on getting fired as a patient

Absolutely this video.  See here.

I’ve been fired as a patient by a psychiatrist for volunteering that I’d foolishly stopped smoking weed, at my own initiative.  His issue was that I hadn’t discussed my decision to start.  Note that I’d finished a pharmacology-related PhD in the last few years.  I knew the things he was saying weren’t supported by the medical literature.  I also knew he didn’t freak out and try to fire me when I was liking Vicodin too much after surgery.

Lacan Lady also tried repeatedly to get rid of me.  I noticed that the points of friction were very much insurance company-related.  At that time, since my ex-wife had BPD, I’d learned about personality disorders and suspected some combination of schizoid and avoidant traits in myself.  Being autistic, I read Millon and everything.  I started to explain my rationale, and it got shut down with “depression can present in all sorts of ways.”  I was getting the vibe that she was trying to spare me the burden of an Axis II diagnosis.  In the end it’s autism, so I think I’m assured of future health care problems regardless.

I was very much hoping for the talk-aimlessly-about-childhood kind of therapy, and she kept trying to get me to enumerate specific goals, all CBT-like.  I had a mindset, based on my existing Zen practice, that things would take care of themselves once I got my head straight.

Things blew up over race and other betrayals, but I did notice that it was approaching a year of therapy.  I’d said I wanted to relate my childhood to my problems, etc., and her response was “but that takes a long time.”  It’s like I knew I was going to be in therapy for years, and she couldn’t get past the expectation that I didn’t get what was necessary.  My suspicion was that the insurance company was going to make her do a bunch of paperwork justifying her existence at that point.

The therapists I’ve found were “Lacanian/existential,” ACT with knowledge of narrative therapy, and psychedelic-friendly Gestalt/Jungian (?).  These all fit my life at the time.  I live in the Bay Area and paid out of pocket for the latter two.  For me, CBT is basically unacceptable in a therapist.

My grad school psychiatrist that started me on the Wellbutrin didn’t dig deep or anything, but I saw Nietzsche on the shelf.  I don’t think I got very much out of giving monthly progress reports on my ability to keep up with grad school hazing.  Yeah, doc, I have more energy, now.  I wrote 15 pages.  Back then I just had dysthymia.  I was fascinated by the concept that suicide rates were higher in dysthymia than major depression, due to the unrelenting hopelessness.

I’ve known someone who didn’t hear back from a therapist after filling out an intake form and checking “yes” next to too many things.

I learned the following joke when learning about my ex-wife’s BPD:  “Q:  How do you treat a borderline?  A:  Refer them.”

Therapists talk shit about their patients in their professional literature like whoa.

In getting started with a new therapist, it’s difficult at first to convey that I’m just autistic, psychology is my special interest, and my dad worked in mental health and we just talked like that.  I didn’t really get grounded like my friends.  Punishment was basically a forced therapy session over it with my dad.  Threat of the conversation/argument was enough to make a lot of things not worth risking it.  All of this is going to look like an attempted pissing contest, “resistance” and intellectualization, something bad no matter what you call it.  I communicate better in writing, but that’s going to be seen as “cheating.”  Failure to stop being autistic will make it seem like I’m the most slow-improving social anxiety patient of all time.

I’d still be undiagnosed if I had to rely on insurance companies and their evidence-based practices and a priori decisions about how long my improvement should take.

Experiencing consistent rejection from mental health professionals doesn’t help in any way whatsoever.

I’m reminded of an anecdote from Irvin Yalom’s Love’s Executioner.  He hates fat people, and works with a fat lady who gets better.  At the end he’s surprised that she knew all along that he was disgusted with her:

“Tell me, Betty, knowing this–seeing that I didn’t look at you or was uncomfortable with you–why did you stay?  Why didn’t you stop seeing me and find someone else?  Plenty of other shrinks around.” (Nothing like a question to get off the hot seat!)

“Well, I can think of at least two reasons.  First, remember that I’m used to it.  It’s not like I expect anything more.  Everyone treats me that way.  People hate my looks.  No one ever touches me.  That’s why I was surprised, remember, when my hairdresser massaged my scalp.  And even though you wouldn’t look at me, you at least seemed interested in what I had to say–no, no, that’s not right–you were intersted in what I could or might say if I stopped being so jolly.  Actually, that was helpful.  Also, you didn’t fall asleep.  That was an improvement on Dr. Farber.”

“You said there were two reasons.”

“The second reason is that I could understand how you felt.”

She goes on to explain about hating fat people herself.  Great success!

And they wonder why we don’t get better.  The most reasonable conclusion to draw from rejection by mental health professionals is the end of all hope.  Like, this person went to grad school to help people with mental health problems, but I’m revolting to them?  Fuck, that’s bad.