Paradox of Success

It wasn't until recently, about eight years after graduating from high school, that I finally got over being ashamed of my grades. My class rank was thirteenth out of three hundred something (I think) and my GPA was over 4.0 from all the "gifted" level classes, but I wasn't perfect and it killed me. My closest friends were all in the intensely praised top ten and I was horrified not to be. Eventually I realized that I did damn well for myself. I did this during four years of constant depressive crisis. Holy wow.

No adults knew that I was depressed until the last semester or two of high school when I started breaking down in much more visible ways. When I read about the interventions that kids with mental illness get in school, I wonder what they would have done for me if my school knew how sick I was. Unfortunately, I doubt they would have done anything because I was still doing so well in school. There aren't many things I can think of that would have helped me other than letting me out of classes instead of having panic attacks over them, but I still doubt they would have even considered giving me any sort of help.

Along those lines, I think a lot of mental health care professionals have branded me with borderline personality disorder or malingering because I did still manage to do well in school. Mental illness severity is determined, in part, by how disruptive the symptoms are to one's everyday life and, for students, one easy indicator is school performance. If I have ace school performance but claim to be very very severely ill, that probably looks a little contradictory. A full schedule of successful extra-curricular activities probably didn't help my case. I can see how this might be confusing to a professional initially, as a first impression. But there were many professionals who spent enough time with me to see that schoolwork was a major coping mechanism of mine, that I am a really bad liar, and that every other aspect of my life was in shambles; they should have been open enough to revising their initial impressions of me to figure out that their impression needed revising. My complete and total desperation was seemingly understood as a perverse plea for pity and attention from a mildly depressed, but generally successful, girl. For a very long time there was no professional who was willing to accept my desperation as primary and try to fit in all the successful parts of my life in as secondary details, the rest started with the successes and filled in my expressed desperation as a detail.


New Psychiatrist

I decided that I needed a plan to stay out of the hospital. My idea was that this would give me more of a sense of safety in general and particularly in regard to wanting to come off medications as much as I can.  I didn't want one of those plans where I write a list of things that will help me cope through various states of distress, but ultimately still leaves the hospital as a last resort. The hospital needed to net even be a last resort. Current-psychiatrist is very quick to shout, "hospital!" so I needed a plan that would circumvent that.

Not knowing any psychiatrist who I could be honest with in a plan like this, I came up with a sneaky plan: when hospital becomes an imminent possibility, I would go into hiding (so that my psychiatrist could not find me to send the police for a "wellness check" or anything), I would act as my own psychiatrist in regard to handling medication changes, and I would buy any necessary medication on the black market. This is not a particularly safe or legal plan, but it is still a lot safer than using the hospital as my back up plan, in the way I understand and experience safety.

Therapist (previously known as "new-therapist") gave me a recommendation for a new psychiatrist instead. She said he is less quick to hospitalize his patients and he is more willing to acknowledge that the hospital cannot help some people and he is more willing to look for actual alternatives. Therapist says he is the best psychiatrist she knows, that she recommends him to almost everyone she knows, even her own family. Dietitian works in the same office as this psychiatrist and gives him similarly high praise.

I went to see this new psychiatrist last week. It went well. It was mostly just me giving him the history of my crazy (which is much easier when I am not in crisis, which is when I am usually giving this history). He reacted to me like a real person, took it at face value when I said that the hospital usually leaves me worse off, joked with me. When I mentioned my no-hospital plan, he mentioned camping in an Ohio forest as a hospital alternative. While I'm not sure that is the particular solution that would work for me in crisis, I am glad for him to have mentioned it because it showed that he took my no-hospital plan seriously and is willing to work with that. After talking to him, Therapist said he enjoyed me, said that I am the sort of person he likes to work with, characterized me as sardonic.

It is weird now to have a whole team (Therapist, Dietitian, Psychiatrist) of mental health care professionals who actually like me and like working with me. I've met so many who have had an antagonistic attitude toward me. So many have blamed me for the failures of their treatment, lied to me, ignored things I've said, not taken me seriously, assumed random things about me, attributed random (usually negative) motives to me rather than asking me, etc.

Having met so many professionals like that destroyed me in a lot of ways. For a while, it destroyed my sense of what was true about the world. When they contradicted my observations of reality, I assumed they were right, I was wrong, and that I was crazier than I was. It destroyed my sense of myself. When they called me manipulative and I couldn't see that in myself even with deep, honest introspection, I concluded that they were still probably right because the manipulative person herself is probably wouldn't recognize that in herself. They destroyed my sense of how I relate to others. Up until then, I had thought I was a generally likeable person. There had been so few people I had ever not gotten along with decently well. Then there was this huge group of people who seemed to loathe me. I was the common denominator, right? So I was more tentative about my belief that I am generally likeable and easy to get along with.

Now I know that my perceptions of reality are fine and always were. Now I know that I am not manipulative and never was. Now I'm learning that I'm generally likable. I'm still tentative about that last one. I still don't know why so many professionals dislike me so much. I've got a lot of hypotheses (I challenge their power, I don't get better the way they expect, they feel threatened by my intelligence, I recognize their lies and lack of respect for patients, etc.). It could be different for every professional who has disliked me, a different combination of little bits of different things, some of which could be among my hypotheses. (It has always seemed to me that there should be one big, over-arching explanation, since this dislike has been so consistent, but there might not be.)

My new psychiatrist like me, respects me, and is willing to work with me on my, not unreasonable, terms. That is a great thing. It is a weird thing. It is a sad thing that this is a weird thing to me.


Do my friends not believe me?







I'm going on hiatus. Mental health care issues rile me up and I'm trying to get to a point where they don't rile me up so much. It is really upsetting and no more helpful for my mental health than that mental health care itself. To do that, I'm going cold turkey on actively pursuing these things. Maybe for a short while, maybe for a long while, I don't know yet. Maybe if I don't actively pursue topics on the wretchedness of mental health care, those same topics will pursue me less. I'm going to close this blog to further comments, too, so that I don't have comments on old posts to rile me up. So I'm not going to be reading about mental health or mental health care during this time. I still love you and I'll still see some of you 'round on facebook, but not in the madosphere.


Subcultural Differences

When I wrote my thesis, there were a lot of things that didn't make it in for various reasons. One of those things was addressing subcultural differences between patients and mental health care professionals. One of the reasons this didn't make it in my thesis was that I didn't figure out a good way to research this (I wasn't sure how to get at this without getting things like emo, goth, etc; or religion and ethnicity).

What I was after in describing subcultural differences wasn't things like emo, goth, punk, straightedge types of subcultures, but smaller. Differences like the unique cultures within families, groups of friends, schools, etc. There are things that are perfectly normal within those subcultures that look weird, perhaps even crazy, to outsiders; but these things are pretty innocuous and totally acceptable on the inside.

In my social circles, most people are probably of above-average intelligence. We use words that others consider "big" and we are willing to ask if we don't know what a word means. We make puns, we tease grammar mistakes, and we acknowledge what we do not know. This is the world I live in.  In my social circles, no one ever considers that I have Asperger's because when I get confused by ambiguous grammar.

In mental health care, these things that are normal in my social circles is misunderstood and cause for them to suggest I have Asperger's:
  • When I use words they don't understand, they don't ask for clarification or definition. They seem to assume that whatever partial understanding they get is correct and then also assume that I use these big words to distance myself from people.
  • When I giggle after my doctor says, "we'll have to keep an eye on that," in response to my concern about a blurry vision drug side effect, the professionals look at me funny, just because they haven't noticed the pun.
  • When I object to the staff telling me, "today will be a better day than yesterday," while telling me that I can't know that today will be worse, they act like I'm just making trouble. They react to it like I am just doing something to annoy them and express my displeasure, not like I am reasonably criticizing the content of their treatment. Even when I explain that they can't know that today will be better anymore than I can know that today will be worse, they still don't understand me; they don't understand that they are wrong even according to their own rules.
  • When we took yarn to make a circle of how big we thought our waists are, our ideal waist size, and our actual waist size, there were exclamations about the yarn stretching when we measured our actual waists. The staff said that yarn does not stretch even after I, having spun my own yarn, explained that it does stretch, as a property of its creation.
  • After reading an article that very carefully defined and contrasted "self-worth" and "self-esteem", an art therapist told me to describe my current self-worth and what my self-worth would be if I was non-eating-disordered. However the article had defined "self-worth" as being immutable, everyone's value being infinite and unchanged by anything they did; while "self-esteem" was defined as one's appraisal of his or her value, which usually does not match their actual value, which is "self-worth". So asking me to describe my "self-worth" with and without the eating disorder made no sense. According to the article, my self-worth would be the same either way, and every person's self-worth is the same as everyone else's. I suspected this was not really what she wanted me to describe, and that I was really supposed to describe my self-esteem, but when I asked, I was accused of being needlessly pedantic. I really didn't know which to do though, since it seemed plausible that she would want us describing our self-worth to make the point that it shouldn't change between having an eating disorder and not having one. She wouldn't help me understand, so I made four lists, self-worth and self-esteem with and without an eating disorder.

In these situations, I'm right. I'm in touch with reality, I am not having any strange thoughts, I'm not pointlessly obstinate, I'm not doing anything wrong or against any rules, I am not expressing any symptoms. But I'm branded as resistant to treatment, as having Borderline Personality Disorder; they tell me I am wrong about physical facts of the world, they chide me for not wanting to get better. If their subculture was similar to mine, they would understand me better. They would understand the words I use or be willing to ask me to clarify, they would understand when I point out that they contradict themselves, they would admit that I know more about yarn than they do. If they were willing to allow for subcultural differences without knowing mine, they might ask how I know that yarn stretches or why I object to their statement that "today will be better." That is harder than asking me for my religion and ethnicity to determine subculture, but it is equally important. Mental health care is one of the places where I find it most important to be understood correctly, because the stakes are so high, and one of the places I am least understood.

(Situations like this make me wonder how most people manage to communicate. Mental health care professionals are not careful to say what they mean, even when asked for clarification, nor are they careful to listen to what I actually say. But most people don't seem to have nearly as much trouble communicating with them as I do. Are people on both ends making the same assumptions, ending with no confusion due to more or fewer assumptions? Are most people equally sloppy with grammar, that they are all making identical mistakes, therefore understanding correctly? When grammar is ambiguous, how do these people automatically assume the correct meaning?)


The victim is not the problem

Mental health care treatment focuses on changing the person who is suffering from mental distress. Even if the cause of the distress is abuse or racism or bullying.

On one hand, I understand this. There is no reason for the victim to have to live a miserable life just because his/her (token motion toward gender neutrality, henceforth ignored for the sake of not being awkward) abuser refuses to change. If it improves her life to avoid her abuser, to move away, to ignore what her abuser says, there is no reason for her not to do those things. I want her life to improve in any way possible.

But on the other hand, I can't help getting stuck. Changing the way the victim does things, telling her she is the one who must change, seems to tacitly accept what her abuser did. I know, I know; this is not necessarily the case, this is not always the case, but it sometimes is the case and it is something mental health care has a long history of being guilty for doing. A hundred years ago when men didn't want to deal with their wives, they sent them to the mental institution where the problem became the wife, instead of the husband. Political dissidents in the Soviet Union were locked in mental institutions to discredit their criticism of the government and imply that they, not the government, are the problem. When racism or sexism or homophobia is the problem, the mental health care professionals tell the victims they must change, often ignoring the greater problem. Strictly speaking, these victims are not ill, do not suffer from a mental illness, but are reacting in an entirely reasonable way to oppression or abuse. Putting them in mental health care implies that they are the problem and lets the abusers and oppressors off the hook.

I'm having a hard time with this. I don't want to be made miserable by the mental health care professionals who acted abusively toward me, it would be like letting them continue to abuse me. But I really really don't want to let them off the hook either. They are hurting so many people and it makes me sob when I think about it too much. I feel like I have to stop this oppression before I can do some kind of "change myself" thing to make myself feel better about it. But I'm pretty sure that will never happen. I have no ideas on how to solve this.


Assertiveness Formula

Practice in using the following assertiveness technique, taught in hospitals: "I feel... when you... because... please..."

I feel frustrated and angry (but I used to feel confused) when you give me contradictory rules because I cannot simultaneously follow contradictory rules, putting me in a no-win situation. Please don't give me contradictory rules and please listen to me when I question them.

I feel frustrated and angry (but I used to feel defeatist and confused) when you react defensively to my attempts at assertiveness because it was you who implored me to try being assertive and told me people would respond in kind. Please make my attempts at assertiveness with you a positive experience so that I am encouraged to be assertive elsewhere.

I feel attacked when you question my vegetarianism because it implies that you think I am lying. Please be upfront with me about the tricky situation you are in regarding the intersection between vegetarianism and eating disorders.

I feel frustrated when you nitpick about word choice (labeling feelings good or bad, using absolutes, etc.) because I have to rephrase my sentence to satisfy your requirements. I feel frustrated when you call me "pedantic" when I phrase my sentences in ways that unequivocally meet your requirements because that puts me in a no-win situation (either my words are wrong or I am a pedant). Please be consistent; don't nitpick about word choice at all or accept the consequences of nitpicking.

I feel angry when you don't take responsibility for your mistakes when I have taken responsibility for my mistakes because it makes me seem a scapegoat for the problem, being the only one to have admitted to making a mistake. Please take responsibility for your mistakes and please apologize for them.

I feel alienated and hopeless when you make generalizations about people with eating disorders that don't apply to me because it invalidates my own experience and implies that you don't understand people who don't fit that mold. Please don't make those generalizations or, at least, please phrase them without such exclusive language.

I feel sad, frustrated, powerless, and unimportant when you don't actively consider what I have to say because I can't change my situation any other way and if I were important, you would listen to me. Please listen to me and actively consider what I have to say, being open to that changing something.

I feel unimportant when you ask if I think I am a typical patient after I suggest ways to improve patient care. I feel this way because I hear the message that if I am an atypical patient, it is not worth considering my suggestions, as it helps only one patient. Please recognize that I am a patient, just as important as any other; please recognize that I may be atypical in my ability to verbalize these problems and suggest solutions, but I am typical in my being hurt by these problems; please recognize that I haven't suggested anything that wouldn't improve patient care generally, even if it is in areas that other patients are unable to identify. 

I feel relieved and surprised when you apologize to me, respect me, or make a change in response to me because my experiences in mental health care have led me to expect the opposite. Thank you. Please continue.

I feel sad and angry when you foster an environment that leads me to distrust mental health care professionals and expect to be disrespected because that is not an environment conducive to improving mental health. Please do better.



I feel betrayed. I was an active member of the Patient and Family Advisory Council of the local psych hospital since the council's inception. I have been away from it for the last six months because they require that patient members not have been a patient there for the last six months. According to that rule, I can return in September, but I think I might hold off until I am feeling the betrayal less acutely.

The hospital staff who were also members of the council were outwardly very polite and respectful toward me. They didn't treat me like a patient, that is, they did not treat me like a fragile china doll, insult my intelligence, or make unwarranted assumptions about me. Still, after a few meetings (once a month), I began to feel uneasy about them. When I made criticisms, they often agreed with my assessments, which I took cautiously as a good sign. Cautious because I doubt any therapist would say that invalidation is good therapy, even if the therapist in question routinely invalidates patients, but a good therapist would answer similarly.

When I mentioned specific situations that happened to me at their hospital, they were sometimes dismissed. The organizer of the council would often note that the self-injury program I had been in wasn't really part of their hospital, but rented space and had their own rules and ways of doing things. Any criticism pertaining to my experience of being in their eating disorders program as a for-really-real vegetarian (meaning my vegetarianism was not related to my eating disorder) was dismissed because vegetarianism was "allowed" now (explanation below).  Sometimes, for criticisms they couldn't dismiss so conveniently, they apologized, but implied that the situations were aberrations and they never knew of those things going on. I had no defense in the face of these excuses because I hadn't been a patient in their hospital for several years and couldn't know that things were still the same. But I suspected things were not so different as they implied. These excuses and dismissals became more frequent over time. Perhaps they tired of me, perhaps I was getting bolder in my criticism and they were feeling more defensive than before, I don't know.

When I was in the partial hospital program in February, my suspicions were confirmed. All the tendril-squishing stories I've written are the sorts of criticisms I made before, but didn't know for sure would still apply. Vegetarianism was allowed this time, which the director of the unit knew, but the dietitian didn't know and I was still held in suspicion for my vegetarianism. The criticisms I had of the self-injury program were mostly still relevant in the eating disorder program, which I suspected because the two programs were not all that differently run when I had been in each several years ago.

The hospital staff members of the council took me in, asked for my feedback, and lied to me when I gave it. Maybe those in the council (more directors and managers than direct patient care staff) are out of touch with what is actually happening between patients and staff. Maybe they know what happens between patients and staff, but are unable to understand how those interactions might be felt by patients, even when a former patient is sitting across the table telling them what happened and how it felt. Maybe they know exactly what is going on and are ashamed and trying to save face. Maybe they know exactly what is going on, but don't think of it as a problem, but make excuses because they see that I think it is something to be ashamed of and that I would be offended if they didn't think it a problem. Maybe when I say, "she told me to hope, and it felt to me like a punch in the face," they are able to see that as a bad thing because they hear it from my perspective, but they aren't able to connect that to situations where they see their staff encourage other patients to hope, because they are conditioned to view that positively. Maybe it is something else entirely, I can't know for sure.

What I do know for sure is that I made criticisms, they were countered with various excuses that I didn't have enough information to dismiss, and when I went back as a patient, almost all my original criticisms were still valid. Whether they intentionally misled me or not, I feel betrayed and I do not think it is unreasonable of me to feel that way.

I do intend to bundle up all my tendril-squishing posts, clean them up and add in specific details that I leave out here to protect anonymity (names, places, etc.), and send copies to the eating disorder unit, the recent perpetrator of these ugly situations, and to the managerial people who have excused away my criticisms, both because they are the superiors to the eating disorder unit, and to point out their own sins. I don't know that anything will come of that, but I do know nothing can come of it if I don't do it.


Pedantry and Gray Thinking

I am normally a bit pedantic (perhaps a lot pedantic). I try to avoid absolutes. I tease people when they say things slightly grammatically incorrectly, especially when it leads to a very different, often humorous, literal meaning than they meant. ("I saw that terrible movie in theaters." Really, why did you see it in multiple theaters if it was so awful?) I'm able to exercise restraint with this, I don't tease like this at work or in serious situations. Usually I do know what people actually mean to say, but just tease them to be silly. Sometimes I genuinely don't know what someone is saying when it is ambiguous or I suspect they misspoke. ("Walmart employees asked to stay behind while flood waters rise" Did the employees ask or were they asked?)

When I am a patient in a mental health care situation, I become pedantic to the extreme. I don't do this to tease, I don't do it to be annoying, I do it in an attempt to avoid trouble. It doesn't really work.

In a staffing I said I felt yelled at. They said they didn't yell, being a bit pedantic. I only said I felt yelled at, so whether I really was or not is immaterial. Also, yes, I might take that pedantic approach to tease, but this is not a teasing situation, and it is a common colloquialism for people to say they were yelled at when no voices were actually raised. I revised to say I felt they were reprimanding me. They said it wasn't a reprimand. I revised to say that they had confronted me because they thought I had done something that they thought was sub-optimal, sub-par, damaging, eating-disordered, inadequate and the confrontation caused me to feel crummy especially because I hadn't actually done the thing they were confronting me over. My final explanation was incredibly pedantic, but they necessitated it with their blanket dismissals of my previous explanations. I had to go to a level of irrefutable, literal fact just to avoid getting dismissed. Many patients would give up without being understood, some might not be able to explain themselves sufficiently pedantically. The professionals could have responded differently to me, in a way that wouldn't be so prone to shutting down conversation. (They tell us how important it is to feel heard, but when they shut down conversations like this, they are making it doubly difficult to be heard. If I didn't insist on clarifying, what lesson do they think I would have come away with? The lesson I did come away with is bad enough.) They could have said, "No one here actually raised their voices to you. What do you mean by feeling yelled at? Did you feel insulted or scared or like we were angry, or what?" They did not express interest in understanding me, just dismissed my statements because they were not literally true (although I would argue that, too). I am pedantic for the sake of understanding (or humor), this seems like pedantry for the sake of evasion.

Depressed people are often overly pessimistic and sometimes make unqualified negative statements. ("Today is going to be awful.") Staff often challenge patients when they make those unqualified negative statements, usually with the argument that they do not know for certain that the day will be awful because they cannot know the future. I can deal with that, they are correct and I see their point. But the staff often make unqualified positive statements. They say "today is going to be great" or tell patients to tell themselves that. I confronted a staff member once who made an unqualified positive statement not five minutes after chiding a patient for an unqualified negative statement. I told her that she didn't know that day would be great anymore than I knew that day would be awful. She said, "I'm just trying to get you guys to think positive," and walked away. In similar situations, I have been told I'm just being pedantic. I am perhaps being a bit devious and trying to make a point in these situations, I don't think that excuses their evasive responses. It doesn't change the fact that we are being equally pedantic, but the rules appear differ between positive and negative, patient and professional. There is still this internally inconsistent system of logic being promoted, one that leaves patients entirely dependent on the staff to do their thinking. It is impossible for me to know where they will be reasonable and logical and where they will be arbitrary. Based on my experience, I tend to assume they will eschew logic at most opportunities, leaving me genuinely surprised and in disbelief when I encounter a professional who acts consistently logically and reasonably.

Professionals harp on and on about avoiding black-and-white thinking. Live in the gray! Live in the rainbow! Black thinking and making unqualified negative statements are confronted and refuted. "You can't possibly know that today will be awful because you can't foretell the future." Okay, your pedantic rules. So if I am to avoid black-and-white thinking, yet still express how I feel, I say, "I feel like today is going to be awful, I don't expect anything to go well" I have not expressed an absolute! I have used an "I" statement! I have done exactly what they have told me to do! What sort of response do I get? "You can't possibly know that today will be awful." I know that, but I still feel hopeless, which is why I used an "I" statement and said "I feel" rather than making an absolute statement. "I don't remember what words you used, I don't want to argue semantics." Wait, what? You nitpicked about my words being black-and-white, I conformed to your rules, you accused me of still being black-and-white, I pointed out that I had followed your rules, and then you dismiss me for arguing semantics? (And I'm the crazy one?) If it is that they are focusing on black-and-white thinking over black-and-white speaking, the situation is no better because I acknowledge uncertainty in thought even when I don't acknowledge it in word. How can they know that I do not? They don't ask; they focus on what I say. I can't win if I don't follow their rules because I get a lecture. I can't win if I do follow their rules because they don't notice, I still get a lecture, and they dismiss me when I point out that I followed the rules.

They want us to avoid black-and-white thinking, so when we are prone to unqualified negative statements, shouldn't the counter be gray statements of possibility rather than blindingly white statements of unqualified positivity? I would say yes. Realism is (part of) the gray area between pessimism and optimism. But whenever I would try to establish a realistic perspective with a staff person, a compromise between my black and their white, they would still tell me I was being negative. I was attempting to bring them into the gray zone by compromising and finding realism, but they called it pessimism and insisted on unqualified optimism. If they are going to teach me to avoid black-and-white thinking, it would be nice if they modeled it for me.








My head nearly exploded.
