It is common cliché to advise the mentally ill to speak up about their suffering, to communicate, and to seek help because — didn’t you know? — there are an incredible number of mental health services available to provide treatment and aid to those in need. I hear people speak of therapy, of crisis lines, of psychiatric care, and of medication. I hear people tell stories of how they conquered mental illness, how they found the “right drug” for them, and how their therapist knows them better than they know themselves. What I don’t hear a lot of are the horror stories: the whispered conversations about medication changing one’s personality, about therapy that didn’t help, about monstrous wait times for psychiatrists — about self-harm, about suicide.
I understand why people aren’t as willing to talk about the negatives. When giving advice to a person with mental illness, it probably doesn’t seem like a good idea to bring up how disastrous the whole process of getting help can be. Hearing the real facts is, well, depressing, and a person who is already depressed doesn’t need any more of that in his or her life.
But it’s also important to tell the truth. When I began navigating the mental health services in London, Ontario, I was eighteen years old, and I believed I could simply ask for help and have it given to me. I was given help, don’t get me wrong — my family doctor prescribed me mood-stabilizing medication and referred me to a psychiatrist, and I began attending regular therapy sessions with a good therapist — but it wasn’t up to the standard that I had expected. The therapy, though good, was not perfectly fitted to my set of problems; the medication turned out to be of no help; and the psychiatrist wait list lasted nearly five months, by which time I was no longer in need of one. I was lucky enough that my mental health got better instead of worse, and I left the whole situation slightly bewildered and uncertain if the messiness that I had encountered surrounding mental illness was an isolated incident or a larger problem which I was too young to comprehend.
If I had understood, if I had been forewarned about the limitations of the mental health services in London, I may have acted differently. I may have faced my doctors with more purpose, knowing that I needed to fight to earn my place in the crowded world of the mentally ill; I may have taken my medication more cautiously, knowing that my family doctor prescribed it to me mainly out of ignorance and the fear that I would harm myself.
The truth is that the majority of people experiencing mental illness for the first time — and, therefore, experiencing the services provided to treat mental illness — are young. Though only 15% of Canadian children and youth are affected by mental illness at any given time, 70% of adults with mental illness develop their symptoms during childhood or youth (Mood Disorders Society of Canada, 2009). This means we have a large number of young adults fumbling through the treatment process with little knowledge of their own brand-spanking-new condition, and, on average, minimal experience in the world of doctors and medicine.
What I’m trying to get across is, though it sounds hopeful to claim that help is available and everyone is on the side of the mentally ill, it’s not exactly true, and it could be potentially dangerous. People experiencing mental illness for the first time need hope, but they also need honesty. They need someone to tell them, “Hey, this is really going to suck, this is really going to be a lot of work that you probably aren’t prepared for, but you can still do it.” Raising someone’s expectations just to shatter them with excessive wait times and ignorant professionals does not, in my experience, only disappoint — it wounds.
I will now relate three of my experiences with three different professionals involved in the treatment of mental illness, all of which occurred from August to November of last year. These experiences do not happen to everyone; other patients suffering from mental illness may have encountered better treatment and better results. All I can do is speak for myself and provide a subtle warning to all those going through the mental health services in London, Ontario for the first time.
My warning is to proceed with caution, to think critically, to be confident, to speak your mind fearlessly, and to, most importantly, trust your own judgement. Though all professionals and organizations carry with them an umbrella of authority, they will never know yourself as well as you do. They aren’t inside your head: you are. Remember that. Remember who’s in control, even when you feel astoundingly out of it.
#1: The General Practitioner
One of the first steps taken by those who suffer from mental illness is to approach the good-ol’ family doctor. A GP is a powerhouse: he or she has the ability to analyze a patient through questioning, provide a referral to a psychiatrist, and to prescribe medication. As they say, with great power comes great responsibility, and if this responsibility is neglected, general practitioners can be as dangerous at they are helpful.
Following the same path on which I had trod nearly three years earlier, I wandered into my doctor’s office in August of last year after experiencing some decently horrifying mental episodes throughout the summer. My old doctor had retired, and I had never met my new doctor before; this created more than a little nervous anticipation inside of me. I was about to admit to a complete stranger that I was in crisis and needed help ASAP. I was about to make myself vulnerable once again.
The new doctor was young, congenial, and efficient. His questions were brisk but kind. He knew more about mental health issues than my last doctor (yay for modern medical training!), and he quickly sent off a referral to a psychiatrist for me. His first major mistake was to prescribe medication to me almost immediately: after only a brief series of questions he decided that I was most likely bipolar, and that a drug called “Seroquel” would be the — although temporary — answer to the problem.
If you know anything about Seroquel, you know that its greatest side effect is drowsiness. I was told to take the drug before bed in the hopes that I would sleep off most of this side effect by morning. Perhaps I slept off some of it, but it persisted throughout the day, and it wasn’t long before I was having trouble remembering phone numbers, appointment times, and other minor details that usually come easily to me. I also grew increasingly depressed; my suicidal thoughts doubled in strength and number.
After consulting my doctor about these issues, he made his second major mistake: he increased my dosage. Apparently the fact that my mood had consistently gotten worse since I had last seen him was not a sign that the meds weren’t right for me, but a sign that I wasn’t taking enough of them. I was too unaware of my surroundings (recall the drowsiness and depression?) to critically think about what was going on, and I took the increased dosage willingly enough.
This albeit simple mistake led to some pretty serious consequences. I became so depressed and suicidal that in mid-October of last year I spent most of one night in the hospital after purposefully taking an excessive amount of the aforementioned Seroquel pills. A “temporary” solution to my problem of mental illness — i.e. the medication — came very close to creating a permanent consequence. After this incident I weaned myself off the medication despite the hesitancy of my doctor and family, and recovered to the state in which I had been before taking the drugs: an unhealthy state, yes, but a much healthier state than that to which the medication had reduced me.
#2: The Pharmacist
But, before the late night visit to the ER and subsequently taking myself off my medication, I had an interesting encounter with a pharmacist filling the prescriptions for my doctor and the other doctors in the building. After receiving the fateful prescription for an increased dosage of Seroquel back in October, I headed down toward the pharmacy on the bottom floor of the building in which my doctor’s office is situated. The woman working at the counter was as brisk and efficient as my GP, but without the tendency to be kind.
“Have you taken this medication before?” she asked after calling me to the counter to present the white paper bag which contained my meds.
“Uh, yes,” I said, “my doctor’s just increased the dosage.”
“Hmm,” she said, looking puzzled. “Okay. Okay, now listen.”
She spoke conspiratorially, as if relating a secret danger to a close friend. She told me that if I wasn’t careful, the doctor would keep increasing my dosage, eventually causing grave damage to the neurons in my brain. I leaned in closer to her, unsure of what she meant. She continued to explain how there were other ways to get over a mood problem that didn’t involve medication, like doing more exercise, spending time with positive people, doing activities that I enjoy, and thinking happier thoughts (these words actually came out of her mouth).
I took my medication and left quickly, too shocked to understand what had occurred. On the bike ride home, I mulled over what she had said to me; I grew appalled at her ignorance. Although I knew that medication could negatively impact the brain, I also knew that mental illness could not be cured by any of the things she had suggested. I knew this because I spent plenty of time with exciting, well-rounded people; I jogged for twenty minutes every day, not to mention the walking and biking I did to get myself to various destinations; I tried each day to do something I loved, which most often happened to be writing or reading; and, though it was difficult, I practiced positive thinking. None of this saved me from being sick.
Furthermore, though my medication turned out to worsen my mood, the pharmacist’s advice could have seriously harmed me. Had I listened to her and stopped taking my medication, and had I been in a condition in which my medication was necessary for my stability, I could have had a detrimental episode caused by withdrawal. The pharmacist had little to no understanding of mental illness and she was not in the position to suggest whether I take my medication or not, she was only in the position to fill the prescription. She had no right to patronize me by claiming my illness was trivial and could be fixed through trivial means. She had no idea where I was coming from, what my problems were, or why the medication had been prescribed in the first place.
Luckily, because I eventually weaned myself off my medication, I never had to approach her again.
#3: The Psychiatrist
Finally, after three months of waiting (three months being a relatively short wait time in the world of mental illness), the referral to a psychiatrist came into fruition, and I found myself on the doorstep of a psychiatrist’s home office in November of last year.
I remember it was raining. The sky was filled with a tumultuous grey mass of clouds and thick globs of rain slipped from the leaves in the trees onto the ground. I had worn my yellow rain boots to combat the gloomy weather and also as a symbol of my excitement and positive attitude for that day. I had never had a psychiatrist before, and I was anxious to know what it would be like to be connected to a specialist in the field of mental illness who could provide quality treatment.
The psychiatrist’s office space was cozy but strangely empty; a radio chattered in the corner of the waiting room. I slipped out of my boots, extracted my wet jacket and hung it in the closet, and sat upon a large, cushioned sofa to wait. The psychiatrist was about five minutes late to join me: she clambered down a set of stairs from an unseen section of the house in knee-high leather boots and asked me to follow her into her office, shaking my hand stiffly in introduction. She then proceeded with the “interrogation” portion of the appointment (I say “interrogation” because that’s what it often feels like — a stranger questioning me about the most personal aspects of my life in short, bullet-like inquiries). I was used to the process and I mentally prepared my responses.
“If I am to follow you as your psychiatrist,” she began, pulling a notebook into her lap, “I first need to know where we are going with our sessions. What goals do you have in mind for your treatment? In other words, why have you come?”
I explained that I was interested in a combination of therapy and medication. If I needed drugs to help with the management of my illness, I didn’t want them prescribed to me by someone who was unfamiliar with my condition, but rather by someone who had taken time to talk with me.
“And what is your condition?” she asked, her pen swooping across the notebook page.
“I don’t know.”
She then asked me about my history from childhood onward, and whether I had experienced any traumatic events; about when my mental illness began and how it was treated at the time; about my current relationships, familial or otherwise; and, lastly, about my recent treatment, including doctor and hospital visits. By the time I had given my answers, I felt that my hour-long session was coming to a close. As I suspected, the psychiatrist soon intimated that time was up.
“I’m going to give you a mood chart,” she said, standing and putting her notebook aside. “Unfortunately I can’t follow you as your doctor, but keeping track of your moods might give you a better idea of what you’re suffering from.”
She began rummaging through a set of drawers for the chart as I sat frozen in my chair behind her, stunned. “You can’t follow me?” I managed to squeak.
“No, I, uh,” she said, reaching farther within the drawers, “I only give therapy to patients who have relationship difficulties they need to resolve. And I don’t prescribe medication.”
I left quickly after receiving the mood chart. The sky outside was still awash with rain and my yellow boots now seemed to mock me from below. A thousand questions pulsed through my mind: if that woman was a psychiatrist, a medical doctor specifically trained to prescribe medication to the mentally ill, why didn’t she? Why had my GP referred me to her when he had known I was interested in medication? Why did she only give therapy to those with relationship issues, and why, most importantly, had she wasted my time with all of her questions when she had known from the beginning that she couldn’t treat me?
By the time I arrived home, most of my anger had subsided and been replaced by sullen disappointment. When I retrieved the mood chart from my jacket pocket, it was soaked through with rain.
These three weren’t my only experiences with the mental health services in London, Ontario. My late night hospital visit was as comfortable and efficient as it could be: I was given a bed within half an hour and released by four o’clock in the morning; my appointment at the outpatient clinic at Victoria hospital was both helpful and hopeful; my weekly therapy sessions are always pleasant; and my communications with the student-oriented organization called “FEMAP” (First Episode Mood and Anxiety Program) have been beneficial, despite the wait for a psychiatrist within that organization being five months long.
I have highlighted the incidents with the general practitioner, the pharmacist, and the psychiatrist because they represent what can happen while seeking treatment for mental illness. When so many organizations, as well as friends and colleagues, claim that help is readily available and easily accessible, they skip over the reality of the situation and risk harming the individual who suffers. Although hope is necessary to heal the mentally ill, false hope makes a person vulnerable not only to negative emotions such as disappointment and anger, but also to the damaging possibilities of dealing with professionals who are unqualified, ignorant, and unaware of the inner workings of a patient’s mind.
Trust yourself. Think critically. Keep moving forward.