So, as recommended, I went to see General Psychiatrist. The appointment wasn’t as perfunctory as I’d assumed it would be – it lasted 45 minutes instead of 10 – but was as much of a waste of time as I’d feared. No, actually, scrub that. It was more of a waste of time than I’d feared. You see, it turns out I’m not mentally ill. That’s a direct quote straight from the General’s mouth. He did go on to qualify a little.
It seems that I presented him with a problem, because, and I quote, ‘you don’t fit any of my criteria’. He performed a handy interpretative mime as he told me this, mapping out a sequence of imaginary boxes on his desk, to signify the diagnostic criteria, and then waving his hands in an amorphous, not-fitting-into-a-box, kind of way, to signify me. Clearly, it is this wilful refusal to squeeze myself into a handily pre-labelled mentalist box which means that I’m not mentally ill.
‘You don’t have schizophrenia,’ he said. Well, thanks, but I never thought I did, what with the whole obviously not being schizophrenic thing. As it happens, I’m not a 17th-century milkmaid called Marie-France either.
‘I don’t believe you have psychosis,’ he said. Interesting shift of language there, I thought. I definitely don’t have schizophrenia, but he doesn’t believe I have psychosis. So, what does that mean, exactly?
Does it mean that he thinks I’ve been stringing him a line trying to get myself diagnosed as psychotic, but he has, with his all-penetrating PsychVision, seen through my pathetic attempts at fraud? I don’t see quite how that fits with the fact that, last appointment, it was him trying to persuade me I was suffering from an illness that could be treated with antipsychotics, not me trying to persuade him.
Or does it signify that he is less certain? That I might be psychotic, but he doesn’t himself think it likely that I’m psychotic at the moment? Certainly he’s never seen me in the grip of, for example, believing I can see or hear things that probably aren’t there, or becoming convinced that I’m under surveillance, or becoming worried that my thoughts aren’t my own. I wonder how many patients are able to produce these symptoms to order during an outpatient appointment? I’ll never be among their number, anyway – when I feel like that, I’m barricaded into my flat, not out travelling for 90 minutes each way to attend an appointment in a Victorian horror show of a mental hospital.
The nub of the problem, I think, is that I can talk about my experiences rationally. Loonies just aren’t supposed to be able to do that. We’re not supposed to be able to say about our unusual experiences, ‘Well, I know they’re not very likely to be true’. Mental illness is, it would seem, an either/or. Either you’re completely irrational, in which case you’re mad and won’t you please come into the mentalist inner circle and would you like to try some of these delicious pills, or you’re completely rational in which case you’re sane and get the fuck away from here you malingering hypochondriac. Somehow or other I managed to shift from one group to the other between my two appointments.
I think part of the reason for that (and I hope you don’t think I’m bragging when I say this – I do think it needs to be mentioned) is that I’m reasonably bright. And, of all of the different kinds of intelligence there are, I seem to have an analytical intelligence. Added to that I’ve had several years of reasonably high-powered academic training. I’m good at asking and answering the questions why and how, in all circumstances.
Now, the General seems to work to a model in which being mentally ill equals being stupid. Maybe he’s right – phrases like ‘cognitive deficit’ seem to get bandied around quite often in discussions of schizophrenia particularly. For what it’s worth, I think some psychiatrists like to believe their charges are thick, because the alternative – that they’re drugging into drooling incoherence people who otherwise would be sharp, and vibrant, and funny (as well as being distressed and disturbed, of course) – is too morally uncomfortable.
But, anyway, leaving aside the larger picture, my feeling is that if I was less intelligent, and, especially, if I was less well-educated, I wouldn’t have been told that I’m not mentally ill. Being articulate about some things seems to mean that, if you run up against something that’s just so scarily weird you can’t put it into words, its significance is discounted. Because, if it really bothered you, well, you’d be describing it in a scintillating array of exquisitely apposite adjectives lifted straight from the pages of Roget’s Thesaurus, wouldn’t you?
One particular reason I think my intelligence and education got in the way is that that the general did give me an alternative ‘diagnosis’. I am, it would seem, officially ‘odd’. I have a ‘unique sense of myself and the world’. In the same way that rich people used to be ‘eccentric’, it seems as though people with an education and an enquiring mind are ‘odd’. I can’t help but feel that, had I gone into the appointment dressed in trackies, and spoken in a thick local accent about seeing people who then disappear, I would probably not have been ‘congratulated’ on my ‘unique way of seeing’.
Certainly it seems as though my ‘oddness’ is going to prove as debilitating as a mental illness might. I can, apparently, look forward to my life being ‘a struggle’. I will struggle to relate to other people, and they will struggle to relate to me. I am likely to spend much of my life isolated and withdrawn from social contact (except for the ‘inadequate replacement’ of email). The General hopes that I will move back towards an ‘average existence, not a normal one,’ over time, but that hope seems rather like a politician’s ‘aspiration’ – not planned for, and unlikely to ever materialise.
Because that’s the other thing about ‘oddness’ – there’s no treatment plan for it. I have, as a special favour, been granted permission to re-attend the General at his consulting room in the summer, although, for obvious reasons, I will be cancelling this appointment in due course. (This time the matter is, I’m afraid, not open to public consultation.) But there is no programme of rehabilitation, no services I can access, no help I can receive. The offer of calling the General’s secretary for an appointment should I feel I need one has been ostentatiously withdrawn. All of these bounteous ‘gifts’ are dependent on the almighty diagnosis, and that has been ruled inappropriate in my case.
My guess is that I may get some comments on this post telling me I need to fight, that I shouldn’t take no for an answer, that the General was obviously wrong, and so on. I know those kinds of comments spring from a caring motive, and, if I get them, I will be very grateful for the kindness that motivates them. If I was minded to fight, I think I would begin by going to see my GP – I’m pretty sure she’d be on my side. But the truth is I don’t really want the treatments that are available, and so there seems little point in fighting.
I just don’t believe, and I never have, in either of those twin gods, Psychoanalysis and Medication. I saw through CBT within about 10 minutes of arriving in the therapist’s office. Art therapy would, for me, be a pointless and humiliating ordeal. With these attitudes, it’s not surprising that the ways of helping me have been exhausted. Much of this is my own fault. I know that it is, and I do not look for undeserved sympathy or consolation.
Still, it doesn’t matter what I think about any of this. As someone who’s not mentally ill, I didn’t need treatment in the first place.