Not long ago I posted Profiles in Tremendousness round 1, which borrowed an idea from the Daily Show to identify some of the non-rockstars I’ve encountered in my own experiences of mental health care. In round 2, I’m going to touch on some of the anti-superstars I’ve encountered in my work as a mental health nurse.
Let’s start with one of the biggest non-rockstars of all. I’ll call him Kevin. Kevin had a very high opinion of himself and of his ability to get to the root of what was going on with a client. He firmly believed that bipolar II was not a legitimate diagnosis, and instead was just another name for borderline personality disorder. He never came right out and said it, but it was pretty clear that he thought any female diagnosed with a mood disorder actually had borderline personality disorder. He would tell these women that they needed to do some reading about dialectical behaviour therapy (DBT). They did so, and of course ended up reading about borderline personality in the process.
If I was the next clinician to see these women, they would tell me how confused and distressed they were, because BPD didn’t sound at all like what they were experiencing (which it wasn’t). I’d try to shift focus onto how DBT has useful skills for anyone with mood regulation difficulties (which is true, but not why Kevin was recommending it), and bite my tongue to keep myself from telling them that Kevin was an idiot. One of his go-to’s for evaluating whether someone was seriously ill or not was the “bus stop test”, i.e. if you were standing at a bus stop next to them would you be able to tell they’re mentally ill. Cue disgusted eye roll now. And if he was unhappy with a client’s behaviour, he would “read them the riot act”, whatever that meant.
While a lot of mental health nurses are very knowledgeable about psychiatric medications, some are frighteningly clueless or prejudiced. Kevin referred to clozapine as “poison”, while Janet was firmly anti-medication across the board. Karen made medication recommendations to clients despite having astonishingly little knowledge about those same medications.
Brent was a big fan of cognitive behavioural therapy (CBT). Which would have been great if he actually knew what CBT involved. He believed that CBT involved distracting yourself from your thoughts. End of story. And this one-trick pony would be trotted out for almost every client. His other standard recommendation was that clients read Eckhart Tolle’s The Power of Now. I won’t deny that it has some good bits, but there’s also some stuff that’s pretty out there. Brent actually agreed with me on that, but didn’t bother tacking this bit of information on when he made the recommendation to clients.
Some nurses are overly keen on pushing the prn medications. A couple of nurses that I used to work night shift with firmly believed that if a client was up during the night, they should be medicated back to bed, and if the client wouldn’t accept the prn orally, they’d call security and do it by injection!!!! There was one time I was coming on for a night shift, and the evening nurse told me that she’d given a client a prn during the evening because he was quite psychotic, and she wanted me to wake him up to give him another prn in an hour or so. I just kept my mouth shut and ignored her.
Then there was Sandra, who thought clients asking for prn meds were just being med-seeking. She would never give prn benzos (even when the client had an order for them) regardless of how distressed or psychotic they happened to be. She had no use for clients with personality disorders, and thought they were just being manipulative. She thought that the only way to handle these clients was with her idea firm boundaries, which translated to being flat-out rude. Clients would tell me that they just didn’t bother going to Sandra about anything because they knew they’d just be shot down.
These anti-superstars have thankfully been the exception rather than the rule. Most of the mental health professionals I’ve worked with have been quite competent, and some have been truly exceptional. But keep an eye out for the Kevins and the Sandras of this world – and when you see them, run as far and as fast as you can in the other direction.