Hey Doc! Sorry about that email.....kind of.....

.....maybe?

Greetings readers!

I am starting to collect letters of termination from mental health clinicians.

While I am confident that I wasn’t getting terrific care from them (two, in particular), I’m also not confident that my responses, which were explosive beyond words, should be a model for everyone else to follow.

Do as you do, not as I say OR do, as THAT is the proverbial recipe for calamity.

Seriously, I’m a time bomb, and when a borderline is angry and uses words, the resultant product can be magnificently brutal.

See keywords: abusive, disrespectful, unprofessional, profanity, vulgarity, etc.

I lost a relationship with a mental health clinician this week, and I had been terminated by a therapist in April of this year. Both incidents were, in their own way, tied to borderline personality disorder and its worst manifestations. The first therapist who fired me seemed both unwilling and unable to treat the diagnosis (not all therapists are prepared to treat borderlines), and to be fair, I was actually the one who fired the second clinician.

We will get to that soon. Promise.

Talk to someone about mental health services enough (and especially a patient in the system) and you’ll hear them speak about falling through the “cracks” of the infrastructure, which is usually what someone says when they lose access to their doctor, medication, housing, or other therapeutic interventions. In such cases, this is the dynamic: procedure or clinician bias trumps all, often shelving actions that are demonstrably beneficial to the patient.

Simply put? Healthcare systems like their rules, doctors have their ways, and sometimes the idiosyncratic needs of a patient are pushed aside to keep the machine going at the same pace.

The result is a story as old as these services: from this point, the patient has to be the very best advocate for their own mental health. At times, help is NOT on the way.

Come with me for a minute. Whatever you are doing will still be waiting for you.

So, a brief review:

In the summer of last year, my mental health went kaboom. At the time I thought it was a good old fashioned cocktail of anxiety and depression, which it was. I just didn’t know that there were more layers to the diagnosis. The year itself, 2022, was populated with all of the horrible things: panic attacks, pockets of freezing and dissociation, repeated isolation and stimulation (such as rocking back and forth in a chair), fits of crying, rages, verbal assaults (from yours truly), and a series of breakdowns that landed me in the mental hospital. All of this madness had an underlying theme: the meds aren’t right yet. The meds aren’t working yet.

And when the meds aren’t working, applying therapeutic skills is more of a fantasy.

At least for me. I certainly can’t speak for anyone else.

During my inpatient stay, I replaced the SSRI that I was on (this is a standard antidepressant, which works off the hypothesis that my brain needs to have more happy chemicals routed in its direction) with prozac. In addition, I was treated with an off label use of hydroxyzine, which is literally an antihistamine. Over the years, patients who have used it have also reported decreased anxiety. The exact reasons for this are uncertain, and research is still ongoing and so forth.

I’m jus a WEALTH of data today, aren’t I?

The point is that the medication worked on both fronts. The prozac calmed me without sending me into an even worse panic attack, and the dosage of hydroxyzine took off the edge, but without the punch and disorientation so common with a benzodiazepine (think Xanax and all its friends).

And all of this treatment was under weekly supervision from a doctor for over 10 weeks. There was never a time in my IOP program in which the dosage of this latter, off-label drug was called into question. It was one of those rare “win win” situations in medications, where the pill does its job without causing another problem.

Fast forward a few months, through the “bridge” refills designed to get me to my next doctor.

At the recommendation of my IOP clinic, I enrolled in a practice that I thought would meet my needs. I was assigned to a clinician earlier this month. At my intake, I discussed some relevant information, in detail, about my meds:

Namely that they have worked well, with minimal side effects, for a period of a couple of months, which is enough time to see what both medications can do.

At this intake, the physician seemed concerned that I was taking a low to moderate dose of hydroxyzine 3 times day, even after I discussed the recent history, success, and medical supervision.

At the NEXT appointment, roughly 3 weeks later, I reminded this doctor that I needed a refill, and was promptly told, “I don’t like that,” after I read the details on my current script.

The doctor didn’t like that. Imagine.

In the moment, I could have spent much more time telling this physician about things that I didn’t like, namely that I had to positively crawl through fire to get medications that worked for me, only to run against physician bias that, as far as I could tell, accounted for almost no particulars of my recent medical history.

I could have told this doctor how much I hated going on the kinds of rages that landed me in inpatient care.

I could have told this doctor about the emptiness that results from chronic feelings of anxiety, and that I had some medicines that really worked.

But I had already mentioned most of those things, if not all of them, at the intake.

The lesson?

My doctor wasn’t listening to me. At. all.

If you work in the mental healthcare industry, and are reading this, please: the spaces for mental healthcare should be safe, kind, and accommodating, and doctors should be mindful of the particulars of each patient. We are hurting and are often ill equipped to deal with whatever conditions follow us. If a patient walks into your office and talks glowingly about the medical interventions from the previous program, the standard reply should not immediately be, “I don’t like that.”

That’s invalidating.

At the time of writing this, I’m happy to report that I have since contacted my old IOP practice and found some solutions to this problem.

But I’m not happy that I had to advocate for this in the first place.

I made phone calls and plans. I wrote emails. Some of these emails were not very polite and would certainly prevent me from running for public office someday.

To that I can only give my best borderline, “Oh well.”

I normally feel a deep sense of shame when I weave tapestries of awful to other human beings and press the send button; this naturally goes with the BPD territory. Get mad. Blow up. Feel shameful.

And there is shame here. No question. My batting average at being the bigger person is not terrific, especially when I perceive serious offense.

But it’s also hard when the threat seems so baffling. When it comes to my health, issues like this are personal.

I feel some shame, but I’m also glad I didn’t go quietly into the night.

I am bored with unacceptable behavior, and I will fight like Hell to protect the remnants of my headspace.

Yours Mentally,

Nathan