“To be honest, Doctor…”

Fifteen minutes into the intake appointment I’d worked for months to schedule, I found myself unable to focus on what the counselor was saying. I was debating whether I should just let her continue talking or stop and correct her. I had a question. It was a very important question, but she was the professional and I wasn’t and I’d been referred by my doctor. I didn’t want to be rude. Finally I decided that it would be better to address it now than to waste any more time. When she paused I jumped in, “I’m sorry, so you’re saying that you are not an eating disorder specialist? I was told I was being referred to a specialist.” Apparently there had been a hiccup in communication between offices and my appointment with the intended counselor had been assigned to this newly-minted LCSW with no experience at all with my issue area but lots of room in her schedule for new clients. Once I realized this I gently backed out of future appointments with this nice but (bless her heart) completely unhelpful new counselor and started over trying to get in touch with the person who could actually treat the condition I was facing. After numerous phone calls and referrals back and forth, a string of scheduled and rescheduled appointments, and nearly six months of red tape, I was finally able to meet with the professional who is best qualified to help me. And I am a person with a pretty good understanding of the mental health system, a strong command of English as my native language, a supportive group of family and friends, enough flexibility in my work schedule to allow for regular doctors appointments, and adequate health insurance coverage. What about women who don’t have one or more of those things?

 

We tend to underestimate how much people have to advocate for themselves with doctors, nurses, counselors, and insurance providers. We think of these folks as people who take care of us, who heal us. And often they do, but they’re also just people. They can’t do their job without complete information, and they rely heavily on us to get it. That’s unfortunate, because it means we have to speak up and fight for ourselves when we’re vulnerable. We have to be willing to correct the professionals when they get something wrong. Before I lose all you doctors and med-students and very smart and talented folks who have worked for years to learn how to help us, let me clarify. Do not ignore your doctor and insist that you and WebMD have this all figured out. What I mean here is that it’s on us as patients to make sure that we talk about what we came to talk about and get answers to the questions we came to ask. That requires bringing up the awkward stuff and going into detail about it when needed. I have a hard time with this. I dreaded the “Are you sexually active?” question for years in college after what happened to me, never knowing how to answer and certainly not wanting to explain why not. I also danced around the questions I really wanted to ask in check ups with my regular doctor and my dentist about how an eating disorder might be impacting my body over time. That meant my they were  missing a huge chunk of the picture when it came to taking care of me.  With that in mind, it’s also our responsibility as patients to correct mistakes when we see that things are getting away from what we need. Maybe you’re building toward the thing you really came to address but your doctor gets hung up on one detail of your story or one minor symptom. Usually this becomes a problem when your struggle presents as one thing but you suspect it may really be about something else, something deeper, something that won’t show up in scans or blood work but that your doctor really needs to know.

 

We tend to think that this isn’t that much of an issue for women when it comes to mental health because we’re supposed to be the emotional ones. Women are allowed to cry and talk about our feelings and ask for help in ways that men are discouraged from and instead told to just cowboy up and not show “weakness”. In this one area, then, shouldn’t those gender norms work out in our favor? Shouldn’t women be doing better in the mental health department, or at least in getting help when we need it?

 

Well, sort of. Turns out women are much more likely than men to talk to their doctors about their mental health, but they are far less likely to see a specialist or go to an inpatient facility to treat any conditions or issues those conversations may uncover.  We’re also far more likely to be diagnosed with depression rather than underlying issues like addiction, and we tend not to correct this mistake. After all, alcoholism isn’t ladylike. Neither is standing up for yourself or questioning an authority figure like a doctor.

 

What does this even mean? Being a “lady” and talking about mental health are not mutually exclusive friends, I promise.

We know women have trouble with this at work. We’re notoriously poor negotiators when it comes to salary, for example. But make no mistake, the problem isn’t that we are bad at advocating; it’s that we’re bad at advocating for ourselves. Self-advocacy– this thing that is clearly so necessary to getting what we need– is painted as selfishness on a woman. It doesn’t fit with our image as other-oriented caretakers, supporters, nurturers. When we’re asked to advocate on behalf of others, though, we do at least as well as our male counterparts. Think mama bear, tiger mom, loyal stand-by-your-(wo)man partner… We can be firm and decisive, as long as it is on behalf of someone else. Sometimes that’s because of pressures from the people around us, and sometimes it’s a fight within ourselves. I really didn’t want to hurt this girl’s feelings by telling her she wasn’t the counselor I was supposed to be seeing and that I had no interest in scheduling a follow-up appointment with her. And lest you think I have actually mastered this whole self-advocacy thing, let me confess: I actually did schedule the appointment and considered going because she was very sincere and seemed to be trying really hard and I was clearly one of her first clients out of school so I didn’t want her to be discouraged. But I finally decided that I probably shouldn’t be coddling the person I was paying to help with my problems, so I called her office and left a bumbling voicemail to cancel in which I apologized profusely and assured her that it wasn’t her, it was me. I hope you weren’t looking for feminist heroines, because there are none to be found here. Just a sister, working it out alongside you.

 

I wholeheartedly reject the idea that a woman is somehow selfish for standing up for what she needs. How can anyone help us if we don’t ask them to? And how can they help us effectively if we don’t tell them what it is we need? It’s not ungrateful or unladylike or whatever other unflattering term you fear may be applied to you. It’s just good sense. Why pay for something that you know isn’t going to work? Why whether the side effects of a medication for depression when you know you really need to treat the addiction causing it? Why take time off of work to go to counseling session only to discuss things that aren’t the real issue? First steps are good, but we’ve got to keep walking if we expect to get anywhere.

 

Embracing that truth takes time, though, so in the meantime, would you do it for me? Standing up for yourself isn’t just about you, it’s about all the women who know you. Taking care of yourself gives me tacit permission to take care of myself. Treating yourself with respect and insisting that others do, too– that they listen to you and make sure that you have the care you need– well, that shows me that I can do the same. We’re creatures of comparison, always judging whether our behavior is normal or okay by how we see others behaving. That’s a terrible habit, but it’s just true. Knowing that, though, why don’t we use our influence for good? Be an advocate for yourself on behalf of others. Do it to create a society that praises good mental health and the women who strive for it.  Tap into that anybody-who-hurts-my-babies-is-gonna-answer-to-me vibe and let the comfort of fighting for a system that makes it okay for all of us to be honest and vulnerable allow you to be honest and vulnerable. Trick yourself into being your own advocate by reminding yourself that when you do, you’re my advocate, too.

  

 

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