My first assessment with the psychiatric nurse

I was just assessed by a psychiatric nurse. Thanks to some research, I knew moderately what the assessment would cover. What I didn't know was how it would be covered. And I'm glad to say nothing I could have researched would have prepared me for this.

"This"  doesn't deserve to be written in a poetic way. Because it's not poetic. It's not art. It's not a script. It's an hour of my life: the interface between myself and a local psychiatric nurse.

My first impression was that she was stern and clinical. Her smile was hard-worn. Her presentation was pristine, well-cared-for, and almost too-cared-for. She was quite defensive. Protective, even, to the point where her words and behaviours, though scripted to reassure and elicit trust, lacked all empathy entirely.

And that's what I felt as I sat there. So I couldn't look at her. Not out of shame, but because I knew that she was the Gatekeeper and whether I liked it or not, she was right. I needed to trust her, even if she didn't deserve it.

I hope at least one person from mental health services is reading this and reflecting on that sentiment. She didn't deserve my trust.

And I didn't trust her.

Instead, I visualised my therapists, one and two. My GP. My husband. The teachers who were good to me. My colleagues. Myself. I looked at myself and talked to her. The questions were textbook. The asides were not.

I found myself playing the game "tell or not tell" with every answer. And for the most part I was authentic. I was vulnerable, honest, and, as she put it: "articulate and intelligent."

I cried and shook from anxiety throughout most of it, soothing myself by repetitively and systematically squeezing the end of each finger. Folding and unfolding my tissues. Rubbing down my arms and legs.

The result of this assessment?

I am simply depressed and anxious.

I am not autistic, because I have feelings. Because autistic people don't sit there and cry.

I am not borderline, because I am not attention-seeking. Because borderline people have victim complexes and are manipulative and self-harm.

My episodes of hallucinations were most likely psychotic depression. And, "they" can't help me unless I agree to take medication. Err, "consider" to take medication.

She was shocked to find out I wasn't on any. Suddenly, she leaned into me, with a curving, seductive smile. Her voice lowered, bright and husky, as she recommended this "fantastic drug" called Sertraline which works wonders.

My body became lifeless, as I fell further into my armour of terror and disbelief. Is this what peer pressure feels like? Does she even realise what she looks and sounds like?  My brain rattled with American anti-drug infomercials of the 1980s: I'm not a chicken; you're a turkey!


Just say no.

She leaned back, with a self-serving smile, as I nodded, passive and accepting. "You're clearly an intelligent girl."  Did my eyes narrow just then or was I still nodding complacently? I stared down at my hands.

There are so many things wrong with what she said, but what strikes me the most is how she said them: persuasively, as though I needed convincing. Her behaviour was unlike any therapist I ever met, because she's not a therapist. She's a psychiatric nurse. And I will try not to hold that against her, when I "consider" what medications the psychiatrist recommends at our meeting (yet unscheduled).

Wow.

I don't think she's wrong. I am chronically depressed and anxious, and I probably would benefit from medication.

I think, perhaps, that if I had received treatment for my depression and anxiety when the illnesses began (as a child), it would be that simple. But I'm 30 now, and medication cannot change the sometimes damaging, always complicated network of defences I've built up to cope.

So, I will see what the psychiatrist says, but moreover I will see how he says it. There is a world of difference between someone telling you that you need an anti-depressant and someone explaining how an anti-depressant will enable you to cope better with the daily stresses and engage in therapy.

This is absolutely a negotiation.

My body, my boundaries. A single pill will not become my only means of support in the world, and I refuse to be persuaded otherwise, especially when I am so vulnerable. I have much more powerful defences than a pill can provide, and if I need to use them, I will.

Like a true Narcissist, the nurse was surprised when I didn't express my delight at her gift of insight: I was not borderline or autistic. "Most people are happy about that." She shifted in her chair with a forced smile: her eyebrows furrowed, her eyes vigilantly observing me.

I felt ashamed. And, like the Narcissist I am terrified of being, immediately fought back with anger. I breathed. I soaked up my tears. I let her suspicious chuckles turn into silence.

And then I drew the line between us.

"Let me make one thing clear." I frowned at her like she was a naughty child. "I was isolated for most of my life." My eyes watered, my hands shook. "There is nothing that you could say that would soothe me. No label would change how I feel."

She withdrew from my boundary. The conversation lingered, and though I sat there, I was already gone. We stood. And then something remarkable happened.

I opened the door myself. I heard her say good bye. I left. I didn't look back.