Behind the curtain

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Navigating mental healthcare in Canada can be a puzzle. pikist

The insights of a psych student with a mental illness

There seems to be no room for mental illness in the discipline of psychology. 

In Canada, the ways in which mental health services are structured, and then acquired by those who need them, are utterly incompatible with the process of becoming an expert in that field. If you have engaged in one process, the other becomes inaccessible to you. 

Being a provider or clinician, it would be easy to feel daunted or nervous to seek mental healthcare, due to a very practical kind of knowledge about what that help may look like or entail. Due to the stigma surrounding mental illness, and the pressure one may feel to maintain a professional image, being a clinician working to obtain support for one’s own mental illness seems fraught. The stakes are high. The pressure to ignore the problem is overwhelming. 

But as a student in Psychology with the goal of becoming a psychologist who also has a persistent mental illness, it is an equally uneasy experience from this side. There comes a moment in many people’s lives while sitting in a doctor’s office that you get a peek behind the curtain and you see the cogs working to drive the machinery. You know why that specific question is being asked, you see the outline of the shape of the opinion being drawn, and you know what each of the potential answers will result in.

In my latest psychiatric appointment (in what will be hundreds in my lifetime), I met with a new provider. We went through a brief overview of my case notes, they asked me some questions and, in the middle of this transaction that is absolutely necessary for my continued mental health and stability – the thing that will help me to do the work I need to do to practice psychology — as I was discussing what my experience of my disorder was, I was suddenly struck by something, and my entire train of thought derailed. 

I’m not supposed to be here. This situation isn’t supposed to happen. People with disorders like mine are not supposed to see the cogs, let alone know what they’re working toward. 

Studying psychology while managing a disorder is a large enough task. Taking on an existential crisis created by the conflict between your experience of symptoms and knowing what the questions will be and where that line of inquiry leads seems unreasonable.   

The key to avoiding the problems in this uncomfortable situation, though, is having a strong, honest relationship with mental health providers that have a personal rapport and history with their patient. And not just for potentially complicated situations with many intersecting variables such as mine — all patients would benefit from this kind of care. 

But with the way things are working in the current conception and implementation of mental health services, that relationship is not something that is common and therefore cannot be relied on. Clinician burnout due to overwhelming caseload, lack of federal and provincial resources, inconsistent implementations and policies, and fragmented, siloed services render the idea of this kind of insightful, long-term relationship impossible in many cases. 

I asked my new mental healthcare provider what kind of information they had on my file from my (many) previous providers. They said there were some notes about my history and my appointments, and I wondered if in the notes it talked about my tendency to minimize and rationalize the experiences of my symptoms. I thought about how they should probably note how I am not likely a very easy patient to work with, and for what reasons that may be. I wondered if it said anything about my work at the university and in the community, which is a very large and important part of me and drives my decision-making. I was curious if it said anything at all about my often voiced concerns and questions about ensuring consistency and routine with my appointments and methods of communication, as that is a simple thing that improves the quality of my life and my experience immeasurably.

These are insights gained with time. When your mental health providers change at least twice a year, all that useful information is lost. So then I start the process again, scoring my own PHQ in the lobby, and trying to resist peeking behind the curtain too much. 

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