The Mental Health System Strikes Back

I’m sitting in a small room on the fifth floor of the local hospital. I’ve had to change from street clothes to scrubs, and my possessions are being examined to see what I can keep. I didn’t bring in much; I turned most of it over to my sister Melyngoch when she left me in the ER. A nurse is sitting at a computer, answering question after question. I haven’t been in this particular hospital before, but I’ve been in enough similar places that the drill is familiar.

I’m reading the questions over the nurse’s shoulder. She has to check boxes about my attitude. Am I hostile? Aggressive? Withdrawn? I can’t help but notice that all of the options are negative. She checks “other,” and writes, “overly polite and helpful.” I can’t help sighing a little—it’s a reminder that whatever I do, however I act, it’s going to be seen through the lens of dysfunction. She asks my name, to find out if I know who I am, and I answer her. She asks if I know where I am. In the psych ward, I say. She corrects me, explaining that this is actually the “stress care unit.” I just smile. I know perfectly well where I am, regardless of what they’ve decided to call it.

******

My depression had been getting worse for the last month or so, something I’d attributed to a combination of environmental stresses, such as unemployment, a gray winter, and the stress of settling into a new place—and, probably significantly, the effects of having gone off my meds two months earlier. I’d naively assumed when I moved that I’d be able to locate a new psychiatrist who could take over my medication management. What actually happened was that it was very difficult to find anyone who accepted my insurance who was taking new patients. I switched insurance at the end of the year, hoping that would help, but was still coming up short. Finally I’d hit a point where I wasn’t sure I was safe, and my therapist was really pushing me to do something, even something as drastic as going to the ER. My family was concerned as well. So finally, on a quiet Friday night, I ended up in the Emergency Room, with Melyngoch there for moral support. They asked the usual questions, and then asked me if I’d sign in voluntarily. Considering where I was psychologically, I figured it wasn’t a bad idea—even knowing that signing in voluntarily definitely does not mean that you can sign back out when you want to go. Once you’re locked up, you’re really dependent on the opinions of your psychiatrist, who makes the call about when you get to leave again.

This particular hospitalization wasn’t especially good or bad—it was pretty much standard fare. But my interactions with some of the staff were simply painful. The first psychiatrist I saw, who was fortunately only there for the weekend, discovered that I was gay and Mormon, and took little time to jump to the conclusion that she had discovered the root of all my problems. “I don’t want to tell you what to believe,” she said—untruthfully, as she was clearly dying to fix my beliefs—”but I hate to see you so sad.” I was dumbfounded. My depression is tied up with a lot of things, and of course the tension between my church and my sexuality is a real challenge. But to have someone reduce the complexity of my life to a single conflict, especially when there were more pressing stresses that were the catalyst for my being admitted to the hospital, felt incredibly condescending. She stared at me and added, “I can see in your face what a painful issue this is for you.” No, I thought, actually the pain arises from having to have this conversation with someone who isn’t even bothering to listen to me. I wanted to talk about bipolar disorder and the symptoms of depression and the pros and cons of different meds—the kind of things that one would hope for in a discussion with a psychiatrist. She wanted to figure out how I could be so foolish as to still be in my church, and kept coming back to what she referred to as my “central conflict.” At one point she asked, incredulously, “you have a PhD in theology and you’re still Mormon?” Actually, yes, I said, through gritted teeth, thinking to myself, please, someone, get me out of here!

I also struggled with staff who were determined to get me to “open up” and talk about the things they thought I should be talking about. I’m actually a real believer in talk therapy. I’ve seen the same therapist for years, and he’s been a huge help to me. But I’m unlikely to really get into personal issues with strangers—especially ones who set off alarm bells for me. Too many mental health workers, in my experience, feel entitled to ask you any question whatsoever and have you docilely answer—and if you don’t play along, you are likely to be labeled as resistant and difficult. I get that being in the hospital means some loss of privacy. I didn’t really like being asked about my suicidality, which for me is a pretty personal thing, but I thought it was a fair question for them to ask, especially given that the onus was on them to keep me safe. And while I dislike having to quantify my depression and anxiety, and am somewhat skeptical about how helpful that even is, I could see that they wanted some way to track things.

But some of them went above and beyond—and  I don’t mean that in a positive way. One nurse asked me five times in about three minutes if I’d been abused, and simply couldn’t accept it when I said no. Are you sure, she kept repeating. I have no doubt that if I had said yes, she would have been salivating at the prospect of interrogating me about every detail. She told me that she would be a bad psych nurse if she only gave me meds and didn’t get me to talk, even after I told her that I really wasn’t interested in getting into anything with her. Having heard that I was religious, she confided in me that that was her spiritual gift—talking to people. Needless to say, I avoided her as much as I could.

And then there were the groups. Oh, wow. I dutifully attended most of them (the exception was arts and crafts, which I just couldn’t make myself do), but quite frequently found it hard to sit there and patiently listen. Positive thinking and cognitive-behavioral approaches are essentially a religion for many mental health workers, and they’re absolutely persuaded that they work for everyone, if only you’ll try hard enough. I realize that some people find that sort of thing helpful, but I really don’t. The best group, I thought, was one with practical advice on how to get your meds for a cheaper price. The worst was one titled “self-esteem, happiness, and attitude,” taught by a man who had informed us the day before that we shouldn’t be eating carbs, as our paleolithic ancestors had not. He gave us a long lecture about how we could, with the correct attitude, change reality.

I was fortunate to have visitors every day—my sisters and friends from the ward came by, and played a big role in keeping me grounded. When all you do all day is interact with people who see you in terms of your disease, you find yourself desperate to spend time with people who see you as a person. My sisters were great at giving me perspective and getting me to laugh at some of the absurdities of the mental health system. Without that, I can see how easy it might have been to have gotten sucked up into the destructive narratives I was being fed, ones in which everything you do is pathologized.

*****

Not everyone was awful, of course. The second psychiatrist I saw treated me with respect, was interested in what I had to say, and didn’t get bizarrely hung up on my religion. He talked a lot about bipolar disorder and how best to treat it, which after my horrible experience with the first psychiatrist was quite refreshing. When I told him I’d actually done a major in psychology, he was genuinely interested in what I thought about diagnoses in the DSM, and where I saw myself fitting in. He had different views on what meds I should be taking than any psychiatrist I’d seen (including the one I’d just seen over the weekend), but when I told him it was exasperating to see psychiatrist after psychiatrist who contradicted each other, he acknowledged that as a legitimate concern, and explained the research behind the recommendations he was making. He also had a sense of humor, and didn’t take himself too seriously. I liked him.

I also appreciated the mental health techs who treated me like a person and not a problem. One in particular always asked me about what I was reading—I spent a lot of time reading, and Melyngoch was kind enough to keep bringing me more psychological thrillers to keep me entertained—and shared his own reading recommendations. That was particularly nice because I always get in trouble in hospitals for reading too much, as it gets labeled as “isolating.” I find that frustrating, because there’s not much to do—”not isolating” means going to the dayroom to watch television with everyone else, and while I can be a total fanatic when it comes to streaming TV shows on Netflix, watching random television isn’t all that appealing to me. Some of the staff get that, but in every hospital I’ve been in, I’ve had to deal with the ones who don’t.

It turned out that the person I liked most in this latest hospitalization was the chaplain. I think it helped a lot that he didn’t have an agenda, wasn’t filling out forms about me, and didn’t have his ego invested in getting me to talk or in fixing my problems. He just came and listened, genuinely listened. He didn’t have answers, but we had a really good discussion about various aspects of religion—and I actually ended up telling him a lot more personal stuff than I’d told any of the staff.

*****

One of the conditions of my getting out of the hospital was that I’d start an intensive-outpatient program. I’ve been in it for a week now, and I have to admit that my experience with it has only heightened my skepticism about much of what passes for mental health treatment. As in the hospital, the sheer entitlement that mental health workers feel to interrogate you with personal questions—especially in semi-public settings—kind of blows me away. Ironically, the first day we talked about boundaries—and how one boundary violation is for someone to repeatedly ask intrusive questions. But that’s exactly what the therapists do. Most of this program is group therapy, and they use group time to ask whatever question might cross their minds. When I said I wasn’t comfortable with this, they explained that this was an intense, short program, and they had to do it to make the most of their limited time. But I’ve been in a lot of process groups before, and there are other ways to run them that respect people’s space and privacy.

I got into trouble my second day there when I tried to explain how giving up on an academic career had been really painful for me, and how I was feeling lost about what to do with my life. They simply couldn’t believe that I couldn’t just magically get an academic job with my PhD. I get this all the time from people outside of academia—”why don’t you just call up x university and get a job there?” But these therapists were particularly persistent, and gave me a long lecture regarding a situation about which they knew very little. When I said that things were simply unlikely to work out the way they were envisioning, they accused me of having low self-esteem. I have to confess that I got sarcastic in response, which was not helpful in furthering the conversation.

But this leads me to one of the biggest problems I see in much contemporary psychological treatment: it completely overlooks the reality of social forces. It treats the individual as if she exists in a vacuum, and needs only the correct meds or the correct thoughts to be cured. For example, in two different hospitals, I’ve had to sit through well-meaning lectures about how money has nothing to do with happiness, and people just need to choose to have a good attitude about their life circumstances. It’s true that research has found that after a certain point, money doesn’t affect life satisfaction all that much. But when you’re talking about whether you’re carrying a burden of debt, or whether you can pay your rent or are going to be homeless, or whether you can afford health care—problems which I’ve found are always real issues for some of the people in the hospital—that’s actually a pretty big deal, and to say that you just need to have a better attitude and choose happiness is nothing short of irresponsible.

*****

One day in IOP, we got to take an inventory which revealed our “irrational” beliefs. These were some of the things that came up as problematic:

“It is an absolute necessity for an adult to have love and approval from peers, family, and friends.” I can see the problem with this if you think that everyone has to love and approve of you. But the idea that it’s not a necessity to have love and approval doesn’t take seriously the extent to which we are deeply social animals. We do in fact depend on each other for positive social connections and affirmation, and the idea that a person should be able to function just as well without them is based on a kind of radical individualism that I don’t think holds up.

“You need something other or stronger or greater than yourself to rely on.” I was annoyed by this because it casually dismisses religious people who find their lives strengthened by relying on God or a Higher Power as irrational and in need of a cure.

And this was my favorite: “The past has a lot to do with determining the present.” Yes, that was labeled “irrational,” and an idea to be overcome. If you believe in linear cause and effect, you need to rid yourself of this silliness and believe in—randomness? I’m not sure. (Ironically, the same therapists who were explaining why this was irrational were also digging to find out more about our childhoods.)

To be fair, some of the beliefs they targeted I could see as more problematic, such as the idea that nothing is worth doing if you can’t do it perfectly. But this is where I break with CBT-style therapies. I don’t think that writing a paragraph to refute an irrational belief (our assignment in this instance) does much of anything—at least, it doesn’t work for me. It feels like an intellectual game. And I’m not convinced that there’s a one-way mental process in which thoughts lead to emotions—quite often, in my experience, it’s the other way around. I’m also not persuaded by the idea that humans are essentially rational beings who simply have to have their logic fixed.

When I was a psych major at BYU, one of my professors mentioned that therapists essentially played the role in our culture that priests used to have. I was surprised to hear that, as it seemed to me that religious authorities still had a lot of power. But I’d lived in Utah for most of my life. And I’ve been somewhat fascinated over the years since to see how much cultural authority therapists do in fact claim. In a program I was in a few years ago, a therapist whom I actually quite liked told me that she wanted me to know that I didn’t have to listen to the people in the castle on the hill (she meant the Oakland temple, I think). I was really taken aback—not even so much by the content of what she was saying, but by the fact that she was so dismissive of religious authority while assuming that I would of course accept her therapist authority. Similarly, I just listened to one of the IOP therapists tell a person in group that he was giving her permission to be mad at God. Again, I didn’t object to the content of what he was saying, but was quite intrigued that he saw himself as being in a position where he had the authority to dispense such permission.

*****

I’m still in IOP, largely because I really like the psychiatrist there and it’s been helpful for me to work with him. But I feel like I’ve had to go into sheer survival mode to get through the other parts. I asked them to please back off on the invasive personal questions during group therapy, and to their credit, they have. Instead I’ve been told such gems as that everything happens for a reason, and that you need to realize that your life has been exactly perfect because it’s what you needed to get you to the place where you are. Bad therapy, in other words, has turned into bad theology. Though maybe the two go hand in hand.