Asking for help

Asking for help doesn’t seem to be very easy. As my maintenance ECT sessions stretch further apart, I am feeling more and more pulled between huge relief at stopping, and horrible fear – also at stopping. Obviously, the hope for me and my family is that I will stay well, be there for them, and enjoy life again. But what if it all happens again, just like it did last summer?

Well, I spoke to a member of staff about this today, who was very reassuring, saying I could restart treatment quickly if needed (probably a good idea), and that I would just need to contact my psychiatrist, or even treatment staff, directly. I am very lucky to have this option, and am so aware that others don’t, so I am talking from a place of privilege. But, the fact is that it’s still difficult. 

Perhaps the biggest problem is me. Despite being a psychiatrist myself, I still find it hard to believe in my own mental illness – I accept it more now, but the bottom line is that I just don’t really get it, and I’m not sure I ever will. So any early shifts towards hypodepression, or indeed hypomania, are hard to recognise. My only experience of being a person is being me, and it’s difficult to think this might vary at different times; also hard to remember afterwards. My husband is better at spotting the changes, but he is an optimist – he hopes they’ll go away. This is nice, as he’s very reassuring, but not always the best.

This initial lack of insight is usually closely followed by difficulties explaining my concerns to my psychiatrist. He is easy to get in touch with, and always sees me quickly, but I think that he, like my husband, can be reluctant to intervene too early (I fully understand why). However this often has the negative effect of making me doubt my own experiences. If he thinks I am well, then my fears of early deterioration must be wrong. Subsequently I often (but not always) become quite ill quite quickly, which means that the time for early intervention is past. 

There have been times in the past, for example when I was first unwell, when I had no idea at all how to communicate how I was feeling, and I think I communicated it very badly. My memories are of feeling terrible, exhausted, agitated and convinced that this would never end. How do you communicate that, and what happens when you do? My impression, from hearing others’ stories is that this is not uncommon; that people have no words for what they are suffering, and, as clinicians, we don’t always understand. Therapeutic relationships break down, diagnoses are disputed, patients feel rejected. And if this is your experience, further attempts at asking for help may be even worse, with both parties on the defensive.

It’s obvious that lack of resources contributes to these problems, but possibly in an indirect way, by bringing out the worst in systems, and, indeed, people. My GP has just retired – I found her so helpful, she made it easy for me to communicate with her. But now, I don’t know any of the others, I don’t know who to see, or who to put on my DVLA form. They don’t know me, either. I also find phones very difficult, and always have, and it gets much worse when I’m ill; I would never be able to navigate a GP phone system. I suppose that could be a useful early warning sign – if it didn’t render me incapable of doing anything about it. And I suspect that I’m not alone in this.

I wonder what would help most? Perhaps asking people their preferred mode of contact, so that they can manage this, although they do also need to know who they can contact, and what they might expect. Sometimes it feels as though psychiatry has become very black and white, with less support available in the community, perhaps leading to people being admitted only when very unwell, given that there are also less beds. There are obviously some great community teams supporting people, but I suspect that many would crave more staff and more resources to do their jobs even better. And I believe that some people would benefit from early admission to hospital before they are detained and acutely unwell; this is becoming impossible now.

As a psychiatrist myself, I’m not proud of the fact that I, too, occasionally find myself thinking that patients are asking for help unnecessarily, and wondering why they even ask. This is totally unfair. In my work, it might be a desperate parent phoning the ward about an adult son with alcohol dependence, hoping for an immediate detox admission. This isn’t something I can provide, but why should they understand that? If I were them, would I not want the same? We have to remember that the constraints of what we can offer may be very real, but not necessarily based on patient need. Instead they may have evolved from what we are able to offer, given resource limitations. Clearly this is not always, or even often, the case; but we need to recognise it when it happens, rather than believing – and even teaching – that it is in the patient’s best interests. Then we may better understand when they ask for help, and be better able to respond.

Asking for help isn’t easy for many of us. People can be perceived as angry and demanding, but we have to think about what they’re asking, and remember that many of our patients are frightened. If we make it simpler and kinder, it will be better. One of my hopefully erroneous assumptions as a patient is that health staff will see me as demanding and entitled because I am a doctor. I really don’t think I am; but even if I was, it would likely be out of fear. 

I hope I’m kind to others, because that’s what I want when I ask for help.