes, I was on a point of the scale that meant I had a mood disorder. I raised a sceptical eyebrow at him because the long stretch of bleak depression I was in meant that I was starting to dismiss the being bipola idea altogether. If that was true, where was my up? Surely it’s not fair just to have the downs? When February bought a suicidal burst and the Crisis Team became involved, he stuffed me full of antidepressants and went off on a year-long sabbatical. Slowly, things did improve. I begrudgingly admitted that the drugs might be helping. Here was the famed climbing up from a dark hole towards the light.
Apparently May is a bad month for people with bipolar; something to do with the change of seasons. I knew things weren't right; I thought it was anxiety and my new Consultant, upped my meds, firstly without ever seeing me and again, after an appointment that lasted five minutes. My mood allegedly flew upwards - and I say allegedly, because I'm still caught up in it all now and I find it hard to believe. Yes, things weren't right; I was stealing, I was not sleeping, I was zipping all over the place and most importantly, there were no consequences. A different doctor reviewed my case and advised that pumping me full of antidepressants, with no mood stabiliser, was a foolish thing to do. But should I believe him? Or the doctor before him? Or the one before that? I want to, because he listened to me. He asked me so many questions, about every aspect of my life; it is all up for debate. I am scared to ask him what his diagnosis is - whether he agrees that it's bipolar, afraid that he will think I am saying it because I want to be Stephen Fry or Catherine Zeta Jones.
I worry that if I’m open with people, they will end up attributing any sort of behaviour to my diagnosis. I am wanting to hang on to the fact that yes, I may have bipolar, but I can also be grumpy just because it’s Monday or because I’m tired or because I’m hormonal. I can talk too much because I’m excited, I can snap at you because I get annoyed just like everyone else.
I am considered to be "high functioning" within my mental health conditon. That sounds boastful and I don't mean it to. Within treatment there is so much emphasis on functionality - are you awake, are you out of bed, are you dressed, are you out of the house, are you in work? If you answer yes to all of those then that's all that matters, to most. However, one of the Crisis Team nurses said to me recently, "yes, that's all very well, but what about your quality of life. We want to help get you well again, so that you enjoy life". Pardon? At first I was taken aback - thinking, hang on, I’m doing my best to behave like an average human being, isn’t that enough? But maybe it's not, when it's just a front, when it's just trying to perfrom at a level that doesn't attract the difficult questions.
"Madness is confusion of levels of fact...Madness is not seeing visions but confusing levels."