The psychiatrist problem

As it’s Mental Health Awareness Week I thought I’d post something in relation to that. This particular post is on the topic of psychiatrists.

Mental Health Awareness Week, 2020.

Understanding another person’s illness can be quite difficult. I’ve never had a broken leg so I can’t fully understand what it’s like. I can however make certain assumptions. I know someone with a broken leg is likely to suffer pain, for example. I’ve had pain myself so I have some idea what it’s like, although I might not understand the specific pain or the degree of pain this person suffers from.

There’s sometimes a lot in specifics and degrees of things.

At one level it doesn’t matter that I don’t completely understand the pain of a broken leg. I know enough to be able to empathise, offer sympathy and provide assistance if I can. At another level there needs to be much more knowledge about a broken leg, though, and that’s when it comes to fixing it.

In an abundance of helpfulness I could have a go at fixing the leg myself but, as I haven’t performed surgery since I dissected a rat in Biology at school, I’d expect the injured person to refuse my offers of help and instead consult a doctor. A doctor would, I hope, have the medical training to be able to fix a broken leg.

So, with a sigh that was heavy enough to disturb my cat for her slumber, I come to mental health. Before you can fix something, you need to understand the problem. A doctor can see a broken leg and that’s useful, but a psychiatrist only has the patient’s words to go on, and that makes things difficult.

Explaining the devastating, genuinely suicidal torment of depression or the overwhelming, all-consuming effect of anxiety is very difficult. You desperately need them to understand the specifics and the degrees. You say the words to a psychiatrist and scan their eyes, looking for a glimmer of recognition that might mean they’ve fully understood it. Sadly, you don’t always see that glimmer. Your heart sinks and you know you're going to get the same pointless things you had with previous psychiatrists.

It isn’t just me. I had this conversation with a good friend of mine a few weeks ago and we both have very similar stories to tell even though (to the best of my knowledge) we’ve never seen the same psychiatrists.

If a psychiatrist can’t grasp the problem, they are unlikely to be able to fix it and that has been the case with a lot of the psychiatrists I've met. Are these people bad psychiatrists? I would hesitate to say they are because it’s impractical to expect all psychiatrists to have suffered mental health problems themselves just to ensure they properly understand them. I'm sure doctors would object to having to suffer a broken leg before being allowed to fix one. The medical profession has to offer something and maybe what we have is the best we can expect.

The trouble is, that lack of understanding can be quite damaging. I have often left appointments with useless advice and I’ve sometimes left with advice that, once I’ve tried to implement it, has made me worse. It would be like a doctor who's trying to fix your broken leg telling you to go home and try hopping. It's not really going to fix the problem.

Again it’s not just me and it’s not a one-off either — I’ve been doing this for 25 years now.

The mistake I’ve made is pursuing things with the same psychiatrist even when they’ve been going horribly wrong. For some reason I've abdicated control of the process and 'gone along' with things when I've known they're going to be unproductive.

The thing is, there are good psychiatrists out there. I don’t know if they happen to be the ones that have a personal insight into mental health or whether they’re just better at it than the others, but they exist because I’ve met one.

The approach this psychiatrist took was different to the quote-from-the-manual approach one usually gets, and it was all the better as a result. Very early on in the session he said he wanted to forget the pointless categorisations and just deal with the problem in front of us. He didn’t bother telling me about circles of thinking I have to escape from, inserting happy thoughts or buying more ornaments. Yes, that really did happen once and I have a porcelain dolphin to prove it, although it has been completely unhelpful and part of me wonders if he just had shares in the ornament industry.

He was quite blunt. There is no cure, no medication will work 100% and it’s about managing the problem as well as I can for the rest of my life. These are things that sufferers who’ve been through the system a few times already know of course, but it’s refreshing to see a psychiatrist skip all the fluff and start at a more productive place.

The key thing, though, is that he seemed to understand how I was suffering — properly understand, and that's rare in my experience.

At this point I must qualify things a bit. There are mental health problems that can be cured by talking therapies, medication or a combination of both, and if you’re suffering from one of those then you need to give the appropriate treatment your best shot.

I’m mainly addressing people like me who have what they used to call endogenous mental health issues that are long-lasting. People who have perhaps been at this for some time without success. People who need to find a way to live with their mental health problems, at least until medical science comes up with better solutions.

I would offer you a shred of hope by saying there are good psychiatrists out there and, if you want to pursue it, keep trying until you find one. Don’t be afraid to go back to your GP and ask to be referred to someone else. Take control of the process yourself. I’d understand, though, if you’ve given up on the whole thing in frustration — I did for a while.

I'm a little uncomfortable with the way I've been throwing around the idea of good and bad psychiatrists. I'm sure that is the case, because it's the case in every profession, but I think there's more to it with psychiatrists. Mental health problems can be very personal, particularly when it comes to what triggers a crisis. Maybe what I'm saying is you need a psychiatrist who 'gets' you.

I’m still completely bonkers of course, although maybe a smidgen less so after finding a good psychiatrist.

I think one of the most important things I can let fellow sufferers know is that you’re not alone, so I'll finish by telling you most certainly are not. Mental health issues can be isolating and there’s a special sort of loneliness that strikes in the throes of a mental health crisis, but there are plenty fellow sufferers out there who understand the crazy way your mind’s working. Hopefully, that’s some small comfort.