Blame in MH care

Looking back on the crisis mode I entered last week, I'm pretty unhappy with mental health care, and the attitude towards the depressed and suicidal.

An MD called called into the end of another medical appointment I was having to discuss "if I'm safe or not". I was honest about where I'm at. I've been going to my medical dr.'s office for almost 4 years and I've never asked for this kind of help.

The MD started to ask if my therapist (CBT T) was frustrated with me because I'm not doing the work/taking responsibility? First of all, this MD is someone I've never met before-as far as I know she does not know me. Secondly, if I had come in with a broken leg, would she ask "Is your dr frustrated with you because you were not careful?"

It seems ridiculous how quick the medical community is to blame the patient.

Even with a job and health insurance, I don't have many options for MH care. God help those who are worse off than I---It is nightmarish to think what a "sicker" person would go through.

I'm not entirely clear on who the MD who called into your drs. appt. was - a psychiatrist? but in any case, being asked those kinds of questions by someone you don't know sounds annoying and frustrating.

I agree with you about how bad MH care can be even if you have insurance. So many companies that may provide really good medical insurance coverage have a second provider for MH care and it gives very limited benefits.

Thanks--Sorry to be unclear.

My primary care dr, CBT T and other regular dr.'s share a practice. I was there to see specialist and I asked him at the end of my apt if I could talk to someone, that I was not doing well psychologically. An MD--not my primary MD, just a random dr in the clinic was available , was sent in to see me--she is not a psychiatrist or psychologist.

I hear you Growlycat.
It's a strange balancing act... Being an adult with adult responsibilities and expectations while trying to cope with warped perceptions and patterns... I find it difficult to tell when it's okay to share how I really feel and when it's time to put on the big girl pants and suck it up. Yet they tell you that you don't have to suck it up... But you can't really trust that, because there is always a wrong time to let down your guard, and when you have poor reality testing skills you can really land yourself in the soup...

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I really honestly try to take whatever steps needed to get better. But I really get annoyed at any "take responsibility" talks. Do MS patients or cancer patients get this talk? Who has the right to judge if I'm taking enough responsibility or not?

It is a catch 22----If I could do certain things I wouldn't be in therapy! I am asking for legitimate help and I'm given the pull up your bootstraps routine. What other illness gets this kind of Spartan reaction? I have an illness in the dark ages of treating said illness. Why am I being judged?

I know Growly, I hate it too, but I don't think it's ever going to change. It's something I try to apply radical acceptance to. I don't like having to take responsibility for all these things, but if I don't nobody will do it for me. In fact, they will lecture me and denigrate me for it. In their eyes, I am an adult and I should be able to do these things. I must try, even if I cannot, even if I am falling apart. I see no other option because I simply refuse to be so poorly regarded.

I have had your experiences and worse over the years.
Thankfully I found a private T I could afford.
Looking back, I think it was some of the bad treatment that drove me on.
Yes looking back I had no insight, no tools and was looking for the mother ship, forgetting, or unable to see I did have choices and responsibility. There were people a lot more incapable and in need of help than I.
I actually use to envy them.
But envy what? Bring contained in a nut house, hoping I'd find the ultimate care. It's not there either.
It's hard to hear, but once we're grown it really is down to us to grab the ropes.
Some end up dead. But a lot, like myself end up just talking about it.

It is ridiculous how the western medical community treats everyone and those who are in the clutches of mental health mds are treated even worse. It is what I fight against for my clients all the time = and I become more and more convinced to never deal with them for myself. I shall stop now because I doubt my ranting at this or your cbt guy will help.

Your point of view does help. Overly idealizing my CBT guy may have paved the way to where I am right now. I think I tell him what he wants to hear because I'm afraid of saying "This sheet ain't working."

If I do keep going with him, I'll be sure to challenge his garbage more often.

Growlycat, I'm sorry to hear you been in crisis mode. I have not read your previous posts on the subject, so excuse me if this question is not relevant, but how is your CBT T's frustration with your work relates to you being safe in face of suicidal thoughts and ideation? Like what was this MD trying to get at? I'm not asking this in rhetorical way, I'm having trouble connecting the dots, not knowing your history.

I know my first post must feel disjointed. I'll try to remedy that.

Last Tues, for some reason my therapy appointment with my "CBT T" (He's slightly more eclectic than that, but he definitely is not psychodynamic!)
I am working on 2 major issues--health/fitness improvement and a driving phobia. Made more headway with the driving phobia than the health issue. In addition to CBT T, I have a long term T (psychodynamic) that I only get to talk to now once every 2 weeks foe 20 min--hardly therapy anymore.

So I've had to rely on CBT guy more that I normally would, including longstanding issues.

I think what happened is that he keeps denying being judgmental about my progress when it is becoming clear that he is getting bored and frustrated with me. His pulling away/disengagement is trigger-y of all kings of old family dynamics. I do recognize this.

I don't get like this often, but on occasion I get into a near-delusional mode where I think my T is trying to cause me pain. I owned up to this early on and warned him that it would happen and what to look for. Because when I'm in the middle of it it feels very real even though I vaguely recognize this is my old pattern.

When I get like this I need massive reassurance that he cares and wants to help me.

I don't think he "gets" me, my past trauma (no curiosity from him in 2 yrs) and now I worry that his care was a sham this whole time.

I'm pretty attached to him so I'm feeling like my center of gravity is gone. I feel hopeless like no one can help me and on it goes.

I can't see CBT having any holding effect during crisis.
Perhaps find another orientation of therapy?
I say this from my own experience.

You may be right!! That is a fear of mine--that his therapeutic orientation is incompatible with what I need.

I was hoping that he was as "eclectic" as he claimed

This makes me wonder if on some level, some mental health professionals don't actually believe in mental health problems.

Although, perhaps, what they were clumsily trying to get at isn't so much a doctor being annoyed at a cancer patient for having cancer, but a doctor being annoyed at a cancer patient who smokes five packs of cigarettes per day.

Unfortunately, mentally unhealthy people make poor self care decisions a lot (I don't know about you, OP) just generalizing. I can see how that would be frustrating for professionals, then again, that's why they get paid huge sums of money.

All good points!

I worry that Dr's make assumptions such as
woman in crisis=personality disorder=RUN!

I hate it when anyone makes assumptions about me without knowing me, especially people who are supposed to be better educated and in a position to help.

And that is part of my catch 22-- If I could do better I would. I do the best I can when I can, which still may be lousy overall.

Your worry is well founded. Unfortunately the only defense against what can be life-shattering ignorance is knowing yourself and your patterns as well as you can and taking responsibility for them. A tall order I know.

Thanks growlycat for the explanation. I find it striking that you started the explanation by talking about how disjointed your first post was, because it seems to me that the kind of therapy you're getting has a disjointedness to it. Not much therapy from the psychodynamic T any longer, more reliance on a CBT T who does not seem to have an emotional connection with you nor an interest in all aspects of you and your history (for instance no curiosity towards your past trauma, as you mentioned), and here we have the MD who does not know you and already making assumptions to find out why the CBT T might be frustrated with you. Maybe I'm projecting here but I got this sense of being lost in the middle of all this, not feeling grounded, not feeling safe.

Safety does not come from mere physical safety but being in presence of someone who gets us, who can connect with us. There is a vulnerability in therapy. If your T is unable or unwilling to go the extra step to reassure you, there better be a very good therapeutic reason for letting you suffer like this. Not for lack of care, not for lack of interest, and not for lack of willingness to relate to you as a whole person just to focus on the specifics of problem at hand (the phobia or health issue). It makes me feel this MD is not doing much better either to help you feel safe and cared for. Your distress makes sense to me. Hard to feel cared for.

It would be nice if healthcare providers were better trained in what I consider more basic issues about relating to other people. It's not all about numbers or techniques, sometimes it's about really caring for the well-being of a person, period.

Hang in there and see if you can get better support from more caring Ts in future, at least people who are more understanding and still have passion for their work.

And to be fair, most people, even the 'mentally healthy' still don't make the best decisions all the time. Everyone does the best they can with what they have. A good MH professional should understand that instead of scolding. Judgement is easy. That's why professionals shouldn't be doing it. If you needed someone to judge you, you could just grab anyone off the street and have them do it.

Frankly it is not the place of a therapist, md, nor any other person who works in so called health care to scold a client. Clients are not children and are free to take the advice or reject it. Or workmwith it as theycan and want and it is not the place of those assholes to judge or criticize it.

I think a lot of them get kind of burned out and jaded. They get tired of dealing with the mentally ill or even the physically ill who don't seem to try to take care of themselves. It's sad, but true.

I think a lot of it has to do with your diagnosis. I've noticed this from my own experience. When I was a teenager I was told I had BPD. After that nobody wanted to help and listen to me. They all assumed I was a manipulator who wanted to ruin any psychotherapist willing to help me. Huh? This was wrong, very wrong, because I was nothing like that. It was very frustrating so I quit psychiatry for almost 6 years. Unfortunately I had to go back because I developed psychosis which was a completely separate disorder. The treatment I got was very different. Clinicians suddenly wanted to help. Medication and therapy was offered to me. This experience made me wonder why they weren't there when I was a teenager. I realized it had to do with the BPD diagnosis. Disgusting.

Another reason has to do with how you present. If you are coherent, calm and willing to discuss suicidal feelings you are seen as being in control. Hospitalization isn't the first option if you have a PD diagnosis, because psychiatrists believe it will make the PD worse. They'll try discussing those feelings first, since they tend to think they are due to some kind of interpersonal conflict that can easily be resolved. Doctors are very limited in how they can help with issues like that. If they can't cure the problem with medication they don't really want to deal with you. Apparently it is too hard.

Unfortunately, it can take some really desperate behaviors (e.g., SI) for a clinician to listen to a patient with BPD. When I was a teenager I resorted to SI just so they would listen to me. It was the only way they would take me seriously. Whenever I asked to talk I was shuggered off and told I was attention seeking. Pathetic.

I really feel for your situation. Unfortunately, I don't know what to suggest.

I don't have a PD, but it's definitely a damned if you do, damned if you don't scenario when it comes to how you present. Because of my upbringing, I don't present like the average depressed person (so I've been told). My T has worked with me for six years and so he knows this about me and he listens to what I say. My PDoc is good at that too although he had to reach out to my T to really get a full picture because I was "laughing and engaged" which created a conflict in his mind of how I was doing.

When my T and PDoc had me put IP earlier this year, my T admitted that he was unnerved at how easily I could get myself checked out because no one would recognize the severity of my depression. In fact, the first day I was there, I was told by one aid that I was "the bright spot in their day". I'm not faking, I'm not covering, it's just... me in some weird way.