Assessed

I had a mental health assessment yesterday — I’m fine; I’m just looking for support on the NHS that isn’t CBT — and it was sort of disappointing.

I’ve written quite openly about my mental health escapades before but it has been a while. I gave an account of my bad run-ins with mental health professionals in Egress — from a shockingly inept school councillor to being patronised by GPs and having two pretty useless rounds of talking therapy — and I blogged about my triple chronotherapy when dealing with a really bad depression early last year.

The triple chronotherapy thing was a miracle cure, for those who are curious. It dragged me out of a depression within days rather than the usual 2-4 weeks it takes when changing medications (if you’re lucky). The problem, however, was that the woman running the trial was so anal about documentation and results that her persistent attempts to call me and do questionnaires ended up making my anxiety worse. Despite considering myself a massive advocate for what is currently an experimental treatment for depression and insomnia, I dropped out of the trial because the anxiety brought on by her phone calls was too much.

Classic NHS catch-22 — the treatment was great; I found the doctors and mental health professionals themselves hard to trust and deal with.

This is my eternal dilemma. On the whole, I function. I find medication works well for me when it comes to balancing out my moods, but my life is unfortunately still defined by a tendency to engage in constant low-level self-destructive tendencies. It makes me feel like a ticking time bomb. Depressions come and go, but each fall is always that much worse than the last one. It is increasingly clear to me that I have a lot of bad coping mechanisms and I need to start unlearning them so the next fall is easier to pick myself up from, not harder. But I’m yet to find a doctor or therapist who doesn’t just make things worse for me.

Nevertheless, I’m trying again.

Over the past few weeks, as I embark on this latest attempt at self-improvement, I’ve been having phone interviews, chats with my GP and various psychiatrists, and today I had a face-to-face meeting to get feedback and hear the local mental health team’s first round of recommendations regarding how I might move forwards. It was positive, on the whole, but also pretty gutting.

I was told I wasn’t eligible for the kind of path I hoped to go down because I’m not acting out self-destructively everyday. What they mean by this, of course, is that I’m not enough of an immediate threat to myself, which is true and fair enough, but I had wanted to emphasise the fact that, although I’m engaged in more of a war of attrition with myself, it’s a war nonetheless, and it’s not going to end well. It affects my life daily and impacts my capacity to hold down jobs and friendships. As far as I’m concerned, I might as well be the sort of self-destructive person they’re looking for. I just lack spectacle. But still, it was not enough.

Why am I telling you this? What has really struck me about yesterday — as I’ve been sat at home, melting in this heat wave, ruminating on what was discussed and trying to recover emotionally from making myself very vulnerable in front of a complete stranger — is that I felt like I’d just come back from a bad job interview.

I cannot shake the feeling that maybe if I’d cried or maybe if I’d played up to how I actually feel a bit more I might have been treated another way. And that makes me feel really weird. As I reflect on what I could have done differently, I start to feel really nauseous. Because I don’t think I’m capable of doing that — of playing the part. Part of the problem is that I’m a kind of high-functioning addict with regards to my own coping mechanisms. I can do what I need to do to get by and push on with my day. Which is to say, I’m good at hiding it. And that’s the problem. Hiding it is wearing me down more than my actual distress is. And so the problem feeds back on itself, affecting not just my mental but my physical health.

I felt this even whilst I sat in the grey office room, unable to do anything about the situation.

Sitting across from someone I don’t know, trying to make a good first impression, being personable and patient, isn’t getting me the help that I think I need. I’m left reeling, running through this inverted assessment back over and over in my head. How could I have sabotaged myself more? Maybe I should have dressed worse… Or maybe I should have said something different in response to that question… Maybe I should have spoken less… Or maybe spoken more… Spoken faster or spoken slower… In effect, I’m left wondering how I can fake my way to a truer representation of myself. How can I turn up the artifice to trick myself into revealing the real me?

Just like in a job interview, assessing the person in front of me and their generic questions, I am trying to figure out what it is they want to hear, in the hope I might get the job (the treatment) I need to live a life.

It is a slippery slope, undoubtedly. I know a few people in my life who have gone too far the other way. So used to being patronised or not taken seriously, they turn the melodrama up the 11. More often than not, it makes the cynicism worse. My mother suffered from this. By the time she was taken seriously, it was too late. She went off the deep end and never recovered. I’ve seen up close that melodrama gets you nowhere.

That traumatic memory has pushed me the other way. I have a tendency to play things down, my girlfriend tells me. One of the side effects of a northerner’s stiff upper lip, which protrudes into every lane of my life except blogging. What a sorry situation.

Regardless, it is clear that high functionality doesn’t get you very far either. What I’m doing to get through the day seems less important than the fact I am still getting through the day. But for how long? Something is going to give. The whole point of doing these interviews is so that I can avoid the levee that breaks being me. It’s only a matter of time.

This feeling is what I hate about how mental health is dealt with in this country — the bureaucracy of it, the overbearing sense of professionalisation. These tendencies are wholly necessary on an institutional level, of course — or so they’d have us believe. When it comes to actually working in a field like mental health, with vulnerable and potentially unstable people, you need the straight-laced backbone of the institutional and its code of ethics to set the tone and certain boundaries. But must these sensibilities really leak out all over the patients themselves? Your professional sense of self creates a mirror, and now I am trying to see myself as a professional invalid.

What was most surreal was that, when I arrived at the assessment centre, I was sat in the waiting room with two women. We ignored each other, for the most part, until the two women started talking to each other. They knew each other already. It turned out they were both there for actual job interviews. It seemed they were moving around as NHS departments restructured themselves during lockdown and had previously met in their official capacities before the world was turned on its head. They were both in the running for a position at this particular assessment centre and were there to interview for a new role.

A wall went up in that moment of realisation. I felt like a patient or a punter who’d come in through the front door and accidentally sat in the staff room. I felt like I was somewhere I shouldn’t be — behind the curtain.

My experience is going to be very different to yours, I thought to myself, feeling my size and dress and demeanor crumble. Perhaps, in the end, it wasn’t. Although I wasn’t a patient, of course. I was a “client”. Every time I was referred to this way in abstract — “we find our clients respond to…”; “we try to provide our clients with…” — I felt distanced from the real reason I was actually there, and not in a good way. Yes, you’re providing a service, but I’m not about to tell you about it later on Yelp.

Nevermind. I guess the interview didn’t quite work out how I wanted but they said they were going to keep me in mind for another position. I didn’t work out on this occasion but keep your fingers crossed I get the next one.