Truth, Lies, and Mental Illness

Some things are better left unsaid. But which things? And said, or unsaid, to whom?

Figuring out how much of our deepest inner workings we should disclose to others can be difficult at the best of times, but there's a whole other layer of complexity when there's mental illness involved.

When getting sent to hospital is a possibility that must be taken into consideration, things get even more complicated.

I'm a pretty inward-facing person, especially when it comes to my depression. By that I mean that people in my "real life" only get the full (or at least full-ish) truth, if they have won that privilege. Online I'm very open, but I've kept my "real life," and online life very separate.

That means that if I'm having strong emotions, that's not something I'm quick to divulge to others. There has to be trust, and not just trust on a general basis, but trust at that specific time, about that specific person, about that specific thing I'm disclosing.

Someone I tell about my depressed mood might not be someone who passes the trust test to tell about suicide. When I'm suicidal, I do a lot of lying by omission, and some outright, blatant lying.

I know that saying I'm suicidal is the closest thing to a one-way trip to the psych ward. Despite being a mental health professional, or perhaps in part because of it, I hate being in hospital. I find it totally degrading, and to be frank, I would prefer death by suicide to hospitalization any day of the week. That may sound extreme, but it's an example of just how aversive hospitalization is as a potential consequence.

As a nurse, I want my patients to feel comfortable telling me what's really going on with them. I am selective about truth-telling with my own health care providers. My last psychiatrist broke trust in a way that was unforgivable, at least for me. I used to be mostly honest with him, but that really didn't work out very well for me. Now I see my family doctor for mental health care. He's great–he's very respectful, and speaks to me like we're on the same level. He also doesn't expect me to tell him everything; he knows that I'll tell him the important stuff.

Even so, I only tell him about suicidal thoughts after the fact, after any chance of being committed to hospital has passed. That's a pattern that I have a hard time seeing any likelihood of changing. Is it high risk? Yes. Do I see an alternative that is both healthy and acceptable? Unfortunately not.

When I'm talking about things related to my mental health, I'm very focused on meeting whatever goal or needs seem to be the most pressing at that particular point in time. I do this with a focus on both self-preservation, and self-protection. I'm careful because that's part of the armour that I wear in dealing with this chronic illness.

Getting back to my previous psychiatrist, where he broke trust was with an extremely invalidating response when I told him about that workplace bullying who was trying (and having some success) at destroying my career. I didn't have a family doctor at that point, so I saw two in quick succession; when I told them why I'd stopped seeing my psychiatrist, they just reiterated his invalidating comments. The trauma of that response to my disclosure was enough to scare me off treatment altogether for about five months, something that certainly wasn't helpful for my mental health.

Sadly, the longer I've had this illness, the clearer it has become that secrecy is an essential part of my mental illness armour. I wish it didn't have to be that way, but the negative messages from the difficult times seem to stick so much more strongly than any positives. Perhaps health care professionals should be more aware of the lies we tell, and the secrets that we don't, and why that is the road we choose.