I had a first appointment with a Nurse Specialist last week. Let’s call her…um…Yvonne. In case you were wondering, her job title means that she’s a nurse who specialises in running group psychotherapy sessions, not that she’s a random member of the public who specialises in nurses. You know, like someone with a uniform fetish or something.
I wasn’t in the most positive of moods when I went to see Yvonne. Partly this was because of my illness – I know it sounds strange, but I have a habit of discounting the effect that has sometimes. Partly it was the circumstances of the appointment, which was 90 minutes away from where I live in an area that the local council would probably call ‘ripe for regeneration’. Even better, it was first thing in the morning, and, of course, the train was late, so I’d had to stand for what felt like forever on a fog-shrouded platform with a bunch of early-morning commuters.
But the other reason for my negative mood was the ridiculous lengths I’d had to go to just to get the appointment.
Prior to meeting with Yvonne, I’d had an assessment appointment with a psychotherapist (call him Dr Saunders), who had decided that I was treatment-resistant. This is a standard tactic used by psychologists, and usually seems designed as a way of punishing awkward patients. In my case, Dr Saunders had been unnerved by my ability to demonstrate that I had already reached the same conclusions as those he was coming to himself. Because of this, he decided I had a tendency to ‘over-analyse’ and ‘over-intellectualise’ situations. (For those of you unfamiliar with psychologist-speak, this translates into plain English as, “This patient has a worryingly sophisticated understanding of psychological concepts, and might actually be able to think for themselves. Yikes!”)
But Dr Saunders did decide that I had a problem with social anxiety, and that this could be addressed in a ‘group situation’. He’s not wrong in that assessment, although it’s probably the most minor of the problems I face, and not really an issue when I’m otherwise healthy. To me, suggesting treatment for it on its own seems rather like re-arranging the deckchairs on the Titanic rather than trying to do something about the whacking great iceberg looming into view, but I was prepared to go along with him, even if I didn’t like the idea of group therapy.
Now, you’re probably wondering why, given everything I’ve said, I had any interest at all in pursuing psychological therapy. There are a couple of reasons. Firstly, as a patient you have to display a total willingness to go along with any and all treatment suggestions, however ridiculous they seem, or you run the risk of being dumped out of treatment altogether. The second reason is that, although I’m very sceptical about some of the pseudo-scientific theories made up by psychologists, I find the actual experience of therapy extremely helpful. After talking to someone who confirms the validity of my thoughts and feelings, and backs up my attempts at self-analysis, I always have a short-term improvement in mood, and I also find it gives me a longer-term perspective as well. I can self-analyse until the cows come home, but I need the reinforcement of therapy to realise I can trust my own conclusions.
The problem is that this isn’t seen as a valid use of therapy. If I was paying for my own counselling, I’m reasonably sure I could find someone prepared to listen to me pretty much forever, but on the NHS, therapy seems to be seen as a once-and-for-all cure, not an ongoing solution. And so, because of that, I found myself telling Dr Saunders how brilliantly insightful his diagnosis was, and trying desperately to convince him that I felt social anxiety was really the root cause of all my problems. I tried to look as meek and humble as I could, and told him I’d be a model patient if only he’d give me a chance.
I don’t know if it was my desperation or the way I stressed the brilliance of his diagnosis (psychologists always seem very receptive to a bit of ego-massage…), but Dr Saunders announced at the end of the session that he was “prepared” to let me to join a psychotherapy group, and that since I had “significant anxieties” about the group he would arrange for me to meet with someone one-to-one in the run-up to joining. I’d ended up with the result I wanted – access to the therapy that I know will help me – but in order to get there I’d had to distort the true nature of the problems I was having so as to fit myself into a pre-conceived diagnostic box.
Well, with all this as the background, you can perhaps understand why I wasn’t in the most positive and helpful of moods as I sat down opposite Yvonne for the first time. But, actually, it was great. Yvonne seemed to be friendly, receptive, and responsive. She was clearly more interested in hearing what I had to say than she was in making me say the kind of things she wanted to hear (and a marked contrast, therefore, to Dr Saunders). I still had to regard my major problem (depression) as off-limits and talk only about specifically social anxiety, but provided I’m careful not to overwhelm her with the full extent of the problems I have, I should be able to widen the focus a bit in the next few weeks.
So, all in all, this story has, for the time being at least, a happy ending. But I was only able to jump through the necessary hoops to get to the happy ending because I’m actually comparatively well at the moment. If I was properly ill I wouldn’t have been able to disguise the true nature of my problems from Dr Saunders, and so his decision that my depression was ‘treatment-resistant’ would have resulted in me being dumped out of treatment altogether. This has happened to me several times previously, with everything from CBT to ‘physical’ psychiatry.
I guess my basic point is this: isn’t there something wrong with a mental health system that refuses to help the seriously unwell? Or that will only help them if they are able to pretend that they only have a couple of easily-solved problems?
The focus of this post has been on the professionals actually involved in the treatment, but I’m probably blaming the wrong people. The real blame probably lies with a system that is so keen to measure success or failure that it’s lost sight of the ill people it was created to help. What matters to the system is the number of successful treatments, not what happens to the people who are difficult to treat, and so end up excluded from all of the treatment options.