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Dear Mental Health Professionals, I have some things to say about "game playing". This is something many people are accused of by MH services, particularly those with a PD label. If this is something you've ever thought of a patient, have you ever stopped to consider 1/
Dear Mental Health Professionals, I have some things to say about "game playing". This is something many people are accused of by MH services, particularly those with a PD label. If this is something you've ever thought of a patient, have you ever stopped to consider 1/
what might actually be going on? Mental health services are a game. The game forces patients to play along before they can access services. Trying to work out what you want from us is like crossing a mine field. Firstly, we must contend with the patient-clinician power dynamic 2/
which many professionals entirely fail to appreciate. We are at your mercy, powerless. Considering how many MH patients have experienced abuse, you would think that replicating this type of relationship would be guarded against. You might think that, but you would be wrong. In 3/
every interaction we have with you, we need to think about how we are being perceived. To be a "good" patient, we must be grateful and submissive to clinicians, but not too much or that's dependency. We need to be independent and responsible, but not too much or that's not 4/
engaging/being resistant. We need to have insight, but not into the behaviour of the clinicians, otherwise we're splitting the team, or projecting. We need to be ill enough to be considered for services, but not too unwell or we will be denied them. We need to get better with 5/
the first therapy or drug or it's a sign of treatment resistance and PD, but ensure it doesn't happen too fast, because that means we're having some kind of mood swing.. So many of your patients sit and consider these interactions, trying to work out what you want, trying to 6/
work out how to be "good". This parallels entirely with the dynamics of an abusive relationship. The problem is, it's not possible to keep this up, because it's ridiculous, and so our responses may become inconsistent, or we may run out of energy entirely. This is when we are 7/
accused of playing the game. The game *you* forced us into, the game *you* created, the game that slowly makes us more and more unwell. When you've spent months, years, or even decades trying to follow all these rules, trying to stroke the right egos, trying to avoid saying 8/
the wrong things, not complaining about poor or abusive treatment, not being upset when your appointments are forgotten about, your meds aren't prescribed right, incorrect information is put in your notes.. trying to be "good", while all the time coping with potentially severe 9/
mental health problems.. when you've done all of that and someone turns around and accuses you of game playing, it feels as if you might as well pack it all in and just leave. Accessing mental health services should not be this hard. It shouldn't 10/
remind you of being abused, it shouldn't force you into these situations, it SHOULDN'T BE A GAME. Next time you think a patient is game playing, consider who's game it is, and who it is that makes the rules - because I can assure you, it's not the patient. 11/11
