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The Person Behind The Patient

Anita shares her mental health journey - from the way her world was turned upside down then put back together again with trust and the right team of mental health professionals behind her.

How my journey began

On the night I first met my psychiatrist, I had been a mother for six days, and I had been an inpatient in the Brisbane Centre For Postnatal Disorders (BCPND), a Mother Baby Unit (MBU) in Belmont Private Hospital for two days.

Prior to my admission I had no history of mental illness, but, for me, its onset was sudden and vicious. It began with postnatal psychosis.

The words ‘postnatal psychosis’ won’t mean much to most people. It is rare. 1 in 1000 women encounter it. This type of psychotic episode is cruelly timed in the days, weeks, or months after birth and can be triggered by a combination of postnatal hormone fluctuations, sleep deprivation, and genetics. For me, sleeping less than 12 hours in the week after going into a 33 hour labour on 2 hours sleep, provided fertile ground for this awfulness to take root.

When I should have been discharged home from the maternity hospital on day five, the nurse on duty and the obstetrician on call could tell I wasn’t well. It wasn’t a difficult assessment. I was curled up on the floor crying and unable to sleep even when given the opportunity to. Thankfully they didn’t send me home. Thankfully they referred me to the BCPND. Because the next day my brain was systematically detached from reality and injected with abject terror.

On that second night of my stay in the BCPND, the psychiatrist was paged when senior nursing staff recognised how unwell I was becoming. I don’t have clear memories of meeting my psychiatrist the night he was paged, just that he was tall and calm.

But here’s what he would have seen when he entered my room in the MBU on that awful night: A cluster of concerned nurses. A husband with confusion etched on his face. And me. A woman who had barely slept in a week. A woman who should have been comatose with exhaustion. A woman who now interpreted her inability to sleep as a superpower.

My eyes felt wide and unblinking. My speech was pressured, words running into each other, urgent to get out. The psychosis hissed falsehoods into my ears and made me say things that I knew weren’t true. I said I didn’t know my husband and that I didn’t have a baby.

Fear threatened to choke me. I asked for a basin to vomit into because I was so terrified.

That night, my psychiatrist could not possibly have known who the person behind his patient was. I was completely obscured by symptoms, and the nature of the symptoms rendered me impossible to communicate effectively with.

The right place at the right time.

I was too unwell to stay in the MBU. I was moved into the SCU (Special Care Unit) and started on high dose antipsychotic medication to peel away the psychosis and see what was left.

When I woke up in the SCU the following morning with a pamphlet stating my rights as an involuntary patient next to my bed, I was unrecognisable to myself and everyone who had ever known me.

And yet, I got lucky. I was in the right place at the right time. If the maternity hospital staff had sent me home instead of to the very place a psychotic episode could be diagnosed immediately and treated appropriately, my story would have been very different.

As it was, I was diagnosed quickly and treated appropriately. I also had no idea at the time that the psychiatrist who happened to be on call the night a psychiatrist had to be paged to assess me, would be the right long-term psychiatrist for me.

I believe all mental health care professionals who interact with patients, but especially psychiatrists must actively work towards recovering the person behind their patient. This is not always easy, nor is it always possible during early consultations. But it is essential to building trust between care giver and patient.

The importance of trust.

Trust between patient and mental health care providers makes treatment more successful. Being seen as a person, rather than a cluster of symptoms, is crucial to building a trusting, collaborative, therapeutic relationship between the medical professional and the person living with mental illness. For me, trust in any mental health care provider only comes if I feel seen as a person.

Patient trust in their health care providers is more important in psychiatry than any other medical specialty. In psychiatry definitive diagnoses can take years to reach. Recovery time frames are fluid. No one can ever tell you when you will be better. You are just expected to trust that at some point in the future, you will be.

Treatment for mental illness often requires a patient to invest time and energy in psychological therapies. And then there are the medical treatments. Medications whose effectiveness and side effects vary from patient to patient. What works for one person can be a disaster for someone else. The main path to find the right medication or combination of medications, is trial and error. It can take weeks, often months. And, as a patient, while you wait, your symptoms may worsen or take time to improve.

In that waiting time, all you have is trust.

That thread of trust can feel flimsy even when your psychiatrist is great at what they do, even when they have worked to build that trust. If a mental health professional hasn’t done that work, the trust is lost and the patient disengages from the relationship, and risks losing any therapeutic benefits.

In the early weeks and months of working with me, my psychiatrist couldn’t have known that someone lively, who loved language and hosting dinner parties, someone who enjoyed time with friends, someone who was professional and organised, someone who loved and was good at their profession as a small animal vet, someone who loved her life and was confident in her place in it, was hiding in a tiny nook of herself that was unaffected by the pathology rampaging through her.

But he combined treating me as his patient with discovering who I was as my symptoms receded, and I eventually returned to being well.

This means he can now accurately assess whether I am well or not as I walk into his consulting room before I say a word. Subtle differences in my expression and tone of voice give information he wouldn’t pick up on if he didn’t know who I was.

It's an ongoing journey.

After that first episode of psychosis receded, my psychiatrist told me I was at risk of a rebound depressive episode, and that I could have an underlying bipolar disorder. I was in disbelief and denial. I didn’t want to hear this. I thought I’d been through enough.

But when a rebound depressive episode not only arrived a month later, but also robbed me of my ability to move much, speak much, or eat as it turned catatonic, I had at least been told it was a possibility. As I became more and more incapacitated and one antidepressant after the other failed to make a difference, my psychiatrist suggested a course of Electroconvulsive therapy (ECT). I was too sick to make decisions, but I trusted him enough to agree. The ECT yanked me out of my catatonic state and got me well enough to go home, by the time my baby was four months old.

As for his mention of a possible underlying bipolar disorder - my symptoms recurred not only after my second baby, but every couple of years long after I’d had that second and last baby. So when he definitively confirmed my bipolar 1 diagnosis, it didn’t come as quite as much of a shock.

It takes time to really understand.

There are many factors that contribute to the challenge of clinicians seeing the person behind their patient and the patient feeling they can trust their clinician. From my experience and observations over the last 15 years I’d say the following two are some of the most important:

The first is a patient’s insight or lack thereof into their symptoms. No one ever has insight into their symptoms when they experience a first episode of illness. During a first episode of mental illness the patient is completely reliant on their clinician’s understanding, compassion, patience, and medical expertise to help them to the other side with as little collateral damage to their lives as possible.

In patients who live with chronic recurrent mental illness insight takes time to develop. This development is part theory by learning additional skills through psychological therapies such as Cognitive Behavioural Therapy or Acceptance and Commitment Therapy, but much of it is learnt by repeated experience.

I have learnt that acquiring insight takes work, and that while no one can do that work for you, you don’t have to do it alone.

It took me over 10 years to really learn my symptom pattern and how to respond to it. I now know its onset is sudden and its progression is rapid. I know I can have seen my psychiatrist for a routine check up on a Thursday with no abnormalities noted by him or me, and by Saturday morning I can be paging him to report I have lost my short-term memory and concentration, and a pathological irritability is setting in. We both know I need to come into hospital because, for me, the time from these prodromal symptoms setting in to developing racing thoughts, speech, and psychotic delusions can be short. I am now able to recognise when my thought patterns are abnormal and communicate this early and very clearly.

Burnout and compassion fatigue

The other factor that I believe could contribute significantly to the challenge of clinicians seeing the person behind their patient is clinician burnout and compassion fatigue.

Drawing on my experience of working as a vet in small animal practice – I have experienced both, and at the time was acutely aware of how they affected the quality of my work.

The first practice I worked in in the UK twenty years ago was in a low socioeconomic area of Essex. It was a quantity over quality practice. Clients could barely afford basic veterinary care. Corners were cut everywhere. We ran on five-minute consultations, with emergencies squeezed in.

Weekends on call were a brutal marathon with no guarantee of a finished meal, shower or sleep between Friday morning and Monday night. I did not have access to a nurse on call overnight. If I saw an animal that needed an anaesthetic and surgery, my husband – Michael – (who had no training) was my nurse.

Working in these conditions in a practice that went against my core values every day was not sustainable. I lasted six months before I resigned. But before that, compassion fatigue and burn out set in. First came compassion fatigue – a vague irritability – with my clients. My tone of voice changed, and my communication skills got sloppy.

Burn out was just the numb shuttering. Nothing left to give.

Attempting to work in a caring profession while under the influence of compassion fatigue or burn out almost exacerbates these conditions because you know you are unable to give your clients or patients what they need and deserve and then guilt creeps in.

From an inpatient’s point of view, I have met and been cared for by many mental health professionals. But even at my sickest I can tell how engaged the person caring for me is in the task, and whether they are aware that there is a person behind their patient. And if they aren’t – that can be the difference between whether I trust them with my thoughts and feelings or whether I hold onto them until I find someone to share them with, who does see me.

It is important to note that as a straight, white, cis-gendered, woman with no concurrent disabilities, who can afford private health insurance, I live with immense privilege. Generally, my experience of mental health care, and being viewed as a person as well as a patient has been very good.

But I know from speaking to others that I am in the minority. There is a spectrum of dehumanisation that sadly feels almost inevitable when people become a patient treated for mental illness, especially if it involves hospital care. And that dehumanisation is the opposite of seeing the person behind the patient.

It is easy to fall back on the default stance that ‘things have come a long way’. But it is equally important to acknowledge that the bar we started at and that is still standard in many parts of the world and in some public hospital systems is very low. For example, chaining patients with mental illness to a wall was, and still is, standard practice in some parts of the world. So, when we say ‘we have come a long way’ it needs to be with perspective.

The importance of passion and compassion in mental health.

I believe the best way a mental health care professional can care for their patients is first by being passionate about the work, or that at least the positives well outweigh the negatives for them. But even more important than this is by looking after their own physical and mental health well. It is almost impossible to work compassionately as a mental health care provider if you are drawing from an empty well.

Another helpful tool to show the person behind the patient are first person narratives of lived experience of mental illness. These accounts can help mental health care professionals develop more empathy and understanding for their patients.

One of my goals in writing my memoir Abductions From My Beautiful Life, was to provide a first person account of my experience of living with a severe mental illness, that included psychosis, and how having access to the right care early, and having a psychiatrist who knows who I am even when obscured by symptoms, has strongly contributed to me living a good quality, well-functioning life.

Everyone experiences symptoms of mental illness differently, and there are many important perspectives out there. Unfortunately, many of them don’t make it out into the wider world. Stigma gets in the way, but often it is just the practicalities of finding time when you are well enough to communicate your experiences.

Often not getting the right care early enough and not having significant periods of wellness between episodes, are part of a collective silencing.

The more people receive timely, appropriate mental health care, the more will be well enough to voice their experiences, the more understanding and empathy will be generated in the community.

I am deeply grateful for the continuity of care I have had, and acutely aware of the privilege that has afforded me such good quality care.

I am also thankful that I got lucky enough to work well with the first psychiatrist I encountered. Over the nearly 16 years we have worked together there have been many challenges. Months in hospital, medication changes, ECT. His unflinching honesty when delivering bad news or not having the answers has always been laced with hope. In the early years, when all I desperately wanted, was an accurate answer to: ‘When will I be better?’ his answer was frustrating but always true: ‘I promise I will get you better, I just don’t know how long it will take.’ Sometimes it has taken a long time. But by working together, I have, so far, recovered from each episode of illness and returned to living a good life.

My psychiatrist first met me when I was the sickest and most vulnerable I have ever been. But he has also seen me living a happy life and functioning well. He knows the person behind the patient and that is why I trust him with my life each time I get sick.

Anita Link writes about her lived experience receiving psychiatric treatment

Anita Link is writer, author, mental health advocate, small animal veterinarian, and mother of two.

Her memoir ‘Abductions From My Beautiful Life’ was published in 2021 and is available to buy on most online platforms, including Booktopia, Amazon, and Fishpond. It is currently also available to buy at Avid Reader and Riverbend bookshops, and at the artists’ hub at Ruby Red Jewellery 107 Romea St, The Gap. Abductions From My Beautiful Life is also available to borrow from the Brisbane City Council Library catalogue.

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