Assessment (noun): the act of assessing; appraisal; evaluation
Also known as a determination of what a bunch of asses meant.
Psychiatrists have fifteen minutes with their patients, so it’s already a reasonable assumption that they base the majority of their assessments of patients on immediate impressions, stereotypes and whatever was current when they graduated medical school and last bothered to read a journal article – which could be fifteen years or more prior.
There aren’t a ton of psychiatrists covered by my insurance, period. Even “good” insurance in America is rarely good for mental health. There are even fewer who prescribe stimulants for ADHD. Once a month I make time out of my weekend to go see one of those to obtain a hand-carry prescription. I then take that hand-carry prescription to my pharmacy to be filled, where I am asked to verify my identity with a form of ID at least twice, report my address, and then have the exact date and time that prescription was filled entered into a state database to ensure I don’t fill the next month’s allotment even one single minute early.*
I am not harassed during any of this process because I present well. I’m “high functioning,” as I’m repeatedly told. However, my psychiatrist’s office isn’t trauma informed – or even that nice to the majority of their patients. They are one of the few that will take those on public insurance, and they don’t feel they have to be nice, I guess. They’ll fill their waiting rooms and make their money either way. The waiting room is regularly filled with a very diverse set of clients, many of whom have ADHD. I go there even though there are clear issues because they are closest to my home and offer weekend appointments. I don’t even know if the other options would be better, so I just stick with convenience. I hate a lot of what I see there, but I really do need weekend appointments badly given how late I work. I don’t think I could maintain that “high-functioning” job that helps so much in the mental health world if I had to take time off every month to go to a psychiatrist appointment that takes an hour (even though we’re only actually seen for 15 minutes) out of the business day. I do have a couple of other options since my insurance isn’t public, but not many.
It saddens me so much that others don’t even get to weigh those limited pros and cons in their choice of psychiatrists to help them with disorders that should be no more shameful than a broken leg or diabetes.
In a waiting room full of people with hyperactive ADHD, people will talk. People will talk a lot. As hard as it is for me to shut up normally – I’m hyperactive, too – I’m not sure how to participate in those conversations.
It’s readily apparent that I – white, financially stable and put-together girl that I am – have a very different experience with my psychiatrist than those who are of limited means, have histories of substance use or who are diverse in more visible ways than just their neurodiversity alone. Others routinely tell stories of being denied medications by pharmacies and by the very psychiatrist I also see. They routinely tell stories of being told what they feel, instead of asked. I don’t speak up much during those conversations. I don’t have that experience with this doctor anymore. (I did at first. It’s always a challenge with each new doctor to prove I am legitimately ADHD and not drug-seeking. Some of my stories would be humorous if they didn’t seriously threaten my stability when each insurance change threatens my access to crucial meds. However, I’ve long since established myself with this doctor. I truly am as high-functioning as he believes. I truly never have and never would abuse a prescription. I am white and I do make a decent salary. I am what he believes he that I am, and thus I, personally, am well-managed medically.)
I’ve established myself with this doctor so much that he volunteers to help me out in ways that he actively denies to others. Something very traumatic has happened this month. That something is horrifying to my family to a degree that surprises me even given all that we have seen before in the treatment of the disabled. We pulled on what we thought was a routine thread on the threadbare sweater and the whole moth-eaten thing is unraveling. It’s horrifying enough that it requires me (and now my Partner, who amazes me in the way he sticks his neck out to help others, too) once again to tangle with abusers in a more formal capacity. I won’t share any more details than that right now. I don’t want to jeopardize the validity of the actions I will take to try to redress this injustice by writing about it prematurely. I also don’t even know how to write about it if I could. Some things I just don’t have the words to speak. Trauma steals your voice because it makes you feel alone in what you’ve seen, even when you have clear evidence you aren’t alone.
I can’t quite write about what I’m going through yet. I’m not sure how much emotional processing it will take later to be able to write about it even when I “can.” Let’s just leave it at the established fact that this country is not a just or merciful place, and some states are far less just and merciful to the marginalized than others. The most recent effects of that injustice led to me being visibly anxious and traumatized at my last psychiatrist appointment. It has to be bad if I can’t hide how I feel when I’m within an organization that judges its clients so much on appearances. In mental health “care”, there’s safety in presenting well.
Even when I slipped and showed how truly anxious and scared I was, the rest of my appearance worked in my favor. I was still offered my regular meds. I was even voluntarily offered additional support for the obvious anxiety I was displaying. I was voluntarily offered anxiolytics of a type that I had heard others say they’d fought for and still been cut off from at my last visit. As my psychiatrist offered – kindly, gently and as far from sounding like an ass as possible – I briefly wondered if maybe the others in the waiting room were somehow wrong about him. Maybe he wasn’t the ass I’d often heard him described? He smiled when I said I don’t want to have to take meds forever for a short-term situation. (And, oh please to the powers-that-be that govern my 9th Circle of Hell let this situation not be forever!)
He smiled and told me that I will always be able to make the choice that is best for me. If he’d stopped it there, he’d have been mentioned on this blog as offering a rare moment of decency in mental health care that I’d have praised.
So, of course, he didn’t stop there.
He finished with a comparison. I could – should, even must – take care of myself because he knew I would never overdramatize or overstate my reactions. If I was this upset, something must truly be wrong. He knew that because I was high-functioning and a joy to work with “unlike most” of the others he sees.
What could I have said to that? How could I have hoped to explain that the very reason I was so visibly anxious was that of a trauma related to what’s happening to one of those “low-functioning” types? How can I explain the terror I’ve felt when – “high functioning” though I am – I have to fight to keep someone else from being medicated into compliance? When I’ve been threatened with loss of all services for someone if I don’t condone high doses of serious psychiatric medications I am not comfortable with, or the use of “humane” restraints that aren’t at all humane?
How could I explain when his words rendered me mute because I was flashing back to all the times “high-functioning” vs. “low-functioning” have been used as a weapon, not as a helping hand? How could I have explained, when in that moment I wasn’t that high-functioning after all? The world is complex. Mental health is situational. In that moment, the cumulative weight of it all rendered me as dissociated as one of his “low-functioning” patients – and any one of those low-functioning patients might be immensely competent in arenas he never chooses to see.
I couldn’t, of course, say anything. Trauma renders you voiceless, and it’s a microscopic form of the broader trauma that doctors slap labels like “high-functioning” on some and let them have autonomy and choice while they slap “low-functioning” on others and take away human decency. I’m high-functioning, but I refuse to be proud of that label. It’s a label, and I know far too well that the only purpose of labeling humans who all otherwise share a diagnostic symptomology is to further separate them, to further discriminate against the ones who don’t make the clinical “cut.” I’m high-functioning, and if I had had a voice left to speak when I was so reminded of that fact, I’d have told that doctor to be ashamed of himself for the fact that he only offers the most viable help to the “high functioning.”
Shouldn’t it be those who are worst off who deserve the most compassion? The most medical help? So why is it me who gets offered it when if it was truly offered to someone else I wouldn’t have needed that extra help at all this month?
It’s mental health awareness month, and with my voice, which I have since partially regained (partially as a result of the extra help from those meds, argh), I want to advocate for the “low-functioning.” It’s my duty – as one of the high-functioning – because I really don’t believe there’s enough difference among any of us to warrant those additional labels to separate us.
P.S. – I’m calling this the third in a series on trust in mental health care, even though it is written nearly a year after the last two. If interested, Part 1 and Part 2 in the series can be found here and here.
*P.P.S. – As an unrelated side note, I tell people I will never support America’s culture of gun ownership until gun owners have to go through at minimum the same level of hassle and background checking I have to go through on a monthly basis to obtain the medications I need to maintain a normal job and function like an adult. If I have to be so regulated just to get meds that I only take in the privacy of my own space, then the ammo used in public should be at least as annoying to obtain.