Why I Don’t Fire the Shrink, and follow-up

I’m sorry to drop the last post down because I think it is one of my more important ones and would like it to get as much traffic as possible. Maybe I’ll make it a page or something, but I wanted to write a little more today.

Tony White over at Graffiti left me a beautiful post with a deep answer to a question about what constitutes a “characterological” or “personality” problem. I guess I asked since I have been accused of the same, though I don’t agree.

I have been trying to draft further questions to him but his website isn’t working. He did, however, inadvertently answer sort of what I guess this shrink is trying to get to do with me – make a connection that will be stable and somehow “heal” whatever is fucked up. Whether I believe in this or not – sounds like one step away from alien healing to me, well, that’s another story.

But I thought I’d give some follow-up to the shrink-related part of this post. I thought that if I’m so curious that I’m writing about it in depth, fairly eloquently, I may as well ask him. I did not go and say, “Hey, buddy, aren’t you kind of useless?” Instead, I phrased the question, “Do you think that maybe at this point, the right thing to do would be to stop trying to make me better and shift into working with the condition I’m in and getting me to a point where I can live with this?” After all, I am functional, I’m not in a state where I’m homeless or actively suicidal or beating my partner. It could be worse.

His answer was an emphatic no, that it is definitely doable to get me to better health.

Leaving me to wonder who in the room really has the denial problem.

* * *

I did call in sick, I think maybe for the first time in my life, the day after that post. I really was sick from whatever drug was doing that to me, had been writhing around and vomiting since 3 AM, but I felt incredibly guilty, and am waiting for the universe to punish me. I did make an appointment with the shrink that day, arrived pale and sweating, and he flipped out and tried to send me to the emergency room (shrinks don’t deal well with physical illness). But still, I’m waiting to be punished.

The worst part is, it doesn’t really matter if I’m there or not. The exact same work still gets done. That’s the bind of this job – it is an incredible amount of work with an incredible amount of responsibility, pay below minimum wage, and yet you are utterly expendable. I did call in, but no one even noticed I was gone the day after.

On the up side, I have started investigating other possibilities for employment when I finish. I think this is a positive sign; instead of helplessness and despair at the world of medicine, I’m being proactive and looking for solutions. Not depressive thinking at all.

* * *

I realize I’m down on the shrink a lot and a lot of the things he says are horribly insensitive and sexist, that everyone I know encourages me heartily to fire him. So for anyone who cares, here are the reasons why I haven’t.

1. He is basically a decent person and is trying to help. I realize that this argument could be made for, oh, say, Sarah Palin, but after seeing psychiatrists from the other side in med school, I know that there are some truly Machiavellian types out there. I could do so much worse. He means well, though our views on what is wrong with me, let alone how to fix it, are worlds apart. It is sad that this is an important point, but it really is. At least I can be fairly certain he’s not out there making jokes about me with colleagues.

2. He has seen my episodes on both ends of the spectrum. I can’t say that he really “knows” me, not at all. But I just do not want to have to start the whole history thing over somewhere else. I don’t want to have to go through admitting to manic behavior. And he has seen it, at least glimpses of it, what I don’t manage to hide, so he has a firsthand clinical impression. That counts for something.

3. He is available. He understands the vagaries of a junior doctor’s schedule and is incredibly flexible about seeing me when I can, including sometimes 7 or 8 at night. He can see me on short notice and understands when I disappear for weeks at a time. I know this also sounds like a dumb reason, but I had to quit the counselor I liked best since starting med school (one of those tough, New York feminists) because we simply could never find a time to have an appointment. Others have demanded a set hour every week, which is impossible for me. I also see this as an extension of reason number 1 – he really does care and is trying to help, even at his own inconvenience.

4. He understands the brutality of medical training. This is the first time I’ve had any kind of therapy with an actual psychiatrist, and one thing that is nice is that I don’t have to explain the concepts of on-call, of how it feels after 30 hours, etc.

5. He picked my good meds. This gave me 4 years of normal, good life. I guess in retrospect he fell onto it more out of luck than talent, but still, I am immensely grateful to him for those four years, in which I lived like a normal person and managed to build a decent life for myself, even if it is all going to shit now, and might actually be crueler to have had and lost than never had at all.

6. About anything not related to my mental health, we get along well. Though here it may sound like a lot of angry silences and friction, whenever we are just chatting about something, we mostly get along. We share an unusual hobby and can chat in a friendly way. Just as long as we don’t drift into points where his basically bourgeois or sexist views come out, but mostly they are only a problem when discussing my life and its twists and turns, which he can’t really understand, being from such a middle class boring place. This is a big issue – he misses a lot of what is culturally normal for me and sees it as psychopathology. We come from the same ethnicity, but grew up in different parts of the world – he in a very conformist (though not necessarily right-wing) place and me as a hippie liberal. He’s the kind of man who pays lip service to liberalism but sees marriage and 2.5 kids and a mortgage as normal and anything else as deviant.

But, as I said, if we stay away from that, it’s ok. Light banter is always pleasant.

7. He doesn’t fall for my manipulation. This is also a big one. For whatever historical reasons, I’m a master manipulator of men – by anything from mental gymnastics and rhetoric to sex appeal, I always get my way. I do get furious when I don’t with him, but I think somewhere deep down, it’s good for me.

8. He recognizes that I’m wasting my life and talent. In fact, has made that very comment to me. This is one of the hot spots of what is bothering me. Unfortunately, most counselors I’ve seen see that feeling, the feeling that I am wasting my talents, as pathological, and try to address it, because on paper I look like I’ve done a lot for my age. He once, unprompted, told me I was wasting my life…and I thought it was one of the most insightful things anyone had said – that he sees through my impressive resume to see the dilettantism behind it.

* * *

But the main reason is #1 – I know I could do so much worse. If it’s all bullshit, I may as well stay with someone who means well.

And no, none of this excuses his obvious countertransference-gone-wild issues, the sexism of calling me borderline because I am an angry female, the utter unwillingness to discuss what he sees as the problem and how he plans to therapeutically fix it, the dismissal and blaming of the patient…but still, at least he’s nice. And that means a lot. Do I really want to go find someone with all that same shit, who also is mean or cold?

* * *

Edit: Tony White read this and pointed out a reason number 9, one of which I was not consicouly aware, but of course, he’s right. It made me laugh to realize that I hadn’t realized this, when it was so obvious to someone else.

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19 Comments

  1. To me they sound like excuses, not reasons, to stay. I think you can do a lot better. Finding a good psychiatrist is not like looking for a needle in a haystack. I think you make the process to difficult for yourself and settle for second best. If I had that many issues with my psychiatrist, I would fire him on the spot. As a matter of fact, I am and am getting a new one for less reasons than you have.

  2. I’m curious how you think you are wasting your life, by being in medicine, you mean?

  3. Yes…by not writing, also. If there is one thing I was put on this earth to do, it was to write, and I didn’t do it. I was afraid. I thought I wasn’t talented enough. I am not talented compared to my family, so I was never encouraged, encouraged instead to be the respectable one.

    And also, in medicine. Yes, I am wasting my life in general in it, but I also am wasting my life by always working way under my potential, never giving myself over to anything fully, taking the easiest route. I have the potential to be a really good doctor, but I’m not. I’m just sliding by. Always.

  4. And yeah, there is an element of excuses in the list.

  5. I don’t know the answer. At this point, I’m scared of starting over.

  6. You are writing, aren’t you? And you’re not done with your life yet.

    As for “sliding by” in medicine – I’ve often felt that way. I’m not doing research; I’m not reading every journal the day it arrives; I’m not looking up every clinical question that arises to see if there’s something newer and better than what I’ve been doing. I’m doing what comes easily for me, mostly. On the other hand, what comes easily to me is what I’m good at. This is where my talent lies.

    I also think I’m a really a writer, and the more I write the more I think that. I’m a lot older than you and it’s still possible. The patients whose lives you touch – and I know they’re out there – do not think you’re wasting your life.

  7. Honestly – I threatened to get rid of my shrink multiple MULTIPLE times and never went through with it. I told him so – to his face, and his response was “I understand. I’ll find you someone if you want me to”. Can you hold on to this guy just for the purpose of him monitoring your meds/moods, and find someone else to talk to? Then you can just make small talk with him once every 6 or 8 weeks, and he can give you refills of your meds and tweak stuff as necessary and find someone else to actually talk to.

    When it comes to your medical practise – you know what I think – I think that you are a talented physician who would be wasting your talent if you were to leave the profession. I think if you didn’t want to practise clinical medicine within the system, there are other ways of working in the profession and holding on to the parts of it that you enjoy – consulting, writing, lecturing, advocating… Finding gaps in areas where they are short on professionals and experts and starting to build your career there.

    Sara, you could act as a psychiatric advocate and make a killing – do it privately… and you’re set.

  8. I know what you mean about Machiavellian psychs. I was profoundly put off by a number of the psychs I interacted with when attached to psych this year…some of them just seemed to hate their patients and their life so much.
    Hows about moving to Australia?

  9. Sara, i really loved the make up and magic post. it was just so beautiful and simply exquisite..
    love, Milo

  10. I can hold onto him just for meds…it’s just like every damn time I get sucked in again because somehow he convinces me that therapy can help. It’s like Charlie Brown and the football.

    Dragonfly – actually me and the partner do plan to do some work for like 6 months in Australia (but no date set) because they need doctors and are always recruiting, I need to pay student loans, and it looks like such a great chance to experience living in another place. And socialized health care!

    I’m also glad to hear I’m not the only one who saw evil shrinks. Hmm…perhaps a fictional character? But I think it’s been done before…Hannibal Lecter etc.

    Milo – thank you, your words about my writing are very touching and special to me.

  11. Border Life (to a comment on another post)
    It is tremendously belittling.

    To be fair, he does take them seriously. Psychiatrists don’t know shit about medicine and are afraid of getting sued, so they actually tend to overreact. Like when sent me to a hematologist when I got big bruises – he called her especially at my hospital that same day to see me and run the tests outside the computer system. (I was actually angry about this, because I didn’t want to see any damn doc at MY hospital, even if it is in a department I never deal with.)

    And the other day when I went in so sick, he tried to get me to let him call his own personal family doc to see me that same day (I refused, not wanting to be treated like the 30-ish chick with psych problems with (psychogenic, of course) vomiting. You know, the one who manages to manipulate her shrink into calling in favors.) And I could see it wasn’t serious…so I refused.

  12. RAch – are you glad or sorry you never went through with it? It seems like overall you are grateful to him…

  13. Hi Sara,
    You say “Psychiatrists don’t know shit about medicine and are afraid of getting sued, so they actually tend to overreact.”…Actually him sending you to a hemotologist sounds like the first caring and thoughtful thing he has truly done for you. Here Psychiatrist go to 4 years of medical school and then here in Canada they go through another 6-7 years of training in their specialty.

    I have sometimes thought my pdoc has been far too “accepting” of my physical symptoms and sent me to specialists when afterwards, when it came back nothing was wrong I think…why would he not suggest I was okay and it was psychosomatic?

    I think the answer is that there is an intense need for trust in a psychiatric relationship. If I went to my psychiatrist and said…I have all the symptoms of ovarian cancer (I did and ge sent me for an ultrasound)…and he told me they were all figments of my imagination…you can imagine where my imagination would go next…he doesn’t care, doesn’t believe me, doesn’t trust me, thinks i’m faking it etc., etc.

    All I know is that therapy with a good psychiatrist DOES help, and when you have a good psychiatrist you will not have to think of all the reasons you might have been wrong about him being no good for you. You will simply believe, understand and know he/ or she is good for you. You will just know it.

    P.S. You are a great writer and there is no reason why you cannot be a writer and a doctor. In fact they seem to go well together. In Canadathe 2006 winner of the Giller Prize (Our biggest literary prize) went to Dr. Vincent Lam for his short story collection, Bloodletting & Miraculous Cures. It was a great book and his medical knowledge made the book more believeable and fascinating.

    P.S.S. You deserve the best help (psychatrist) and you deserve to live a happy and fulfilling life…and honestly any person living near you would be blessed to have you as their doctor, because you care.
    hugs,
    …aqua

  14. Sar – in the end, I’m glad I never went through with finding a new psychiatrist – because the relationship, after 8 years of being extremely rocky and distrustful has finally solidified into something that is workable… and extremely therapeutic. And for that I’m extremely grateful each and everyday.

  15. Aqua – my understanding is that Psychiatrists don’t undergo that many years of specialty training in Canada – 4 years of MD training, and maximum 5 (if they do a fellowship) most onlly do three or 4.

  16. I just so love it when i can go to a therapy session and then feeling so uplifted and happy about myself. it has happened a few times (five or six) in the past five years that i have been with my therapist. i just wish so much that it could happen more often. i love you Sara xxxooooo

  17. I think 4 of med school (or depending on country, pre-med 4, med 4, or med 6-7) and then 4-6 of specialty training is standard for psychs in most parts of the world. The thing is, medical knowledge is maximum right at the end of med school and you forget the parts that aren’t part of your work at an alarming rate and in psych they forget a lot. On top of htat, they often weren’t the students who excelled at that kind of stuff anyway.

    Rachel – 8 years???? I guess that’s more acceptable when 1/4 or more of your income isn’t going to it.

    Wasn’t crazy about the Lam book.

    And it’s funny, it’s far from the first or only caring thing he’s done for me. It’s just that caring or not, it’s not really helping. I never really doubted that he cares, we just don’t see eye-to-eye on almost anything.

  18. Maybe youd do better with a female therapist. There may be things you need to discuss where the transference relationship you have will just get in the way, like I think youve noticed.
    I suspect its the nature of the transference thats making him think you lie in the borderline part of the spectrum.

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