How to stop self-defeating and help them to help me?
January 17, 2012 10:49 AM Subscribe
How can I approach the task of analysing my own mental health professionals without defeating myself before I even get started?
posted by talitha_kumi to health & fitness (10 answers total)
For six years now I have been a patient with a mental health service specializing in treating personality disorders. My case manager has asked me to write to him to tell him what aspects of my time with the service have been helpful, what aspects have been harmful, and what aspects haven't made a difference either way for me. He told me that the reasoning behind this request is to guide them in deciding how best to offer help that will be helpful. When I queried if this was a preliminary step in the service attempting to kick me out, he told me that this was not their intention, but that I should consider whether leaving the service would be useful or not.
One of the reasons I am being asked to do this is because I frequently find it difficult to say anything, either to flag up when I am struggling, to ask for help, or to explain what is wrong. It is often easier to put things in writing than it is to say them aloud. Another is that since May last year I have been going through a prolonged and intense period of depression and anxiety which has involved being hospitalized three times, and led both the service and my husband to question whether anything they're doing for me and with me is helping or hindering. I have had depression since early childhood (was first diagnosed with depression at 15 and am now 30) and have had bad times before, but they have never before been this bad, nor lasted anywhere near this long. Although I have now returned to work again after having been on sick leave for months, there doesn't seem to be any sign of improvement - I returned to work because I'd run out the clock on available paid sick leave, and staying at home didn't seem to be helping at all. Working isn't helping either, but at least this way I'm being useful to someone and getting paid.
At first I tried to approach the task as if I were writing an essay. I wrote a framework of section headings that I thought I needed to cover of some of the various things that have happened over the years, and I put them in a vaguely coherent order. I thought that if I then wrote a few sentences to go with each of the headings about whether specific things the service had done had helped or not, and if not whether the issue might lie with external obstacles or my own fault or with their approach, and if them doing anything different might have helped change that specific outcome for the better, then the end result would be a reasonable stab at answering the question. I thought that maybe breaking the question down into smaller specific chunks might make it easier to handle.
That was last week. And I haven't written a single word since. Every time I think about the task I get overwhelmed by the scale of it. I feel guilty and ungrateful for questioning the efforts of the professionals who have put a great deal of time and effort into trying to help me, even though they have explicitly asked me to question them. I blame myself for being depressed at all, and doubly so because I feel helpless to do anything about it and hopeless about any prospect of meaningful recovery. I keep focusing on the pronouncements of several of the psychiatrists who assessed me whilst I was in the hospital, who told me that since my depression and anxiety are caused by my personality disorder, I will feel this desperate and this despairing for the rest of my life and there is nothing anyone can do to help me because I am not genuinely ill. I feel guilty for the valuable time and scarce resources that have been wasted on me when they should have been given to others who stand a chance of recovering. And at the same time, I keep worrying that this whole exercise is a way for the service to justify abandoning me. That if I say anything bad about them, they will get angry with me. That since I am unfixable and worthless, they are right to cut their losses and abandon me. That I should do the decent thing for all concerned and remove myself from the equation before my existence does any more damage to everyone around me.
What should I do? How do I approach the task I've been given in such a way that I can answer the questions asked of me, instead of getting sidetracked and overwhelmed by the side issues and imagined catastrophic consequences of doing so? Am I already on the right track and just need to push harder, or is there another way I should be coming at this which will let me get through my own ruminating self-defeating monologue for long enough to tackle the actual question and get a meaningful answer?