I saw a psychiatrist today for review. It was a new psychiatrist; I think the last one is off sick. Whatever the reason, turnover on the NHS is high and I’ve seen loads of psychiatrists. I did have one who I saw for several years, but she was the exception. I mentioned to her that my depression has worsened in the last few weeks. Neither of us felt that changing medication is an appropriate response at the moment as I’m almost on the highest dose of clomipramine (my main antidepressant) and cutting anything (I’m on three different psychiatric medications) just makes things worse. We spoke a bit about the effect of unemployment on my mental state and she said she could potentially refer me to somewhere that could help, but we’re not doing that for the moment as it seems that there isn’t much they can offer that isn’t being offered by the two organisations I’m already in touch with. I also spoke a little bit about being on the waiting list for autism diagnosis, but there isn’t much that can be done about that.
To be honest, I have these reviews every quarter or so and the main reason I go is so that if my mood suddenly gets worse (even worse than currently), I’m on the system and can see someone easily, rather than having to be referred again by my GP, which is a lot of hassle and also slow. I feel somewhat guilty about wasting NHS resources, especially as one of the bloggers I follow was complaining about lack of NHS resources today, but, as I mentioned the other day, I feel that this is the system I’m in and it’s acceptable to make the most of it. I do believe in public healthcare, but I think the centralised model of the NHS dates from an era of confidence in central planning that is now long past. If you were building a public health infrastructure from scratch today, you would not build something like the NHS (as is often stated, the NHS is respected worldwide, but almost never imitated).
Plus, I do believe that with the best will in the world, the NHS will always be overstretched. If something is free, the demand, economically speaking, is potentially infinite. If someone was giving out free bars of chocolate, you would potentially take as much as you could, limited mainly by the room you have to store it and the expiry date. People aren’t going to request chemotherapy without needing it, but potentially many treatments could be over-prescribed to people who want help, but don’t urgently need it (similar to the over-prescription issue with antibiotics). If they had to pay for it directly, they probably would not get it, being deterred by even a nominal price, but they will take any help that is free. In an egalitarian, free-at-point-of-use system, it is hard (legally as well as practically) to discriminate between people who urgently need help and those who could benefit from some help, but are not in urgent need. There is some prioritising of the very needy on the NHS (I think at the discretion of the GP referring the patient, which makes it open to abuse or at least inconsistency), but if you do not need help very urgently you just go on the waiting list with a bunch of people who need help significantly, moderately and perhaps only slightly.
Beyond this, psychiatry and psychotherapy are incredibly labour intensive (one patient per therapist per hour for therapy; three or four patients per psychiatrist per hour) and requires highly-trained (and therefore expensive) psychiatrists therapists. Mental illness is common and even people with mild mental health issues could potentially benefit from therapy (to be honest, even some people without a diagnosable condition could benefit from therapy, if money was no object) . The result is that mental healthcare is always going to be overstretched, until we find a way either to significantly improve human psychological resilience or overcome our limited resources. It is, however, not politically correct to say this. Everyone (I mean politicians and commentators of all stripes) buys into the idea that, if only there was more money and less wastage, the NHS would be fine.
The appointment was not particularly long, but I finished exhausted, which was perhaps not the best setup for what happened next…
I started to fill in the application form for the school teaching assistant position. The form is ten pages long, and they still want a cover letter on top of that (to be fair, I don’t think the form has any sections not in standard job application forms; I’m just used to filling them in online where the length isn’t immediately obvious). I got completely overwhelmed by anxiety and despair. I feel both overqualified and under-qualified. Overqualified, because they’re really not expecting someone with an MA to apply for this type of job (to be fair, if I did get the job, I would consider using it as a step towards becoming a qualified teacher). Under-qualified because I have minimal experience with children and am considering this role primarily because other people think I’m good with children, which is not necessarily the best way to be going about things. I don’t feel that I’m particularly good with children, although when I do have positive interactions with young children I do find that restoring rather than draining. But I don’t have those types of interactions (or any interactions, really) all that often. Plus, I’m not at all sure I could cope with a noisy classroom, autism-wise. From that point of view special needs teaching, which is often one-on-one, might be better, but I don’t know how to get qualified for that or how to tell if I’m at all suited.
I really feel that this is a bad idea, but I don’t know what else to do about it, especially as everyone around me is saying that it is a brilliant idea. The frustrating thing is that this job is literally around the corner from where I live. My commute would be a walk of under ten minutes! And it’s a Jewish school too. I don’t know what to do. I’m thinking of writing to the school I’m applying to and asking if I could volunteer as a teaching assistant for a couple of weeks and see how it goes. My Mum has also suggested speaking to a friend of hers who is a primary school teacher (and who has apparently been saying for years that I would be a good Jewish primary school kodesh (Jewish studies) teacher).
Other stuff is going by the wayside to try and work on this application, and a couple of librarian applications. “Other stuff” being applying for unemployment benefits and working on my novel. This time of year is always crazy for religious Jews, with so many festivals in such a short space of time leading to cramming too much stuff (work and other essential activities and chores) into the other days, but I had hoped to make some progress with the novel.
I’m not sure whether to write this, as it concerns someone else as well as me, but it’s mainly to criticise myself. I got annoyed with my Dad for something. When I decided to contact the school to see if I can volunteer as a teaching assistant, he said I should phone them rather than email and I got annoyed with him. Like many autistic people, I hate using the phone. It makes me anxious and I get confused about what to say, when to say it and when and how to end the conversation. My Dad knows I hate phoning, yet he continually tells me to phone people when I say I intend to email them. I don’t know why he does this. I know he says you get an immediate response on the phone, which is true, and that some people don’t answer emails, but email leaves you with a paper trail, which is also useful and the bottom line is that phoning panics me enough that I will procrastinate to extremes, whereas writing an email is (somewhat) less procrastination-inducing.
I just feel bad about getting annoyed with Dad and shouting at him as one of my three Jewish new year’s resolutions was to try to shout at my Dad less and get angry with him less often. I used to get on well with him, but in the last few years, we clash more and more often. I think his personality has changed quite a bit in recent years and I don’t know why. I have some ideas, but I can’t go into them here. I also feel more assertive about saying I have issues from autism now that I have done a lot of reading on it and realise that some of my quirks/difficulties are well-known symptoms of autism, whether it is failing to follow implicit instructions or to take initiative, forgetting verbal instructions and being somewhat pedantic and literal (all points of conflict with Dad).
I know he isn’t going to change and that if I want to improve things, I need to change things myself, but I don’t know how, especially as autistic facial expressions and tone of voice have historically been responsible for me getting into arguments with all my family quite unintentionally i.e. people assume I’m angry when I’m not. My resolution was to pause before responding to him, but it’s hard to remember that in the heat of the moment and obviously I completely failed to do it here.
One last thought: at shiur (religious class) today, the shiur rabbi was saying that, at this time of year (Rosh Hashanah and Yom Kippur/Jewish New Year and Day of Atonement) we should not ask for health, prosperity etc., which we might not use correctly, but rather to be able to serve God in a way without suffering/with health, prosperity etc., but with the emphasis on serving God, not the suffering-free life. I have a horrid feeling that the reason I can’t deal with my issues is that, on some unconscious level, I don’t want to serve God without suffering, either from self-loathing or a martyrdom complex.