As a mental health nurse, I always hoped that my clients would feel comfortable and safe enough to be open and honest with me. As someone with depression, though, being open and honest is likely to go straight out the window if it appears to conflict with whatever goal or need feels most pressing at the time. While this may sound manipulative, it’s something I’ve learned to do for the purpose of self-protection and self-preservation. It’s part of the armour that I put on when my illness leaves me feeling weak and defenceless. Recognizing the lies we tell is important in understanding what their purpose is.
I don’t think this is uncommon, either; the lies we’ve told can continue to echo through our minds, even when we’re sure we had to tell them. Lies by omission don’t go away simply because we choose to skip over them.
Medication adherence is a common thing to lie about, often motivated by concern about some form of negative reaction or consequences. Often it means the prescriber isn’t in as good a position to adjust treatment appropriately, but that may pale in comparison to the potential consequences of being open.
After my first hospitalization, conditions were put on my nursing license that I had to see my psychiatrist regularly and take medications. Between my hospitalization and my eventual return to work, I had a suicide attempt that I didn’t tell anyone about. After that, I figured what’s the point of taking medications if I feel like crap anyway, so I stopped them. Luckily, the meds gave me enough of a start that I was able to achieve full remission anyway. For more than a year while the conditions were on my license, I lied about taking my meds. I even picked them up regularly from the pharmacy to keep up the lie. Unfortunately, it came back to bite me in the ass when my then-boyfriend overdosed on my large stash.
The topic I lie the most about is suicidal thinking. My past experiences in hospital were quite negative, and I never want to be hospitalized again. Being held involuntarily was particularly difficult. Disclosing suicidal ideation is one of the quickest ways to get committed to hospital, so I keep my mouth shut. Is that a safe, healthy way to approach the issue? Of course not. But in the weighing of pros and cons, there’s little that would win out against my desire to avoid hospitalization.
I also omit symptoms that I either do not want or do not feel ready to talk about. At one point I had gone off meds for a while after a 3-strikes-you’re-out series of negative experiences with doctors. After a couple of sleepless months, I realized that drugs were a necessity. At the same time, I didn’t want to risk talking about my depression and getting the same unhelpful response. The mental compromise that I was prepared to make was to only admit to being unable to sleep. In doing so, I could get my mirtazapine and quetiapine back on board and get some sleep. After a little while longer, I felt safe enough to disclose the rest of what was going on.
In the end, we can just try to do the best we can with the situation we’re faced with. The more that health care providers understand that, the easier it might be for us to remove some of that armour. It’s not realistic to think that the lies we tell and the secrets we keep will ever disappear entirely, but it’s worth reflecting on what underlies them so they don’t end up coming back to bite us in the butt.
Have there been lies you’ve told, either outright or by omission, to your treatment team?