I fought my mental health issues on my own for over 40 years. During that time there were periods where I recognised that I was depressed but there was always a cause and so I didn’t recognise it as clinical depression. I certainly didn’t recognise it for the complex Post Traumatic Stress Disorder (C-PTSD) that it was.
Part of my problem in not recognising it was that despite my seeing many doctors, and even counselors, during those 40 years, I didn’t fit their stereotye of a patient with mental health concerns.
I was simply too intelligent and too well presented.
It’s an issue that I discuss with my current psychologist and psychiatrist quite a lot. When I can turn up to Emerg and request to see the Crisis counselor, bluntly tell them that I need immediate help and admission and still get sent home because I’m too articulate and clean, there is something wrong with the way mental health is understood by those very professionals that are meant to be there to help us.
Ironically, the highly intelligent are actually far more likely to suffer from mental health concerns. Yet they are also the least likely to actually get help. Simply because they don’t tend to present either as the stereotypical patient or because they’re just considered eccentric. The “absent minded professor” comes to mind in my own field.
The stereotypical mental health patient is one that hasn’t showered or washed in days, so smells and is incapable of following logical thought. That is self-medicating in some way so tends to be seen as a pill seeker. In reality, some of these behaviours are due to the high correlation between mental health concerns and addictions; so addiction is the root of the way many mental health patients present, not the mental health concern itself.
Five years ago, when I finally got help, I was the only admitted patient that didn’t also have addiction issues. Not because I don’t tend towards addiction. In fact the opposite is true. I’m even more likely to try self-medicating first, according to the research. However, I’m also well aware of the dangers of self-medication through the inappropriate use of prescription drugs, or the use of street drugs, smoking or alcohol. So I take great pains to avoid these.
I very rarely drink alcohol. Especially, as I have an odd ability to metabolise it incredibly fast so I have never once experienced a hangover (My birth father has the same ability).
I take the least medication that I can and when I am prescribed, and need to take, something that could be an issue, I have it dispensed in very small quantities (just 1-2 weeks at a time) so that I can’t easily misuse it.
I’ve only once taken street drugs and that was unknowingly. I once ate a brownie laced with cannabis. I hated the feeling of being out of control, so never touched it ever again. I am actually allergic to marijuana (not uncommon for those of us with latex allergies) so can’t even be around other people smoking it.
Lastly, due both to medical issues and my awareness of my tendency towards addiction I don’t take painkillers unless I have no other choice. Usually only when I’m hospitalised. That’s despite hundreds of broken bones and incredibly high pain levels on a daily basis.
So you see I don’t fit the stereotype, as I’m not a pill seeker either.
However, the problem with this is that I don’t then tend to get help when I need it. I am too resiliant and I present too well. People in emergency services don’t know me. They haven’t seen the deterioration in my self-care because what they see in front of them is still above the level of their expectation.
I know that I actually haven’t showered in a few days, that I would normally never be seen outside the house in sweatpants covered in dog hair, that it has taken every scrap of energy I have to simply make it out of my house to get help.
They don’t see that though.
They see somebody in comfy clothes that if they get close to, they might realise smells a little but not really enough to bother them. Worse still they hear my intelligence. They hear my asking questions that may need answers that they can’t provide without getting more help. They hear me question why they want to treat me in a certain way.
So not only am I an intelligent mental health patient, I’m an informed one. I know what has worked for me in the past. I know what hasn’t. I’m not going to simply agree to the standard treatment, as that isn’t effective for me. You need to step up, review my chart, and understand that I have real problems with medications and that I have serious non mental-health issues that have to be addressed too.
Mental health patients are stigmatised all the time. The media tends to portray the extreme ends of the psychiatric diagnoses such as ‘split personality disorder’ or the violent bi-polar patient, which certainly doesn’t help.
In reality, for many patients with mental health concerns their brain simply doesn’t quite work in the same way as others. For many this was caused by trauma. For some, it is simply a matter of biology or genetics just like any other medical condition.
Regardless of the cause it is time to stop stigmatising people with mental health concerns and for the media to start portraying mental health concerns far more realistically.
It is also time that the medical professionals themselves stop stereotyping mental health patients. It makes no difference to them how intelligent I am, or how well I present, or how informed I am about my condition, or treatment options, when I turn up in Emerg needing help with a broken bone.
Likewise, it should make no difference when I turn up requesting help with mental health concerns.
If I’m asking for help – I need it.
A quick and dirty search for research on the misuse of mental health services reveals nothing. There are thousands of papers published on the inappropriate use of emergency services but nothing immediately comes up for the inappropriate use of mental health services.
Hmmmm… so if patients don’t tend to inappropriately use mental health services and you have a patient in front of you, that doesn’t fit your stereotype but is still asking for help with a mental health concern….
Maybe it’s time to just provide that help?