How can I feel comfortable with my psychiatrist again?
July 1, 2015 7:14 AM Subscribe
My psychiatrist lost his temper with me on the phone yesterday and said a lot of hurtful things. I must have deserved them, but I feel terrible. I have an appointment with him tomorrow (7/2) at 8am EST I need help figuring out how to keep my cool and understand how to be both a better patient and a better person.
I apologize in advance for how incredibly long this is, and thanks in advance for those of you who read it.
I have a long-standing (~4 year) relationship with my psychiatrist, to whom I am forever grateful for pulling me out of a deep, prolonged suicidal depression in 2012. He took care of me and for a long time and was very understanding, patient, and seemed genuinely pleased to have me as a patient. I have also consistently been in talk therapy during this time, also within his practice (but not with him, rather with various therapists that report to him.)
I have a very long history of MDD and GAD, since I was about 14 years old. This psychiatrist also diagnosed me with Borderline Personality Disorder in the last year, though he said I only exhibit certain traits of it (mood lability, abandonment issues) and not others (impulsivity, splitting, manipulation). This is just for your background understanding of who I am. I see a separate therapist entirely at a different practice for DBT skills treatment for the BPD.
In the past couple of years, I have realized through trial and error, trauma, and extensive research (without his help, but with his understanding and support) that I have serious hormonal issues that make me sensitive to many types of birth control that have a very specific kind of progestin, and this has exacerbated my mental health issues severely. I will not go too far down that rabbit hole here, but the short(ish) of it is that in the past 3 years of being on countless birth control methods (and sometimes none at all), I've realized that certain types make me profoundly suicidal. One of these is Nexplanon, which I had to have removed recently after another 3 month ordeal with deep suicidal depression. I will be getting a tubal ligation soon, but had to go back on birth control pills in the meantime (one of the traumas I experienced recently is pregnancy and abortion, so I want to be as cautious as possible).
I want to interject here and explain that during this last 3-month bout of suicidal depression, the one that ended with the Nexplanon removal, my pharmacy mistakenly gave me half of my prescription of Klonopin. I didn't notice until it was too late unfortunately, and since it's the type of drug that people abuse, I had to contact my psych for assistance. While he did call a new script in, he assumed that I had been taking more (I wasn't -- I keep strict tabs on my medication intake), and cut me off any time I tried to explain otherwise, saying that it was irrelevant and he didn't have time or energy to listen to me. I didn't feel comfortable seeing him after that. I haven't gone in since, but have continued my talk therapy.
Back to the story. My gynecologist noticed that I was taking a mood stabilizer that interferes with the efficacy of my new birth control and told me to stop taking it immediately, and to contact my psychiatrist right away so I could get on a different mood stabilizer. I called the office to make an appointment with my psych, but he didn't have one available for over a week. Knowing that it would not be healthy for me to discontinue mood stabilizers for so long, I left him a voicemail explaining the situation and asking if he could call in my old mood stabilizers (that don't interact with my birth control) while I wait to see him in person. He didn't return my call. I left 2 more voicemails over the course of the next 3 days, and at this point my mood was plummeting as I felt the results of discontinuing a needed medication. I finally called my therapist and asked if she could speak to him, since I wasn't sure why he wasn't getting back to me.
He finally called me back. He seemed very angry. I admit that I was crying throughout the call (quietly, but still, really horrible form on my part, but I can't control my tears). He told me he'd heard my voicemails, but had no intention of returning my calls because he saw I had an appointment with him scheduled and he didn't see any reason why my request was urgent or important. "I don't remember ever telling you to discontinue your mood stabilizer." I explained again that my gynecologist told me to discontinue immediately. He sighed and looked up my new birth control, declared that my gynecologist was wrong, and told me to continue taking the medication. He admonished me for making phone calls instead of coming in (again, I took the first available appointment, which isn't until tomorrow).
He then asked me why I hadn't been coming. I explained that I was uncomfortable and scared to come in to see him. I told him that he was clearly very angry with me. He said he was definitely frustrated with me (he didn't explain why), but certainly not angry. I also said that I was scared to come in after the way he'd handled the Klonopin issue. He told me that I was projecting, and that it hadn't registered for him as an issue. "We will never know how that medication got lost," he said. And then I made a really horrible mistake. I said (and admittedly I said it very calmly, but still, it was just so horrible of me to say): "Doctor, the medication wasn't lost."
And then he began to yell at me. "You know what, timory? I told you I wasn't angry and you don't believe me. I don't have the time or desire to deal with you or your problems. I'm not going to sit here and give you therapy and listen to your problems when all of your pathologies about abandonment and fear of criticism are coming out right here on the phone. You are being completely ridiculous!"
Then I made my second huge mistake and (still crying, I seriously have a problem controlling my tears, and I know that is a MAJOR failing of mine) told him, also quietly but I was making an idiotic attempt to stand up for myself, that I felt even more uncomfortable seeing him after hearing him say that. He said, "are you seriously telling me that you want to end our therapy relationship right now?" I stammered and said no, no, I don't know what I want. "I'm just really not well," I said. "No, you're not!" he screamed. "And you called me ridiculous, so..." but he interrupted me and said "Yeah, you ARE being ridiculous!"
I was at a total loss. I apologized profusely, and he said "apology accepted" very curtly. I told him I'd be in for my appointment. He repeated that he really thought I was "better than this" and that discussions like this need to happen in person, which is absolutely true.
This man is a professional and I trust him, and I want to please him. Making sure that he is happy with me is more important to me than my well-being. I am trying to understand sincerely what I have done wrong, and to tamp down the parts of me that are saying "it's not okay for him to treat mw like this."
Things to consider:
I'm an unreliable narrator. Since having the Nexplanon removed, the suicidality lifted almost immediately. However, my life circumstances right now are not particularly good, and I am not in a great place in general. I haven't slept more than a few hours a night for about two weeks (I'm one of those weenies who needs 8-9 hours/night to be functional). I am prone to exaggeration and hyperbole. I had been crying throughout the phone call, so perhaps he believed that I was manipulating him. Perhaps my account here is completely inaccurate, as well? I have tried to present this objectively, but I know that my pathologies prevent that from being possible.
Here is how I'm trying to handle things, but I need more help:
He is only human, and I must have behaved ridiculously. I should have realized that it was totally ridiculous to have such a fear of pregnancy that I'm uncomfortable having sex with both birth control and a condom if the BC's efficacy is lowered by a mood stabilizer. I should never have stopped taking the mood stabilizer just because my gyno told me to. I should just have abstained from sex altogether until my psych was able to see me in person and never have left him any voicemails at all. Then all of this could have been avoided. It was in no way an emergency and calling him AND my therapist was outrageous, and he was more than justified in his frustration and outburst. His methods of ignoring telephone calls may simply be a form of training me to realize that my behavior is unacceptable. Yelling at me might be a form of tough love. He knows that I have extremely deep-seated self-hatred and that I put other people's needs before mine, so while every fiber of my being is screaming "everything he said makes me hate myself more!", I know he either did it out of tough love or just because I had really tested his patience so much with my abhorrent behavior that he just couldn't take it anymore.
Any advice is extremely appreciated. I see him tomorrow at 8am, and I am panicking so much that I can focus on nothing else. I am trying to meditate and use the skills I've learned in DBT, but I'm really struggling.
I have a long-standing (~4 year) relationship with my psychiatrist, to whom I am forever grateful for pulling me out of a deep, prolonged suicidal depression in 2012. He took care of me and for a long time and was very understanding, patient, and seemed genuinely pleased to have me as a patient. I have also consistently been in talk therapy during this time, also within his practice (but not with him, rather with various therapists that report to him.)
I have a very long history of MDD and GAD, since I was about 14 years old. This psychiatrist also diagnosed me with Borderline Personality Disorder in the last year, though he said I only exhibit certain traits of it (mood lability, abandonment issues) and not others (impulsivity, splitting, manipulation). This is just for your background understanding of who I am. I see a separate therapist entirely at a different practice for DBT skills treatment for the BPD.
In the past couple of years, I have realized through trial and error, trauma, and extensive research (without his help, but with his understanding and support) that I have serious hormonal issues that make me sensitive to many types of birth control that have a very specific kind of progestin, and this has exacerbated my mental health issues severely. I will not go too far down that rabbit hole here, but the short(ish) of it is that in the past 3 years of being on countless birth control methods (and sometimes none at all), I've realized that certain types make me profoundly suicidal. One of these is Nexplanon, which I had to have removed recently after another 3 month ordeal with deep suicidal depression. I will be getting a tubal ligation soon, but had to go back on birth control pills in the meantime (one of the traumas I experienced recently is pregnancy and abortion, so I want to be as cautious as possible).
I want to interject here and explain that during this last 3-month bout of suicidal depression, the one that ended with the Nexplanon removal, my pharmacy mistakenly gave me half of my prescription of Klonopin. I didn't notice until it was too late unfortunately, and since it's the type of drug that people abuse, I had to contact my psych for assistance. While he did call a new script in, he assumed that I had been taking more (I wasn't -- I keep strict tabs on my medication intake), and cut me off any time I tried to explain otherwise, saying that it was irrelevant and he didn't have time or energy to listen to me. I didn't feel comfortable seeing him after that. I haven't gone in since, but have continued my talk therapy.
Back to the story. My gynecologist noticed that I was taking a mood stabilizer that interferes with the efficacy of my new birth control and told me to stop taking it immediately, and to contact my psychiatrist right away so I could get on a different mood stabilizer. I called the office to make an appointment with my psych, but he didn't have one available for over a week. Knowing that it would not be healthy for me to discontinue mood stabilizers for so long, I left him a voicemail explaining the situation and asking if he could call in my old mood stabilizers (that don't interact with my birth control) while I wait to see him in person. He didn't return my call. I left 2 more voicemails over the course of the next 3 days, and at this point my mood was plummeting as I felt the results of discontinuing a needed medication. I finally called my therapist and asked if she could speak to him, since I wasn't sure why he wasn't getting back to me.
He finally called me back. He seemed very angry. I admit that I was crying throughout the call (quietly, but still, really horrible form on my part, but I can't control my tears). He told me he'd heard my voicemails, but had no intention of returning my calls because he saw I had an appointment with him scheduled and he didn't see any reason why my request was urgent or important. "I don't remember ever telling you to discontinue your mood stabilizer." I explained again that my gynecologist told me to discontinue immediately. He sighed and looked up my new birth control, declared that my gynecologist was wrong, and told me to continue taking the medication. He admonished me for making phone calls instead of coming in (again, I took the first available appointment, which isn't until tomorrow).
He then asked me why I hadn't been coming. I explained that I was uncomfortable and scared to come in to see him. I told him that he was clearly very angry with me. He said he was definitely frustrated with me (he didn't explain why), but certainly not angry. I also said that I was scared to come in after the way he'd handled the Klonopin issue. He told me that I was projecting, and that it hadn't registered for him as an issue. "We will never know how that medication got lost," he said. And then I made a really horrible mistake. I said (and admittedly I said it very calmly, but still, it was just so horrible of me to say): "Doctor, the medication wasn't lost."
And then he began to yell at me. "You know what, timory? I told you I wasn't angry and you don't believe me. I don't have the time or desire to deal with you or your problems. I'm not going to sit here and give you therapy and listen to your problems when all of your pathologies about abandonment and fear of criticism are coming out right here on the phone. You are being completely ridiculous!"
Then I made my second huge mistake and (still crying, I seriously have a problem controlling my tears, and I know that is a MAJOR failing of mine) told him, also quietly but I was making an idiotic attempt to stand up for myself, that I felt even more uncomfortable seeing him after hearing him say that. He said, "are you seriously telling me that you want to end our therapy relationship right now?" I stammered and said no, no, I don't know what I want. "I'm just really not well," I said. "No, you're not!" he screamed. "And you called me ridiculous, so..." but he interrupted me and said "Yeah, you ARE being ridiculous!"
I was at a total loss. I apologized profusely, and he said "apology accepted" very curtly. I told him I'd be in for my appointment. He repeated that he really thought I was "better than this" and that discussions like this need to happen in person, which is absolutely true.
This man is a professional and I trust him, and I want to please him. Making sure that he is happy with me is more important to me than my well-being. I am trying to understand sincerely what I have done wrong, and to tamp down the parts of me that are saying "it's not okay for him to treat mw like this."
Things to consider:
I'm an unreliable narrator. Since having the Nexplanon removed, the suicidality lifted almost immediately. However, my life circumstances right now are not particularly good, and I am not in a great place in general. I haven't slept more than a few hours a night for about two weeks (I'm one of those weenies who needs 8-9 hours/night to be functional). I am prone to exaggeration and hyperbole. I had been crying throughout the phone call, so perhaps he believed that I was manipulating him. Perhaps my account here is completely inaccurate, as well? I have tried to present this objectively, but I know that my pathologies prevent that from being possible.
Here is how I'm trying to handle things, but I need more help:
He is only human, and I must have behaved ridiculously. I should have realized that it was totally ridiculous to have such a fear of pregnancy that I'm uncomfortable having sex with both birth control and a condom if the BC's efficacy is lowered by a mood stabilizer. I should never have stopped taking the mood stabilizer just because my gyno told me to. I should just have abstained from sex altogether until my psych was able to see me in person and never have left him any voicemails at all. Then all of this could have been avoided. It was in no way an emergency and calling him AND my therapist was outrageous, and he was more than justified in his frustration and outburst. His methods of ignoring telephone calls may simply be a form of training me to realize that my behavior is unacceptable. Yelling at me might be a form of tough love. He knows that I have extremely deep-seated self-hatred and that I put other people's needs before mine, so while every fiber of my being is screaming "everything he said makes me hate myself more!", I know he either did it out of tough love or just because I had really tested his patience so much with my abhorrent behavior that he just couldn't take it anymore.
Any advice is extremely appreciated. I see him tomorrow at 8am, and I am panicking so much that I can focus on nothing else. I am trying to meditate and use the skills I've learned in DBT, but I'm really struggling.
I don't see that you did anything wrong, and I'm very concerned about how hard you're being on yourself for:
- Not allowing the Klonopin mixup to be dismissed as "lost" (totally reasonable! Not a "horrible mistake" to stick to your guns about this!)
- Being a human being going through a rough patch who cries. He's a psychiatrist. (Talking to his distressed patients on the phone occasionally is part of the job!)
- following other doctors' advice about meds interactions. (You did the straight-up right thing here.)
You sound like you acted completely normally.
posted by purpleclover at 7:27 AM on July 1, 2015 [31 favorites]
- Not allowing the Klonopin mixup to be dismissed as "lost" (totally reasonable! Not a "horrible mistake" to stick to your guns about this!)
- Being a human being going through a rough patch who cries. He's a psychiatrist. (Talking to his distressed patients on the phone occasionally is part of the job!)
- following other doctors' advice about meds interactions. (You did the straight-up right thing here.)
You sound like you acted completely normally.
posted by purpleclover at 7:27 AM on July 1, 2015 [31 favorites]
Whoa, you are being way too hard on yourself. No mental health professional should ever treat you this way. No type of professional, period. I would find another psychiatrist who is not mean and impatient with the very symptoms that he or she exists to treat.
posted by something something at 7:28 AM on July 1, 2015 [17 favorites]
posted by something something at 7:28 AM on July 1, 2015 [17 favorites]
Unless you are describing the content of outright delusions, the psychiatrist's behavior was badly out of line, to the point where you should find a different one. Really, he should probably be reported to some sort of oversight body for this, but it's very understandable that you don't have the energy to do something like that now.
At any rate, stop defending him. Making excuses for what he did is not productive; there's no legitimate excuse for how he acted. The fact that he decided to yell at you because you followed your gynecologist's advice or for calling his office to ask advice is so out of line with appropriate ways to care for patients that I'm worried about the other people in his practice.
I'm sure it's hard to find someone new, and I wish I had concrete advice to offer on that front, but you need to find someone different from him. It's obvious that, whether or not he's helped you in the past, he's no longer providing adequate care -- you've even been avoiding seeing him because he treated you so badly in the wake of a pharmacy screwup. It also sounds like he dropped the ball on helping you figure out your birth control issues, since you say that it was basically you who figured it out, not the doctor you visit who is supposed to be an expert on how drugs affect the brain.
If you need to visit him to get more drugs before you can start searching for a more adequate doctor, do it, but if you don't, cancel tomorrow's appointment. No one needs that kind of shit in their life, you deserve way better.
posted by mister pointy at 7:30 AM on July 1, 2015 [20 favorites]
At any rate, stop defending him. Making excuses for what he did is not productive; there's no legitimate excuse for how he acted. The fact that he decided to yell at you because you followed your gynecologist's advice or for calling his office to ask advice is so out of line with appropriate ways to care for patients that I'm worried about the other people in his practice.
I'm sure it's hard to find someone new, and I wish I had concrete advice to offer on that front, but you need to find someone different from him. It's obvious that, whether or not he's helped you in the past, he's no longer providing adequate care -- you've even been avoiding seeing him because he treated you so badly in the wake of a pharmacy screwup. It also sounds like he dropped the ball on helping you figure out your birth control issues, since you say that it was basically you who figured it out, not the doctor you visit who is supposed to be an expert on how drugs affect the brain.
If you need to visit him to get more drugs before you can start searching for a more adequate doctor, do it, but if you don't, cancel tomorrow's appointment. No one needs that kind of shit in their life, you deserve way better.
posted by mister pointy at 7:30 AM on July 1, 2015 [20 favorites]
Find a new doctor. I wouldn't go to anyone who treated me like that.
posted by three_red_balloons at 7:33 AM on July 1, 2015 [11 favorites]
posted by three_red_balloons at 7:33 AM on July 1, 2015 [11 favorites]
Woah. I'm no kind of expert and I can only go on what you've written here, but to me that sounds 100% unprofessional, inappropriate, and outright cruel on his part. In particular, I don't see how he was in any way right to upbraid and insult you and, well, be an asshole towards you, especially when you were in such a vulnerable state. It doesn't sound to me like it was in any way deserved or that his behaviour should be excused as some kind of understandable consequence of your own.
In your position I would definitely be looking for a new psychiatrist ASAP, in the meantime doing only what is needed to ensure your medication is maintained.
posted by Drexen at 7:34 AM on July 1, 2015 [6 favorites]
In your position I would definitely be looking for a new psychiatrist ASAP, in the meantime doing only what is needed to ensure your medication is maintained.
posted by Drexen at 7:34 AM on July 1, 2015 [6 favorites]
There are no circumstances under which it would be okay for ANY medical professional to say what he said to you. You NEVER deserve to be verbally abused by a therapist or any other doctor. Dump him, block his numbers, and treat yourself kindly as you seek out a new support system.
posted by Hermione Granger at 7:35 AM on July 1, 2015 [11 favorites]
posted by Hermione Granger at 7:35 AM on July 1, 2015 [11 favorites]
Response by poster: If you need to visit him to get more drugs before you can start searching for a more adequate doctor, do it, but if you don't, cancel tomorrow's appointment. No one needs that kind of shit in their life, you deserve way better.
My concern is that I also have an appointment with my therapist tomorrow, who is in the same practice, and who works for him. I am not sure if I can keep seeing her if I do not see him. I think I have to see him in order to keep seeing her. They work together as my mental health team to determine what's best for me. Up until the 6-9 months or so it's been a very good system.
posted by timory at 7:36 AM on July 1, 2015
My concern is that I also have an appointment with my therapist tomorrow, who is in the same practice, and who works for him. I am not sure if I can keep seeing her if I do not see him. I think I have to see him in order to keep seeing her. They work together as my mental health team to determine what's best for me. Up until the 6-9 months or so it's been a very good system.
posted by timory at 7:36 AM on July 1, 2015
You should tell your therapist precisely what you told us. So she can report him for his unprofessional behaviour.
Pleasing him is not more important than your wellbeing. They are your employees. You hire them. Your wellbeing is their job.
posted by Mistress at 7:38 AM on July 1, 2015 [78 favorites]
Pleasing him is not more important than your wellbeing. They are your employees. You hire them. Your wellbeing is their job.
posted by Mistress at 7:38 AM on July 1, 2015 [78 favorites]
He is only human, and I must have behaved ridiculously.
Given your background, it's understandable that you try to rely on the reactions of other people you know well as opposed to just the narrative in your head when it comes to the question "am I being reasonable here?" But in this case, I suspect this strategy's backfiring, because the second half of that sentence really doesn't follow the first. He is only human, and given the context you've provided, he's the one whose reactions seem ridiculous, here. Humans can have crappy weeks and snap at people unkindly. I wouldn't be able to deal with that in a mental health professional (well, at least if they didn't check themselves and apologize immediately) but it sounds like you have a longstanding productive relationship with this guy, so in your shoes I'd go to the appointment and evaluate from there.
posted by deludingmyself at 7:41 AM on July 1, 2015 [4 favorites]
Given your background, it's understandable that you try to rely on the reactions of other people you know well as opposed to just the narrative in your head when it comes to the question "am I being reasonable here?" But in this case, I suspect this strategy's backfiring, because the second half of that sentence really doesn't follow the first. He is only human, and given the context you've provided, he's the one whose reactions seem ridiculous, here. Humans can have crappy weeks and snap at people unkindly. I wouldn't be able to deal with that in a mental health professional (well, at least if they didn't check themselves and apologize immediately) but it sounds like you have a longstanding productive relationship with this guy, so in your shoes I'd go to the appointment and evaluate from there.
posted by deludingmyself at 7:41 AM on July 1, 2015 [4 favorites]
I must have deserved them ... how to be a better patient ... really horrible form on my part ... I made a really horrible mistake ... I made my second huge mistake ... a MAJOR failing of mine ... I trust him, and I want to please him ... I apologized profusely
After four years of therapy, I don't understand why you sound like the abused half of an abusive relationship.
Making sure that he is happy with me is more important to me than my well-being.
In fact, this is so on-the-nose that I almost wonder if you're putting it on a bit.
But assuming you're not: You're a customer, not a victim. You're getting bad service. Find a new service provider. If you're not ready to DTMFA, print out what you wrote here, take it with you to your appointment and follow deludingmyself's advice.
posted by Leon at 7:45 AM on July 1, 2015 [59 favorites]
After four years of therapy, I don't understand why you sound like the abused half of an abusive relationship.
Making sure that he is happy with me is more important to me than my well-being.
In fact, this is so on-the-nose that I almost wonder if you're putting it on a bit.
But assuming you're not: You're a customer, not a victim. You're getting bad service. Find a new service provider. If you're not ready to DTMFA, print out what you wrote here, take it with you to your appointment and follow deludingmyself's advice.
posted by Leon at 7:45 AM on July 1, 2015 [59 favorites]
Someone could be very good for/to you with one problem - the first bout of serious depression - while not being good for/to you for other problems. Maybe this is a guy who can have compassion when someone is in an extreme state but who is really shitty at dealing with people on a routine "I have low level problems" basis. The guy could have helped you a lot - for real, from a place of compassion - in the past, while hurting you badly now.
You don't know what's going on in his life that might make him speak inappropriately to you. Maybe he's in the middle of a nasty divorce. Maybe he's addicted to something. This isn't to excuse his behavior - on the contrary!! - but rather to point out that someone can be really, really shitty to you and not only can it not be your fault but it can have nothing to do with you at all.
I am concerned by this whole "I am an unreliable narrator" bit in light of your other comments. Obviously, IANYP, but I know a couple of people with BPD diagnoses (which has made me skeptical of the way BPD is diagnosed/framed in our society, but that's another story) and I have a couple of friends who really are unusually unreliable narrators, and I have never known any of them to describe something where someone said harsh stuff to them and have it just be their diagnosis or unreliability talking. I've known people to take things a little too seriously, sure, but not with the kind of thing you're describing - only with things that were genuinely ambiguous.
He is only human, and I must have behaved ridiculously. I should have realized that it was totally ridiculous to have such a fear of pregnancy that I'm uncomfortable having sex with both birth control and a condom if the BC's efficacy is lowered by a mood stabilizer. I should never have stopped taking the mood stabilizer just because my gyno told me to. I should just have abstained from sex altogether until my psych was able to see me in person and never have left him any voicemails at all. Then all of this could have been avoided. It was in no way an emergency and calling him AND my therapist was outrageous, and he was more than justified in his frustration and outburst. His methods of ignoring telephone calls may simply be a form of training me to realize that my behavior is unacceptable. Yelling at me might be a form of tough love. He knows that I have extremely deep-seated self-hatred and that I put other people's needs before mine, so while every fiber of my being is screaming "everything he said makes me hate myself more!", I know he either did it out of tough love or just because I had really tested his patience so much with my abhorrent behavior that he just couldn't take it anymore.
Is it possible that one thing you struggle with is proportion? That's something that I struggle with as an anxious person - it's very difficult for me to say "maybe I didn't make a great choice, but this person was still an asshole". It always has to be "unless I was perfect, my behavior was awful and anyone's behavior to me was justified" or "If someone was awful to me, I need to comb through my behavior until I find the thing that justified what they did".
Perhaps you were really irritating, perhaps your psychiatrist was tired, perhaps he feels that you need 'tough love'....but still, assuming the basic truth of your account here, the guy was yelling at a crying patient over the phone and has - apparently based on nothing about you - decided that you somehow caused your Klonopin issue and are lying about it. Those things aren't okay or normal behaviors, and if he can't control those things, he needs some medical leave for himself.
I think I would look into finding another doc, and I would share some of this with your other therapist.
posted by Frowner at 7:46 AM on July 1, 2015 [16 favorites]
You don't know what's going on in his life that might make him speak inappropriately to you. Maybe he's in the middle of a nasty divorce. Maybe he's addicted to something. This isn't to excuse his behavior - on the contrary!! - but rather to point out that someone can be really, really shitty to you and not only can it not be your fault but it can have nothing to do with you at all.
I am concerned by this whole "I am an unreliable narrator" bit in light of your other comments. Obviously, IANYP, but I know a couple of people with BPD diagnoses (which has made me skeptical of the way BPD is diagnosed/framed in our society, but that's another story) and I have a couple of friends who really are unusually unreliable narrators, and I have never known any of them to describe something where someone said harsh stuff to them and have it just be their diagnosis or unreliability talking. I've known people to take things a little too seriously, sure, but not with the kind of thing you're describing - only with things that were genuinely ambiguous.
He is only human, and I must have behaved ridiculously. I should have realized that it was totally ridiculous to have such a fear of pregnancy that I'm uncomfortable having sex with both birth control and a condom if the BC's efficacy is lowered by a mood stabilizer. I should never have stopped taking the mood stabilizer just because my gyno told me to. I should just have abstained from sex altogether until my psych was able to see me in person and never have left him any voicemails at all. Then all of this could have been avoided. It was in no way an emergency and calling him AND my therapist was outrageous, and he was more than justified in his frustration and outburst. His methods of ignoring telephone calls may simply be a form of training me to realize that my behavior is unacceptable. Yelling at me might be a form of tough love. He knows that I have extremely deep-seated self-hatred and that I put other people's needs before mine, so while every fiber of my being is screaming "everything he said makes me hate myself more!", I know he either did it out of tough love or just because I had really tested his patience so much with my abhorrent behavior that he just couldn't take it anymore.
Is it possible that one thing you struggle with is proportion? That's something that I struggle with as an anxious person - it's very difficult for me to say "maybe I didn't make a great choice, but this person was still an asshole". It always has to be "unless I was perfect, my behavior was awful and anyone's behavior to me was justified" or "If someone was awful to me, I need to comb through my behavior until I find the thing that justified what they did".
Perhaps you were really irritating, perhaps your psychiatrist was tired, perhaps he feels that you need 'tough love'....but still, assuming the basic truth of your account here, the guy was yelling at a crying patient over the phone and has - apparently based on nothing about you - decided that you somehow caused your Klonopin issue and are lying about it. Those things aren't okay or normal behaviors, and if he can't control those things, he needs some medical leave for himself.
I think I would look into finding another doc, and I would share some of this with your other therapist.
posted by Frowner at 7:46 AM on July 1, 2015 [16 favorites]
Find a new psychiatrist. He was completely out of line, unethical, and should offer you a profound apology even though you should still find another doctor.
(I'm a therapist, by the way, and am generally skeptical of the questions here about what to do about a mean mental health provider. This situation is egregious and in no way your fault.)
posted by OmieWise at 7:47 AM on July 1, 2015 [41 favorites]
(I'm a therapist, by the way, and am generally skeptical of the questions here about what to do about a mean mental health provider. This situation is egregious and in no way your fault.)
posted by OmieWise at 7:47 AM on July 1, 2015 [41 favorites]
"This man is a professional and I trust him, and I want to please him. Making sure that he is happy with me is more important to me than my well-being."
Show this question to your therapist, and stop seeing this psychiatrist immediately.
posted by hush at 7:48 AM on July 1, 2015 [36 favorites]
Show this question to your therapist, and stop seeing this psychiatrist immediately.
posted by hush at 7:48 AM on July 1, 2015 [36 favorites]
Confirming what's said above - this is not acceptable behavior on his part, and I think it would be worth having at least a discussion with your therapist about whether there's a possibility for you to keep seeing her while seeing someone else for meds. For what it's worth, I go to a set-up much like yours, but there are a couple of different prescribing doctors, and when I had a long wait to start seeing one of them, my therapist actively gave me numbers of other good local psychiatrists who were experienced with my particular issues, and suggested I could go to someone outside their practice if that would help me get care sooner. It may be a total non-issue for you to do the same.
posted by Stacey at 8:01 AM on July 1, 2015 [3 favorites]
posted by Stacey at 8:01 AM on July 1, 2015 [3 favorites]
My concern is that I also have an appointment with my therapist tomorrow, who is in the same practice, and who works for him. I am not sure if I can keep seeing her if I do not see him.
That may be a sacrifice you have to make, then, because you can't make your mental health contingent on this psychiatrist's willingness to treat you appropriately.
Frankly, given how much abusive treatment you've accepted from the psychiatrist, I'm not confident that the therapy you've gotten so far has been helpful anyway.
posted by mister pointy at 8:02 AM on July 1, 2015 [10 favorites]
That may be a sacrifice you have to make, then, because you can't make your mental health contingent on this psychiatrist's willingness to treat you appropriately.
Frankly, given how much abusive treatment you've accepted from the psychiatrist, I'm not confident that the therapy you've gotten so far has been helpful anyway.
posted by mister pointy at 8:02 AM on July 1, 2015 [10 favorites]
He behaved absolutely appallingly for any kind of human being, but even more outrageously for a psychiatrist. He has a duty of care to his patients. The American Psychiatric Association has not made its ethics information available to the public, but he's bound by the AMA's guidelines as well, obviously. He did a lot of things wrong, here. You did nothing.
(Separate from his abusive behaviour but also important: did he ever ask you about the medication you were taking when suicidality came up?)
posted by cotton dress sock at 8:07 AM on July 1, 2015 [8 favorites]
(Separate from his abusive behaviour but also important: did he ever ask you about the medication you were taking when suicidality came up?)
posted by cotton dress sock at 8:07 AM on July 1, 2015 [8 favorites]
I said (and admittedly I said it very calmly, but still, it was just so horrible of me to say): "Doctor, the medication wasn't lost."
I don't see anything remotely horrible about that. Even if a regular conversational partner might get annoyed at being contradicted, a psychiatrist is supposed to (a) be professional above all and (b) know how to be kind to his patients, who are by definition not interacting with him at their best.
But really, maybe not the most tactical communicative approach, but absolutely not something to feel bad about in any way. At all.
This man is a professional and I trust him, and I want to please him. Making sure that he is happy with me is more important to me than my well-being.
Does he know this? Because someone who's thoroughly professional and trustworthy would work hard to turn the priorities you describe here around. You're the patient and your well-being is the entire point of your acquaintance and every single one of your interactions.
Like you said, he's only human. He can simultaneously be the person who was wonderful for you in one situation and a person who is not being good to or for you in another. Maybe he's going through some issues of his own. Maybe he genuinely believes he's right. It really doesn't matter. The behavior you described is very problematic. Again, a professional psychiatrist is in a position where he is given the trust of patients in often very fragile conditions, and I absolutely believe as such he needs to bend over backwards to not abuse that trust in any way. It's not easy, he's only human, but you need to remember that. I would thank him for the good he's done, move on to another psychiatrist, and feel at peace with it.
posted by trig at 8:08 AM on July 1, 2015 [2 favorites]
I don't see anything remotely horrible about that. Even if a regular conversational partner might get annoyed at being contradicted, a psychiatrist is supposed to (a) be professional above all and (b) know how to be kind to his patients, who are by definition not interacting with him at their best.
But really, maybe not the most tactical communicative approach, but absolutely not something to feel bad about in any way. At all.
This man is a professional and I trust him, and I want to please him. Making sure that he is happy with me is more important to me than my well-being.
Does he know this? Because someone who's thoroughly professional and trustworthy would work hard to turn the priorities you describe here around. You're the patient and your well-being is the entire point of your acquaintance and every single one of your interactions.
Like you said, he's only human. He can simultaneously be the person who was wonderful for you in one situation and a person who is not being good to or for you in another. Maybe he's going through some issues of his own. Maybe he genuinely believes he's right. It really doesn't matter. The behavior you described is very problematic. Again, a professional psychiatrist is in a position where he is given the trust of patients in often very fragile conditions, and I absolutely believe as such he needs to bend over backwards to not abuse that trust in any way. It's not easy, he's only human, but you need to remember that. I would thank him for the good he's done, move on to another psychiatrist, and feel at peace with it.
posted by trig at 8:08 AM on July 1, 2015 [2 favorites]
Agree with everyone saying this sounds like an abusive relationship, and that any therapy you are in with him or anyone else clearly isn't working. You need to stop seeing this guy immediately
>I know he either did it out of tough love or just because I had really tested his patience so much with my abhorrent behavior that he just couldn't take it anymore.
There's no concept of tough love here. He's not your wrong-but-well-meaning-father he is a mental healthcare provider. There shouldn't be any love OR any unnecessary toughness, but he should have concern for your well-being.
Seriously, there is something so off here, and he acted so inappropriately. Your self-flagellation is also super inappropriate (berating yourself for crying and standing up for yourself! Two normal impulses that no psychiatrist should be phased by). You didn't do anything wrong.
See if your GP or someone can get you back on your old meds, then start looking for a new therapist and psychiatrist. I wonder if females would be a better fit for you?
posted by hejrat at 8:09 AM on July 1, 2015 [5 favorites]
>I know he either did it out of tough love or just because I had really tested his patience so much with my abhorrent behavior that he just couldn't take it anymore.
There's no concept of tough love here. He's not your wrong-but-well-meaning-father he is a mental healthcare provider. There shouldn't be any love OR any unnecessary toughness, but he should have concern for your well-being.
Seriously, there is something so off here, and he acted so inappropriately. Your self-flagellation is also super inappropriate (berating yourself for crying and standing up for yourself! Two normal impulses that no psychiatrist should be phased by). You didn't do anything wrong.
See if your GP or someone can get you back on your old meds, then start looking for a new therapist and psychiatrist. I wonder if females would be a better fit for you?
posted by hejrat at 8:09 AM on July 1, 2015 [5 favorites]
Response by poster: Pleasing him is not more important than your wellbeing. They are your employees. You hire them. Your wellbeing is their job.
Mental health professionals are people, too. They are allowed to have bad days, and they are allowed to be frustrated with patients, especially problem patients like me who hound them incessantly.
In fact, this is so on-the-nose that I almost wonder if you're putting it on a bit.
You're right. I'm really prone to exaggeration and hyperbole. I think I am highly likely doing that here and just writing all of this to get sympathy and incite the kind of responses I'm getting here. I'm sure that he was being totally reasonable. I'm trying to regulate myself emotionally, and I shouldn't have said that. I apologize.
posted by timory at 8:14 AM on July 1, 2015
Mental health professionals are people, too. They are allowed to have bad days, and they are allowed to be frustrated with patients, especially problem patients like me who hound them incessantly.
In fact, this is so on-the-nose that I almost wonder if you're putting it on a bit.
You're right. I'm really prone to exaggeration and hyperbole. I think I am highly likely doing that here and just writing all of this to get sympathy and incite the kind of responses I'm getting here. I'm sure that he was being totally reasonable. I'm trying to regulate myself emotionally, and I shouldn't have said that. I apologize.
posted by timory at 8:14 AM on July 1, 2015
You haven't done anything remotely wrong. His behavior has been outrageously out of line and unprofessional.
I know how difficult these situations can be, and how it can shake you to the core; a year or so ago a psychiatrist who had worked miracles for me in the past turned overnight into such a nightmare of unprofessionalism I was forced to stop seeing him. Now, your situation may or may not be at that point - I'm not there with you in real life, so there may be details I can't see. But oh, how I feel for you! And I know how stressful and panic-inducing it can be to think about having to find a new doctir under the circumstances! I think it might be worthwhile to print this question and take it to your therapist.
Bottom line: No patient deserves to be treated the way you have described your doctor treating you. Heck, no human being deserves to be treated that way.
posted by The Underpants Monster at 8:15 AM on July 1, 2015 [4 favorites]
I know how difficult these situations can be, and how it can shake you to the core; a year or so ago a psychiatrist who had worked miracles for me in the past turned overnight into such a nightmare of unprofessionalism I was forced to stop seeing him. Now, your situation may or may not be at that point - I'm not there with you in real life, so there may be details I can't see. But oh, how I feel for you! And I know how stressful and panic-inducing it can be to think about having to find a new doctir under the circumstances! I think it might be worthwhile to print this question and take it to your therapist.
Bottom line: No patient deserves to be treated the way you have described your doctor treating you. Heck, no human being deserves to be treated that way.
posted by The Underpants Monster at 8:15 AM on July 1, 2015 [4 favorites]
This is so wildly not okay. I don't care how reasonable and nice you want to be; his behaviour is unacceptable and outright abuse (and yes, it sounds long term). It is not beneficial to any of our mental health to make excuses for abuse. Excusing this psychiatrist means more abuse of you and others. It is not a form of healing.
posted by lokta at 8:18 AM on July 1, 2015 [4 favorites]
posted by lokta at 8:18 AM on July 1, 2015 [4 favorites]
Mental health professionals are people, too. They are allowed to have bad days, and they are allowed to be frustrated with patients, especially problem patients like me who hound them incessantly.
Everyone is allowed to be frustrated with anyone. You cannot, as a mental health provider, express that frustration in a way that could be interpreted as callous or cruel to your patient going through a tough time PERIOD. No matter how frustrated you are. He is in the wrong, and your statement about wanting to please him being more important than your wellbeing is still fucked up, regardless of the fact that ~he's a person too~
You're right. I'm really prone to exaggeration and hyperbole. I think I am highly likely doing that here and just writing all of this to get sympathy and incite the kind of responses I'm getting here. I'm sure that he was being totally reasonable. I'm trying to regulate myself emotionally, and I shouldn't have said that. I apologize.
Don't apologise, you've done nothing wrong here either. In fact, this response almost guarantees that you weren't putting it on, and it indicates that your treatment is not working well at all for you right now. It seems that your therapist is subordinate to your psychiatrist, and in a case such as yours (just from your responses here) that seems deeply inappropriate.
posted by hejrat at 8:25 AM on July 1, 2015 [10 favorites]
Everyone is allowed to be frustrated with anyone. You cannot, as a mental health provider, express that frustration in a way that could be interpreted as callous or cruel to your patient going through a tough time PERIOD. No matter how frustrated you are. He is in the wrong, and your statement about wanting to please him being more important than your wellbeing is still fucked up, regardless of the fact that ~he's a person too~
You're right. I'm really prone to exaggeration and hyperbole. I think I am highly likely doing that here and just writing all of this to get sympathy and incite the kind of responses I'm getting here. I'm sure that he was being totally reasonable. I'm trying to regulate myself emotionally, and I shouldn't have said that. I apologize.
Don't apologise, you've done nothing wrong here either. In fact, this response almost guarantees that you weren't putting it on, and it indicates that your treatment is not working well at all for you right now. It seems that your therapist is subordinate to your psychiatrist, and in a case such as yours (just from your responses here) that seems deeply inappropriate.
posted by hejrat at 8:25 AM on July 1, 2015 [10 favorites]
They are allowed to have bad days, and they are allowed to be frustrated with patients, especially problem patients like me who hound them incessantly.
Actually, no. This is not true at all. It's true of many professions, but mental health workers are HIGHLY TRAINED not to react this way to patients. They are expected to seek out their own therapists and mental health workers to help manage their feelings toward patients and clients that may come out in or interfere with treatment. You literally told your psychiatrist that his frustrated reaction with you was interfering with your relationship and ability to talk to him, and he responded with even more potent frustration instead of discussing it with you. He did wrong. Not up for debate.
In the mental health profession (I come from a family of psychiatrists, psychologists, and social workers, and used to work in the field myself), psychiatrists are known as arrogant and difficult to work with. They are not known for being kind to patients. Talk to your therapist; she may already know about his behavior and help you figure out how to proceed. If you feel you're an unreliable narrator, she may also have some more insight into the situation since she has the benefit of knowing both of you.
posted by Yoko Ono's Advice Column at 8:26 AM on July 1, 2015 [32 favorites]
Actually, no. This is not true at all. It's true of many professions, but mental health workers are HIGHLY TRAINED not to react this way to patients. They are expected to seek out their own therapists and mental health workers to help manage their feelings toward patients and clients that may come out in or interfere with treatment. You literally told your psychiatrist that his frustrated reaction with you was interfering with your relationship and ability to talk to him, and he responded with even more potent frustration instead of discussing it with you. He did wrong. Not up for debate.
In the mental health profession (I come from a family of psychiatrists, psychologists, and social workers, and used to work in the field myself), psychiatrists are known as arrogant and difficult to work with. They are not known for being kind to patients. Talk to your therapist; she may already know about his behavior and help you figure out how to proceed. If you feel you're an unreliable narrator, she may also have some more insight into the situation since she has the benefit of knowing both of you.
posted by Yoko Ono's Advice Column at 8:26 AM on July 1, 2015 [32 favorites]
Best answer: You're right. I'm really prone to exaggeration and hyperbole. I think I am highly likely doing that here and just writing all of this to get sympathy and incite the kind of responses I'm getting here. I'm sure that he was being totally reasonable. I'm trying to regulate myself emotionally, and I shouldn't have said that. I apologize.
Everything you write here sounds like me, and the reason I do it is because I struggle with a balanced understanding of the world, although it is much better since I had a couple of years of really good therapy. For me, it was about a really fragile sense of self - if I wasn't perfect, then I was worthless, and the only thing that could restore any kind of "worth" for me was the most abject "I was 100% wrong, here is why" apology. Saying "yes, I made a mistake but there were some other things in play and really the sun will still rise tomorrow" was just about impossible for me.
I don't know what's going on with you, but I hear a lot of abjection in these comments.
Your therapist could be a sympathetic human being and a sterling fellow who none the less treated you really badly. You could be needy and whiny and still not deserve to be yelled at on the phone.
Also, it's okay to want sympathy. People without any diagnosed issue at all can be slightly unreliable narrators who play for sympathy a bit; to me, that's part of talking through something bad that's happened. It's okay to want some reassurance or to feel a little self-pity.
Now, you may not be at all like me, but your writing reminds me of me: I would get in this state where I would lurch back and forth between wanting sympathy and wanting to hate myself for wanting sympathy, where I would let myself into situations where I would be treated really badly (not because I deserved it! but because there are bad people out there and I had a habit of not setting boundaries because I didn't know how and being emotionally abused was familiar). I would find myself in situations again and again where I was "bad" and I had to abjectly apologize, and only after I was in this state of abjection did I feel okay about myself - only after I had "confessed" as you did here that I probably was just making it up, it was probably all my fault, etc. This was because I had grown up feeling like I was bad and inadequate in every way and the only way I felt at home in the world was when I could put myself in situations where I would be treated as inferior and wrong.
For me, I found a really compassionate therapist (I was very, very lucky). I basically talked to him for two years (and then he was hired away to train others, he was that good....) and now I have internalized his voice - I have a tiny therapist inside my brain, and when I get into this "I am a bad person and I have to get everyone to recognize how bad I am" state, I can listen to the tiny therapist who talks me down and exercises compassion.
This psychiatrist - and I know he's only the prescribing guy - does not sound compassionate.
posted by Frowner at 8:28 AM on July 1, 2015 [39 favorites]
Everything you write here sounds like me, and the reason I do it is because I struggle with a balanced understanding of the world, although it is much better since I had a couple of years of really good therapy. For me, it was about a really fragile sense of self - if I wasn't perfect, then I was worthless, and the only thing that could restore any kind of "worth" for me was the most abject "I was 100% wrong, here is why" apology. Saying "yes, I made a mistake but there were some other things in play and really the sun will still rise tomorrow" was just about impossible for me.
I don't know what's going on with you, but I hear a lot of abjection in these comments.
Your therapist could be a sympathetic human being and a sterling fellow who none the less treated you really badly. You could be needy and whiny and still not deserve to be yelled at on the phone.
Also, it's okay to want sympathy. People without any diagnosed issue at all can be slightly unreliable narrators who play for sympathy a bit; to me, that's part of talking through something bad that's happened. It's okay to want some reassurance or to feel a little self-pity.
Now, you may not be at all like me, but your writing reminds me of me: I would get in this state where I would lurch back and forth between wanting sympathy and wanting to hate myself for wanting sympathy, where I would let myself into situations where I would be treated really badly (not because I deserved it! but because there are bad people out there and I had a habit of not setting boundaries because I didn't know how and being emotionally abused was familiar). I would find myself in situations again and again where I was "bad" and I had to abjectly apologize, and only after I was in this state of abjection did I feel okay about myself - only after I had "confessed" as you did here that I probably was just making it up, it was probably all my fault, etc. This was because I had grown up feeling like I was bad and inadequate in every way and the only way I felt at home in the world was when I could put myself in situations where I would be treated as inferior and wrong.
For me, I found a really compassionate therapist (I was very, very lucky). I basically talked to him for two years (and then he was hired away to train others, he was that good....) and now I have internalized his voice - I have a tiny therapist inside my brain, and when I get into this "I am a bad person and I have to get everyone to recognize how bad I am" state, I can listen to the tiny therapist who talks me down and exercises compassion.
This psychiatrist - and I know he's only the prescribing guy - does not sound compassionate.
posted by Frowner at 8:28 AM on July 1, 2015 [39 favorites]
OmieWise:I'm a therapist, by the way, and am generally skeptical of the questions here about what to do about a mean mental health provider.
I am also a therapist and equally skeptical (and also skeptical of your motivations in asking) but I completely agree that you should find someone new. It is understand able that you feel attached to this psychiatrist and the therapist in his practice but one can feel attached to people who are not acting in your best interests. The cliche of the battered spouse comes to mind.
posted by Obscure Reference at 8:32 AM on July 1, 2015 [1 favorite]
I am also a therapist and equally skeptical (and also skeptical of your motivations in asking) but I completely agree that you should find someone new. It is understand able that you feel attached to this psychiatrist and the therapist in his practice but one can feel attached to people who are not acting in your best interests. The cliche of the battered spouse comes to mind.
posted by Obscure Reference at 8:32 AM on July 1, 2015 [1 favorite]
Response by poster: Frowner, you have described me very well.
I also "struggle" with a deep understanding of how to advocate for others. I'm not a practicing attorney, but I am an attorney, and I do health law and policy wonkery and analysis for a living. I used to do legal aid. If this had happened to somebody else, I would have no question about what advice I would give them. It would be the advice everybody is giving me here, except I'd also be telling them to keep paper trails of everything and probably throw in a long rant about the state of mental health care in the US to boot. But I am not other people, I am me, and I somehow do not deserve good care. I think in black and white, and I think in terms of blame. This is why I am in DBT.
In the meantime I have to go in tomorrow, and I do not know how to behave when I go. If I tell him I want to end the relationship, he will repeat how disappointed he is in me and how he truly thought I was a better person, and as somebody who is as self-hating as I am, I just can't bear to hear that. I would rather find another pretense to leave than to ever have to hear those words from him.
posted by timory at 8:37 AM on July 1, 2015 [1 favorite]
I also "struggle" with a deep understanding of how to advocate for others. I'm not a practicing attorney, but I am an attorney, and I do health law and policy wonkery and analysis for a living. I used to do legal aid. If this had happened to somebody else, I would have no question about what advice I would give them. It would be the advice everybody is giving me here, except I'd also be telling them to keep paper trails of everything and probably throw in a long rant about the state of mental health care in the US to boot. But I am not other people, I am me, and I somehow do not deserve good care. I think in black and white, and I think in terms of blame. This is why I am in DBT.
In the meantime I have to go in tomorrow, and I do not know how to behave when I go. If I tell him I want to end the relationship, he will repeat how disappointed he is in me and how he truly thought I was a better person, and as somebody who is as self-hating as I am, I just can't bear to hear that. I would rather find another pretense to leave than to ever have to hear those words from him.
posted by timory at 8:37 AM on July 1, 2015 [1 favorite]
You don't have to see him tomorrow or any time, at all. You can cancel by phone.
posted by cotton dress sock at 8:39 AM on July 1, 2015 [16 favorites]
posted by cotton dress sock at 8:39 AM on July 1, 2015 [16 favorites]
If I tell him I want to end the relationship, he will repeat how disappointed he is in me and how he truly thought I was a better person
If he genuinely says something like this, it's all the more reason to dump him. Looking for another healthcare provider should not merit disappointment and says nothing about what kind of person you are.
THAT SAID I get how it can be hard to deal with that sort of thing face to face. I think you could go in tomorrow, get the prescription you need, then let his office know you aren't going to be coming in anymore via phone. Really, you only need to talk to his administrative assistant for that.
posted by hejrat at 8:40 AM on July 1, 2015 [6 favorites]
If he genuinely says something like this, it's all the more reason to dump him. Looking for another healthcare provider should not merit disappointment and says nothing about what kind of person you are.
THAT SAID I get how it can be hard to deal with that sort of thing face to face. I think you could go in tomorrow, get the prescription you need, then let his office know you aren't going to be coming in anymore via phone. Really, you only need to talk to his administrative assistant for that.
posted by hejrat at 8:40 AM on July 1, 2015 [6 favorites]
Response by poster: I'm confused and I'm feeling a little paranoid by the therapists here asking about my motivations in posting this question. Is there something I've done wrong? What motivations could I have? I'm really concerned about this skepticism. I promise I don't have any malicious intentions! I'm not gearing up to be litigious in any way. I just want to be a better person and learn how to have a better relationship with my psychiatrist.
posted by timory at 8:40 AM on July 1, 2015
posted by timory at 8:40 AM on July 1, 2015
Your motivations are in line with every single Ask Metafilter questioner in history. You want to be heard and understood, and you want advice.
posted by cotton dress sock at 8:42 AM on July 1, 2015 [12 favorites]
posted by cotton dress sock at 8:42 AM on July 1, 2015 [12 favorites]
I don't think anyone here thinks you have any malicious intentions. But I think everyone here finds it concerning that you keep talking about "becoming a better person" "you did things wrong" "maintaining the relationship with your psychiatrist." Nothing you've posted here suggests ANYTHING about your moral character, and it's all very indicative that this treatment team you have right now is a bad fit for you and is not helping you properly.
posted by hejrat at 8:43 AM on July 1, 2015 [6 favorites]
posted by hejrat at 8:43 AM on July 1, 2015 [6 favorites]
Best answer: If this were me - as avoidant as I am, and only giving this advice because you're at the 'what do I do tomorrow' stage - I would go in, pretend it was a normal visit, say what I needed to say and then do a ghost/slow fade and avoid his calls if any. Surely you can get records transferred by letter or through his admin? Basically, just fake it until you have another therapist lined up.
If you can't "break up" with the dude if you have to hear him tell you that he's very disappointed, etc, then break up through avoidance. Sure, that's not the Advice Column Gold Standard, but it seems like the important thing is for you to be able to detach yourself from the guy.
Also, he is a grown man. If he really is so entangled with his patients that he can't handle the "disappointment" of the end of a therapeutic relationship, it's time for him to check in with his own therapist. He is not your dad or your boyfriend or God or the Big Other.
posted by Frowner at 9:00 AM on July 1, 2015 [11 favorites]
If you can't "break up" with the dude if you have to hear him tell you that he's very disappointed, etc, then break up through avoidance. Sure, that's not the Advice Column Gold Standard, but it seems like the important thing is for you to be able to detach yourself from the guy.
Also, he is a grown man. If he really is so entangled with his patients that he can't handle the "disappointment" of the end of a therapeutic relationship, it's time for him to check in with his own therapist. He is not your dad or your boyfriend or God or the Big Other.
posted by Frowner at 9:00 AM on July 1, 2015 [11 favorites]
I'm confused and I'm feeling a little paranoid by the therapists here asking about my motivations in posting this question. Is there something I've done wrong? What motivations could I have? I'm really concerned about this skepticism. I promise I don't have any malicious intentions! I'm not gearing up to be litigious in any way. I just want to be a better person and learn how to have a better relationship with my psychiatrist.
Maybe you can have unconscious "motivations" that are not your fault or bad or malicious but that modulate your behavior in ways that hurt you. Or at least, I know I have those.
If I posted this question, I might have a whole stew of motives, for instance (and I think this is the kind of question that I could easily...well, probably pester my friends with rather than post, but still). I would be motivated, consciously, by my feelings of hurt, dread and anger and my uncertainty about how to proceed. I might also have that same "motive" of "getting people to tell me I'm a bad person so I have to apologize so I can feel better about myself" thing. I might also - even if it were contradictory! - have a motive of "getting people to tell me that I'm not a bad person and that I was right so that I can feel better about myself". I might feel so guilty about my relationship with my psychiatrist that I might even post something on purpose to elicit "you're doing it wrong" because that would explain the guilt. I might want to avoid responsibility for a decision that I was fearful about making.
Basically, I might have fifty million contradictory motive all sloshing around. But none of them would be about malice or deception - they would just be about how I am not totally transparent to myself.
I think that one of the things that a good therapist does is provides a space for you to work through these things. I know from my own therapy that this can be uncomfortable or embarrassing, because who wants to admit that we're a complicated slosh of feelings and are not always honest with ourselves? (Have you ever read Robertson Davies's novel The Manticore? It's about therapy (Jungian therapy, okay, whatever) and I found the emotional process of the narrator to be immensely helpful for me.)
I think that when folks ask emotionally charged questions like this one where there's a lot of back story, we often have multiple motives. I think that the more we're in complicated situations and complicated pain, the more motives we're likely to have. Again, this isn't about being sketchy or bad or malicious or deceptive - it's about how complicated we are. No one is totally transparent to themselves ever, but therapy is where you can go to get self-transparency about a specific set of things that cause you problems.
For me this is maybe difficult because I want to be good. It's difficult to say and accept that I have mixed motives in everything - some of them altruistic, some self-aggrandizing or self-serving. Like, I enjoy helping people, but partially because that makes me feel important and special and better and different, and because it quiets certain of my own anxieties, not just because I am So Compassionate, etc.
posted by Frowner at 9:11 AM on July 1, 2015 [3 favorites]
Maybe you can have unconscious "motivations" that are not your fault or bad or malicious but that modulate your behavior in ways that hurt you. Or at least, I know I have those.
If I posted this question, I might have a whole stew of motives, for instance (and I think this is the kind of question that I could easily...well, probably pester my friends with rather than post, but still). I would be motivated, consciously, by my feelings of hurt, dread and anger and my uncertainty about how to proceed. I might also have that same "motive" of "getting people to tell me I'm a bad person so I have to apologize so I can feel better about myself" thing. I might also - even if it were contradictory! - have a motive of "getting people to tell me that I'm not a bad person and that I was right so that I can feel better about myself". I might feel so guilty about my relationship with my psychiatrist that I might even post something on purpose to elicit "you're doing it wrong" because that would explain the guilt. I might want to avoid responsibility for a decision that I was fearful about making.
Basically, I might have fifty million contradictory motive all sloshing around. But none of them would be about malice or deception - they would just be about how I am not totally transparent to myself.
I think that one of the things that a good therapist does is provides a space for you to work through these things. I know from my own therapy that this can be uncomfortable or embarrassing, because who wants to admit that we're a complicated slosh of feelings and are not always honest with ourselves? (Have you ever read Robertson Davies's novel The Manticore? It's about therapy (Jungian therapy, okay, whatever) and I found the emotional process of the narrator to be immensely helpful for me.)
I think that when folks ask emotionally charged questions like this one where there's a lot of back story, we often have multiple motives. I think that the more we're in complicated situations and complicated pain, the more motives we're likely to have. Again, this isn't about being sketchy or bad or malicious or deceptive - it's about how complicated we are. No one is totally transparent to themselves ever, but therapy is where you can go to get self-transparency about a specific set of things that cause you problems.
For me this is maybe difficult because I want to be good. It's difficult to say and accept that I have mixed motives in everything - some of them altruistic, some self-aggrandizing or self-serving. Like, I enjoy helping people, but partially because that makes me feel important and special and better and different, and because it quiets certain of my own anxieties, not just because I am So Compassionate, etc.
posted by Frowner at 9:11 AM on July 1, 2015 [3 favorites]
Best answer: So I have BPD, or at least "traits", which is what my psychiatrist told me back when I definitely had fullblown BPD--which was fair, because I'd probably have completely flipped a table thru sheer force of emotional overwhelm if they'd told me about it then.
It sounds like you're confused about how this person has been treating you as well as feeling really down. When that happens to me, I can accidentally conflate tone of voice, how I think the person feels about me (i.e. that I am the scum of the earth), and words that the person has been saying to "make" them match up. This has caused massive problems because I don't remember conversations going the same way other people do, etc.
It's important to point out that I do this unconsciously. Usually it ends up something like this: Once I was sure that my therapist had said something derogatory about a DBT program I was planning to do--wrote an angry journal entry, the whole nine yards--got there the next week, asked her about it all pissed off, and it turned out she didn't even remember saying anything like that.
Sometimes it's a little more upsetting and I need to be alone to process what I think happened. The reason I mention my faulty memory is that I think you're possibly reacting to this situation with your doctor, and now, this thread in this way and may benefit from taking some time away.
BUT having this problem is not a carte blanche excuse to treat you badly.
I have this problem. I know I have this problem. I think it's ridiculous--yet my therapist, social worker, and psychiatrist handle it by encouraging me to ask them if they're [angry/frustrated/tired of me]. No penalties for asking! Always okay to ask!
They especially don't: criticize or yell at me in any way; call me annoying; tell me that I'm being ridiculous. I know for a fact that I've told my social worker (who's been with me the longest) some pretty fucking ridiculous things. But they know I'm telling them the truth as I understand it, and they understand mental illness.
It doesn't sound to me like your psychiatrist understands this part of mental illness. EVEN IF you shouldn't have done ANY of the things you did... well, uh, your thinking is sick. That's why you're mentally ill. My treatment team addresses my lapses respectfully and moves on.
Even if you WERE wrong about the medication being screwed up by the pharmacy (how?), and SHOULD have ignored your gynecologist* (really?) and WERE avoiding your psychiatrist out of fear of being criticized (uh, guess what happened when you did talk to him)-- even if all of that were true and nothing in the parentheticals were, you would still be deserving of more empathy and care.
Take it from someone who used to believe that I didn't deserve decent treatment, just like what you've written seems to indicate you do. Your psychiatrist really screwed up by treating you disrespectfully and it doesn't matter what problems you have.
* BTW, I called my psychiatrist when I was worried that Lamictal would affect my Mirena. Despite the fact that the Mirena's hormones are localized and thus impact by antibiotics is negligible (iirc it says so on the PI sheet), I wanted info on Lamictal. No one thought this was a weird request, and in fact the nurses that work with my doctor commented on it being a good question.
posted by saveyoursanity at 9:50 AM on July 1, 2015 [23 favorites]
It sounds like you're confused about how this person has been treating you as well as feeling really down. When that happens to me, I can accidentally conflate tone of voice, how I think the person feels about me (i.e. that I am the scum of the earth), and words that the person has been saying to "make" them match up. This has caused massive problems because I don't remember conversations going the same way other people do, etc.
It's important to point out that I do this unconsciously. Usually it ends up something like this: Once I was sure that my therapist had said something derogatory about a DBT program I was planning to do--wrote an angry journal entry, the whole nine yards--got there the next week, asked her about it all pissed off, and it turned out she didn't even remember saying anything like that.
Sometimes it's a little more upsetting and I need to be alone to process what I think happened. The reason I mention my faulty memory is that I think you're possibly reacting to this situation with your doctor, and now, this thread in this way and may benefit from taking some time away.
BUT having this problem is not a carte blanche excuse to treat you badly.
I have this problem. I know I have this problem. I think it's ridiculous--yet my therapist, social worker, and psychiatrist handle it by encouraging me to ask them if they're [angry/frustrated/tired of me]. No penalties for asking! Always okay to ask!
They especially don't: criticize or yell at me in any way; call me annoying; tell me that I'm being ridiculous. I know for a fact that I've told my social worker (who's been with me the longest) some pretty fucking ridiculous things. But they know I'm telling them the truth as I understand it, and they understand mental illness.
It doesn't sound to me like your psychiatrist understands this part of mental illness. EVEN IF you shouldn't have done ANY of the things you did... well, uh, your thinking is sick. That's why you're mentally ill. My treatment team addresses my lapses respectfully and moves on.
Even if you WERE wrong about the medication being screwed up by the pharmacy (how?), and SHOULD have ignored your gynecologist* (really?) and WERE avoiding your psychiatrist out of fear of being criticized (uh, guess what happened when you did talk to him)-- even if all of that were true and nothing in the parentheticals were, you would still be deserving of more empathy and care.
Take it from someone who used to believe that I didn't deserve decent treatment, just like what you've written seems to indicate you do. Your psychiatrist really screwed up by treating you disrespectfully and it doesn't matter what problems you have.
* BTW, I called my psychiatrist when I was worried that Lamictal would affect my Mirena. Despite the fact that the Mirena's hormones are localized and thus impact by antibiotics is negligible (iirc it says so on the PI sheet), I wanted info on Lamictal. No one thought this was a weird request, and in fact the nurses that work with my doctor commented on it being a good question.
posted by saveyoursanity at 9:50 AM on July 1, 2015 [23 favorites]
On preview
NO
Don't ask to remove the question and let me be a person to say, tell people who are fucking with your mind to bypass this question.
Aaaannnd onwards with the answer I want to give:
In the meantime I have to go in tomorrow, and I do not know how to behave when I go. If I tell him I want to end the relationship, he will repeat how disappointed he is in me and how he truly thought I was a better person, and as somebody who is as self-hating as I am, I just can't bear to hear that. I would rather find another pretense to leave than to ever have to hear those words from him.
Perhaps you need to take just these words with you. These seem like core things to work out with your therapist talk therapy as well, because you have relayed an interaction that reads to me much like either a aggressive father/child or abused lover/lover or brainwashed/compliant victim dynamic. Is it his intention to provoke you? Whatever, what a fuck up. He sounds fire-able and with a good amount 'what the fuck dude, get your shit together or get reported' etc.
Question:
Is it part of some therapeutic mechanism to threaten the very thing - abandonment - he knows is your biggest fear and archaic issue? Could the doctor please explain this threat and his enactment of it with you over the phone recently?
Maybe you don't ask this at all - but you think it and hold it in your mind as a valid perception of his dance with you. You watch and you kickstart that analytical brain of yours into an area of careful, observing scrutiny of the process in front of you.
Is it part of the therapeutic relationship for your psychiatrist to assert petty enactments of dominance over all other medical mechanisms you have maturely put in place to take care of your whole body? - ie contraception, pregnancy fears, sexuality, mood etc. You followed medical advice correctly. Would he prefer that your pharmacist had made follow up calls, or your gynecologist? What is his particular problem with you taking control of the range of medical interventions being organised for you across a range of medical practices? Why was he unavailable to your other professional providers in a timely manner?
Is it the doctor's usual practice to display unregulated emotional outbursts with his clients? How does the doctor manage his irregularity in emotional control with his clients? This lack of control has breached the therapeutic relationship distinctly and dangerously.
You don't have to ask these questions.
You don't even have to go deal with this twit, but if you want your medications and you have to suck up a visit, get it straight in your head that this guy has some bad form he's displayed and if there's any bullshit from him, you think of your questions and speak from that position.
posted by honey-barbara at 9:52 AM on July 1, 2015 [4 favorites]
NO
Don't ask to remove the question and let me be a person to say, tell people who are fucking with your mind to bypass this question.
Aaaannnd onwards with the answer I want to give:
In the meantime I have to go in tomorrow, and I do not know how to behave when I go. If I tell him I want to end the relationship, he will repeat how disappointed he is in me and how he truly thought I was a better person, and as somebody who is as self-hating as I am, I just can't bear to hear that. I would rather find another pretense to leave than to ever have to hear those words from him.
Perhaps you need to take just these words with you. These seem like core things to work out with your therapist talk therapy as well, because you have relayed an interaction that reads to me much like either a aggressive father/child or abused lover/lover or brainwashed/compliant victim dynamic. Is it his intention to provoke you? Whatever, what a fuck up. He sounds fire-able and with a good amount 'what the fuck dude, get your shit together or get reported' etc.
Question:
Is it part of some therapeutic mechanism to threaten the very thing - abandonment - he knows is your biggest fear and archaic issue? Could the doctor please explain this threat and his enactment of it with you over the phone recently?
Maybe you don't ask this at all - but you think it and hold it in your mind as a valid perception of his dance with you. You watch and you kickstart that analytical brain of yours into an area of careful, observing scrutiny of the process in front of you.
Is it part of the therapeutic relationship for your psychiatrist to assert petty enactments of dominance over all other medical mechanisms you have maturely put in place to take care of your whole body? - ie contraception, pregnancy fears, sexuality, mood etc. You followed medical advice correctly. Would he prefer that your pharmacist had made follow up calls, or your gynecologist? What is his particular problem with you taking control of the range of medical interventions being organised for you across a range of medical practices? Why was he unavailable to your other professional providers in a timely manner?
Is it the doctor's usual practice to display unregulated emotional outbursts with his clients? How does the doctor manage his irregularity in emotional control with his clients? This lack of control has breached the therapeutic relationship distinctly and dangerously.
You don't have to ask these questions.
You don't even have to go deal with this twit, but if you want your medications and you have to suck up a visit, get it straight in your head that this guy has some bad form he's displayed and if there's any bullshit from him, you think of your questions and speak from that position.
posted by honey-barbara at 9:52 AM on July 1, 2015 [4 favorites]
What I'd do is ask this question to someone in your real life. I personally doubt that you're delusional to the point where you're radically distorting what happened (not just misinterpreting or being a little manipulative as human beings virtually always are). But if you're so delusional that you're radically misunderstanding your job and your interactions with others, someone in your real life will have noticed this.
Do you have a history of substantial delusion?
I'm a bit curious about your childhood, actually. What possible reason do you have for believing that random strangers on the internet can instantly see that you're delusional, even if you are? Why are you so eager to back-pedal this stuff when we're all just pixels? I think you're picking out the most uncomfortable aspects of the most uncomfortable comments and inflating them to "this is 100% the explanation of everything".
Have you been getting enough sleep? Have you had breakfast? I know that if I had a really shitty phone call I might easily have been awake much of the night, too sick for breakfast and feel really pallid and off-kilter and freaked out, and that would influence how I would respond to this stuff.
Also, you know you have this job doing stuff - you have a place where you live, you buy food, etc etc. It is far more likely that you're freaking out than that you're totally delusional.
My best advice would be go and have a decent meal and a nap if you can.
posted by Frowner at 9:55 AM on July 1, 2015 [5 favorites]
Do you have a history of substantial delusion?
I'm a bit curious about your childhood, actually. What possible reason do you have for believing that random strangers on the internet can instantly see that you're delusional, even if you are? Why are you so eager to back-pedal this stuff when we're all just pixels? I think you're picking out the most uncomfortable aspects of the most uncomfortable comments and inflating them to "this is 100% the explanation of everything".
Have you been getting enough sleep? Have you had breakfast? I know that if I had a really shitty phone call I might easily have been awake much of the night, too sick for breakfast and feel really pallid and off-kilter and freaked out, and that would influence how I would respond to this stuff.
Also, you know you have this job doing stuff - you have a place where you live, you buy food, etc etc. It is far more likely that you're freaking out than that you're totally delusional.
My best advice would be go and have a decent meal and a nap if you can.
posted by Frowner at 9:55 AM on July 1, 2015 [5 favorites]
You've misunderstood me.
You have two doctors, you are currently in crisis, and the primary doctor yelled at you and berated you in response to a pretty normal concern about medication interactions.
There's no reason to continue with this healthcare team. Seek immediate support/intervention from your nearest well rated hospital because that's medically wise. Don't continue with a health professional who berates you and discounts your concerns. You deserve GREAT care.
posted by jbenben at 9:58 AM on July 1, 2015 [5 favorites]
You have two doctors, you are currently in crisis, and the primary doctor yelled at you and berated you in response to a pretty normal concern about medication interactions.
There's no reason to continue with this healthcare team. Seek immediate support/intervention from your nearest well rated hospital because that's medically wise. Don't continue with a health professional who berates you and discounts your concerns. You deserve GREAT care.
posted by jbenben at 9:58 AM on July 1, 2015 [5 favorites]
It doesn't even matter what he said afterward, if I had issues with my birth control, which is a CRITICAL MEDICATION for anyone who needs it for health reasons or is sexually active, and my psychiatrist KNEW it had made me suicidal in the past, and he didn't return my calls about a possible DRUG INTERACTION between my CRITICAL birth control and a CRITICAL mental health medication within a very very reasonable timeframe, I would be looking for a new psychiatrist like yesterday.
(The caps are to emphasize how important this is. Medications are nothing to be taken lightly. Birth control is DEFINITELY nothing to be taken lightly, especially especially especially if you are sexually active. If you're reporting this guy's lack of response accurately, which may feel to you like a less subjective metric than reporting what he said in the heat of the moment, I would be Outtie 5000, and I would speak privately to my therapist to see if there was any way I could keep seeing them outside of his practice.)
I don't care what your mental health problems are, the people who are giving you you care have a responsibility to be firmly in your corner, even when you're at your worst, and even when they don't feel like it. That's what being a professional means. You deserve so much better than this.
posted by WidgetAlley at 10:09 AM on July 1, 2015 [21 favorites]
(The caps are to emphasize how important this is. Medications are nothing to be taken lightly. Birth control is DEFINITELY nothing to be taken lightly, especially especially especially if you are sexually active. If you're reporting this guy's lack of response accurately, which may feel to you like a less subjective metric than reporting what he said in the heat of the moment, I would be Outtie 5000, and I would speak privately to my therapist to see if there was any way I could keep seeing them outside of his practice.)
I don't care what your mental health problems are, the people who are giving you you care have a responsibility to be firmly in your corner, even when you're at your worst, and even when they don't feel like it. That's what being a professional means. You deserve so much better than this.
posted by WidgetAlley at 10:09 AM on July 1, 2015 [21 favorites]
Response by poster: Frowner: I'm a bit curious about your childhood, actually. What possible reason do you have for believing that random strangers on the internet can instantly see that you're delusional, even if you are? Why are you so eager to back-pedal this stuff when we're all just pixels? I think you're picking out the most uncomfortable aspects of the most uncomfortable comments and inflating them to "this is 100% the explanation of everything".
I don't think this thread needs to go delve into actually psychoanalyzing me too deeply (although given how helpful your particular comments have been, I'm more than happy to continue discussing offline in MeMail or e-mail if you are willing, so as not to clutter the thread), but I will make these points about your allusion to Maslow's hierarchy of needs, as well as what real-life people see:
-No, I haven't been sleeping.
-No, I haven't been eating.
-My work has been very stressful and the grant funding for my job is ending soon and I will be unemployed shortly. My performance has been suffering, but I'm lucky enough to have research assistants who are kind to me and able to pick up my slack when I'm unwell.
-My friends and family have never once thought I was delusional -- just very sensitive. My ex husband has bipolar and experienced true delusion in psychotic breaks. I took care of him for several years (I should note we are still very close). My emotional instability has never reached anything approximating this.
posted by timory at 10:14 AM on July 1, 2015 [4 favorites]
I don't think this thread needs to go delve into actually psychoanalyzing me too deeply (although given how helpful your particular comments have been, I'm more than happy to continue discussing offline in MeMail or e-mail if you are willing, so as not to clutter the thread), but I will make these points about your allusion to Maslow's hierarchy of needs, as well as what real-life people see:
-No, I haven't been sleeping.
-No, I haven't been eating.
-My work has been very stressful and the grant funding for my job is ending soon and I will be unemployed shortly. My performance has been suffering, but I'm lucky enough to have research assistants who are kind to me and able to pick up my slack when I'm unwell.
-My friends and family have never once thought I was delusional -- just very sensitive. My ex husband has bipolar and experienced true delusion in psychotic breaks. I took care of him for several years (I should note we are still very close). My emotional instability has never reached anything approximating this.
posted by timory at 10:14 AM on July 1, 2015 [4 favorites]
If I tell him I want to end the relationship, he will repeat how disappointed he is in me and how he truly thought I was a better person
Oh no, that's not right. Not right at all. He is the one who is disappointing, and who should have been a better person. And most of all, a better therapist. He is doing a piss-poor job!
posted by Too-Ticky at 10:14 AM on July 1, 2015 [4 favorites]
Oh no, that's not right. Not right at all. He is the one who is disappointing, and who should have been a better person. And most of all, a better therapist. He is doing a piss-poor job!
posted by Too-Ticky at 10:14 AM on July 1, 2015 [4 favorites]
This person, the way you have been describing his actions, has acted very badly and very obviously badly towards you. So for a lot of us there is a great disconnect between what you say he did and your conclusions ("I did something wrong, help me not do somethimg wrong!")
It's a big "huh?!" moment. When this happens, people in ask me often try to dig deeper to guess at the reason for this disconnect. They can't believe you don't recognise it because to us it is so very obvious. So people start guessing...have you misrepresented the guy? Misinterpreted him? Has he gaslighted you? Are you saying these things to achieve a specific effect and get a certain sort of answer? Etc. etc.
That said, I think you should always see Ask me answers as a sort of buffet where you sample the answers and consider if they have any bearing. They're just suggestions that may fit or be wildly off course, given that we only have a couple of paragraphs to work with.
Don't let doubters upset you. They're trying to help, too. Doesn't mean they have the definitive answer.
posted by Omnomnom at 10:35 AM on July 1, 2015 [7 favorites]
It's a big "huh?!" moment. When this happens, people in ask me often try to dig deeper to guess at the reason for this disconnect. They can't believe you don't recognise it because to us it is so very obvious. So people start guessing...have you misrepresented the guy? Misinterpreted him? Has he gaslighted you? Are you saying these things to achieve a specific effect and get a certain sort of answer? Etc. etc.
That said, I think you should always see Ask me answers as a sort of buffet where you sample the answers and consider if they have any bearing. They're just suggestions that may fit or be wildly off course, given that we only have a couple of paragraphs to work with.
Don't let doubters upset you. They're trying to help, too. Doesn't mean they have the definitive answer.
posted by Omnomnom at 10:35 AM on July 1, 2015 [7 favorites]
I have BPD and MDD too.
He behaved grossly unprofessionally. You are making excuses. Refer to your DBT workbook and practice; you were setting appropriate boundaries and standing up for yourself by not letting him insinuate that you were responsible for the medication shortfall.
I would also like to note that I see a lot of self judgement and use of 'should' in what you're saying. Maybe take some time to be mindful about those things, and why you are doing them?
Remember what DBT says about effectiveness, also. I feel like it would be most effective for you to terminate this therapeutic relationship ASAP. What do you feel is going to be most effective for your short- and long-term goals here? Echoing talk this over with your therapist today. Memail if you need to.
posted by feckless fecal fear mongering at 11:01 AM on July 1, 2015 [6 favorites]
He behaved grossly unprofessionally. You are making excuses. Refer to your DBT workbook and practice; you were setting appropriate boundaries and standing up for yourself by not letting him insinuate that you were responsible for the medication shortfall.
I would also like to note that I see a lot of self judgement and use of 'should' in what you're saying. Maybe take some time to be mindful about those things, and why you are doing them?
Remember what DBT says about effectiveness, also. I feel like it would be most effective for you to terminate this therapeutic relationship ASAP. What do you feel is going to be most effective for your short- and long-term goals here? Echoing talk this over with your therapist today. Memail if you need to.
posted by feckless fecal fear mongering at 11:01 AM on July 1, 2015 [6 favorites]
While calling out doctors, let us not omit chastising the gyn. You should not be expected to be an intermediary between two docs on an issue of drug interactions. And, getting your call, the psychiatrist should have initiated a discussion.
posted by SemiSalt at 11:05 AM on July 1, 2015 [2 favorites]
posted by SemiSalt at 11:05 AM on July 1, 2015 [2 favorites]
I'm really prone to exaggeration and hyperbole. I think I am highly likely doing that here and just writing all of this to get sympathy and incite the kind of responses I'm getting here. I'm sure that he was being totally reasonable.
I encourage you to go look at the many Ask Metafilter questions where people tried to get sympathy and instead got major lectures about how wrong they are. You're getting sympathy because the facts show you deserve sympathy. You yourself said you don't have a history of delusion, so you've presented the facts, along with maybe some spin and hyperbole. But AskMe is a place where respondents regularly cut through the spin and reinterpret the facts, taking into account the possibility of subjective misinterpretation. So, I don't think you need to worry about whether you swayed the answers. I think you deserve the sympathy you're getting. I hope you can find a care team who can treat you respectfully.
posted by salvia at 12:32 PM on July 1, 2015 [9 favorites]
I encourage you to go look at the many Ask Metafilter questions where people tried to get sympathy and instead got major lectures about how wrong they are. You're getting sympathy because the facts show you deserve sympathy. You yourself said you don't have a history of delusion, so you've presented the facts, along with maybe some spin and hyperbole. But AskMe is a place where respondents regularly cut through the spin and reinterpret the facts, taking into account the possibility of subjective misinterpretation. So, I don't think you need to worry about whether you swayed the answers. I think you deserve the sympathy you're getting. I hope you can find a care team who can treat you respectfully.
posted by salvia at 12:32 PM on July 1, 2015 [9 favorites]
Best answer: (I'm a therapist, but not yours)
Agree about how awful the psychiatrist is treating you. However, I wouldn't necessarily quit the psychotherapist at this point. As somebody up there already said, I'd go into the psychiatrist and be as neutral as possible. Just hear what he has to say about the drug interaction thing and get the prescription that you need. I wouldn't bring up the previous conversation(s), the phone calls, anything like that.
Then I'd go to my next therapy appointment and discuss with your therapist (whom we assume you like and trust) what happened with the psychiatrist. See the response you get. Only THEN would I make a decision about what to do next.
I think the best thing, maybe, as many have said above, would be to continue with your therapist and get another psychiatrist, but if the therapists in this practice really "report to" the psychiatrist (rather than are equal peers within a treatment group), this may be impossible. You'll see.
But certainly you need to see a psychiatrist who is able and willing to deal with emergencies as they come up (and having a gyn. tell you that you must stop your current medication immediately IS an emergency, even if she was wrong!) and MUST be willing to return your phone calls. Returning phone calls is a big part of their job!
However, bottom line is: you are not a child, even though the psychiatrist is treating you like one. You get to go to your appointment with your dignity intact. You didn't do anything wrong. Not answering your phone calls is on him, not you.
posted by DMelanogaster at 1:18 PM on July 1, 2015 [13 favorites]
Agree about how awful the psychiatrist is treating you. However, I wouldn't necessarily quit the psychotherapist at this point. As somebody up there already said, I'd go into the psychiatrist and be as neutral as possible. Just hear what he has to say about the drug interaction thing and get the prescription that you need. I wouldn't bring up the previous conversation(s), the phone calls, anything like that.
Then I'd go to my next therapy appointment and discuss with your therapist (whom we assume you like and trust) what happened with the psychiatrist. See the response you get. Only THEN would I make a decision about what to do next.
I think the best thing, maybe, as many have said above, would be to continue with your therapist and get another psychiatrist, but if the therapists in this practice really "report to" the psychiatrist (rather than are equal peers within a treatment group), this may be impossible. You'll see.
But certainly you need to see a psychiatrist who is able and willing to deal with emergencies as they come up (and having a gyn. tell you that you must stop your current medication immediately IS an emergency, even if she was wrong!) and MUST be willing to return your phone calls. Returning phone calls is a big part of their job!
However, bottom line is: you are not a child, even though the psychiatrist is treating you like one. You get to go to your appointment with your dignity intact. You didn't do anything wrong. Not answering your phone calls is on him, not you.
posted by DMelanogaster at 1:18 PM on July 1, 2015 [13 favorites]
Response by poster: I want to note that yes, my psychiatrist is my therapist's boss. I do not know if this means she has to report everything I say to him, nor do I think that means that I have to have them both treat me. I have calmed down a bit and done some mindfulness meditation since posting this and I think that the wisest choice for me is to simply go in tomorrow morning, make no mention of the phone call, listen to what he has to say, speak as little as possible without being rude, and then go to my therapy appointment later in the afternoon and ask my therapist whether it is appropriate to discuss my psychiatrist with her.
I also want to share what a childhood friend of mine (and now a therapist, although of course not MY therapist) shared with me after I spoke to her about this. Her treatment of the matter may help clarify things because she is always honest with me about my behavior.
Wow, hey, first off left me just say how awful it is that this happened with your psychiatrist. I know you wrote about feeling like an "unreliable narrator" as far as how the conversation shook out, and we'll never know what "really" happened since since we've only getting your side. Regardless.. it sucks that your takeaway message from him added up to him going"blech on you for being a crappy patient, etc." That's awful. Your feelings are valid and real and you are completely justified in feeling the way you do. Period. (Go back and read those last few sentences again, since I know your mind just chimed in to say "no it's not!" Valid feelings. You has them.)
Because he is the psychiatrist, he has more power in the relationship. And with that is an unspoken contract. The doctor promises a safe, confidential, space for the patient and to use their skills and expertise for the welfare of the patient, with the patient being willing to share honestly about their experiences. An alliance is formed for the benefit of the patient. And it sounds like this alliance has been damaged. I won't tell you to find a new doctor, and I won't tell you to stay with him. Mostly because I can't tell if this was a one time moment of unprofessionalism, or if there is a larger pattern of him abusing his power and harming his patients as a result.
I would ask this one question: Is he someone you want to continue working with because you feel he will help your mental health? Not "I'll work with him because I don't want him to be disappointed in me" or "I'll work with him to show myself and everyone I can put on my big girl pants and be strong." Just a deceptively simple question, do I trust this person to help guide me in my mental health? And his reaction during your next appointment can also help inform this, like if he plays the denial game or pulls the "I'm sorry you feel that way" card, chances are he may not be there for you in clutch situations (while possibly being a fine psychiatrist the rest of the time.)
There's a story I read of a patient who started crying in front of her psychiatrist, and he ran out of tissues, so he left the office frantically looking for tissues, and came back a few minutes later with a wad of toilet paper. At their next session, the patient brought up how awkward that was and the doctor denied that it was in anyway. And when she said it was a little funny to her, he was all "what do you mean?" And "why is this important to you." She knew then that she didn't trust him to be real with her and just admit to being human, and decided not to return to him.
Hope this helps some, and let me know if there's anything else you think I could weigh in on for you. I like that you can come to me with this stuff and you can always trust that I will let you know if anything feels like "too much" for me. :)
posted by timory at 1:28 PM on July 1, 2015 [10 favorites]
I also want to share what a childhood friend of mine (and now a therapist, although of course not MY therapist) shared with me after I spoke to her about this. Her treatment of the matter may help clarify things because she is always honest with me about my behavior.
Wow, hey, first off left me just say how awful it is that this happened with your psychiatrist. I know you wrote about feeling like an "unreliable narrator" as far as how the conversation shook out, and we'll never know what "really" happened since since we've only getting your side. Regardless.. it sucks that your takeaway message from him added up to him going"blech on you for being a crappy patient, etc." That's awful. Your feelings are valid and real and you are completely justified in feeling the way you do. Period. (Go back and read those last few sentences again, since I know your mind just chimed in to say "no it's not!" Valid feelings. You has them.)
Because he is the psychiatrist, he has more power in the relationship. And with that is an unspoken contract. The doctor promises a safe, confidential, space for the patient and to use their skills and expertise for the welfare of the patient, with the patient being willing to share honestly about their experiences. An alliance is formed for the benefit of the patient. And it sounds like this alliance has been damaged. I won't tell you to find a new doctor, and I won't tell you to stay with him. Mostly because I can't tell if this was a one time moment of unprofessionalism, or if there is a larger pattern of him abusing his power and harming his patients as a result.
I would ask this one question: Is he someone you want to continue working with because you feel he will help your mental health? Not "I'll work with him because I don't want him to be disappointed in me" or "I'll work with him to show myself and everyone I can put on my big girl pants and be strong." Just a deceptively simple question, do I trust this person to help guide me in my mental health? And his reaction during your next appointment can also help inform this, like if he plays the denial game or pulls the "I'm sorry you feel that way" card, chances are he may not be there for you in clutch situations (while possibly being a fine psychiatrist the rest of the time.)
There's a story I read of a patient who started crying in front of her psychiatrist, and he ran out of tissues, so he left the office frantically looking for tissues, and came back a few minutes later with a wad of toilet paper. At their next session, the patient brought up how awkward that was and the doctor denied that it was in anyway. And when she said it was a little funny to her, he was all "what do you mean?" And "why is this important to you." She knew then that she didn't trust him to be real with her and just admit to being human, and decided not to return to him.
Hope this helps some, and let me know if there's anything else you think I could weigh in on for you. I like that you can come to me with this stuff and you can always trust that I will let you know if anything feels like "too much" for me. :)
posted by timory at 1:28 PM on July 1, 2015 [10 favorites]
Yes! Excellent. Make the decision from Wise Mind.
posted by feckless fecal fear mongering at 2:44 PM on July 1, 2015 [2 favorites]
posted by feckless fecal fear mongering at 2:44 PM on July 1, 2015 [2 favorites]
Would you feel comfortable with someone close to you going with you to the appointment? I had a family member recently that was very distraught over a visit with her doctor, but when I went with her the next week, she was able to be much calmer and later verbalized that most of her reaction the previous week had been due to her own panic and frustration at the time. She had a completely different perception on the second visit and continues to see this doctor. It might even be helpful if they just went with you as far as the waiting room to help distract you until the appointment if you don't want them to see the doctor with you.
Stress, frustration, and panic can certainly color our perceptions of events. This is true of everyone. Your description could perfectly well be completely accurate or full of hyperbole. There is no way for us to know, nor is it our place to judge. I would recommend that you go, with a support person if possible, and then decide whether or not you want to continue with this doctor.
And remember, the patient is the customer. The doctor is the service provider. I have literally gotten up and walked out on a doctor or two or three who was dismissive or condescending.
posted by tamitang at 6:26 PM on July 1, 2015 [5 favorites]
Stress, frustration, and panic can certainly color our perceptions of events. This is true of everyone. Your description could perfectly well be completely accurate or full of hyperbole. There is no way for us to know, nor is it our place to judge. I would recommend that you go, with a support person if possible, and then decide whether or not you want to continue with this doctor.
And remember, the patient is the customer. The doctor is the service provider. I have literally gotten up and walked out on a doctor or two or three who was dismissive or condescending.
posted by tamitang at 6:26 PM on July 1, 2015 [5 favorites]
Best answer: It's also possible there's just something going on with him right now - or something was going on right when he was making the call. It's an awfully short time frame that he was mean to you in - just one phone call. Maybe he's been visiting a dying parent in the hospital all week or something, and felt like his regular responsibilities were a horrible intrusion - yes, that's bad job performance, he's got his regular responsibilities to do. The question is whether it's something that's normal for him, or whether it's a weird, rare, one-off strange behavior.
Maybe you want to keep seeing this therapist you like while you find a second psychologist - it would probably be a good idea to get a second opinion now that you're getting better at seeing your own problems, standing up for yourself, etc, even if you weren't going to leave the first psych. Some counselors/psychs may be better at helping you when you know nothing and need help getting on your feet, and not so good at helping once you're starting to walk and find your own way. (Think parents - some parents are better with babies, some parents are better with teenagers... but a parent who wants you to stay a baby forever isn't a very good parent!)
But I wouldn't immediately assume that, out of 14 years of experiences with this psychiatrist, the one that's Authentically True is the one phone call where he was frustrated and short with you. (And "the medicine was lost" doesn't necessarily mean it was lost by you - maybe he just meant it was lost by the pharmacy!) Look at your other interactions with him. What's he like?
posted by Lady Li at 12:18 AM on July 2, 2015 [1 favorite]
Maybe you want to keep seeing this therapist you like while you find a second psychologist - it would probably be a good idea to get a second opinion now that you're getting better at seeing your own problems, standing up for yourself, etc, even if you weren't going to leave the first psych. Some counselors/psychs may be better at helping you when you know nothing and need help getting on your feet, and not so good at helping once you're starting to walk and find your own way. (Think parents - some parents are better with babies, some parents are better with teenagers... but a parent who wants you to stay a baby forever isn't a very good parent!)
But I wouldn't immediately assume that, out of 14 years of experiences with this psychiatrist, the one that's Authentically True is the one phone call where he was frustrated and short with you. (And "the medicine was lost" doesn't necessarily mean it was lost by you - maybe he just meant it was lost by the pharmacy!) Look at your other interactions with him. What's he like?
posted by Lady Li at 12:18 AM on July 2, 2015 [1 favorite]
I am concerned about the answer above, and even more so about the fact that you chose it as a best answer.
It doesn't actually matter if anything is temporarily going on with your psychiatrist. He's a person, sure. But he is legally held to a higher standard than other people, because of the power differential inherent in his work, and the inherent vulnerability of (all of) his patients. He has a serious job with serious consequences.
He abused his power in several ways, which I think were pretty fairly outlined by honey-barbara above.
(Additionally, you're lucky you put two and two together and caught the actually life-threatening side effects you experienced from the Nexplanon.)
Can you update on how things went today?
posted by cotton dress sock at 9:05 AM on July 2, 2015 [4 favorites]
It doesn't actually matter if anything is temporarily going on with your psychiatrist. He's a person, sure. But he is legally held to a higher standard than other people, because of the power differential inherent in his work, and the inherent vulnerability of (all of) his patients. He has a serious job with serious consequences.
He abused his power in several ways, which I think were pretty fairly outlined by honey-barbara above.
(Additionally, you're lucky you put two and two together and caught the actually life-threatening side effects you experienced from the Nexplanon.)
Can you update on how things went today?
posted by cotton dress sock at 9:05 AM on July 2, 2015 [4 favorites]
i just can't favorite what saveyoursanity said enough, and I love what your childhood friend wrote to you. Am also concerned you chose Lady Li's answer as one of the best. It doesn't matter what else is going on in his life. He is trained to keep that from fucking up his patient relationships, especially a patient who he knows well and therefore ought to know will take it very hard. I mean, the fact that he did this shit with you tells me he doesn't actually know you or your triggers and he's been working with you for how long??
Really can't get over the manipulative "I thought you were better than this" crap.
posted by Yoko Ono's Advice Column at 11:56 AM on July 2, 2015 [3 favorites]
Really can't get over the manipulative "I thought you were better than this" crap.
posted by Yoko Ono's Advice Column at 11:56 AM on July 2, 2015 [3 favorites]
I just want to nth everyone who's said that therapists and psychiatrists are trained to handle their emotions when dealing with patients/clients/analysands. Heck, even managers are. It's one reason they're paid more: (good) managers need to recognize, modulate, and digest their subjective, emotional reactions. Even a raised voice is not good. There are vanishingly few situations which could justify Raised Voice, and among them we're talking major big stuff like stealing. If you're having a bad day, you recognize it and deal with it. If you feel yourself getting angry at someone, you breathe and remind yourself of whatever it is you've identified as your peacemaking trick (everyone's different).
Your psychiatrist is supposed to know this sort of thing. There are even schools of thought in psychiatry/psychology which take everything a person says as true, because in their schools of thought, everything has truth to it. You gave us your truth in the latest update. You're facing deep losses. You didn't lose your medication, though. No wonder you held onto that truth. You may be exhausted, hungry, facing down unemployment and financial loss, but dammit, you didn't lose your medication.
As for projecting? Always keep in mind that part of being human is projecting. It's an essential element of empathy. It's only mistaken projection that needs assistance in setting right.
I am no psych person, just someone very blessed to have a wonderful therapist (psychoanalyst in her case). And I'm a budding manager learning to handle my emotional reactions. So I know it's possible.
posted by fraula at 3:09 PM on July 2, 2015 [2 favorites]
Your psychiatrist is supposed to know this sort of thing. There are even schools of thought in psychiatry/psychology which take everything a person says as true, because in their schools of thought, everything has truth to it. You gave us your truth in the latest update. You're facing deep losses. You didn't lose your medication, though. No wonder you held onto that truth. You may be exhausted, hungry, facing down unemployment and financial loss, but dammit, you didn't lose your medication.
As for projecting? Always keep in mind that part of being human is projecting. It's an essential element of empathy. It's only mistaken projection that needs assistance in setting right.
I am no psych person, just someone very blessed to have a wonderful therapist (psychoanalyst in her case). And I'm a budding manager learning to handle my emotional reactions. So I know it's possible.
posted by fraula at 3:09 PM on July 2, 2015 [2 favorites]
Psychiatrists have more professional training than most managers for a reason. Psychiatrists should not be losing their tempers or working out their own ego issues with clients; if they ever slip up, which should happen extremely rarely, they should own up to it and apologize.
timory, I hope things went ok today. I also hope you find a treatment team that helps you feel more empowered and worthwhile.
posted by jaguar at 9:27 PM on July 2, 2015 [7 favorites]
timory, I hope things went ok today. I also hope you find a treatment team that helps you feel more empowered and worthwhile.
posted by jaguar at 9:27 PM on July 2, 2015 [7 favorites]
« Older An online quiz tool that gives test-taker detailed... | Adjusting to life on the outside Newer »
This thread is closed to new comments.
I would not want to return to any health professional who said those words to me.
Hopefully other people with more experience in mental healthcare will be able to chime in with more constructive steps to take, but from my point of view as a person who has seen more than her fair share of doctors for some nonstandard health issues, this would not be OK. It is reasonable and valid for you to be uncomfortable with this person being your psychiatrist after he straight up told you he didn't want to deal with you. That's unbelievably unprofessional.
posted by phunniemee at 7:24 AM on July 1, 2015 [63 favorites]