When Mental Health Systems Don’t Listen and Rely Too Heavily on Medication.
You get your life destroyed. Put simply, that’s what it feels like. To be put on some meds for a diagnosis you don’t agree with and that seems to run contrary to your experience. And I’m talking specifically about mental health services in Wiltshire, the part of the UK where I live. My experience of having been under the care of these services has been abysmal. They failed to listen to my concerns in the first place and didn’t act upon those concerns in an appropriate and proportionate manner when I raised them. I was left high and dry on the wrong medications for two and a half years and every move they’ve made since has been to doggedly stand by their initial diagnosis and maintain treatment with the wrong meds.
I suffer from obsessive-compulsive disorder and have done since I was at least nineteen. The way I interpret it now, this disorder ultimately spilled over into me having panic attacks and manic episodes when I was about twenty-two; this led me to being sectioned under the UK’s Mental Health Act, where you can be detained in hospital for treatment. At the time, they diagnosed me as having had a first-episode psychosis against my protestations that I was suffering from OCD and that I was clearly dipping in and out of a manic state. Part of the problem, it seems to me, is the ineffective abilities of psychiatrists to appreciate the subtleties and nuance in language (especially if English isn’t their first language), and there may also be an element of the NHS trying to save money via prescribing cheap antipsychotics instead of the expensive SSRI’s that I would have needed to treat my OCD.
On the first point, and I hate to come across as xenophobic here, but it is a legitimate concern. The first psychiatrist that treated me as an outpatient while I was under the care of Wiltshire’s Early Intervention Team for Psychosis was a Dr. Tanden, a man of south-Asian descent whose first language clearly was not English. I felt misunderstood by him, treated coldly and rudely, and felt that the words I was using in our conversation were being misunderstood either deliberately or as a consequence of a latent inability to appreciate the subtleties of what I was saying. Since then, the NHS in my area have only dug a deeper hole for themselves as I mentioned that there could be a myriad of diagnoses that fit to explain the overarching complex of my ‘mental health’ such as anxiety, bipolarity possibly, an autism spectrum disorder, PTSD, and found that these were all being routinely ignored by community mental health services in favour of their very limited understanding of the term psychosis.
When it comes to this limited understanding, I’ve had psychiatrists assert to me that delusions — one of the core diagnostic criteria for a psychotic illness — are merely that which “not everyone believes”. I found that definition to be a workable definition for the term ‘heresy’ but, when it comes to delusions per se, the DSM-V is quite clear on this. A true delusion must be contradicted by incontrovertible evidence or rational argument to the contrary in addition to being idiosyncratic; a lot of people might not appreciate the subtleties of this, least of all those who do not speak English as a first language. A delusion must be demonstrably false, it must also be a fixed belief, and I’ve never had any particular attachment to my beliefs (which relate to people from my university attempting to murder me); I’d far rather that weren’t the case. Nonetheless, they’ve adhered rigidly and dogmatically to this assertion of psychosis (with no apparent basis in evidence) and have treated me as such and have labeled me as such.
The damage that this has caused to my relationships might be irreparable. My family started treating me as though I’m some sort of dangerous lunatic, someone who’s likely to try and hurt them in some way at any moment. My friends have all disappeared (bar a few) and no longer speak to me. I’ve had my driver’s license suspended by mental health services contacting the DVLA limiting my ability to drive and, hence, also to hold down employment. I’ve been made homeless by my family on two separate occasions all the while suffering from, albeit, very serious mental health problems though just not the mental health problems I’ve been diagnosed with. And when it comes to the endless debates and outright arguments with psychiatrists over the now five times I’ve been hospitalised, it seems I get absolutely nowhere with them and they seek only to support the prior decisions of their colleagues to prevent, presumably, the reputation of their already shoddy service going further down the pan and/or to prevent me suing them for clinical negligence as I rightly ought to.
On this second issue of NHS budgets and money, I think there might be quite a clear impetus there to tar anyone coming onto a psychiatric ward as psychotic. A course of antipsychotic treatment comes at a fraction of the price of treatment with SSRI’s and they, from their position(s) of dominance as doctors, can merely assert their efficacy without actually having to provide any hard evidence. It smacks to me also of the David Rosenhan experiments involving people admitted to psychiatric wards claiming to hear a voice in their heads saying “thud”, all were diagnosed with schizophrenia; in this, there may be a tendency to a mania for psychosis and schizophrenia among the psychiatric community, that far from running diagnostics properly, they’re content with asserting a blanket diagnosis of psychosis or schizophrenia (or, as in my case, schizoaffective disorder) without actually having to read the rest of the DSM (psychotic disorders are usually listed near the front) and assessing the likelihood of other illnesses in comparison to that.
It may well be the case that psychiatrists are lazy doctors. A lot of medical students choose the route through psychiatry because of the work-life balance (not to mention the huge pay packets available for, by the standards of other doctors, not all that much work). The end result is that patients are walked over by these people. We get churned through a system which we enter with severe mental difficulties and these difficulties are only worsened by ineptitude, incompetence, a desire to scrimp and save, a lack of caring, an inability to listen, and a blithe disregard for the genuine sufferings of a person who — in many cases (including, I suspect, my own) — shouldn’t be there in the first place and, instead, should be taking SSRI’s prescribed through a psychiatrist, referred by a GP, and having talking therapies. Now I find myself in a position where my civil liberties are being impacted by certain people (who acknowledge my vulnerability to being sectioned) having me detained as a means of further abusing me. That’s a topic for a different article and, on that matter, the attitude taken by even the best psychiatrists I’ve come across within this system is that it’s somehow my fault and that I need to change in some way. This attitude has, of course, been adopted also by members of my family.
The adjunct to the central point of not listening, and not caring, in the title, was the overreliance on medication and the dismissal of psychological treatment — i.e. talking therapy. At the time when I was receiving my allowed sixteen sessions of psychotherapy with an NHS psychologist, I was also taking medications that were actively worsening my condition. While, in principle, I feel that the therapies would have been the most useful part of my whole course of treatment, I found them to be ultimately abortive due to the fact that I was being incorrectly medicated. A lot of people swear by the medication. But I don’t. There is not a one-size-fits-all solution to mental health and each person’s case must be considered on an individual basis. We must not be treated as statistics, we must be treated as the complex and rational, and irrational, and troubled (often), living entities that we are. I doubt any of the community mental health workers whom it was my dubious privilege to be surrounded by for five and a half years ever detected any noticeable change in me on medication or off medication. Other people didn’t seem to. And as for the traumas of the past, I feel that they can only be finally resolved by talking to someone about them and by opening up. The medications make me closed off from myself and give me an inability to feel true and deep emotion as I otherwise would. They stunt my ability to be a social creature as I otherwise would be and they make me feel dulled and despondent. If you take that to be an improvement you have something seriously wrong with you.
Receiving psychological treatment in the form of talking therapy was the one time during the whole course of my treatment where I felt respected and looked upon as an equal. The rest of them look upon you as either a nuisance, a troublemaker, or something worse. Never during the course of my treatment have I found any antipsychotic medication I’ve taken to be of any real value except very recently with the so-called DEPOT injection of aripiprazole. They silence the voices in my head (which now only flare up in rare fits and starts), but they take away deeper and more important things to me such as my sense of self-worth, my contact with my emotional self, my creative abilities (to some extent), and my ability to laugh, joke and be happy with other people. At the heart of all this is, I feel, a culture of ignorance within psychiatry and structural problems with our National Health Service which, in the case of certain mental health services, need deep cultural changes and a profound change in attitude if they’re to, at last, be rated “good” by the Care and Quality Commission instead of “inadequate” or “requiring improvement”.