Culture  A therapist of one’s own

One student’s disappointing experience with McGill’s mental health services

I began this project knowing that improving the state of McGill’s Mental Health Services (MMHS) would require full self-disclosure. While my assessment of MMHS is reinforced with some administrative reports and statistics, it is my experiential honesty that I feel will be most valuable to readers. Those who can most lucidly identify the flaws of MMHS are on the receiving end, and, if our voices are heard, we can help to correct them.

It all began when I left home in 2006 to attend university in Halifax. Miles away from the support networks I had depended upon in Ontario, the intense moods swings I had known in high school intensified.

I became obsessed with solving the unpredictability of my future. Though this concern is shared by many high school graduates, I handled it differently than most. For long periods of time, I stopped sleeping; instead, I passed the late hours by compiling lists of goals that I was to accomplish and going for walks at odd hours of the night. Filled with an energy that I could not contain or share with others, I would exhaust my racing thoughts on paper or pavement until they had outrun me, and I was forced to let my body rest.

Friends were alarmed by my inconsistencies. Where one week I would proclaim my happiness to Halifax’s cobblestone harbourfront, the next week I was on my roommate’s floor, in shambles over life’s bitter chaos. As my moods rocked between extremes, my grades remained consistently high, confusing my friends and family. They wondered how I could be terribly sick ,but still rack up A’s while writing for the campus newspaper on the side.

Based on the academic success of my first year of university, my parents weren’t opposed to the idea of me finishing my degree at McGill in 2007. After transferring, my grades remained relatively stable and I continued to engage in extracurricular writing activities. But my inconsistent moods continued, and my anxiety sharpened.

One night, while trying to finish an essay, I became so overwhelmed by my inability to concentrate that I began to scream and cry. Scared and alone, I called a helpline that specializes in anxiety to help temporarily subdue my panic. The next day I went to MMHS.

Given the number of students that seek mental health treatment at McGill, I was told that I would need to wait at least two weeks before seeing a professional. Since it can take up to six months to get an appointment with a psychiatric professional outside of McGill’s services, I was advised to visit McGill’s counselling centre while these two weeks passed. Of the 17 psychologists employed at McGill’s counseling centre, seven are Psychology graduate students. One of these students treated me.

She focused mostly on discussing familial conflicts, and I distinctly remember her offering me a Werther’s candy after we had finished the interview. She was very friendly, but I felt that her style of counselling was unsuitable for my needs. While all students in McGill’s graduate Psychology program must have GPAs over 3.3, they are not required to have had practical experience in the field.

For someone who was biologically predisposed to manic depression and chronic anxiety, the success of this novice counselling session could be only temporary. Without regular psychiatric sessions and some pharmaceutical assistance, its effect – giving me the sense that my life had some order – would melt away almost as quickly as a Werther’s candy.

Two to three weeks after my initial contact with MMHS, I received an appointment with one of their full-time psychiatrists. This doctor was welcoming, and provided me with the prescription drugs I would require to help manage my mind’s precarious state. He was adamant that these pills would be ineffective if I did not combine them with therapy. I viewed this as a sign of his professionalism and felt positive about the help I was about to receive.

The patient-therapist relationship differs from the relationship between a patient and his or her general practitioner. Because therapeutic prescriptions are largely opinion-based and can often affect a patient’s personality, they are more often rejected than other forms of medical treatment. Further, there is a natural imbalance in the relationship between therapist and patient. While the therapist listens as an objective audience to the patient’s explanation of his or her problem, the patient enters a position of total vulnerability and forfeits the fate of his or her mental health to the therapist. Thus, it is essential that trust is established between the patient and therapist in order to ensure that the patient will be honest and that he or she will accept the advice that the therapist offers.

It was in my therapist’s repeated failure to secure this bond that MMHS ultimately failed me.

During our sessions, my doctor promoted the problematic view that I seemed perfectly intelligent, and thus capable of gaining control over my emotions. While he might have offered this statement as a way of showing his “unconditional acceptance” and encourangment of my self-disclosure, it implied to me that I was somehow a failure. Much of my distress was caused by the time I spent trying to reconcile my illogical emotions and behaviours with my rational conscious thoughts.

I feel the need to point out that certain neurological disorders (such as schizophrenia, which often begins to surface between in one’s late teens and early twenties), do not always allow for the supremacy of conscious and rational thought, regardless of the intelligence of the patient. While medicine can be used to assist the suppression of some of these behaviors, to a large extent, the schizophrenic simply learns to exist with them. This discredits the idea that intelligence has any strong correlation to one’s overall mental state. Second, many mental illnesses, like manic depression – to which I am biologically predisposed – are experienced periodically. “Most bipolars are thoughtful, deliberative, perceptive and responsible when not ill,” according to Thomas C. Caramagno, author of Flight of the Mind, an analysis of the relationship between Virginia’s Woolf’s creative genius and her manic depression. Manic depression, Caramagno notes, “comes and goes, and when it is gone, individuals are not sick or insane.”

I visited my psychiatrist at MHS two or three weeks after I first made the appointment, and over a year after I had been suffering such “manic” and “depressive” episodes. Hence, if I appeared to be a fully-functioning and intelligent individual when we met, it may have been because I was – at the time when he saw me. Feeling that my illness was undermined by my intelligence, I hardly wished to give my therapist the full opportunity to assess me after he had made such a remark.

This sense of estrangement mounted when, on my third visit to his office, he confused me with another patient by the same surname. The misidentification suggested the unimportance of my case in his eyes, an implication that would hold as the session continued.

Breaching the central code of confidentiality in patient-doctor relationships, my doctor revealed medical information about this patient before realizing his mistake. He laughed meekly at his error, but was unable to reclaim any greater sense of trust from me. From then on, I suspected that the information being shared between us was not truly confidential, or if it was, it was because he had forgotten it by the time I had left.

After this appointment, I saw my therapist much less frequently. I remember visiting him once, several months later, for assistance with a panic attack, and once this year to refill my prescription. Our patient-therapist relationship is mostly impersonal, just like it is with any other McGill administrator.

In order for MHS to offer the “full service” model it advertises to its students, it must ensure the trust of its patients. This will most likely require expanding the number of full-time psychiatrists, so that personal and memorable relationships between doctors and patients can be built.

Despite my strained relationship with McGill’s MHS, there is one companion whom I trust fully. She was a sharp lady of London breed, and her untamed thoughts knew the greatest wisdom of the world. She once wrote of her own mental state: “My own brain is to me the most unaccountable of machinery – always buzzing, humming, soaring roaring diving, and then buried in mud.” Yet, for patients who suffer from illnesses like the one she suffered for a lifetime – in and outside of the lines – I wish that their fate will not resemble hers.

“On the outskirts of every agony,” wrote Virginia Woolf, “sits some observant fellow who points.”