I was listening to a podcast episode on psychodynamic understanding (link to the episode at the bottom of this post), where one of the problems with the Norwegian mental healthcare system is addressed by one of the speakers; the fact that you, as a patient, need to be awarded the ‘right to treatment’ (by some overworked soul at your local District psychiatric centre, who hardly looks at you when you’re filling out the many, often poorly translated, forms they need to be able to pigeonhole you, I might add).

Then, if they deem you deserving of treatment (i.e., if you’ve ticked enough boxes), you will be allowed 12 short, yet excruciating, weeks of treatment before you are either referred to the next level or chucked out on your arse with more questions than answers and expected to be all better so that they can award the next person in the queue some added trauma by giving them the same treatment. This 12 week period, I might add, will only be sufficient time for some diagnostics and very little actual treatment. Effectively, we are left activated yet untreated – worse off than when we came in.

And now we have to explain everything, again, to someone new.

Before I go on, I must state that I do recognise that there are exceptions within the mental health care system – there are some extraordinary mental health professionals out there, and they will do their absolute best to see to it that you get proper treatment and that it lasts as long as possible. They will look you in the eye, engage you in conversation and show some of their own personality in the process. The are not so interested in dehumanising themselves or the situation – they genuinely want to help and find their work both fascinating and rewarding. They show you that you have value.

The only problem is that you will rarely meet such an individual during the initial stages of your treatment, as they are often specialists. What’s more, they have to fight the system in order to succeed. Regardless, I applaud these people – GPs and specialists alike – and wish there were more of them, so that they wouldn’t have to work so hard to fix things that should have been handled by someone else at an earlier stage in the process.

Now, back to the rant.

For many of us, our trauma or emotional wounds are embedded in our unconscious and deeply rooted in something we experienced in childhood, and to treat that, you will need a lot of cognitive behavioural therapy (CBT) to create new neural pathways and change your perspective and life for the better. More often than not, you just need the opportunity to talk about your past and discuss your diagnosis and the way forward with an expert. Talk therapy isn’t even on the table in Norway – seemingly, they only want to make you fit into one of their perfect little boxes to see which prize you get in the diagnostics lottery and send you on your way whilst patting themselves on the back for a job well done. The fact that we, as patients, are traumatised and, for those of us with a neurological disorder, have been trying to fit in by masking our symptoms for our entire lives, are ignored by the people that are responsible for referring us to the next treatment facility (if they decide to do so).

We do not want to be ill, we are not used to asking for help, we are ashamed of ourselves and our inability to be normal, we don’t feel as if we are even worthy of help, yet you expect us to honestly and accurately score ourselves using a scale that ultimately shows us how useless we are and, indeed, how unworthy.

Additionally, we have already had enough people telling us that we are ‘too much’, and very often feel so bad for the therapist – knowing that they will have to carry with them the information you give them – that we simply hold back and try to act as if it’s not as bad as it might seem. When, in fact, it is almost always far worse.

A professional with a manageable workload would probably be able to see through such self-effacing behaviour, alas, this is not the case in public healthcare.

If there’s anything I’ve learned from being in the system since I was about 16, mental health issues need a hell of a lot more than a meagre 12 weeks of yourself filling out forms and never touching on the issues at hand to be worked out. What’s more, due to the heavy workload, there is a lot of illness in the public sector, so in a lot of cases there’s inconsistencies and halts in treatment, not to mention office hours and holiday closures. Weirdly enough, mental illness doesn’t operate after any office calendar, and the patient is left feeling that they made their therapist so ill that they needed a break from them or that they don’t matter enough to get the number to an emergency service or similar. You see, someone that’s entirely broken down mentally and emotionally, wouldn’t do themselves the favour of asking for said number.

To most patients with severe trauma, their illness is all-encompassing – it affects nearly every aspect of your life. To the individual, it is like a cancer of the brain that is shutting down your body bit by bit whilst hacking away at your will to live. So, whoever decided that we are expected to fix ourselves in 12 weeks time and not want to kill ourselves after – because now we feel more alone, dirty, useless and more of a burden than ever – can take a long walk off a short pier. In my humble opinion.

Furthermore, a lot of us patients have trust issues. Also, who do you know, that would happily just start talking about traumatic events they’ve experienced throughout their lifetime to a complete stranger, unless they’re a complete narcissist? Establishing trust takes time – the fact that you are a licensed professional means very little to the person sat across from you, that has yet to meet anyone who hasn’t betrayed their trust at some point. Why should you be any different? People break their confidentiality all the time.

The World Health Organisation (WHO) states the following: “Every human being has the right to the highest attainable standard of physical and mental health“. Promoting “good health and well-being” is the third of the UN’s 17 sustainability goals. The very first article in the UN’s declaration of human rights states:

All human beings are born free and equal in dignity and rights (UN,n.d).

I would argue that failing to treat mental illness in the same way other chronic illness is treated is a violation of our human right to equality in dignity, because we certainly are not dignified enough as human beings to deserve anything other than pity from the Norwegian healthcare system. We hear you loud and clear. You mean to say that we are a pest and a burden and should therefore be treated as such, so that we will understand that our place in society is beneath everyone else.

Well, the joke is on you – we already felt that way anyway.

Now, one can also argue that mental health issues is a pandemic, yet unlike the corona virus, it they are not being treated as such, even though a mental health patient is much more likely to have an unwanted effect on those aroung them, or even society as a whole, (financially or worse) if left untreated, as opposed to someone that suffers from covid.

Take, for example, the children of a parent that suffers from an untreated mental illness, that might become victims of emotional incest or parentification. Their emotional wounds alone would need treatment, not to mention how the hereditary nature of most mental health illnesses could mean they are undiagnosed as well. With a parent that isn’t paying enough attention to them, they will likely not seek help themselves until it is far too late. It is a vicious cycle.

In fact, since mental health sufferers often don’t get the help they require, they are spreading the disease to those close to them due to its toxic nature. Surely, that’s something we want to avoid, yeah?

This is just the tip of the iceberg. I could write books on this topic, it is that close to my heart. Oh, wait, I have done just that! Well, one, anyway. If you’re interested in reading it, you can go to the Buy the Book section of this site and do just that. A follow-up is currently in the works.

See you next week for another reflection.

If you want to (and is a Norwegian speaker), you can listen to the Psykiateren-podcast episode by clicking on the Spotify icon below.

• Spotify