I suppose if she's crazy, it's all right to make fun

A woman who calls herself Maderine wrote an offensive post yesterday in which she claims to be a therapist of some kind, then goes on to vilify a client with borderline personality disorder, violating that client's privacy and showing evidence of a fundamental misunderstanding of the need for acceptance in providing treatment for this disorder.

Since her comments are moderated, I'm not sure mine will make it on her blog, so I'll post it here:

I'm not sure you'll post this comment, but I hope you read it.

1) If you are, in fact, a person who "treats" clients, you have violated a tenet of your profession by describing -- and in this case vilifying -- at least one of them.

2) Your description of someone with borderline personality disorder is grossly unprofessional and exhibits a lack of understanding of what it means to have this disorder. You are surprised that a patient with this disorder is manipulative? Clearly, her attempts at gaining acceptance at any cost -- including wishing she had cancer so she could be part of a support group -- indicates she is not feeling accepted on a very basic level. It is one of the basic truths of treating a borderline personality disorder that the relationship between a client and a therapist be one of enormous trust and ACCEPTANCE.

It is condescending of you to say you have tried your best (don't you try that way with all clients?) to help this poor, dumb woman. You don't "truly care" for her on one hand and then ridicule her in public.

3) Your own stated need to cry out "Love me, everyone! Love me despite my many failings!" is an interesting statement. Examine that one in light of your client's needs. Isn't she saying the same thing?

4) You probably weren't racist, but you protest very loudly. Wouldn't a professional therapist be able to address this in a manner that seems pretty obvious -- that the poor woman is seeking attention in yet another manner? Is no one seeing that? Did you drop her like a hot potato? I'm betting you did; imagine how that affected her.

You are welcome to blog about anything you want, but your credibility as a therapist is now shot. What state are you in? What license do you have? Would you like me to forward this blog entry to your licensing agency? Your hospital administration?

Perhaps one of your "real life" friends would do it for me.

P.S. Here's the original post, just in case it disappears when Maderine realizes how she's exposed herself legally and ethically:

I Am NOT a Shrimp, I'm a King Prawn, OK?

Strangeness surrounds me, or maybe I'm generating it all, and it's trickling down and forming this weird miasma that just keeps rising. How would I go about finding the source of this strangeness? Consult a psychic? Throw the Tarot? Read my tea leaves (a challenge, since I use teabags)? At any rate, I know not the source but balk at the rising tide of Strange. It makes me feel small and segmented, invertebrate.

After more than a year of blogging, I told some real people (meaning people I've actually seen breathing) about my blog. Now I am reluctant to write. That wasn't my intent. I thought it would be a nice connection; that these, my real-life friends, could read what's on my mind at any given moment, comment if they wish, ignore things if they wish. It made sense at the time. Now I need some verbal Viagra or something.

My heart cries, "Love me, everyone! Love me despite my many failings!" But my fingers are still, my mind blank. Sorry, folks (and You Know Who You Are)--maybe you should just go somewhere else. Leave me with my imaginary friends here. Seriously, I'll be fine. Call ya next week.

And the sudden cessation of my waterfall of words is only the first thing that's playing my nerves like a lutist. The second is that one of my vast collection of patients with borderline personality disorder has decided that I'm racist. She has a limited IQ but an amazing capacity for manipulation. She has a number of illness that are not based on physiology, for example: pseudoseizures, a congenital anomaly that she insists is a tumor, a biopsy-proven benign breast mass for which she has attended a number of breast cancer support groups (and, might I add, she has been politely evicted from these groups across the city). Despite the challenging nature of our relationship, I truly cared for and took care of her. And she has informed the hospital risk-management (read "legal") team that I'm a racist and she's taking her case straight to the governor.

What? WHAT??!?

Since when does not kowtowing when a patient's demands are truly not in her best medical interest (with "best medical interest" as conscientiously defined by a group of her primary and consulting physicians--not just something I randomly made up) constitute RACISM?

There are two schools of thought about the role of race in medicine. One school says that every patient presentation should include race right up front: "This is a 40 year-old white male who is in today for follow-up of hypertension." "This is a 28 year-old Native American woman who is in for a routine OB visit." "This is a 19 year-old student from Vietnam who is in with concerns about abdominal pain." The thinking of that particular school is that there are certain conditions--both acquired and congenital--that are found in certain races with greater frequency than in other races. Therefore, the logic goes, you pave the way to a good diagnosis by presenting race up front.

The second school says that race is irrelevant in the initial part of a patient presentation. "This is a 40 year-old male who is in for follow-up of hypertension" and so on. Their logic is that, at the point at which race becomes important (IF that point is reached), the question can then be asked, "Is this patient at any increased risk for Condition X based on race?" If the answer is yes, it is explained. If the answer is no, it is left to lie. They believe that biases based on race are unconsciously or consciously evoked up front and premature conclusions may be drawn if race is one of the first things a physician hears about a patient.

I fall into this latter camp. If race becomes important beyond the category "Human Race," then we'll cross that bridge when we come to it. I philosophize with residents about this. I rarely specify a patient's race when I am describing a patient. I try, honestly, not to see color at all (while at the same time being culturally sensitive). And now I feel like this person--this desperate, needy person--has just hurled a javelin into my heart. Does my exacting care not mean ANYTHING?

The hospital administration is on my side. They have reviewed the records extensively and concur that I have provided exemplary care. But somehow what they think doesn't matter nearly as much to me as what SHE thinks.

And almost as important as me suddenly becoming racist is this: I'm a Genus-ist, too. I'm all anti-Canine now because of a rather dreadful experience I had with a piece of fruit.

I was cleaning up after dinner this evening and saw half a piece of apple on baby boy's plate. I popped it in my mouth and noticed several odd things simultaneously: the apple piece seemed warm and softer than I would expect. It had a salty flavor that was unusual. It seemed almost moist. I was about to write this off to just being baby boy drool--to which I am no stranger--when big boy came in. "Oh, Mom, I'm glad you moved those plates. The dog was licking baby boy's!" Oh, URP. You have got to be kidding me...I just ate ABC apple from the DOG!!!!

Yes, I know that there are those of you who are doing something else right now and not reading this at all who are thinking, "Dog saliva is better for you than human saliva." All well and good, but go show me the primary research that proves this AND tell me if the research dogs drank out of the toilets and ate tampons for fun? I bet they didn't.

Shit, maybe THAT'S where the miasma is coming from!

...Oh, my Absence of Readers, what else? Plenty more, but I'll save the rest for another time. I feel low tonight, blue and empty. Invertebrate. And nauseated.