There have been a few discussions here about medical records and therapy notes, so I'm starting a new thread as to not steer other threads off course.

Therapists and psychiatrists are included in health insurance and treated as healthcare so are part of the system...Withholding and distorting information about a person's healthcare by medical providers is finally starting to change course after decades of information asymmetry. The culture of withholding information from patients and lying goes way back to Hippocrates:

Perform your medical duties calmly and adroitly, concealing most things from the patient while you are attending to him. Give necessary orders with cheerfulness and sincerity, turning his attention away from what is being done to him; sometimes reprove sharply and sometimes comfort with solicitude and attention, revealing nothing of the patient's future or present condition, for many patients through this course have taken a turn for the worse.5(p297,299)

Information asymmetry, although often used in economics, can also be used more broadly in the context of purposely withholding information from the other party to benefit the information holder. In healthcare, the control over information is traditionally used to benefit the providers, not the patients whether it's economic or for many other reasons . The more information shared with patients, the more they would be exposed to lawsuits and scrutiny.

Remember how the travel industry used to be--travel agents had inside information. With the internet, now you can see the cost yourself if you go on that vacation in September instead of July. Travel agents were very against the transformation of their industry, and the travel agent has become fairly obsolete. Within healthcare, they have the same thing going but also it's the result of a paternalistic, authoritarian system that is thankfully starting to change, though only recently. It's interesting because it has been largely unaffected for decades and providers aren't too happy about the change towards patient autonomy. Many in healthcare don't seem to want their control over information to change either, though I doubt they'd ever become entirely obsolete.

While I have no doubt that some doctors care about harming a patient through sharing information, it is also well known that doctors frequently lie to patients for their benefit rather than the patients.

Lies in the doctor-patient relationship are common.16 Physicians often minimize problems, fail to tell the whole truth, or resort to overly simplified explanations. Two important arenas for potential omissions are the delivery of bad news and the admission of errors.

Lies in the Doctor-Patient Relationship
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2736034/

The article above also includes attachment theory and therapist views. One reason I feel strongly about this is past trauma and being violated, but also my values--they have no right to come between my mind or body. Which is what they have been doing to patients for decades-making decisions for them rather than letting the patient have their autonomy as many of them think they have the right to do this.

Also, it is a very interesting ethical discussion topic. My position on this is that all information must be shared with patients--no questions asked. Except in cases of minors or mental incapacity. Risks should be disclosed and the patient can then decide whether or not to view it. It's the patient's mind and body.

When Doctors Need to Lie
https://www.nytimes.com/2014/02/23/o...ed-to-lie.html

Enjoy the articles.

One more quote from the first article:

In an 1871 graduation speech, Oliver Wendell Holmes concluded, “Your patient has no more right to all the truth you know than he has to all the medicine in your saddlebag … he should only get just so much as is good for him.”13(p388)

[justbreathe1994]

Originally Posted by Rayne_

There have been a few discussions here about medical records and therapy notes, so I'm starting a new thread as to not steer other threads off course.

Therapists and psychiatrists are included in health insurance and treated as healthcare so are part of the system...Withholding and distorting information about a person's healthcare by medical providers is finally starting to change course after decades of information asymmetry. The culture of withholding information from patients and lying goes way back to Hippocrates:


Information asymmetry, although often used in economics, can also be used more broadly in the context of purposely withholding information from the other party to benefit the information holder. In healthcare, the control over information is traditionally used to benefit the providers, not the patients whether it's economic or for many other reasons . The more information shared with patients, the more they would be exposed to lawsuits and scrutiny.

Remember how the travel industry used to be--travel agents had inside information. With the internet, now you can see the cost yourself if you go on that vacation in September instead of July. Travel agents were very against the transformation of their industry, and the travel agent has become fairly obsolete. Within healthcare, they have the same thing going but also it's the result of a paternalistic, authoritarian system that is thankfully starting to change, though only recently. It's interesting because it has been largely unaffected for decades and providers aren't too happy about the change towards patient autonomy. Many in healthcare don't seem to want their control over information to change either, though I doubt they'd ever become entirely obsolete.

While I have no doubt that some doctors care about harming a patient through sharing information, it is also well known that doctors frequently lie to patients for their benefit rather than the patients.


Lies in the Doctor-Patient Relationship
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2736034/

The article above also includes attachment theory and therapist views. One reason I feel strongly about this is past trauma and being violated, but also my values--they have no right to come between my mind or body. Which is what they have been doing to patients for decades-making decisions for them rather than letting the patient have their autonomy as many of them think they have the right to do this.

Also, it is a very interesting ethical discussion topic. My position on this is that all information must be shared with patients--no questions asked. Except in cases of minors or mental incapacity. Risks should be disclosed and the patient can then decide whether or not to view it. It's the patient's mind and body.

When Doctors Need to Lie
https://www.nytimes.com/2014/02/23/o...ed-to-lie.html

Enjoy the articles.

One more quote from the first article:

I am studying bioethics in college and have always been very interested in the ethics of medicine and power difference between client/patient and provider. It makes me angry at times studying consent, patient autonomy, benovelence, and justice (the core principles of bioethics) in the healthcare system because a lot of issues regarding these principles are so inherent and imbedded in the system that there doesn’t even seem to be an easy place to start. Take consenting to a surgery for example, even if the doctors (experts) explain all the risks in accesssible terms, can the patient really give their completely informed consent? Only the doctors are truly aware of everything that can go wrong and the likelyhood of complications occurring. And how do therapists respect clients with equality and dignity in psychotherapy if the clients’ perceptions are inherently “skewed” but they are “consenting” to the “expertise” of their provider? Sorry to go on that little rant lol... I just had a Bioethics class.

That is so interesting! And now you are living it, firsthand. You'll get an A+ in the class...

Feel free to rant away, this thread is open to anything. You have every right to feel strongly as you do, and being passionate can be much better than being apathetic. Apparently others feel strongly too as laws had to be passed to force providers to share health information with patients.

I could talk about ethics for hours, so it's nice to hear your thoughts. That always seems to come up in the debate-patients don't fully understand. But as Joe Biden recently said:

..After the former VP contended that patients deserve access to their own information, Faulkner asked: “Why do you want your medical records? They’re a thousand pages, of which you understand 10.” To which Biden responded, “None of your business.” He went on to explain that “if I need to, I’ll find someone to explain them to me, and by the way, I will understand a lot more than you think I do.”

https://www.forbes.com/sites/nicolef...u-demand-them/

You might like that NY Times article (though I think the comments are more interesting than the article).

[maybeblue]

I recently had the very unfortunate experience of dealing with medical bureaucracy incompetence in all of its glory. I'm sorry if this is graphic...but I had food poisoning and I had some bloody diarrhea. My regular doctor is on medical leave so I saw someone else in her clinic...a male nurse practitioner. I google stalked him afterwards and found out that he graduated less than a year ago. He told me that I might have colon cancer and he "needed" to do a rectal exam. I kept trying to understand what he thought he would accomplish with that. He kept bring up cancer, like over and over. I have a history of abuse...by a doctor. And I had a panic attack. I was sobbing. I told him about the abuse history, but he ignored it and kept talking about cancer. I kept trying to bring up the food poisoning and he kept dismissing it.

Long story short, I ended up giving in and doing the exam, even though I never understood why he wanted to do it. He would just say that he needed to check for blood, but of course there would be blood. Why on earth would I lie about that? But I was so panicked that I couldn't even think, so I let him push me into it. Basically, I kind of acted like an abuse victim.

After the exam he still wouldn't listen to me or empathize even a tiny bit, although I was still crying. His exact words were "I'm sorry you are upset. I don't know why you are upset. And then he started pressuring me to schedule a colonoscopy *that day*. I didn't want to, but I wanted to get out of there and that seemed to be the only way so I caved again.

I went through with the colonoscopy because now I was paranoid about cancer. And the surgeon told me very directly that it was an unnecessary referral based on the symptoms that I had. He told me that I almost certainly had infectious colitis, and in fact that is what I had.

I complained to the clinic manager. I ended up having a meeting with the CEO of the hospital. I think this was coercion. My therapist says it was. Honestly I'm not sure I even had the capacity to consent right then. I was so terrified.

I got his note and he diagnosed me with "ischemic colitis." He did admit that he never talked to me about it. My guess is that after the visit he went online and googled "bloody diarrhea" just like I did. I told the hospital CEO that was my theory, since he surely never mentioned any other possibilities than cancer to me.

Since then I have been having panic attacks and maybe flashbacks? Anyway, it's been nearly a month and I think about it all the time. I have to go back on Thursday...not to him. I'll never see him again, but to another provider to get my kidneys retested. Another thing he never mentioned was my abnormal lab values. I had to discover that on my own from the medical record. I'm also going to ask her about anti-anxiety medication, which I've never needed before. The CEO of the hospital agreed to arrange it so that there is no way I will run into him in the hallway. He says that he will make sure he's on a different wing that day. So that's good, because I do not think I'd handle that well. I'm already nervous enough about going.

I want to request that they put something in the medical record about this. In particular, his note says that I told him about the abuse history after the exam. I absolutely told him before. I know I did because I was hoping he would reconsider or at least slow down and show a little empathy. That bugs me. He also said "patient verbalized understanding of the plan," which I know is boilerplate stuff, but I never said I understood the plan. I reluctantly acquiesced to the plan, but I never understood or agreed with it.

[mostlylurking]

I'm so sorry maybeblue. That is so awful. I agree it's coercion and I can understand why you're having some trauma reactions like flashbacks. Can you bring someone with you, a friend perhaps, as support when you go back?

[maybeblue]

Originally Posted by mostlylurking

I'm so sorry maybeblue. That is so awful. I agree it's coercion and I can understand why you're having some trauma reactions like flashbacks. Can you bring someone with you, a friend perhaps, as support when you go back?

I could, but I'm afraid it will make it worse. My husband tries to supportive and I could bring him, but he is very smothery. Also he tends to talk for me and I noticed that when I would go with my mother-in-law to the doctor that the doctors would tend to talk to the most rational, calm person in the room, and that's not really likely to be me. And that would drive me crazy.

My sister-in-law would be a better advocate, but there are things that I would like to tell the doctor that I really don't want her to know about. I'll just suck it up and go.

Each to their own ideas I suppose but I feel painting the entire profession in such a brush stroke is irresponsible.

I"m very sorry that happened to you maybeblue. I actually know someone who died from infectious colitis at a youngish age, so that is a dangerous scenario. It's really impressive the CEO has gotten involved in your case, as issues like that can be covered up.

My PTSD leads to triggers when doctors try to tell me the issue I have is something that it's not. Despite that experience, nothing triggers me more than medical stuff that brings up stuff realated to being misdiagnosed when in a life threatening situation. I have another type of PTSD now.

Had an abusive experience with a doctor too:

Possible trigger:

I was molested by a doctor at 14 when i went to one of those quick primary care/urgent care clinics for oral contraceptives and he did an internal exam without gloves. he wanted me to come back for a follow up before writing the prescription though nothing was found in exam

Good listening is underrated.

It sounds very violating. It's also surprising the doctor could be that bad. Hard to imagine cancer being the top contender for something that came on as suddenly as food posioning does.

Originally Posted by justafriend306

Each to their own ideas I suppose but I feel painting the entire profession in such a brush stroke is irresponsible.

I'm just describing the color of the paint. The canvas and brushes were already created, and those in the profession are doing the painting.

There are laws and research and entire organizations created to address these problems, so I personally would not take credit for being the one to point them out on this forum. Of course ignorance is bliss.

Resources about medical records charges:

Are you paying too much for your medical records?

High fees are “a vestige of an old paternalistic system,” Krumholz says, one where patients didn’t ask for information or participate much in decisions about their care. “I have an agenda, which is to tip the balance of power” to the patient, he adds.

https://www.forbes.com/sites/nextave...dical-records/

HIPAA Infographic
https://getmyhealthdata.org/provider...a-infographic/

Select the state abbreviation link to go to the relevant statute:
Medical Records Copying Charges

[amicus_curiae]

Hunh.

The idea that I would lie to my shrink — or that my shrink would lie to me — (I don’t know the words to use) seems farcical.

I think that I may be the only living being who has received good — or good enough — psychiatric care throughout my life. I’ve worn the canvas and leather jacket with metal buckles and been further restrained after bloodying my face by running into the paddled panels but — honestly? — in hindsight those experiences really were “for my own good (or safety).”

To my knowledge I’ve never had any doctor withhold information from me. Certainly never found that any doctor falsified information in any way.

When “in my right mind” I’ve had doctors who’ve “talked down to me” and I’ve been a little too vicious, maybe, in my reactions but the results have been effective in producing the desired effect of respect (even when forced).

I feel like I deserve a trophy as the sickest person alive to have received competent care throughout seven decades. I’ve had faulty diagnoses concerning my longevity but not without consensus of practioners and not without full explanations at the time — and effusive apologies after my continued survival.

Comparing images of my heart with healthy hearts is like comparing freezer-burnt decades-old ham hocks to a newly cut eye-of-the-round.

Jeez.

[maybeblue]

Originally Posted by Rayne_

I"m very sorry that happened to you maybeblue. I actually know someone who died from infectious colitis at a youngish age, so that is a dangerous scenario. It's really impressive the CEO has gotten involved in your case, as issues like that can be covered up.

It sounds very violating. It's also surprising the doctor could be that bad. Hard to imagine cancer being the top contender for something that came on as suddenly as food posioning does.

I'm sorry about your doctor experiences too. I also hate when they tell me that I have something I don't. Especially when I'm giving them good evidence that it's something else. Good doctors won't get upset if you question them politely. They will consider your opinion too.

I google stalked the provider. He's actually a first year nurse practitioner. He's also kind of an idiot. It's a small town and a small hospital. It's hard to cover stuff up here. I know someone else who went to him and had a misdiagnosis as well. I asked him to complain too and he did. I figure multiple complaints will mean more.

I'm not entirely done being a pain in their necks yet. I want my side of that story in the medical record. They said they would put it in. We'll see.

When I saw him he took labs but didn't go over the results with me. My creatinine was high. So in my complaint letter I asked that some other provider look at those labs and tell me if there was anything to worry about. In the apology letter that had all kinds of typos and cut and paste errors they said "Dr. P says that there is nothing significant in your lab results. The kidney function is chronic and shows only subtitle changes since 2014." So I said "what the heck does that mean?" It sounds like they are saying "don't worry about that lab result, it's just your chronic kidney failure." Only I have never been diagnosed with chronic kidney failure. So the first I am being notified of a potentially life threatening disease is in an apology letter?

I don't have chronic kidney failure. I had food poisoning. I was dehydrated. I think 2014 was one of the three times I had pancreatitis caused by a medication that they gave me (sulfa antibiotic), so I was probably dehydrated then too. I just got my levels re-tested when I wasn't dehydrated and they are normal.

It's not paranoia if they really are out to get you.

Originally Posted by maybeblue

I'm sorry about your doctor experiences too. I also hate when they tell me that I have something I don't. Especially when I'm giving them good evidence that it's something else. Good doctors won't get upset if you question them politely. They will consider your opinion too.

I was born with some fairly serious medical conditions so I've had a lot of dealings with many doctors over the years. If there is one thing I've found to be almost always true it is that doctors do not like to be wrong, and they don't like to admit when they don't know something. I have no clue if it is a common characteristic to their personalities before they go into the field, or if it's something that comes about due to being expected to know the answers, but I have run into it countless times, as has pretty much everyone else I know.

As an example, I was having some ligament issues last year...

The first doctor I saw misdiagnosed it, then refused to do any testing to discover what was actually going on when it became apparent he'd been wrong.

The second doctor I saw also misdiagnosed it, and also refused to do any testing to figure out what was actually happening. I wound up having to do the research myself to discover what was going on and how to fix it. Brought it to the doctor, and with it in hand managed to get him to do the testing. After the tests the doctor wouldn't let me come pick up the results, instead trying to make me wait over a month for an appointment. By this point it had been like half a year I'd been in pain from this issue with no help from them.

I managed to get the results through my physiotherapist who has access to my medical files. A one minute glance revealed that it was exactly what I had suggested was going on, and that the fix for this is very time sensitive or I'd be looking at long term damage and surgery.

When I finally saw the doctor again he acted pissy the whole time, then told me to come back in a few months if it was still a problem. He offered no advice on what to do in the mean time, and no apology for having gotten it wrong for so long. All because he had been wrong and gotten shown up by me having found the answer.

I'm still not out of the water with the problem and may wind up requiring surgery for their refusal to give it a proper check.

That's not to say all doctors are terrible or anything like that. I have had really a good doctor, and the specialists I see are awesome. But there are also a lot of doctors whose ego undermines their ability to perform their jobs properly.

[maybeblue]

Originally Posted by nextstep_butwhat

That's not to say all doctors are terrible or anything like that. I have had really a good doctor, and the specialists I see are awesome. But there are also a lot of doctors whose ego undermines their ability to perform their jobs properly.

That is so true. And I wonder sometimes if they are taught to be "confident" in order to "keep the patient calm." The second time I had pancreatitis the doctor ordered a CT scan and the radiologist said "looks like inflammation of the pancreas." And the doctor said that it could be "coincidental" and "we weren't going to just treat everything that randomly showed up on a CT scan." But my symptoms fit pancreatitis. So I threw a fit and insisted on the blood test, which came out positive. The doctor never admitted she was wrong, but she did start treatment, so I guess that's something.

The reason I chose my current doctor as my primary doctor is because I saw her the third time I had pancreatitis. I went in and said "I think I have pancreatitis." She said "that's really unlikely, it's probably stomach flu." But she gave me the blood test and when it came back positive she said "you were right." Her being able to consider different information and admit that she was wrong made me trust her more than anyone I'd seen there before.

[bobcat21]

I hope this on the same topic ( apologies if it isn’t) Let’s say I happen to leave My current T and go to a new T and we left on bad terms and I do not under any circumstances do not want my new T contacting my old T because again we left on bad terms the new T can’t ask my old T for my old records for any reason am I right? I just ponder this because I am thinking of switching Ts and I know when I do it’ll be on bad terms. I hope this makes sense and apologies if isn’t on topic.

Originally Posted by bobcat21

I hope this on the same topic ( apologies if it isn’t) Let’s say I happen to leave My current T and go to a new T and we left on bad terms and I do not under any circumstances do not want my new T contacting my old T because again we left on bad terms the new T can’t ask my old T for my old records for any reason am I right? I just ponder this because I am thinking of switching Ts and I know when I do it’ll be on bad terms. I hope this makes sense and apologies if isn’t on topic.

From what I understand, the new T has to have your permission to talk with the old T. Just don't give them permission. Take care.

amicus_curiae, I didn't see your post before. Glad that you like your psychiatrists.

[amicus_curiae]

Originally Posted by Rayne_

amicus_curiae, I didn't see your post before. Glad that you like your psychiatrists.

My posts take some time to show up.

I’ve only had one ‘bad’ shrink and he had the grace to treat my symptoms well before

Possible trigger:

murdering our mutual girlfriend and killing himself.

I really don’t even like to say that he was abusive, only that he was persuasive.

Last year I attempted to get my records from the time that I spent in a state mental hospital 1999-2003. They had been destroyed.

I think that digital records are terrific.

[Shazerac]

Originally Posted by amicus_curiae

My posts take some time to show up.

I’ve only had one ‘bad’ shrink and he had the grace to treat my symptoms well before

Possible trigger:

murdering our mutual girlfriend and killing himself.

I really don’t even like to say that he was abusive, only that he was persuasive.

Last year I attempted to get my records from the time that I spent in a state mental hospital 1999-2003. They had been destroyed.

I think that digital records are terrific.

HOLY CRAP now that’s a bad shrink.

[Jazz1971]

Originally Posted by bobcat21

I hope this on the same topic ( apologies if it isn’t) Let’s say I happen to leave My current T and go to a new T and we left on bad terms and I do not under any circumstances do not want my new T contacting my old T because again we left on bad terms the new T can’t ask my old T for my old records for any reason am I right? I just ponder this because I am thinking of switching Ts and I know when I do it’ll be on bad terms. I hope this makes sense and apologies if isn’t on topic.

Unless they are in the same practice, your new T needs permission to contact the old one. Most of the time, Ts won't take the initiative to do this.

[Wonderfalls]

One more quote from the first article:
Quote:
In an 1871 graduation speech, Oliver Wendell Holmes concluded, “Your patient has no more right to all the truth you know than he has to all the medicine in your saddlebag … he should only get just so much as is good for him.”13(p388)

____________________________________________________________
To those as confused about history as I am this is OW Holmes, Sr--the noted physician, writer etc.. His son, Oliver Wendell Holmes, Jr, was the Supreme Court Justice.

To those as confused about history as I am this is OW Holmes, Sr--the noted physician, writer etc.. His son, Oliver Wendell Holmes, Jr, was the Supreme Court Justice.

That's interesting!

Hopefully he was inspired by disagreements with his father and not the other way around.

[here today]

This is a little off-topic, hope it's OK. If anybody wants to continue, I can try to move the discussion to another thread.

Originally Posted by amicus_curiae

. . .
When “in my right mind” I’ve had doctors who’ve “talked down to me” and I’ve been a little too vicious, maybe, in my reactions but the results have been effective in producing the desired effect of respect (even when forced). .

I think this may be a core difference in why you don't seem to be able to understand my perspective and experience with therapy

I've never been psychotic, just depressed. Never involutarily committed or restrained by others "for my own good".

But the perhaps "natural" ability to react, or even take notice, when others "talked down to me" was internally restrained, numbed out, "dead" by the time I was a teenager and entered therapy. Or so it now seems, based on my own research and feelings that have "come to life", and perhaps helped to come to life through therapy.

The problem for me has been what to do with those feelings and impulses after they were unearthed? My responses and reactions to being/feeling disrespected were at first, and still somewhat, too primitive to be "socially acceptable", and the therapists therefore reacted and put me down again. I had not developed an ability, or confidence, that I could produce a desired effect of respect, even when forced. And did not get it from therapists. I didn't even consciously, exactly. know that was a desired effect, or that I "deserved" it.

So my kind of "mental illness" seems very different from what you have had. And although I may know myself somewhat better than I might have without therapy, I've also been hurt by looking to therapists for expertise and knowledge that I now believe they do not have, at least in cases like mine. It's something that I understand you do not understand, but that doesn't mean it's not real for me and others, or worthy of respect.

Originally Posted by justbreathe1994

I am studying bioethics in college and have always been very interested in the ethics of medicine and power difference between client/patient and provider. It makes me angry at times studying consent, patient autonomy, benovelence, and justice (the core principles of bioethics) in the healthcare system because a lot of issues regarding these principles are so inherent and imbedded in the system that there doesn’t even seem to be an easy place to start. Take consenting to a surgery for example, even if the doctors (experts) explain all the risks in accesssible terms, can the patient really give their completely informed consent? Only the doctors are truly aware of everything that can go wrong and the likelyhood of complications occurring. And how do therapists respect clients with equality and dignity in psychotherapy if the clients’ perceptions are inherently “skewed” but they are “consenting” to the “expertise” of their provider? Sorry to go on that little rant lol... I just had a Bioethics class.

Along with the inability to tell when I was being disrespected, I lacked an understanding of power and differences in power. Too threatening, I guess, I just numbed it out. When the awareness started to come, it was very "prickly", like when your foot goes to sleep and then feeling starts to return. But, that meant I was socially sometimes kind of "prickly", too, with consequences that I didn't/couldn't understand and which left me pretty dysfunctional for a long time. Still am, somewhat.

This is a little off-topic, hope it's OK. If anybody wants to continue, I can try to move the discussion to another thread.

Post away, here today!!

(I like the way that sounds )

[amicus_curiae]

Originally Posted by here today

This is a little off-topic, hope it's OK. If anybody wants to continue, I can try to move the discussion to another thread.

I think this may be a core difference in why you don't seem to be able to understand my perspective and experience with therapy

I've never been psychotic, just depressed. Never involutarily committed or restrained by others "for my own good".

But the perhaps "natural" ability to react, or even take notice, when others "talked down to me" was internally restrained, numbed out, "dead" by the time I was a teenager and entered therapy. Or so it now seems, based on my own research and feelings that have "come to life", and perhaps helped to come to life through therapy.

The problem for me has been what to do with those feelings and impulses after they were unearthed? My responses and reactions to being/feeling disrespected were at first, and still somewhat, too primitive to be "socially acceptable", and the therapists therefore reacted and put me down again. I had not developed an ability, or confidence, that I could produce a desired effect of respect, even when forced. And did not get it from therapists. I didn't even consciously, exactly. know that was a desired effect, or that I "deserved" it.

So my kind of "mental illness" seems very different from what you have had. And although I may know myself somewhat better than I might have without therapy, I've also been hurt by looking to therapists for expertise and knowledge that I now believe they do not have, at least in cases like mine. It's something that I understand you do not understand, but that doesn't mean it's not real for me and others, or worthy of respect.

Along with the inability to tell when I was being disrespected, I lacked an understanding of power and differences in power. Too threatening, I guess, I just numbed it out. When the awareness started to come, it was very "prickly", like when your foot goes to sleep and then feeling starts to return. But, that meant I was socially sometimes kind of "prickly", too, with consequences that I didn't/couldn't understand and which left me pretty dysfunctional for a long time. Still am, somewhat.

To clarify: I’ve never been involuntarily committed, either. I’ve been restrained more times than I can count, though, during my three-years-and-five month in State ‘custody.’ And psychotic? Even today I am psychotic — difficult to explain how the degrees of psychosis seem to work; maybe this psychosis is benign in that it allows me to function. Previous psychotic episodes — 1970’s-2011 — have been more malignant.

I actually think that I can empathise, somewhat, with being ‘dead’ — during most of my mute period, I had such a wide spectrum of deadness, numbness and episodes that reinforced my invisibility, my lack of worth, my complete assurance that, like the dead, I did not speak. I don’t have a complete memory of this time, just some of what I felt. The worst periods may have been (and these seem, now, to have been the most common) those times when I was a robot. I still have those feelings. Now, today. Anyway.

I was only able to roar, as I said, when “in my right mind.” The truth is that I’ve never been in my right mind but have been ‘functional,’ for long periods. I think that my first psychotic episode was 1970-1971.

One thing that I thought of last night: I was in law school when I first saw a shrink and have been an attorney for the majority of these continuing therapy days. Maybe — maybe — there was a kind of professional mutual-admiration going on? I had a very successful group practice for over a decade, crazy as hell but that was just me being me.

So, let me see if I understand.

You lacked the ability to naturally react to others when they were talking badly about you because you were emotionally numb. You began therapy in your teens. You spoke to your therapist about your feelings of being disrespected and s/he responded by disrespecting you, again, reinforcing the idea that you weren’t worthy of respect. You experienced the same with other therapists. Because of these experiences you don’t believe that therapists have the expertise or knowledge to handle cases like yours.

In addition to feeling a lack of respect you also feel as though you lacked the ability to understand social power. You only came to understand “power” recently but only in a manner that you found offensive and you engaged in social interactions in which you repaid offense for offense and these responses left you socially dysfunctional even to this day.

Is that a fair summation?

If so, I think one difficulty might be that I don’t see any type of mental disorder in your description of your problems — but that’s coming from someone who’s really screwed up so, grain of salt, etc.,but you are surrounding “mental illness” with quotation marks. If your numbness is still around and rises to that chronic feelings of emptiness, I know that’s one symptom of borderline personality disorder (because I’m BPD!) but feeling unworthy of respect, not understanding the dynamics of social power and feeling dysfunctional because of these feelings? Maybe a social worker who regularly deals with at-risk adults? I honestly don’t know who might be competent to handle the kind of problems that you describe but I do understand why a psychotherapist might be a horrible ‘fit.’ A sociotherapist?