Right, well, it’s dawned on me that I was somewhat ungracious in my reaction to your comments on my last post. (In other words, I was a prick.) Apologies if you were caught up in the middle of it. (In other words, I’m sorry I was a prick.) The thing is, I was on my way to bed, and I just decided to give my emails a quick check before I headed off, and I found that my inbox had exploded, thanks mainly to comments left on the blog. And I was genuinely taken aback that no-one seemed to have recognised that the post was meant to be funny, mainly because folk didn’t seem to have had the same problem with recognising that the previous entry in the experiment idea was intended to be at least partly tongue-in-cheek. Anyway, as with anything that’s trying to be funny, if it doesn’t work then that’s the fault of the ‘comedian’, not the ‘audience’.
I’ve been giving some thought to why some of you seem to have been so ready to jump to the conclusion that it was a ‘face-value’ post, and I think I might have hit on something. I think some (or maybe a majority, or possibly all) of you expect me to fail in what I’m trying to do here – i.e. to disengage from MH services and manage my own mental health. You’re expecting me to suffer a major meltdown. Not in a nasty way, far from it, but in a lovely, kind, worrying-what-the-consequences-will-be kind of way. But the thing is, you really don’t need to worry.
Let me explain why I think so.
First of all, I am in the incredibly lucky position of being – just about – able to make a decision about whether or not I need to be involved with MH services. Many people aren’t as lucky as me. My mentalism involves some pretty unpleasant mental states (depression, anxiety, paranoia, ideas of reference which sometimes deepen into (or close to) delusions, auditory hallucinations, and so on), but I am, just about, able to force my way through them all. I am incredibly lucky that, in my case, willpower seems to be enough – for so many people all the determination in the world just isn’t enough to make it. The difference isn’t a reflection on me or them as people – it’s just that I’ve had a lucky break, and they unfortunately haven’t.
Something else that I think helps is that I happen to have a very analytical mindset. I am an exceptionally analytical person, always, everywhere, in any situation. There are lots of downsides to this (‘over-reading’ a situation is one obvious example), but one of the upsides is that I am pretty good at thinking about things, as opposed to just thinking them. This is my default way of thinking, and I think it’s why I’m not bad at spotting when my thoughts start to go a bit peculiar, and managing to at least half-persuade myself that they are peculiar enough to be wrong. Luck is the major factor here, too – it’s exceptionally rare that the peculiar thoughts are powerful enough to overwhelm me, although I have been temporarily overwhelmed once in a while.
I think if you were designing a mental toolkit to help someone cope with the kind of mental symptoms I experience, you’d pretty much choose to include what I already have. Determination and strength of mind to force a way through the unpleasantness, rather than getting lost in the middle of it. A habitually analytical thinking style to foster recognition that some thought or perception or belief or certainty, no matter how plausible it may seem, is nonetheless odd enough to not be relied upon. But again, none of this would be enough if my problems were any worse than they are, so again it’s evidence of how lucky I am.
The other great strength I have, I think, is nothing to do with any intrinsic qualities I may or may not have, and everything to do with my experiences. The truth is, I have been semi-detached from MH services for years, mainly because I’m a stubborn bastard, and this means I already have a lot of experience of dealing with things on my own. Since my last appointment with General Psych I’ve experienced a major depressive episode (see this post, and subsequent ones, for details, assuming you want details) and a psychotic (or at least semi-psychotic) breakout (see here for details on that one), and a major anxiety flare-up (see here).
It seems to me that there are two basic ways of looking at this. One is to say that someone who experienced all of this in under three months (end of April to mid July) is clearly unwell, seems fairly unstable into the bargain, and would probably benefit from a psychiatric check-up followed, almost certainly, by a visit to a pharmacy. The other way of looking at this is to say that, in addition to experiencing all of these events, I have also come through them unscathed without the benefit of MH professionals or the medications they may have prescribed. In other words, my primary reason for thinking I can get through whatever my mind throws at me is that I have already got through what my mind throws at me. Again, luck is the major factor here – I am incredibly lucky that my mind only throws at me stuff that I can just about cope with.
I think I understand why you may be worried. I, too, have read blog posts by people announcing their intention to go it alone in terms of their MH, and have read a few days or weeks later about some crisis that has required either hospitalisation, or the involvement of a crisis team, or at the very least a rapid return to the treatment plans their psychiatrists had previously recommended. I can see why the straightforward balance of probabilities makes you think this will end badly for me. However, I think there’s a major difference with my situation.
Most of the people who have decided to go it alone have had their situations complicated by medication. In other words, they’ve had to cope either with the side-effects of med withdrawal, or with a resurgence of symptoms they didn’t realise that their medication was controlling, at the same time as they are trying to cope with the psychological and emotional consequences of withdrawing from MH treatment. I, on the other hand, have been taking no medication whatsoever since I took myself off escitalopram, and have never taken antipsychotic medication, despite having experienced psychotic symptoms (or potentially psychotic symptoms – no hard and fast conclusion was ever reached) for well over a decade.
Of course, I am still going to have to face the other side-effects of MH withdrawal. As I’ve already noted, the thought that I am now ‘on my own’ has caused me a certain amount of apprehension, and I’ve felt a few flutterings of anxiety as well. The way I have coped with this has been very straightforward – by reminding myself that nothing material has changed. Before my decision to withdraw from MH treatment I was already coping without the aid of medication; after my decision all I have to do is continue with this. Before my decision to withdraw from MH treatment I already had, in effect, sole responsibility for managing my MH as I was not telling my psychiatrist about many of my more troublesome symptoms, nor receiving treatment for them; after my decision all I have to do is continue with this.
Probably the most significant way things haven’t changed, though, is what would happen if I were to experience a crisis. As I explained in a comment on an earlier post, the chances of a crisis coinciding with my twice yearly trip to see a shrink were monumentally tiny in the first place. If by some outrageous fluke they had coincided, I wouldn’t have gone to the appointment because, in a compromised mental state, I would have lacked the ability to handle the additional stress of attending. In reality, my response to a crisis, pre-withdrawal, would have had to be either phoning the clinic to ask for an appointment, or going to see my GP.
Both of those options are still open to me. They don’t advertise the fact for obvious reasons, but general psychiatric outpatient clinics tend to accept self-referrals from patients who have already had some contact with them, particularly ones they would have preferred to keep under observation in the first place. Even if I wasn’t able to get an appointment at the clinic (and, frankly, I would be unlikely to go down that route anyway, not least because I would have to negotiate my way halfway across town to get there), I can make an appointment to see my GP. This would almost certainly be the option I would go for, because the GP surgery is located about 5 minutes walk from my front door. My nurse therapist told me that something like 90% of all referrals to crisis teams in my city are made by GPs anyway, even though most of the patients referred are already in contact with hospital-based MH services. I guess very few people’s mental health fits neatly round an outpatient appointment card.
All of this is well and good, but I do realise there is another approach to this whole thing. You could quite legitimately take the view that the difficulties and inadequacies I experienced in my time with MH services were very largely my fault. I habitually withheld information I didn’t want them to have, and I tended to approach consultations in a fairly confrontational spirit, neither of which are behaviours conducive to getting the best out of the people I encounter. Given that my life is barely functional as it is – I can’t work, I rarely leave my flat and go months at a time with no real life social contact – you could make a very good case for arguing that what I needed to do was, not disengage from MH services, but rather to engage with them more fully.
There’s a lot to recommend that argument. I suspect if I read somebody else writing what I’ve written that would probably be my recommendation. So why don’t I take my own advice? I can try to dress this up with semi-logical reasons, but the truth is I just don’t want to. I don’t want to spend my life on the med-go-round. I don’t want to have nosy, inquisitive people crawling all over my life, and judging my emotions, and second-guessing every decision I make.
No psychiatric patient wants this, of course; we all resent it with equal force. The difference is that I seem to be in the incredibly lucky position of being just about well enough not to absolutely require the involvement of MH services, or at least well enough most of the time to be able to disguise the periods when I am unwell. All I’m doing is taking advantage of that.
This may not be sensible. I am very possibly condemning myself to a crabbed, uncomfortable, limited life that could be transformed if only I would allow myself to be helped. But it is my decision to make, and I’ve made my choice. Maybe it’s nothing but short-sighted, belligerent, self-defeating, wrong-headed, bloody-minded stupidity, but I’m sticking to it. I told you I was a stubborn bastard.
So, did I convince you? Or are you all saying to yourselves ‘Methinks the Nutter doth protest too much’…