Afternoon team, how are we all? I know what you’re thinking. Months of silence and then two posts in week! What is this? But recent events have kind of made me cross enough to the extent that I have settled myself down with a cup of tea and an episode of The Glades on in the background (I know it’s dreadful, don’t judge me) for some ranting time. (Edited to add: I am in no was trying to discourage anyone from seeking the help that they need. Rather, I wanted to talk about the realities of accessing help and the effect it might have.)
So Robin Williams is dead. That’s sad. I get it. But it is no more sad than the death of anyone else who gets to the stage of despair and exhaustion of living with mental illness when suicide seems like a perfectly rational and sensible solution. New stats for Scotland (where I happen to be) tell us that 795 people in 2013 found themselves in that place of no hope. Every single one of these deaths is just as sad as that as a celebrity. Now this may be an unpopular opinion but the public outpouring of grief is something that gets my hackles up. I find that there’s a very strange distinction between the private, gut-wrenching, world-shaking grief you experience when you lose someone close to you and the theatrical, enacted Greek chorus of wailing and gnashing of teeth that follows the demise of someone famous. You’re not “heartbroken” or “devastated” that a guy that you saw on TV and never met is dead and if you honestly think that you are then nothing bad has even happened to you in your life. Anyhow, the thing that really got to me was the endless stream of people on my Twitter timeline posting well-meant but misguided platitudes along the lines of “please get help” or “just reach out” or “just talk to someone”. This made me so angry for a number of reasons, which I shall expand upon below. Stay with me.
Asking for help is hard and has consequences. There it still a huge stigma associated with admitting that you are struggling with your mental health. I wish there wasn’t, but there it is. It takes a long time for some of us to work up the courage to talk to someone. You might receive a supportive, understanding reaction from the person that you open up to but, you know what, you might not. Asking your boss for time off for Doctors appointments and psychologists appointments can, in some cases, risk your professional reputation or your job. I know, I know, I shouldn’t be that way. But sometimes it is.
Help is not always available. If I had to rely on the help I got from the NHS, I wouldn’t be here now. Mental health provision is chronically underfunded and budget cuts are making things worse and worse. Waiting lists for assessments for counselling tend to run at about 3 months. Once you’ve been assessed to see if you’re “sick enough”, it’s back on the waiting list for another 3 months or so before you finally get access to a standard 8 or 10 week course of therapy. Not miraculously fixed after that? Back on the waiting list you go. Want to check in with the same GP? Nope. But have some pills which will make you sick to your stomach and make you believe that your teeth are thin. I hear they’re supposed to help. Thankfully, when I was at my worst, I had the university health centre to fall back on. It no longer exists in that form but, for a while, I was seeing my GP, psychologist, psychiatrist and a practice nurse each once a week. The NHS just cannot provide this level of support for all of the people who need it. I wonder if any of the people braying “just get help” have ever tried to access mental health services. I’m guessing not. Just asking for help rarely helps. Many of us have asked for help over and over and over. In fact, getting help requires fighting every step of the way. First you have to convince yourself that you are sick enough to deserve help, then you have to convince your doctor, then you have to get stuck in the eternal cycle of waiting and getting appointments and places losing your referral and waiting again. Asking for help is no guarantee of help.
Help might not fix you. Counselling is not once size fits all. Medication is not right for everyone. Even the best help might not make you better. We only have to take Robin Williams as our example. A rich man with access to all of the best help America could offer, still felt that suicide was the only possibility. Just stop and listen to yourselves. I have seen enough doctors, counselors, therapists and CBT practitioners over the years to know that, as in anything, some are better than others. More than that, they are people to whom you are expected to open up to and discuss your feelings with. If you don’t like or trust them on a personal level, you’re not going to get anywhere. Poor or badly-suited therapy can even make you a whole lot worse. The first therapist I ever saw wore bad pink eye shadow with no mascara and really ugly shoes. In addition, she probed into things that I was really really not ready to process or think about or talk about. I used to come out of those sessions doubled over with sobs. After my 8 sessions, I was left feeling like my insides had been scrubbed raw. There was no follow up support. Nothing. In contrast, the only therapy I have ever felt really helped was from the Uni health service and was actually therapy for post traumatic stress disorder. I had weekly or fortnightly sessions for months and months. Even then, I wasn’t cured or fixed. Recovery can be a lot a things for people with mental health conditions. Sometimes is it just simply managing to cling on to the surface of the planet. Sometimes it is living as well and as fully as is possible for you. That might not look “fixed” to a lot of people, but screw them.
Thoughts of suicide or self-harm do not mean actions of suicide or self-harm. I think that when you have been in that place where doing harm to yourself seems like a sensible and legitimate option, it is never not an option ever again. I can only speak for depression and anxiety but we have a different system of logic to other people. Sometimes we are so fed up of feeling nothing that to see something, anything, reminds us that we are alive. Sometimes we are so exhausted by barely existing or we feel like such a burden to our loved ones that never having been born or ceasing to exist seems completely rational. You can’t expect to understand if you have never been there. However, these sort of feeling can also act as a gauge of how bad things are for us. Sometimes they can be quite comforting because we can think “at least I’m not feeling so bad that I am actually going hurt myself.” We know ourselves when thoughts are just thought and when they might translate into actions. The last therapist I saw, who was a nice person and I’m sure just doing her job, asked me to fill in one of those depression and anxiety scales. Among them were questions like “I have thought of doing harm to myself” and “I feel like it would be better if I did not exist”. Tick and tick. Yes I had these thoughts but I knew myself that I was in a place where I would not cause harm to myself. They were just thought. Anyway, this therapist struggled to understand the distinction and basically wanted to keep me in her office and launch a full scale intervention. And that is the story of how I learned never to be honest about my thoughts ever again. Main point, don’t try to understand suicidal thoughts if you’ve never had them. You can’t. Any they might just be thoughts.
It tells people to “try harder at getting better”. This is my biggest problem with these insensitive platitudes that are bandied around in cases such as these. It places the failure to get better squarely at the feel of those who are experiencing mental health problems. The message that comes across to us loud and clear is “YOU COULD GET BETTER IF YOU TRIED. ALL YOU NEED TO DO IS ASK FOR HELP. JUST TRY HARDER TO GET BETTER!!!” It individualises the problem, it draws attention away from the need for reducing mental health stigma, from funding cuts and systemic lack of access to care. Most of all, it makes us feel like crap.
So next time someone famous pegs it, think before you tweet. This how your exortations to “just get help” will sound to those it is aimed at. Instead, try talking about the issues that stop help from being available and accessible to many. That is all.