And other stories from psychiatry.
Working in mental health, we see things with varying regularity. There are the seriously ill, the recovered seriously ill and those in a rut looking for an answer. The latter can have both the former qualities or neither. This answer takes on different forms. For some people it is in the shape of a pill, for others, it is a label which they feel might help them in some way or justify their mistakes in life. It may just be a friendly ear, or a chance to reason things through. One thing I notice with alarming regularity is that what I sense people need isn’t what I can offer. The system does not cater for these people that have fallen through the cracks. Some call it shit-life-itis, others call it A-copia. Words that on face value seem disrespectful and diminishing of human experience. But are the presentations diminished to fit the solutions we have to offer? Working within the NHS sadly affords professionals a limited tool bag within Psychiatry, and the only thing that can be handed out without a waiting list and with limited resources is drugs.
When responding to the demands of genuinely desperate people lacking answers and at rock bottom, handing over a prescription can feel like a temporary or partial resolution. I am not talking about conditions such as clinical depression, bipolar disorder, anxiety or psychosis that would genuinely benefit from medication and have evidence to prove that fact. I am talking about patients who have fallen somewhere below our social systems or those that have been kicked whilst they’re down too many times in life. They are not standing on top of life, it is crushing them.
These people have no one to turn too and nothing to focus their energy on. Sometimes, they have learnt ineffective habits and coping strategies that walk them round and round until they end up back in the same old situation, but they are pulling their hair out as to why. Their self-esteem is dwindling, their motivation has evaded them, and they start to look for ways to pass the time without thinking or reflecting on their position. This can be endless TV (and consequent insomnia), chain-smoking, drink or drugs, busying their mind with restricting food and counting calories, the list goes on. Anything to forget the monotony of repeating cycles. We are all shades of these people. We are these people. We may have been afforded a better start in life or found our way to a better equilibrium. Psychiatry groups presentations into code-able diagnoses, but real mental health is a spectrum on which we find even ourselves.
One thing that we all need is a focus. Something that can occupy our minds and distract us from our mental health struggles, but also breed benefit (not cirrhosis, insomnia or a weed habit that may work in the short term but eventually take us down). I saw a 15-year-old with depression and self-harm. When she struggled with her mood and overwhelming anxious thoughts she would go upstairs to her collection of 32 pets and select one of her favorites. A big fat rat. She would stroke her rat. He made her feel calm and connected. He made her re-connect with her core. She was an animal lover and this made her different to all her friends. This enjoyment and connection with her own unique spirit gave her hope and she, in turn, had something to focus on.
The next most important step in the chain is success. When we strive through adversity to achieve even small goals it is a great feeling. We feel a little better about what we can achieve and so we tentatively try again with a slightly bigger goal. Suddenly, we have a project, a skill, a hobby, some voluntary work, a new job… We are defined by our own identities manifest as action. Everyone should have their rat. This may be a journal, a small DJ booth or a football team. I believe the arts are the keystone. I have seen a lost 14-year-old transform after learning the bass guitar and becoming the only girl in the rock band. I have seen a 17-year-old foster kid win awards for his mental health inspired art. The arts are not just about outcomes but are also therapeutic in their process. They provide emotional relief in the form of catharsis and exploration. They provide a skill, a hobby and a sense of achievement.
Well, it wouldn’t work for me you might say. True. I don’t dispute that. After all, you might be a rat guy. I will say, one of the biggest barriers to finding our rat is lack of motivation and low self-esteem. These are present in depression whether it is stand-alone or the product of an emotionally labile character. That is why sometimes we might need a little help with finding our rat. To get a person through this hump requires a listening ear over time (time — an important word, and often lacking in healthcare). It requires positive emotional support, non-judgement, and empathy. Psychiatry should be about one human helping to raise another up at their time of need so they are ready to find their purpose. I do not dispute there is a time and place for drugs, but there is a time and place for creativity, engagement, and natural curiosity. There is a time and place for focus and success. Everyone needs a little help to find their rat.
This is an opinion piece and is not representative of any body or organization.