So today I want to write about depression and how the public health system here fails to help mental health patients and just ends up marginalising them even more. Disclaimer: yes, I am angry at the failure of the system to actually produce any worthwhile help for depressed people; yes, I also have a rather convoluted alphabet soup of other intertwined issues (OCD, PTSD, anxiety disorder, social phobias, Aspergers and ADHD) but I don't want to go into those today because those are at least acknowledged by the system even though they are not really being addressed despite my repeated requests to do so - but what I am about to write is solely regarding the issue of depression and the failure of the mental health system to correctly diagnose it and take it seriously. And yes, I am writing from personal experience - although mine is far from the only story, I know way too many others who are in similar positions.
Specifically, I want to write about the difference between "clinical" depression and "reactive" depression, and how the different terms result in being treated in a completely different way by medical personnel and authority figures. I will state right now that this post may be a little rambly and/or disjointed because once I start writing about this stuff I tend to go straight into stream-of-consciousness mode (and this is not helped by the PTSD that often comes with talking about my depression and the stuff that is associated with it)...but please bear with me, because I have something important to say and it needs to be both said and heard.
I have been followed by the black dog since I was about 12 years old. But trying to get the fact that I have been clinically depressed for my entire adult life actually acknowledged has proven to be a nightmare. Add to that the fact that I can't take any form of psych meds (anything that alters brain chemistry) because I am hypersensitive to them and they have very bad side effects (like making me violent when they are supposed to make me feel BETTER), and it is no fun. Every therapist or psychologist or psychiatrist I have ever seen has looked at what has gone on in my life in the week or so leading up to me speaking to them, and based their diagnosis solely on that, regardless of how many times I have told them I have been depressed continuously for most of my life. This is partly because they can't be fucked doing their jobs properly (hey, I'm just a lowly public health patient, I don't deserve proper health care because I don't have shitloads of money to pay for it, yanno?), and partly because once you are in the mental health system here, NOBODY takes anything you say seriously and you are constantly up against the attitude of "you are mentally ill, you don't have a CLUE what you are saying, we are the professionals and we know everything".
In my case, I have only ever sought help for my depression when things have got so bad that I was suicidal - partly because I know that the system here won't help me *until and unless* I front up at the psych ward triage threatening self-harm, and partly because I am a proud bastard who hates asking anyone for help. So, because something drastic usually happens before I get to that point, the so called professionals who assess me instantly make the incorrect assumption that I was not depressed until that happened, and write my depression off as "reactive" and tell me to go home because I won't do anything serious.
For those of you who don't know, the difference as it has been explained to me between "reactive" and "clinical" depression is that reactive depression only occurs when something traumatic happens to trigger it and the rest of the time the person is relatively happy; clinical depression differs from this in that the person is always depressed. Now the reason that constantly being written off as having "reactive" depression makes me angry is that I am NOT only depressed when something happens - I am depressed all the time, but I have only sought help when something really BIG has happened (like unexpectedly having my guts torn out by losing care of all of my children without warning). It pisses me off that the mental health people only want to look at the five minutes before I seek help and go "oh, THERE'S your problem" rather than actually LISTENING to what I am saying about how long I have been depressed and taking me seriously. It seems that if you are actually stupid enough to admit to having a mental illness or needing help, you lose the right to be taken seriously or treated as if you actually have some functioning brain cells that can scrape up some semblance of an IQ (for the record, mine is 150 so I *do* have some intelligence there and I do NOT take kindly to being spoken at like I am retarded or a two year old child who has done something naughty and is being scolded).
Every. Single. Time. I have spoken to anyone within the mental health profession, as soon as they hear that something has gone wrong that has prompted me to seek treatment before I go from feeling suicidal to DOING something, they get that same look, the "oh, the poor dear" face. They nod knowingly at my notes, peer over their glasses at me like I am some kind of antiquated medical curiosity and they tut tut at my situation....and then they say "you are NOT clinically depressed. You have reactive depression because it is all in response to X event that has just occurred, and we are not going to do anything further to treat you because we KNOW you won't hurt yourself".And having a psychiatrist ask me why psych drugs don't work (implying that they DO work, but I just want to be a difficult bastard and not take them) and whether I think I have a chemical imbalance in my brain that causes the depression (do I LOOK like a freaking psychiatrist?), and then when I tell him "I am clinically depressed and have been for 28 years, the reason I only look for help when things blow up is because the same shit keeps happening and it is caused by the same people who I can not legally get away from because there are court orders that say so" he rolls his eyes and says "well at least you have SOME insight into the fact that you are causing your own problems".....SERIOUSLY.
BULLSHIT I have reactive depression - that dog has been following me the whole time. Sometimes he's tailing me and I can only catch him out of the corner of my eye, other times he's up in my face snarling and baring his fangs - but he's ALWAYS there. ALWAYS. If I had reactive depression, that would be like the dog that is behind the fence who only barks when you walk past the house he lives at. But this dog is out of the yard, off the leash and he NEVER goes home.
Even my GP does not take me seriously when I tell her that things are not going well - it has taken me 28 years and multiple therapists, doctors, hospital visits (and a couple of hospital stays of several weeks for complete breakdowns) and STILL they do not take me seriously - it's only now that I am in transition and a lot of the previous issues have lessened, that my GP is starting to listen to me when I talk about my depression and tell her I am NOT leaving her surgery till she gives me the referrals I have asked for.
And even then, I have not been referred to a psychiatrist (because Medicare does not cover much of the cost of those and I simply cannot afford to spend a couple of hundred dollars a month on seeing a pshrink - never mind the fact that I would be needing to do so for a LONG time). I have a referral to a psychologist at a counselling service - but I have to wait. I have been put on a waiting list (and I can tell you from experience that those can be up to 18 months long, even if you are suicidal) for an appointment - then when I DO get one, I am allowed up to 12 appointments a year free before I have to start paying full price (and with my multiple issues, 12 appointments would probably last me 3 months, as I have found in the past that weekly therapy is the only way I can actually get some use out of it). Even with my GP actually finally acknowledging that I NEED some help (don't get me STARTED on how many different agencies I have approached and how often over the years to try to get this help before now), I am still only being given access to the absolute bare minimum, which is not going to be much help at all.
So why am I writing this? Because I have suffered in relative silence (I have made plenty of noise, but the rest of the world appears to be completely deaf to my racket) with my depression and related issues for 28 years and I will not stand for this any more. I know FAR too many others who suffer in complete silence because they know that if they ask for help, they are permanently branded incapable of making their own choices or knowing what their issues are or what help they might need, and treated like they are retarded (not to mention the fact that this assumption is pulled up EVERY time by the system to put them back in their box and steamroll the fuck out of them when they try to get help - this attitude cost me my children because a blatantly biased psychologist wrongly stated for a court that I had a "personality disorder" and was SO far off the mark it was not funny, but when we asked for a review and second opinion, the courts gave the report back to the same psych! so as a result I lost my children and whenever I try to fight anything, the slurs that were made by this psychologist and by the other people involved in the court case who had agendas, are thrown back in my face and I have no way to remove them).
As we all know, mud sticks - and once someone has lied about you in court or on any kind of record like medical or legal (classic example, my own PARENTS claimed in court that I was a drug user and "brain damaged" from falling off a horse when I was 12, in a blatant character assassination - despite the fact that the aforementioned psych even stated in her report that there was "no evidence of organic deterioration of the brain associated with drug use" because I have never used drugs in my LIFE, and there was NO medical evidence whatsoever to support the "brain damage" allegations, I am STILL labelled with this 10 years later. Pardon me for a minute, but if a parent suspects a child has brain damage, don't you think they would actually ask the doctors to investigate, rather than not saying a word, letting the kid suffer and then choosing 18 years later to bring it up in court and claim it as fact because it's a convenient way to hurt them and get what you want? Funny how the courts and the psychologist never spotted THAT one....but that's another rant for another time).
I'm not sure if I feel any better for having written this (as the aforementioned PTSD has now reared its ugly head and is threatening to send me on another downward spiral), but it needed to be said. The mental health "system" has a LOT to answer for (and don't even get me started on overworked and underpaid medical staff and the public health system that is so overloaded....). It's bad enough for heteronormative, cisgendered people who suffer from depression and other mental illnesses - but for a transgender person (already THE most marginalised group in society as it is) to be further marginalised by what effectively amounts to a refusal by the system to acknowledge or treat mental illness (depression etc - and most trans* folk suffer from depression at some point that is specifically related to being trans which is NOT a mental illness despite being in the DSM), is tantamount to the government saying "fuck you, you don't fit the boxes, we want to wipe out anyone who isn't what WE define as normal." It effectively takes us off the radar altogether and makes us invisible - if we are not capable of functioning "normally" in society due to dysphoric issues or depression or whatever else, and are told we don't matter by the government who refuse to acknowledge our existence, the public health system (because many of us have to use this due to not being able to work because of mental health issues) who refuse to treat us or take us seriously, and denied access to any useful treatment to cope with or lessen the mental health issues that make us less able to function, how the hell are we to be expected to actually FUNCTION? It's a vicious circle - the more we seek help, the less we are taken seriously as knowing what we need or that we even NEED the help, and the less help we get, the more we need.
I am sick of being handballed every time I say I need help as "someone else's problem" or told that my issues are not serious enough to need help. If they are serious enough that every medical professional I have ever spoken to acknowledges that they impair my function considerably, then they are serious enough to need help, but I never get any even when I ask for it. It's enough to make a man consider becoming a danger to himself and society solely so that the system will slap a CTO on his ass and force him to undergo treatment, because that's the only way he will GET it. Funny how only the cases who refuse treatment are given priority, when the ones who are screaming out for help are ignored, solely because they are actually owning up to NEEDING it.