Across and Inside my Universe

What's My Problem?

Why am I so upset about the group therapy?

It's not the end of the world if I'm faced with something unpleasant about myself, however awful it feels or seems.

It's not the end of the world if I feel as though I was manipulated by the psychiatrist.  Would it have been better if she hadn't done so? (If she actually, intentionally did; manipulation is in the intent.)

Sure.

Is it any surprise to me that she's insensitive, dominant, strong in her opinions, outspoken about them, and has a definite idea of what she feels is best?

Put that way, no, no it's not.

It's never fun to be receiving such things, from a doctor no less, and even more difficult to bear, from a psychiatrist.

Still, I can discount some of her "authority" by thinking of the above things that should not surprise me anymore.  Why would I put alot of weight on what someone like that says, if it's not specifically medically related?  Ie, if it's not medical advice she's giving me but therapeutic (both are medical in their way but I think you know what I mean).

So regardless of how she was, as I discussed in my last post, I can follow the chain of thoughts that led me to a very bad place, to a very . . . difficult view of myself to approach, let alone investigate.  That makes it hard for me to discount anything, and so leaves me with a feeling similar to the picture up above.

I feel kind of like it would be healthiest for me to set aside this difficult, painful view of self for awhile and just keep on plugging away, step by step, at improving.  It's hard though because this thing wants to pull out the rug from under me and just bring everything crashing down.

Perhaps I'll gain some more perspective and/or distance from it in therapy tomorrow.  I feel like I've already gotten a little, as I'm not flailing around emotionally, as much as I was.

Still, I really do not need another really bad thing to think about myself, when I get suicidal, to pile on top of the other really bad things I think about myself.

Life however doesn't care how many bad things come your way, it just goes on.  So I need to as well, hopefully putting this in a better place.

I Herd You

I went to what I thought was a support group that my psychiatrist runs, for adults with AD(H)D.   It turned out to be group therapy.

She had an agenda, that she guided and directed the group through and towards.  She lectured from time to time; she drew conclusions and presented them as "the" way to feel & think about things.

In some ways, she was as indelicate as a bull in a china shop; however, there was also a sharp mind behind the questions, conclusions, directing.  She knew what she wanted us to think, and she took us there, by leading, pretending to guide, snapping at our heels like a sheepdog if we weren't quite drinking the Koolaid she was dispensing, by running us into the pen she had decided was where we needed to be.

There wasn't much support, and what support she gave to others in the group eventually morphed into her adapting what they'd said, into her agenda for where she wanted things to go.

Now, before this group session I'd had an appointment with her, which went fine, since we'd made some things clear last time.  Such as the notion that I am my own person, in my own life, and I am the best one to decide what works for me, and not her.

That obviously applies to anything, but when you go to a group thing like this you try to leave yourself open to learning something, gaining some support, or insight, or something . . . by the time you realize there's a sheepdog at your heels, you've gone a ways down a path that may not be for your good.  You do your best to keep from bursting into tears through the rest of the appointment, to keep from going where it is that the sheepdog is pushing you, but you are already falling down that mountain.

So there's a knife in my heart, and you'd think it'd be relatively easy to pull it out by discounting the source; obviously she's not a sensitive nor observant nor supportive nor respectful therapist.  Why would one give much weight to what she wants, what she says?

It's not that simple, however.  I wish it was.  See, the things I thought and felt, the places I went to, the conclusions I found, well, there's a train of thought and feeling that I had during this process.  Both she and the group were stimuli in that process, but I can still follow the path in my mind and heart that led me to a really bad place.

I am having difficulty discounting that, erasing it, setting it aside, or whatever.  I can't un-think how I got there.

I feel it's a therapist's professional responsibility to not command the direction of things, to not make conclusions AND present them as what IS, to not herd you towards a prticular destination.

A good therapist, even if they had a particular destination in mind for you, even a general one, that they felt was healthier for you, they would discuss things, perhaps point out paths you might not have considered, discuss how you feel about them, objectively weigh the pros and cons, but they'd never take the reins and grab you and pull or shove you down a path of their choosing.  That's part of what I mean by herding.

I feel like a therapist should respect the vulnerability of the patient(s) and use care and concern, among other things, when working with them.

To not just willy nilly, but purposefully, push patients down a path that they don't know where it's going, and by the time they have some idea they are so distressed that just about anything at that point will settle in and try to take root . . .that is bad therapy, at the least.

Of course, I'm an adult and not just turning myself over to go wherever she wants, but I didn't realize until after this happened, how vulnerable going to something like this makes you, even if you are nervous, scared, and wary.  I had made a decision some time ago to try to learn what I could from whatever the source, sometimes having to set aside my feelings about the source and just consider the infomation.  This, too, made me vulnerable, besides all my other psychological/emotional issues.

I ended up in a very bad place.  Much of that is me, but the therapy itself and the manner of it, is also a big factor.

I'm starting to think, now, that what she said in our amicable appointment a month ago, that whatever she says, it's my choice what I decide is useful for me, is partially an excuse for her brash, forceful "therapeutic" manner.  That she can excuse quite a  few things by saying or thinking that the patient can chuck it all out, if he/she wants. 

If this is so, then she's at the least rather irresponsible.  The people who go to see a psychiatrist are often vulnerable in a variety of ways, and many are not equipped to fend off or sort through her forceful assertions, her "therapy" if you will.

So I think that her expecting her patients to be confident enough and self-aware enough to discount what she says if it's not best for them is disingenuous at the least, irresponsible and harmful at worst.

My Mother Lives In Her Own Reality

My mother posted on Facebook, "My grandchildren are bright, brilliant, and they take after their grandmother."

GAG.

This is the same woman who hit me on a regular basis as a teenager.

This is the same woman who thinks she did a good job counteracting bullying when we were kids.  The subject of bullying came up recently when we were down there, and she said, "When (my sister) was in junior high, there was one time (my sister) was being bullied and I nipped that in the bud!"

She said this like she took care of it ALL.  HEL-lo!  Um, Mom, we younger three kids of the 6 kids were bullied mercilessly for over a decade, EACH!  You think you did GOOD?  You don't even KNOW what was going on!

And, I think she's forgetting the time I and my younger brother were sort of kidnapped; I very fuzzily remember that I think that was one thing she found out about, and my parents talked to one of the teens involved (just one?  why not both?).

She doesn't know I was beat up, several times, and THAT's why my glasses were broken; it wasn't because I slipped and fell in the snow . . . she doesn't know I was whipped with a jumprope with all those sliding plastic thingies on it, and that the pain from that was like a hundred stinging bees . . . and so much other crap.

CLUELESS.  Although she shouldn't be about the hitting thing, but then again at the time she saw nothing wrong with it; why would she now?  Then again, each of us kids holds a part in the fact that she's clueless; our relationship may not have been good enough then for us to want her to know?  But when older, we could have told her . . . I dunno that the relationship has EVER been good enough to tell her, though . . .

UGH ugh UGH.  Keeping my mouth shut when she exhibits her pride in her mothering skills, or anything else I've mentioned, is both hard and easy.  Hard because . . . I'd so love to verbally slap her in the face with reality.  (Hmm, the violent metaphor there, is probably not too hard to figure out why.)  Easy, because . . . she has no idea we look down on her for stuff, that these things happened (or that they were wrong), and we do, and she looks the fool to those of us who know . . .

It's sad, really, that she is so . . . out of touch.  Sad and pathetic . . . although I remember the raging mother coming after me physically and cornering me before whaling on me . . . and then I stop feeling sorry for her.

I dunno.  Empathy is good, but . . . when she throws this stuff in MY face, empathy is the furthest thing from my mind . . .

This whole situation reminds me of something one of the Mythbusters says, "I reject your reality and substitute my own!"  The difference here being that she either doesn't know she's doing it, or any glimmers of what reality is are too painful for her to face, so she lives in a constructed shell of glossed over (maybe painted over) memories.

When The Doctor/Patient Relationship Becomes Heated

I don't pretend to be an expert on this, or that what I have to say is, in fact, all that earth-shattering on this or any matter.

Still, ever since the Shrink Rappers announced a "heated" or "hot" theme for the upcoming Grand Rounds to be hosted on their blog very soon, I have NOT been able to get the above-titled topic out of my head . . . and so, I will get it out of my head and onto my blog, no matter any reservations I have about being so forward as to submit something for Grand Rounds . . .

I have had two different heated exchanges (actually, they were alot more one-sided than exchanges, with the heat all coming from the doc) with doctors, both of them psychiatrists. One male, and my first psychiatrist, and the other female, and my third and current psychiatrist.

I think it is a negative thing for ANY doctor to yell at or harangue/browbeat their patients, but I feel that with psychiatrists, even when seeing them just for medication management, that since it is usually expected that psychiatrists be sensitive to one's feelings etc., that when they act disrespectful and "heatedly", it's even a bit MORE jarring than it would be from another medical profession.

Now, doctors are human. They are not perfect; they have feelings and good days and bad days and life crises all happening just like the rest of us. I can understand this, and, in fact, in one of the two cases I mention above, it really helped me deal with the episode. The other episode, with my current, female psychiatrist, is harder for me to deal with, and in fact it still bothers me a great deal.

Before I get into specifics, let me say that as a patient, when you are sitting there on the receiving end of some "heat", or ire, or intense aggravation, or anger, even, it is shocking, bewildering, and causes you to wonder what is wrong with you or what you did wrong, as the patient, to deserve what is happening. You are shocked because, if you've had enough dealings with this doctor (about a year, in my first psychiatrist's case, when this happened) you know that he normally conducts himself much more professionally; to see and FEEL such unfettered, intense, unpleasant emotion, directed at YOU . . . well to say it is bothersome is an understatement.

It directly impinges on trust; you wonder, as you get past some of the shock, if you can trust this professional with the most intimate things that you think and feel, things that are necessary for them to diagnose and treat you correctly. If you HAVEN'T had enough dealings with the doctor to know that they usually act more professionally, OR if some of your dealings with them have been laced with discomfort from feeling they are forcing their agenda down your throat, then as you sit there feeling the "heat" you may also end up in "survival mode", doing your best to survive what feels like a verbal assault, trying to get through it as best you can. In my case with my current psychiatrist, this "survival mode" kicked in without conscious thought, and I didn't identify it until later that day or the next day.

I guess I'm trying to say that perhaps some of the difference in how I feel about, and how I handled, the two different incidents, is based, in part, how my usual interactions with that doctor go; how much a partner in my treatment I feel I am with each particular practitioner, and perhaps partly based on my past history, in the female's case, with a dominant, physically abusive woman.

So, here's what happened. With my first psychiatrist, well, he's definitely a Type A personality as they say; very strong, very opinionated, but rather intelligent, always acting in a professional manner, even though he frequently had things to say to me that were difficult to hear. I didn't always agree with those things, but the times I did, were very profound. I don't believe the times I didn't meant he was right, I was wrong, and just wouldn't see it. I really felt that sometimes he didn't listen to me and would come to his conclusion before hearing everything he needed to to come to the most informed conclusion.

This became the basis for his going off on me, one day . . . he spent 25 minutes in angry discourse at me about how I go on too much and waste his time by taking up so much time. After getting over some of the shock, I thought, wait, isn't this the pot calling the kettle black? Who is taking up a bunch of time now? Wouldn't this time be better spent working out our apparent communication problem?

Basically, I sat there and quietly listened until he was done. The appointment ended very soon thereafter, and I was rather upset, although in some ways not . . . . because it was SO UNLIKE him. I also had reason to think that he might be personally going through some emotional difficulties, because the previous summer he'd been suspended by the, whatever the Psychiatric Board or authority is that disciplines psychiatrists. I believe it was an unfounded charge, based on a random meeting long after he'd stopped treating someone, but then, he COULD be rather aggressive in his opinions and ways of interacting (nothing inappropriate, just very assertive) and someone could easily resent that and want to punish him for it.

Regardless, after I went home that day I wondered if he was still dealing with the fallout from his suspension; I imagine it's not easy to get a substitute to cover your practice for 3 months, nor would it be easy to deal with the opinions of your colleagues once they found out you'd been suspended, and even harder, dealing with your patients' feelings about it. So that is what I suspected was going on, so I had an easier time dealing with this.

Still, at the next appointment he apologized for his behavior, saying something about he'd been going through something at the time. I accepted his apology and we moved on, though I did still continue to have problems with him not listening to me enough (yes, I could keep appointments to the 15 minutes, I didn't always go over.)

Eventually, he decided to close his private practice and become a consultant-liason psychiatrist at a local hospital; the timing of this decision was such that I knew he had to have been mulling it over that fall when he ripped me a new one. The deed was done less than 6 months after the harangue.

The second, more troubling to me incident, happened in January of this year with my third, and first female, psychiatrist. I'd been seeing her since the previous March, with a break at the end of summer into late fall. She has a very different philosophy, is an "integrative" psychiatrist, is Buddhist, and is a strong, dominant female personality. At various times I've felt like she's trying to shove some random agenda of hers down my throat . . .

In January, I had finally decided to tell her I was afraid of her. This is a good thing, no? Then the doctor can understand why I seem hesitant or other things . . . Well, apparently my "mistake" was in the type of insight that had led me to realize this; I had realized that because my mother used to physically abuse me, I was afraid of my psychiatrist since she was a strong female, with dominating characteristics. To me, the connection of the two seemed like a no-brainer . . . if one woman in your life beats you and tries to dominate you (there were reasons behind the hitting), then it may make you wary and even afraid of other strong, dominating women.

BIG mistake on my part. I told her straight out, "I'm afraid of you because my mother used to hit me.", figuring that psychiatrists are extremely familiar with the concept of transference . . . . She was instantly OUTRAGED upon hearing this and so angry it took her a few moments to be able to speak and then she assaulted me with angry questions about things like, was she my mother, what does one thing have to do with the other, and eventually she asked me if she was being scary right now . . . . by this point I had unconsciously retreated into "survival mode" and really could not identify ANYTHING I was feeling at that time; I tried, and couldn't feel anything, so I said "No.".

Well, HELL YEAH she was scaring me! Once I'd had some time and space between her and I, oh boy could I identify my feelings . . . . she was proving how RIGHT I was to be scared of her. She FORCED me to answer every question, in a way that made me feel stupid and insignificant, staring me down until I answered. "Do I LOOK like your mother?" "No . . . " "AM I your mother?" "No . . . " and she asked me some other things but honestly I was too traumatized to remember it all. I just remember feeling so verbally assaulted . . . .

In thinking about it now, I feel that she really missed an important opportunity, as a doctor, to connect with her patient and deal with an issue that would interfere with the doctor/patient relationship if left unaddressed. EVEN if she couldn't recognize the validity of the transference principle as something that could fit with her very strange and different philosophies, why throw the baby out with the bathwater and not stop to consider that I said I was scared of her? If she could have set aside the philosophy she couldn't stand, and seen the very real issue between us, then she would have done what was best for her patient, in that situation, in my opinion.

But, as I say, doctors are human too, and when one REALLY objects to a particular school of thought or psychiatric philosophy, perhaps that invalidated to her everything else that was attached to it in the statement I had made. I've often wondered if I had just said, "I am afraid of you", if the reaction would have been much different.

Perhaps, but perhaps not. I suspect she would've assaulted me with questions like, "Do I look frightening?" "Am I scary?" "What, specifically, scares you about me?" and when I couldn't come up with an answer, she'd satisfactorily verbally beat me down with the fact that I couldn't possibly be scared of her, just like she did this last January. But I may be being unfair; perhaps it really WAS the "unacceptable to her" psych concept of transference that was the basis for her going off on me. Perhaps she WOULD have listened if I'd put it differently, but you see, she's the doctor, and I'm the patient, and no matter what "could have" or "should have" been done differently by me, she acted unprofessionally and unacceptably towards me.

Why do I find her behavior so much less acceptable than my first psychiatrist's? Perhaps it is because she had a history of forcing her way on me . . . but then I think, didn't Psychiatrist Number One also have a strong way about him, where he tried to get me to think along his lines of thinking? Yes, he did . . . Then again, he'd never given me an ultimatum, like she had. He'd never tried ramming wierd goals for me down my throat, like she had . . .

In the end I think I can safely say that part of the difference in how I reacted to the two incidents is, indeed, related to my fear of strong, dominant women based on how my mother treated me. Part of it, though, I think is that I had more a feeling of being a partner in my treatment with the male psychiatrist; I wouldn't hesitate to stand up to him, which was saying ALOT for me, because I usually shrink from such things, and he had VERY strong opinions. Still, since I really wanted him to understand me, I knew I had to press for standing up for my view, or my experience, or my thought process that I wanted him to UNDERSTAND before coming to a conclusion.

I guess, after writing that last paragraph, it's easy for me to see now that my mother IS a big part of it; I could stand up to HIM, but not to HER.

Six months down the line from the "heat" I received from my current shrink, and I am still having trust issues, and definitely fear issues. I finally may be getting up the courage to bring up the issue with her again (sans mother), but I am not sure if I have the courage. I do hope that if she gets angry again I can tell her what I think of her unprofessional behavior . . . and lack of insight into the issues that can interfere with a good doctor/patient relationship.