First and foremost, working in the community, with a recovery team, confirmed a few things I already knew about myself. 1) rehabilitation/recovery is for me. It fits my experience, my skills, my biases. Rehabilitation almost seems to be the job I've done for the past three years only better paid and with slightly more paperwork, which brings me onto: 2) community nursing is an even better fit for me than recovery. I've always been quite diligent with tasks, anything involving forms, computers and the like, and I really felt like I found my niche. I spent four weeks barely stopping to catch my breath, all the time thinking I could actually do this. I learned a lot about my future opportunities from my mentor and a third year student I was working alongside, and within about a week had planned out the next seven or so years of my career (all based around becoming an IAPT nurse). My mentor was supportive, but at the end of my stay reminded me of the importance of doing something that both fits you well and interests you simultaneously, and said she hoped I'd pick them for my management placement. I'm organised enough to be a care co-ordinator, she thinks. I'm still trying to get my head around the fact that I might be a decent nurse.
It wasn't all fun and games (though most of it was, I admit): a lot of my views were challenged. The consultant psychiatrist involved with the team seemed like a thing of legend, someone who couldn't actually exist: a doctor who used medication minimally, saw the bigger picture of the patient's background and social needs, and wrote gigantic letters after every appointment and review. A psychiatrist who doesn't blindly believe in medication as magic bullets, oh my! I only met him once or twice and I'm fairly sure he's an actual wizard. He can't be human. Seeing his work and his connection with his patients truly gave me hope for the future, that other doctors like him could exist.
My negative view of medication was also put on shaky ground. A lot of our patients were on Clozapine, and were functioning successfully in a way they'd failed to on other medication. One patient had spent three years in hospital, started Clozapine, and has now been home for ten years. He isn't symptom-free, but he can manage his experiences. Countless other patients had similar stories. Clozapine is a potent antipsychotic, and not commonly used because of the physical side effects and need for monitoring, but it sounds like the closest thing psychiatry has to a magic bullet. It doesn't fix people's lives, but it seems it can give people the power to take back control of more of it than they might have otherwise had.
I've been having a similar dilemma on a personal level: academically and ethically opposing most medications, but seeing positive outcomes. Yet more critical psychiatry reading (this time, Anatomy of an Epidemic) has made me even more cautious of the poor science behind antidepressants (amongst other psychotropic drugs). I cringe when I hear depression explained as a chemical imbalance, wince at the justification for the use of SSRIs being explained entirely inaccurately. And yet, I take Citalopram myself. And you know what? It works. Or I'm fairly sure it does. This is my second time on it and whilst the first time it simply seemed to only make me emotionally numb, this time, I am happy. Is it life or the medication that's lifting my spirit? We'll never know. I daren't come off it to find out. So while I can and will acknowledge the faulty science behind antidepressants and antipsychotics, I can also acknowledge that they sometimes work. Even if they potentially create a never ending cycle of dependency. Even if they alter brain chemistry that wasn't originally faulty. Even if academically, I know better.
I got to visit a few acute wards on placement, too. They were in a reasonably affluent area, the opposite of the location of my first, awful placement, and as much as I hate to use that as a basis for comparison: they really weren't as bad, as uncaring, as boring, as I remember. One ward had a pool table, access to musical instruments. The atmosphere was relaxed, calm. A patient came to the office to ask a nurse if they could use the phone to make a quick call, the nurse responded cheerfully with an "Of course you can!" I still don't think acute care is the right environment for me, but my view has definitely softened a little. There are good places out there, caring places where patients aren't treated like prisoners.
And! I saw a nurse who was shorter than me AND looked as young as me too. And she was funny, kind, yet authoritative at the same time. I just wish I'd met her before a patient told me I looked too young to be a nurse, and that I looked "about 14". My complex lives on.
The good thing about training as a mental health nurse is that once you've qualified, there's no end to the opportunities available to you. You can specialise in therapy, run off and work in prisons, become a researcher, work your way up the management structure on the ward, run off and dual-qualify in adult nursing, and a billion other things, I'm sure. And I'm so, so glad. This is perhaps ignorance on my part, but I wish I'd known more about what I was getting into before I started this degree. This might sound strange in light of all the positivity I'm feeling about my career lately, and don't get me wrong, there are parts I really like. Discovering that my mentor had worked alongside one of her patients since before she qualified made me hopeful for the supportive relationship I could develop with my own patients in the future. But things like sectioning, and the almost total involvement of professionals in patients' lives, is what makes me uncomfortable. I find something inherently discomfiting about telling someone who doesn't believe that they're ill that they actually are. I find the idea of psychosis as an illness bizarre in itself: how do we know what we see is real? How do we know we're not hallucinating? How would we know if what we saw was a hallucination? Don't get me wrong, I'm not denying the distress our patients experience, but from a philosophical viewpoint, I'm not sure I can reduce someone's experience into an illness. I didn't agree with The Myth of Mental Illness much when I first read it (or, rather, attempted to), but it, along with Philip K Dick's ideas about reality, are beginning to click into place for me. I get why people need to be held in hospital, I get why people might need to be coerced into treatment against their will -- but getting it doesn't mean I want to be the person doing it.
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