All I wanted was an apology

Well, it seems Manderine really didn't have the power of her conviction. Less than a day after I criticized her for trash talking a patient with borderline personality disorder (see my earlier posts), her blog is gone. Not just the offensive post, but the whole blog.

I have to say, from reading through her blog earlier, it wasn't hard to figure out that she was in training at a major hospital in the midwest. It wasn't hard to figure out which school, but that's not relevant here.

It brought up some interesting things for me. I was furious that she thought it was OK to violate a person's privacy like that (her defense: it was an amalgam of patients' histories, not just one). She, or someone wiser than her, agreed with me that it was ethically and/or legally wrong, which is why she removed it.

I was also hurt at her description of a person with borderline personality disorder and the lengths to which that person (supposedly) went to get attention and caring. And the tone in which that description was made was so ... cold. So cold. And this from one of the people who will be a future psychiatrist/therapist/doctor. (Wasn't completely clear to me.) This is why our mental health system is in such crisis.

What do you think about all this?

Where do you think a therapist should discuss her feelings about her clients?

In defense of her offensive post in which she says disparaging things about a patient, Maderine commented on my post of earlier today that:

a) She had (or could have) changed identifying characteristics of the patient so it's perfectly OK, and
b) Gee, she was just expressing her own emotions at the experience of having this patient (oh no!) be difficult to deal with.

What you missed in my original comment, Mandarine, was that in crying out for attention about this, you are exhibiting the very behavior in which you criticize Patient X.

You certainly could have said:

"I have a patient with a difficult diagnosis that requires significant time and attention. He/she has consistently cried out for attention to the degree of feigning illness and making a false claim against me.

"This has caused me great distress, ..."

Is there any reason to identify the patient any further? This is not a scholarly article you are writing for a medical journal in which "removing identifying characteristics" is appropriate and (more importantly) agreed to by the study participants who sign a release allowing this. Do your patients sign a release allowing you to describe them in ANY way in an online blog that is personal, not professional? Doubtful. I doubt any legal privacy policy would even allow that.

If you are absolutely sure of your ethical position, let's take the post to a discussion group of therapists and ask them. Better yet, let's take it to an ethical review board in your state or let your hospital administrator review it.

Even better, you could suck it up like a moral human being and say "My feelings are hurt by this person and I'm angry and a little embarrassed by it all. I tried my best and am frustrated by the experience of treating a person who is not responding. I feel helpless. I cried out in my blog because of these feelings, and maybe I went too far. I will think about this and consider my clients' privacy more thoroughly in the future."

Maderine, the place for you to discuss your feelings about your patients is with your own therapist, a colleague or your boss. Not the Web at large. Even if you really, really want to. Just like your patient, you are desperately seeking attention. I only hope you won't sacrifice the dignity of another human being to get it.

P.S. I laughed out loud when I read on your profile that the first "interest" you list is "fiction." Maybe you ARE your patient.

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.

How to really help

Have you ever tried to soothe someone who is out of control? Someone, say, like I get when I'm dysregulated -- so hurt and so mad and so uncontrollably flipped out that you don't think you could say anything right no matter what you say?

Here is a list of the top 25 things NOT to do, along with a good list of great things you can do.

Thanks to Lisa Dietz for compiling it.

What I want

I know that I can't have some of the things I want in life. I still want them.

Is this a matter of stubbornness? Will? Is this a symptom of borderline personality disorder? I read about projection recently and came away with this nugget:

When I feel a certain way about something, I may project those feelings onto someone else. I love the holidays, and I may simply assume that those around me do, too. I may have big trouble even contemplating that someone around me doesn't really like the holidays and would be just as happy skipping them.

I keep thinking: "But if that person were to have the holidays with me, we would have fun. It would be a different way of experiencing things, and maybe it would be different." Or "No one can hate the holidays."

Yes, I understand projection. I wonder if I am unaware of the times I do it. I know that some issues have much greater saliency to me than they do to others, and I know it feels frustrating when I can't express that saliency well enough to make others feel it as strongly as I do.

This is a project for me.

I wonder, sometimes

I read something recently, don't know if it's true.

A narcissist is someone who has an inordinate fascination with himself or herself. Someone who thinks only about me, me, me.

Borderline personality disorder is the opposite. For those with this disorder, there is no me.

There's no me here. I wonder sometimes where I am. I am whoever I need to be to get through the moment. I adjust and adapt and carry expectations like mothers lug heavy diaper bags or business people hump through airports with a carry-on and a laptop.

I wonder, sometimes, where I am.

Thanks for all the work!

A woman named pep~172~fox over on MySpace has created a page with some carefully selected and compiled information about borderline personality disorder and dialectical behavior therapy. It's well done. Thanks for all the work.