Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists, interested bystanders are also welcome. A place to talk; no one has to listen.
Wednesday, August 04, 2010
I Haven't Gotten There (Yet)
A psychiatrist I know is going through a phase-of-life change. It's one you only get to once. He's made the comment that in looking back, he made some mistakes and said some things he shouldn't have to patients who were going through this same phase-of-life change, long before he did. The event of it has made him more empathic to what his patients were feeling, something he didn't comprehend until he was in the same shoes.
I know the feeling. People look to their psychiatrists for wisdom, and you know, we don't always have it. Patients will ask for suggestions about marriage or child-rearing from psychiatrists who may be single, childless, or on their eighth divorce. It doesn't mean we don't have the answers-- sometimes these things are better dealt with from a safe distance-- but sometimes it might. I look back at some of the things I said to the parents of teenagers, back when mine were oh-so-cute-and-loving toddlers...and I wince...oh, my, I was so clueless back in the day. Can I recall my patients? I'm sorry, I said some stupid things back then. I shrug a lot more than I used to. I don't know if it's helpful, but I do know it's more honest.
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No, we don't always have wisdom. We are physicians, not wizards, sages or gurus. We are supposed to be expert at diagnosing and treating mental disorders. I'll bet that few of us have experienced the effects of chlorpromazine, ECT, PCP. I can also be fairly certain that I will never experience giving birth to a child. I have never claimed to be wise or to have any of those experiences under my belt.
Just how did the public come to expect so much of us anyway?
Little wonder that so many are so disappointed in psychiatry.
"I would have to say that unless one HAS suffered the loss of a child, they are not qualified to tell any grieving parent when they should be "over" or "past" the death of their child. It never goes away. "
From someone commenting on the NPR segment on grief and depression which Dinah posted an entry about previously. This woman tragically lost her son and commented on the NPR site.
I couldn't agree more.
A friend of mine was moving to another state and requested that I ask my psychiatrist for a referral. I thought it was a long shot, but I asked and his advice was to find someone older than the patient. He's 69 going on 70 and I have found him to be wise. I had an MFCC once who was advising me to dump my husband. When I found out she had been married 5 times and was yet again divorced the advice seemed not to be trusted and I quit seeing her. On the flip side, I have a (different) friend who lost her house and everything she owned at age 62 in the 2005 Katrina flooding of New Orleans. She is still suffering depression and refuses to go to ANY sort of counseling because she says that unless the mental health professional lived through it they would be inadequate. Her general practitioner gave her an antidepressant that she continues on which seems to barely lift her mood. This counterexample shows that a prospective patient (or perhaps even a patient seeing a clinician) might not appreciate that every mental health professional does not have to live through every death, fire, disaster, job loss, in order to be of value.
In my opinion, the issue isn't that the public expects so much of psychiatry. I think it is the clash of perceptions.
Pat Deegan, who has a PhD in psychology and who was hospitalized 8 times for schizophrenia talks about this here:
PSYCHIATRIST **** ME
You are getting better ***** Your cure is disabling me
Your symptoms are gone**** My symptoms no longer bother you
You are more in control**** Haloperidol is controlling me
You are stable **** I can't think or feel
You are functioning again **** My life is without meaning or passion
She is so right when she says the psychiatrist's interpretation becomes the only valid story.
I see that behavior on this blog and similar ones. I also saw it during visits with my psychiatrist. It isn't intentionally malicious but it definitely exists.
By the way, just so you know I am not picking on psychiatry, I think this also occurs in medicine in general. An allergist I dealt with a few years ago denied that a drug had a specific side effect that is very common.
Because he was the medical professional and I was the lowly patient, his version was the correct one. Unfortunately, I was so stunned I didn't respond. I wish to god I had.
Shrinks are people too.
You don't always have to have gone through sommething to be the most empathic therapist, but then again, in that certain something sometimes, sometimes it makes you a better therapist.
Ie, you don't have to have been mugged to empathize with someone who has been, but as in this psychiatrists's case, apparently he wasn't able to empathize very well with people experiencing what he is currently now going through, or perhaps I'm not using the right word, there, with empathize - perhaps he wasn't able to QUITE understand, really, what they were going through, to "get" the essence of their experience.
Not to put him down or anything, as I'm saying it's a more general thing sometimes some people can empathize or understand things they haven't experienced, and sometimes it's a bit more difficult.
Basically I guess I'm saying what you posted, heh. Just in my own, ramblin' way.
AA, that's an . . interesting point of view.
I have to agree with AA. While in some ways it's natural that one's perspective colors his/her response, in the context of a therapeutic relationship that can end up absurd, a waste or time, or even dangerous. I had one therapist who insisted that the medication he had me one (one not even available in other countries because it's safety profile was not up to par) could not cause the severe rash, cognitive impairments and blackouts I started having after hitting a certain dose. He insisted on this to the point that an impartial observing roommate had to be called in to give "evidence" -- inarguably dangerous. I had a second therapist with homosexual orientation who persisted for three years in insisting that I was involved in a romantic relationship with a housemate - despite my explicitly saying I was heterosexual, and even despite both the housemate and I being in (different) heterosexual relationships - not dangerous, but absurd.
AA is right, because the therapist/psychiatrist/psychologist is a "mental health professional," and because the patient is seeking mental health and therefore inherently ill on a non-physical level, the former MUST be right. For all the talk of getting rid of stigma about mental illness, I find that "mental health professionals" are often the ones propogating it strongly themselves. After all, us patients can't possibly be sane enough to have independent thought!
As I said, dangerous and absurd.
Not every doctor is completely ethical, and a sometimes completely separate issue, is that not every therapist is always aware of their own, interfering issues. That doesn't excuse poor treatment, however. They "should" be professional enough to educate themselves about their own issues, but many apparently don't. It sounds like some are not aware of their own biases that are interfering with the objective treatment of their patients. If they ARE aware of such biases, it's unethical treatment. IF they aren't aware of it, it's sloppy practice to not make ones' self aware of ones' own issues so you can treat your own patients more objectively, but . . . people are human, and no one acts as one "ought" or "should" all the time.
It's sad, that this affects people in the ways the recent anonymous said about the therapist insisting about certain things and such.
It makes me glad that I've had the therapist that I've had.
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