Are doctors really trained to provide what we, as people with mental health problems, really need? Ok, this might ruffle a few feathers, but it has been on my mind for a while so I’m gonna go with it anyway.
In the years I’ve been in contact with the ‘specialist’ mental health services I’ve had an array of psychiatrists, most of whom I’ve felt just didn’t cut it. They include:
- A locum who prescribed me diazepam to take whenever I felt the urge to harm myself (at the time that was pretty much any time I was awake)
- One who wanted to put me on a section 3 (6 months) to save unnecessary paperwork later(?). (note: It didn’t happen and I was discharged less than a month later)
- A doc that seemed unable to leave things be and kept altering my medication every time I saw him – whether I wanted him to or not
- A lovely fellow who was adamant that patients could not dictate where (and how) they would be treated. Bless his ‘lil cotton socks
- The same one often refused to see my parents at the same time as me (leaving them frustrated and unheard, and me unsupported)
- Many that were oblivious to the fact that I wasn’t coping and needed more support (despite me telling them so)
- A few that gave up the ghost when their beloved medication wasn’t the magical cure that they’d hoped
- Only one that I felt actually listened and took on board what I was saying
I do think some of these doctors had perfectly good intentions and that they probably believed they were doing the right thing – but like I said – they just didn’t cut it.
Maybe it’s down to their training. I mean, during their time at medical school they learn anatomy, biology, how to diagnose physical disorders and how to treat and/or cure them. They learn how to decide which tests to perform and how to interpret their results. Maybe they develop their bedside manner – practice interpersonal skills whilst learning the ropes. Junior doctors have to trail behind those higher up on ward rounds, where the patient is often discussed (at the end of their bed) in terms of their illness alone – the broken leg in bed 5, the chronic asthmatic in bay 2 and the bypass op in bed 8. They are encouraged to become a professional (read: detached and clinical attitude).
Even before the students enrol in med school their background is largely science-based. Although students without the right ‘A-Level’ subjects can apply for a place, they have to do foundation work to catch up. Grades are important too – as medicine is so popular universities can ask for top grades (A’s or B’s).
I’m not sure how this foundation helps a person work with people experiencing mental ill health/distress. I am sure, though, that it is part of the problem.
Many service users feel that there is a big gap between them and their consultant psychiatrist. Communication can be strained and it can be difficult to open up. Imagining them outside of their role is also problematic – I’m sure they do have lives, but (due to ‘boundaries’) we generally know little about them). For me it sometimes feels like we’re from different planets and that they just don’t get what I’m about.
Personally I don’t like being seen as a mix of signs, symptoms and neurological imbalances. I am a human being and many things outside of my specific ‘illness’ affect my mental health. Many ‘symptoms’ are actually normal reactions to my circumstances and environment (i.e. not sleeping due to worrying about money, feeling low because I feel like I have no say). I’ve found that some doctors can be slow to catch on to that. I guess it’s easy, once someone is labelled as ‘mentally ill’, to be on the lookout for signs of illness and miss the information that makes sense of it. Especially if you’ve seen 1000s of similar cases (or so you think) and only have a limited amount of time to spend on each.
As it is often said – mental illness is not like a broken arm. You can’t take an x-ray of the mind to diagnose the problem and putting a person’s head in a cast is unlikely to help. Why do psychiatrists need so much medical training, then? I’m sure they know as much as anyone about the interactions of the medications they prescribe – though very little is really known about how they work and it’s largely a case of trial and error. Besides, a mental health pharmacist also has a lot of in-depth knowledge in this area, anyway.
Why is it that an oxford graduate would make a better psychiatrist than the bloke I know down the pub (who works in a local shop). In my eyes life experience, a caring and empathic nature and people skills are far more important than qualifications and medical training. Obviously training is necessary, but this could be in therapeutic skills, counselling, person centred planning, the recovery approach, medication and (most of all) listening. Service users and carers’ experiences could be used in a positive way by enabling them to train in such a role. It would also allow people from many different backgrounds to practice psychiatry. This might make a more approachable, relevant and less daunting service.
Doctors would still have a part to play, but would be acting in a more supportive role. They could advise on medication and physical issues, whilst not having total control. Mental health nurses, support workers, psychologists and OTs would also have more input (whereas they are often dismissed in the current system). As someone learning to survive the mental health system I feel this would be a change for the better. As it is, not all of us survive.
Rachel Waddingham © 2002
A note from Rai: This is an old article written for another site, but someone recently asked me to make it available online again. It was written when I was much more involved in services than I am now – but I think much of it still stands. I’ve been lucky enough to meet some excellently human psychiatrists through my work, but have still encountered far too many who just don’t get it. It is scary that 10 years later the same issues I wrote about here are still relevant. I would have hoped that we had moved forward from this. We are way overdue for a revolution in the mental health system.