Profiles in Tremendousness is a segment on the Daily Show with Trevor Noah that pokes fun at the competency (and lack thereof) of various characters in the Trump White House. I’m going to borrow that idea to take a look at the less than stellar characters I’ve come across in my own journey receiving mental health care.
Difficult ≠ borderline
My first hospitalization was a sh*tstorm of incompetence all around as far as I was concerned. Years later, I found out a little tidbit that gave at least some objective confirmation of that. One of my discharge diagnoses was borderline personality traits. There’s nothing wrong with that diagnosis if it’s accurate, but unfortunately, sometimes it says more about a practitioner’s stigmatized views than anything else, and is applied as a euphemism for “difficult patient”.
Any competent psychiatrist would know that a diagnosis of personality traits/disorder can’t be made cross-sectionally (i.e. just looking at a specific point in time), particularly when someone is acutely ill; it needs to be made based on patterns that are relatively consistent throughout the person’s life.
The hospital psychiatrist seemed to have skipped this lecture in med school, and instead decided to ignore taking any sort of social history or gathering any collateral information and instead just slap a label on because I fought the treatment team tooth and nail while I was in hospital. Not only does this leave me with a diagnosis that doesn’t accurately reflect my experience, but it minimizes the significance of the challenges that people with BPD often face every single day.
How can I convince you I’m not suicidal?
I used to go to a medical clinic associated with the local university’s medical school, where I would see whatever medical resident happened to be on duty. The discharge summary and who knows what else from my first hospitalization were in my chart at the clinic, and I think a lot of the residents were scared because I was the crazy girl who had tried to kill herself and they didn’t know how to deal with that.
When I went in for pap tests, they would always insist on doing a PHQ-9 (a depression screening test). One day I went in asking for a lab requisition to get routine blood sugar and cholesterol checks. I was stuck there for an hour because, even though my illness was in full remission at the time and I had a psychiatrist who I was seeing regularly, the resident had a very hard time believing I wasn’t suicidal and planning to jump in front of a bus the moment I left the clinic.
The first time I tried therapy was okay but not particularly productive. I decided to try again through my Employee Assistance Program when I became depressed a few years later. I wasn’t thrilled with the therapist’s interviewing style, but the real treat came as we were wrapping up the session. Her advice was that I would feel better if I started dating. Seriously? That was the end of that. To top it off, when I emailed her to say that I wouldn’t be seeing her again and explained the reason, she thought it was peculiar that I would have chosen to fixate on that particular statement. Um, perhaps because it represents incompetence?
That theme came up again more than once. I clearly remember a nurse in hospital who observed that I must be depressed because I was single, and that must have been why I attempted suicide. Between her and the nurse who was convinced that I must have attempted suicide because I was angry about something, it was a sad state of affairs. But the stellar lack of competence didn’t end there.
Paging Dr. Freud
The hospital psychiatrist who initially treated me on the inpatient unit knew I didn’t like him (I guess the screaming and swearing was a pretty strong hint), so he decided to transfer my care to a different doctor. This character was very much of the psychoanalytic/psychodynamic therapy persuasion. As far as I could tell, he was even more of a nutbar than I was.
My first meeting with him was all very Freudian, with a focus on sex and early childhood. How old was I when I lost my virginity? Did I like sex? Did I remember how I felt when my brother was born when I was 3 years old? He told me that the ONLY way for me to get better was to get psychoanalytic therapy, and I should only be on meds for a couple of months and then come off them. Wowza.
But I wanted to get discharged, so I said the things he wanted to hear. Later, my community psychiatrist commented that he wasn’t sure who that discharge summary was written about, but it definitely didn’t sound like me.
How much can you cope with?
A couple of years ago, things started falling apart. A very close friend died unexpectedly. I was bullied at work and ended up quitting because of it. I was worried about getting sick, but I held it together. And then I found out that my ex-manager was doing his best to destroy my career (in very much a reality-based sense, not a cognitive distortion sense), and the sh*t really hit the fan. When I went in to see my psychiatrist, I was so slowed down that I moved from the waiting room to his office at a snail’s pace, and had a hard time even stringing a sentence together.
He knew about all the other stuff I’d made it through, but the best he could come up with was that I needed therapy to learn better coping skills so I wouldn’t get depressed when things like this happened. I’m not sure why he thought that was the appropriate response and the appropriate time, but that was the last time I ever saw him. Once trust is broken, I’m done. So I decided to go see my new GP, who didn’t know me from a hole in the ground. And what did she have to say after I told her the reason I’d decided to stop seeing my psychiatrist? “Don’t you think you do need better coping skills?” Are we passing around stupid pills?
Don’t get me wrong, there are some great mental health professionals out there; I know because I’ve worked with some of them. Unfortunately, there are also some real duds, and in the next edition of Profiles in Tremendousness I’ll cover some of the specimens that I’ve worked with. It would be nice if this wasn’t an issue we faced when trying to access mental health care, but sadly it’s far too often the reality.
What have been some of your worst experiences?
There’s more on mental illness stigma on the Stop Stigma page.