By Mike O’Brien
Trigger Warning: This content contains information and reference to mental illness and suicide. If you or someone you know is affected by mental health issues or the content discussed, please call the Samaritan’s 24 hour hotline on 116 123. The Campaign Against Living Miserably (CALM) offers support to men between 17:00 and 00:00 on 0800 58 58 58.
This’ll be a long ride, so let’s get to know each other. I’m Mike, and I’m a writer with bipolar disorder and ADHD. It’s the worst. I’m not good at being a person. I suffered abuse as a kid. I get anxious at restaurants when I butter bread in case it’s another mundane thing I screw up. I come from a deeply loving but dysfunctional working-class family. My life is a fleeting rollercoaster on the rails of impulse. I have periods of dangerously elevated mood where I make ambitious investments and sleep around, yet somehow never sleep. I also have periods of dangerously low mood where colour is absent and I try not to kill myself. Underlying it all is a chronic inability to direct my focus.
Life’s not great. I stare at neurotypical people doing neurotypical things in equal parts awe and envy. Sustainability seems distant and naive. But I’m also an award-winning critic who is still breathing and has heard it all before. Well-intentioned people are going to offer vague and patronising advice. Some of it helps. Barely any of it gets results. I’m here to tell you exactly how Cardiff’s mental health systems work and how to navigate them productively. A positive attitude is not enough: this is a long journey that demands proactivity and introspection. You have no choice but to embark.
You want to reach diagnosis. You may not think you do, but you do. If that diagnosis is ‘go home’, count yourself lucky. I’m going to teach you how to get there without private healthcare. You’ve probably consulted the university wellbeing service. Maybe you’ve even seen your GP. What did you tell them? What came of it? I bet either:
- Wellbeing offered you counselling or CBT, which was nice, but didn’t get you where you wanted, and you didn’t actually read what they told you to read
- Your GP prescribed you 5mgs of citalopram (or equivalent) which just made you feel a bit ‘off’
- You’ve bottled it up because it’s ‘not that bad compared to other people’
Whatever the case, you’re still at the drawing board. You can’t quite put your finger on it, but something is wrong. Maybe you’re noticing your life isn’t as ‘normal’ as you once thought. Maybe the words ‘anxiety’ and ‘depression’ mean something to you. But until you have it in writing from someone better qualified, it will be an invisible enemy that you do not understand. You can’t anticipate the manoeuvres of an enemy you only vaguely perceive. That’s why you want a diagnosis. It personifies the opponent of your progress. Fortunately, getting one isn’t all that difficult once you know how it works. The hardest parts – waiting times and unreceptive doctors – are beyond your control and must simply be survived.
Write it down
Want to kill yourself? Can’t breathe in front of others? Whenever you feel like it, make a note of it. Don’t get caught up in the details. Just get it down. Put a memo in your phone. Don’t do it because it’s therapeutic. Do it because it’s evidence. The sad state of the NHS means that you do not enjoy the privilege of being a patient. You must overcome the vulnerability a patient approaches a hospital with. You are a lawyer and you are going to court to represent yourself.
The NHS is big. It’s a nebulous, bureaucratic system with finite resources, and the only way to fairly get anything moving is with empirical evidence. How you feel is evidence only to yourself. Build on your feelings in note form. Be honest, confront yourself, develop insight. Above all, provide examples. If you’ve made plans to kill yourself, write down the methods, the motivations, the protective factors stopping you (or lack thereof). If you’re anxious, write of how you couldn’t breathe during a social setting and had a panic attack. Transform your pain into symptoms on a page that can be approached methodically.
On writing, Ernest Hemingway famously said, ‘show, don’t tell’; it is not enough to merely tell your doctor that you have depression. Until you demonstrate it adequately, you will be a hot potato patient and you will get around.
Here’s exactly what to do: ring Cardiff University Wellbeing on 029 2251 8888. Pick the counselling and wellbeing option. Tell them you need to talk through your problems with someone. They will arrange an appointment for you. Attend it. One thing I hear all the time is ‘but I won’t know what to say’. This is a nonissue. At my first one, I babbled in tears about feeling ‘wrong’ and it was still productive. This is a safe space for developing an emotional and mental vocabulary. Like any skill, it takes practice. You aren’t supposed to know what’s wrong or what to say.
Wellbeing is for learning your weaknesses; the GP is for long-term solutions, if necessary.
Tell wellbeing you want to figure this out and document your symptoms to prepare for a GP appointment. You’ll have a few sessions, in which time the two of you may develop an idea of what this could be. The University’s wellbeing service might be enough for you. If it is, fantastic. If not, ask your counsellor for a letter referring you to the GP. If they feel it’s appropriate, they’ll write you one. But keep it for yourself – do not give it to the front desk at your local practice, because you won’t get it back.
Call your GP’s practice the second it opens and go to the next available appointment. Bring the letter you got from wellbeing to the doctor directly, alongside any other symptomatic evidence. You have about fifteen minutes to make a compelling case. Plan your pitch. It is perfectly acceptable to go to your doctor with an agenda. If you think you have depression, or anxiety, or bipolar disorder, say it. Doing so creates a discussion with diagnostic criteria that you can assess together. If you bumble in anxiously with nothing to say but ‘I don’t feel so good’, you will be met with equally vague solutions. Approach the conversation no differently to how you would if you had tonsillitis. Instead of ‘there are white spots at the back of my throat‘, or, ‘it hurts when I swallow’, provide your mental symptoms. These could be, ‘I’m constantly fatigued’, ‘I have suicidal ideations’, ‘I lose control over basic functions in social settings’. Prepare situational examples for the main ones.
Something inside you is uneasy about picking up the phone. That’s the fear that the doctor won’t take you seriously. Unfortunately, doctors are people too. There’s a chance you could be dismissed, talked over, or hurried along during a busy day. During my first NHS consultation, my doctor refused to believe I had suicidal ideations and told me to lie about it at the next assessment because he knew better. Looking back, this was malpractice. But you’d be surprised at how even the strongest people can be coerced into enabling their own mistreatment in an environment as vulnerable as mental healthcare.
This fear comes from within. It is the phantom of the legitimacy you aren’t giving yourself. Just because something is illusory, however, does not make it easy to overcome, especially if you hail from a cultural background of no-nonsense ‘get on with it’ parents. At some point, you’ll wonder if they’re right, if you really are just a big baby. But if nothing’s wrong, then tell me: what are you doing here? Nobody seeks mental healthcare for shits and giggles. You’ve come this far for a reason: you have genuine symptoms and you need help. Good doctors will ask probing questions; if a doctor answers them for you, you’re not talking to a doctor at all.
I will make no guarantee that the first professional you see will be kind and understanding. Fortunately, there is more than one doctor in the world. Persist – which you must – and you will find one willing to entertain a constructive two-way dialogue. When you do, ask what your options are. You may be offered medication. Take it if you like (beware; side effects are real and they can be immobilising). But I’d recommend asking to be referred to your local Community Mental Health Team (CMHT). This is the upper tier of mental healthcare that will investigate your case on an individual basis. You’ll be assigned a psychologist whom you’ll meet with every six to eight weeks or so. This is the person who will monitor you and provide a diagnosis.
That’s half the battle
You need to be mentally prepared for the truth. Here’s a fun thought: what does ‘disorder’ mean? Mankind may seem developed to you, assuming a total lack of political engagement in the last three years. But evolution is a slow burn. In the grand scheme of human history, we have enjoyed a sliver of peacetime. Our species has barely had enough time to decide what it ought to be, let alone the wealth of time required to psychologically evolve to these standards. Psychopathology, like me at my school prom, is young and woefully unexplored. Terms like ‘disorder’ are words we use to describe how productive we are in the way society conventionally understands it. It is by no means an assessment of your capability as a human being overall.
One piece of advice you’ll get is ‘be kind to yourself’. No; be fair to yourself. Kindness is too forgiving to be applied unconditionally. Everything that’s happening to you is bullshit, but it does not absolve you of accountability. You may have family, you may have friends, you may have lovers. All, in some way, will tell you that everything will be okay, that all wounds heal with time. It’s a comforting phrase but it lacks substance. It is action, yours entirely, that will bring you through this difficult process. Self-advocacy and personal responsibility are central to survival.
You will falter. You will miss appointments. You will fail at jobs and relationships you weren’t mentally ready for. But it’s all a part of the game. This is a delicate balance to strike, and day-to-day life will be the most difficult factor because it isn’t designed with you in mind. You are inherently abnormal. You may be mentally incapable of regular structure. That doesn’t matter. Set realistic goals and achieve them. It doesn’t matter if you’re doing it 3am like a nutter. It doesn’t matter if you eat a sandwich by its individual parts. It simply needs to be done; no one else can do it for you.
Waiting times will seem endless. In the interim, there are coping mechanisms that people will recommend. Try them all, even if they seem asinine. These include breathing exercises, rigorous daily routines, ‘life hacks’, and so on. Some of these might work for you: if so, great. But no one knows what to say to you if nothing works out, so I’ll have a go.
This is a formative time in your life. You are cursed with mental and emotional inconsistency and it’s very easy to lose yourself in that. Form yourself before it forms you. Give your name meaning. Do you believe strongly in something? Do you love someone? Do you have a passion project that demands your attention before you die? If you have nothing to live for, like I did, find something – it’s not like you have anything better to do. Get it down on a post-it note. Stick it on your wall. Look at it when you are feeling low and remember what you serve at your fullest. Take good care of it; it’s the real you.
Rise and shine pal, it’s time to fight the dread. 029 2251 8888.