How you can still appreciate the NHS when it’s let you down.

 

Throughout the pandemic, we have rightly been celebrating the NHS and all the staff who have worked so hard, in genuinely harrowing circumstances, to try to save lives. But for some of us, it’s not quite as simple as the rainbows and hashtags would suggest. 

If you need a specific treatment for a specific, known illness or injury, or even long term treatment for something disabling that requires multiple hospital visits over the course of your life, you can be rightly grateful for the NHS. The same applies to everyone who needs any appointment or treatment that is free at the point of service, and affordable prescriptions. I genuinely do believe that a national health service is the best kind of health service, and hearing about other people’s experiences of being bankrupted by private health care is horrific. Health care is a human right, and the only way to ensure that is through a free universal health service. 

But the ideal that the NHS was built upon - free universal health care from cradle to grave - and the reality can be very different experiences. If you have health issues which are complex or difficult to diagnose, it can be a revolving door of frustrating, fruitless appointments, months of waiting only to be passed on to another department, and in my case, a GP who just shrugs and says ‘We probably won’t ever know what’s wrong with you!’ Now, the complexity of a person’s case is obviously not the fault of the staff, and neither is the waiting time or bureaucracy or lack of resources. Most staff are doing the best they can with what they’ve got, and what they’ve got is never enough. But this often exacerbates an institutionalised attitude that dismisses patients perspectives of their own experiences of their own bodies, and nowhere is this more obvious and damaging than with mental illness. 

As soon as you’ve been diagnosed with a mental illness, it’s like a big red flag on your medical records saying DO NOT TRUST THIS PERSONS OPINION ABOUT THEIR OWN HEALTH and ITS PROBABLY MENTAL ILLNESS SO ITS NOT YOUR PROBLEM. You are often treated like you must be a hypochondriac, any issues you have are ‘just anxiety’ like it’s not a big deal, and all you have to do is calm down and your physical symptoms will go away, even if they are not related to mental health. Sometimes physical symptoms are related to mental health, but a combination of mental and physical health treatments are needed, because, and I don’t want to shock you, our minds and brains directly interact with our bodies. This can work like a feedback loop where something such as trauma causes a rush of stress hormones like adrenaline and cortisol, which directly cause physical symptoms such as sweating, dizziness, panic attacks, new or worsening allergies, food cravings, slow metabolism and weight gain over a long period of time. If you only try to treat the physical symptoms rather than the cause, that’s more stressful and may make it worse, but if you don’t try to treat them at all, it can severely limit your ability to work on your mental illness. It’s one of the reasons a lot of mentally ill people take medications which help with some of the physical and psychological symptoms, and taking the edge of those means you can concentrate more fully on psychological treatment. This then treats the cause of all the issues, making the symptoms more manageable and the loop goes in a positive direction rather than a negative one. 

One of the most frustrating things is, most medical practitioners seem to be unaware of this, beyond prescribing drugs for common mental illnesses. Most of my GPs have only ever done their mandatory 6 months on a hospital psychiatric ward during their training, where they really only check and prescribe medication. There is a severe lack of training and understanding of mental illness and the physiological symptoms of it, and most of my time at a GP has been spent looking at a rabbit in headlights expression and a pamphlet for talking therapy when I speak about mental illness, but then a dismissal of any other symptoms as ‘just anxiety’ and no help coping with them. I’m both expected to be the expert on my own mental health and seen as unreliable and untrustworthy when describing my physical problems. 

One of the worst things I’ve had to cope with is a severe lack of understanding that weight gain is more often a symptom of another health problem than the cause of them. Most regularly, stress is the biggest contributor, along with poverty. Now, as circumstances and social inequalities are the causes of these issues, medics can’t really do much about them. But that doesn’t stop the imposition of ‘obesity’ reduction targets being put on the NHS, with little resistance from medical professionals. If you are considered overweight, it will be mentioned at every single interaction with medical staff. Despite the fact that long term research proves that diets don’t work for long term weight loss. Despite that they usually cause a period of rapid weight loss followed by a plateau, then weight gain, so you are heavier than before you started. Despite the fact that weight cycling (loss gain loss gain) is worse for your health than remaining at a bigger size. The only reason it’s focused on is because it is seen as an issue for which the individual can be blamed, that relies on false and discriminatory assumptions about laziness and lack of willpower, and can be used to cover up failings in structural socio- economic inequality caused by bad policy. 

So, how do you remain grateful for the NHS while experiencing and acknowledging its failings? You separate the ideal from the reality, and push for change that gets us closer to that ideal. You acknowledge that the medical institution self-selects for people more comfortable with the medical model of disability and illness rather than the social model, but that this can change. And you acknowledge that the medical staff are all flawed human beings doing the best they can. Sometimes it will be extraordinary acts of care and compassion, and sometimes it will be uncomfortable displays of prejudice and elitism. But it’s worth it for the promise of what it could be, and it’s certainly worth protecting.