The Reality of Mental Health Treatment: A Patient’s Perspective

“Why don’t you take a seat?” He references one of two plush chairs facing the desk in his office. She glanced around the room. His office was typical—quaint, furnished with light yellow paint, wooden accents, and several abstract art pieces. Sitting directly behind his mahogany desk was a large square window looking out over a not-so-special section of downtown Rochester, Minnesota. 

They say sunlight is supposed to help those sorts of encounters, but on that day the overcast gray skies tossed colorless leaves on the streets. The neutral light from the window spilled over the paisley patterned carpet with each design on leading into the next. 

On his desk sat three picture frames, each facing away from her, towards the window. Likely a family, judging from the wedding band on his left hand and the wrinkles sewn deeply into his face. Wrinkles that betrayed the years of time he had spent working to fix people. On the wall, perpendicular to his desk, hung a large mahogany clock. She began to sit down on the chair that was furthest away from the stranger in front of her, while focusing on the minute hand that was moving in slow motion past the 12. She was suddenly pulled back into the reality of the meeting about to take place. 

This initial meeting was the worst but the most important. One wrong word, a wrong move, and he would label, and file her away in a category he thought he knew all too well: Anxious, Depressed, Crazy, Bipolar. The first visit was the only one where she would have any control at all, so she relished in the little power and autonomy that still remained on her side of the mahogany desk. During this visit, she too would judge him, and decide how much of her history, how much truth, and how much trust she might share with her new mental health practitioner. In all honesty, she was still deciding how much this overweight middle-aged man might be able to help her at all. She pictured his life as privileged: a plush home, perfect wife, and three kids. She wondered if his money had bought him happiness, or if this—too—might be fake. 

He was looking over the series of questions she had answered in the waiting room—all of which had given him a simplistic clinical picture of her history. The answers were only an accumulation of events that happened to her, and they did not account for the pain, story, or triumph behind each one. As she sat, she reminded herself to keep her physical body in check so as not to attract any unwanted stereotypes. She sat properly, with her back straight, legs crossed, and hands in her lap, waiting for his eyes to meet hers. 

For a moment, she took in his persona. He looked just under 6 feet tall, with light silver hair waving over the sides of his spectacles, which were secured over his soft brown eyes. He looked kind but had an air of aloofness about him. Maybe he was a friend of your grandfather you never knew or a distant relative that had been estranged. He was a simple, soft-looking man, even still, he held all of the power. She dared his eyes to meet hers instead of staying fixed on the medical and psychological questions he had in his lap.

Do you have any history of chemical abuse? 

Yes 

Did you experience any abuse as a child in your home (physical, verbal, emotional or sexual) or outside your home? 

Yes

Have you experienced any abuse in your adult life (physical, verbal, emotional or sexual)?

Yes

Briefly describe the problem for which you are seeking to have counseling for? 

I need help. The noise in my head is too loud. My thoughts are too quick. I need help.

The patient questionnaire she filled out was likely looking grim in the hands of the professional sitting across from her. In that moment she wondered what he was thinking as he scanned over the endless questions that recounted some of the most intimate and negatively defining moments of her life. Could he understand that behind each qualifier there was a broken piece of her puzzle? Did he think of her as a case or a person? Was his attention on her at all? Maybe he feels sorry for me, she thought. Worst of all, she mustered, he was human and he felt empathy for her—she too was taking pieces away from him to be sitting there in front of his desk, across from his clipboard, separated by those pieces of paper. She wondered if he even read all of the questions or each option on those pieces of paper that she had meticulously worked to fill out.

Symptom	None	Mild	Moderate	Severe
Abandonment Issues			Moderate
Aggressive Physical Behavior	None
Aggressive Verbal Behavior	None
Alcohol Abuse			Moderate
Anger Issues			Moderate
Anxiety/Tension				Severe
Binge Eating			Moderate
Childhood Issues			Moderate
Cognitive Problems			Moderate
Compulsive Gambling	None
Concentration Issues				Severe
Conduct Problems	None
Decreased Appetite			Moderate
Delusions	None
Diet Pill Misuse			Moderate
Difficulty with sleep			Moderate
Fatigue			Moderate
Feelings of guilt/shame				Severe
Feelings of helplessness				Severe
Feelings of hopelessness				Severe
Feelings of worthlessness				Severe
Financial Issues				Severe
Food Concerns				Severe
Phobias			Moderate
Prescription Drug Use			Moderate
Relationship Issues			Moderate
School Problems			Moderate
Self Induced Vomiting				Severe
Gender Identity Issue	None
Grief/Loss			Moderate
Hallucinations	None
Health Concerns			Moderate
Homicidal Thoughts	None
Hostility	None
Hyperactive			Moderate
Impulsive			Moderate
Illegal Drug Use			Moderate
Impulsive Spending			Moderate
Increased Appetite				Severe
Irritability				Severe
Laxative Abuse			Moderate
Legal Problems	None
Mania			Moderate
Marital Problems	None
Mood Swings			Moderate
Obsessions/Compulsions			Moderate
Pain			Moderate
Panic Attacks				Severe
Paranoia				Severe
Parent-Child Conflict			Moderate
Peer Relationship Conflict			Moderate
Self-Harm			Moderate
Sexual Problems			Moderate
Social Isolation				Severe
Weight Changes			Moderate

She knew it was a lot. A lot had happened for her to be sitting across from this man. A lot has to happen for someone to get to the point where they think paying to talk it out with a stranger will help them put the pieces of their life back together. 

Finally, his eyes locked with hers. In that moment, with his eyes locked on hers, there was a mutual understanding—they were no longer strangers. At least she was no longer a stranger to him. She handed her life’s secrets to a stranger who would remain a stranger, yet he gained the privilege to the most intimate pieces of her life. 

It was ironic, actually, how much went into this moment. In fact, irony would not do justice to the sheer paradox; that she was sitting in this chair, at this time, wearing the clothes that she was, looking into his eyes. She knew what would happen next. Next he would ask her what it was that brought her in—why she was sitting in front of him, what needed fixing, even though he already knew. In fact, the last thing she wished he would ask at that moment was why she was here because she knew what he was holding in his hands. 

There would be the intake questionnaire, The Generalized Anxiety Disorder 7 (GAD7) survey, the Patient Health Questionnaire 9 (PHQ9), and her general health information. Those who had ever been to a counseling appt., had a baby, or seen a psychiatrist know exactly what those are. The PHQ9 and GAD7 are short surveys that help decide on the amount of help a patient might need—they were one way to assess where she was at mentally, while sitting in his office. The PHQ7 was usually where it started for her. It assessed her anxiety, while the PHQ9 assessed her depressive thoughts and feelings. Again, her mind trailed toward the questions and answers he was glancing through. 

By now she had most of the questions memorized down to her score, and what the score told the clinician about her current state. She thought first to the GAD7- Over the last 2 weeks, how often have you been bothered by the following problems? Feelings of nervousness, annoyance, fear, worry, restlessness, etc. From the GAD7 her mind jumped to the PHQ9- Over the last 2 weeks how often have you been bothered by the following problems? Feeling down, depressed, hopeless, little interest or pleasure in doing things, etc. The highest you could score on the anxiety questionnaire was a 21, while you could get up to a whopping 27 on the Depression Ranking.

The numbers would give him a sense of where she was at, and a quick mental tally based on what she’d filled out in the lobby that day had her around an 18 in the GAD7, and a 22 on the PHQ-9— high scores. These scores landed her in the categories of having severe anxiety as well as being severely depressed, both sharp reminders that she was in fact not doing well.  This inner dialogue was getting louder as she waited for him to say something. 

The noise in her head was making it hard for her to show up to work, much less to focus on doing the rocket science her job required of her in genetic research at the clinic. The sound of her thoughts got louder and louder as she tried to pull herself out of bed, into the athletic gear, and onto the running trails to prepare for the marathon coming up in November. The happenings of her buzzing mind were making it difficult for her to answer her younger siblings’ calls with excitement in her voice as though the pieces of her world weren’t imploding. The lack of control had her fantasizing about throwing up her food again, just to feel an ounce of control in this fucked up world—this world where real people with real problems are labeled and tucked away in a filing cabinet in a mahogany desk. 

At that moment, sitting across from him, the noise was particularly loud. It screamed of her parents’ divorce after 35 years of marriage and four kids, of cheating, of bad sex, of alcoholism, porn, post traumatic stress disorder, love, and secrets. Her mind screamed with secrets. Small pieces that she had filed away beneath her deep seeded hatred for herself. 

“Fake it till you make it” her mother would tell her, and she had done just that. After so much fake, though, she sometimes wondered what was real and what was not. Recognizing where her thoughts were headed she attempted to pull herself back, once more, and glanced at the clock that had allowed only three quarters of an agonizing minute to pass.

Despite her best efforts to focus, her mind continued to race through her history faster than he could possibly review on those pages. She was wondering if he would forgive her for hoping that he wouldn’t ask her why she was there. She was not sure what she could possibly tell him and had no idea where to start except for the 18 and the 22, the “yeses,” and the “severes” he had read on the pages he was holding. She imagined what he saw now as he looked across his office at her and judged her.

Despite having little to no order in her head, no words to say aloud, nor a plan to get better, she had dragged her ass out of bed, showered for the first time in a week, and skipped breakfast just to be sure she wouldn’t give in to the temptation to throw up. All of this, all this fake, so that she could tell him when he asked her that she was doing better today. She had waited to show up until her hair dried, put real pants on (jeans), and even threw on a little mascara in a feeble attempt to make him see her and not the numbers on those papers. Getting to his office had not been easy for her, but she managed to get there while drifting between the offer for hope she might get at the office, and an endless fantastical loop of escape. 

 I am here, she thought, because what is going on in my head is starting to make me feel crazy. There are so many thoughts, so much noise, so many secrets, so much faking, so many thoughts… The minute hand finally reached the 12, just as he finished flipping through the pages in front of him. As he began to speak, she willed her thoughts slower constraining the maze of her mind to simplicity. Forcing her mind and body to focus on his face while he opened his mouth he spoke—

“So, tell me what brought you in today?”

-Just your friendly neighborhood scientist,

Lauren Nellie Anderson

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