Monday, January 23, 2012

A Matter of Perspective


Often, when two people can't get along, it seems like the issue is one of communication.  People say things that are ill-phrased, or the person hearing a statement assumes an intention that is not meant to be.  Sometimes, a well-worded conversation fixes the problem, often with words such as, "I'm sorry that upset you.  I never meant it to come off that way and I meant to say X."  A misunderstanding, it happens all the time.  I sometimes suggest that people read the book Difficult Conversations by members of the Harvard Negotiation Project.  The book talks about the value of feeling heard, and how it is important to understand the intentions of the other party.  You can't imagine how often I hear stories about people that sound a little off, and when I ask why someone would say or do those things, I hear theories of how the other party is jealous, or just enjoys watching my patient suffer, or is manipulative, or sometimes the stories have quite complex theories dating back to an event that occurred long ago and doesn't seem that memorable.  Now the theories could be right, people are jealous, or manipulative, or sadistic, but often I can think of alternative explanations that would explain the same story, and I do think that it may be valuable to ask someone their intentions when things go wrong.


Sometimes, people hit a place where nothing can be said that is right by either party.  There are irreconcilable differences.  One person may talk of their heart-wrenching distress and weep their story, while the other hears it as "there he goes again trying to get my attention with his tears," and the crying party feels like their honest and sincere attempts are useless on someone with a hard heart. You can find your own variations on this theme, I'm sure.


I've started to wonder if I have perhaps come to this place with our Shrink Rap commenters.  I feel like I say something and the response indicates that my comments were misinterpreted.   I try to clarify, it just gets worse, and our comment streams now end with readers insulting the blog, me (apparently I'm someone's nightmare shrink and jail would be preferable--which leads me to wonder why such a person would read our blog), and my choice of topics to discuss.  If I talk about an observation I've made, people get angry because of a scenario they've extrapolated that to, which was never what I meant in the first place.  Attempts to clarify seem to be futile.  I don't feel heard, and clearly, some of the commenters don't either. 


And sometimes I feel like readers don't want a discussion at all.  A story is written in, and I often sympathize with the story because our readers write in about very touching, and often tragic, difficulties.   They also sometimes seem to feel that it is the Shrink Rappers' obligation, job, or destiny to right the wrongs they see in psychiatric practice and I do believe we've let these readers down.  Sometimes, I feel terribly bad for the person who has been victimized, but I'm also aware that I've heard only one side of the story, and I may talk about what the other side might be.  And while I don't believe people should suffer, I do sometimes feel that it's helpful to see other perspectives.  It enables a search for a solution to occur with a more thoughtful dialogue.  But it also means that I sometimes sound unsympathetic in that my answers are read as "Yes, but..."  From my point of view, that's part of the discussion, and if you want to say something and want us to respond with absolute sympathy, having heard half of a story that often demonizes our profession, and you don't want to know how the other side might look at it, then I don't think Shrink Rap is the place to come.   I am not likely to write a post about how psychiatrists are all evil and manipulative control freaks who want only to incarcerate, abuse, and poison their patients.  And it's not that I don't believe there may be evil shrinks out there, or stories of abuse, or nasty and disrespectful nurses, and I certainly do believe there are psychiatrists who practice quick, uncaring psychiatry for the sake of a bigger paycheck, but sometimes I want to consider other possible explanations.


Let me give an example from recent posts.  I put up an article from USA Today on how involuntary commitment is so unpleasant and that if it were more humane, it might not be so awful.  I put it up because I agree with it.  People wrote in to talk about the abuses they've suffered, and that is fine, it's what I expected.  But several people complained about being searched, and how it was offensive and insulting and given their past histories and diagnosis, this was inappropriate.  I understand their pain and humiliation, but what doesn't get mentioned is the perspective of others when things go wrong.  The patients are new to the unit, the staff has no idea who is dangerous and who is not, and psych units can be very unpredictable places.  Some of the policies are made as reactions to bad things that have happened, and often patients have assaulted other patients, or the staff, and suicide attempts (and completions) are not that uncommon.   A patient might be insulted at being searched, but is he also insulted when searching is not done and he's stabbed by another patient who came in with a knife taped to his leg?  Wouldn't that lead to the same "unbelievable" cry?  And to read our blog, one would think that no psychiatric patient might ever care about the safety of the hospital staff or their right to be concerned about it.   It's not that I don't empathize with commenters' suffering, it's that I'd rather there was just a token nod to why it may be necessary.  Why does a four-year-old have to remove and x-ray her flip-flops to get on a plane.  Do we really think she's going to blow it up?  No, but perhaps we think that if they stopped x-raying children's flip-flops, then a terrorist might then use them as a vehicle for a bomb.  Or maybe it's all ridiculous and we should be a little bit more thoughtful about our security procedures.


One commenter was distressed about being strip-searched and made the statement that other hospitals don't all do this.  Not my field of expertise, but it does seem to me that if one can say "I understand why it's done, I want you to understand how damaging it is," and then go on to say that other institutions don't do this and propose other, less damaging means of addressing the same issue (?metal detectors, drug dogs, pat downs, body scanners, whatever) perhaps there is some power to this.  Maybe you get people looking and they say Wow, the institutions that don't strip search patients actually have a lower violence rate (I don't know this, but we do think it's possible that there would be less violence if patients aren't enraged).  But someone is going to read my comments about staff and patients being in danger as meaning that I think it's fine to violently rip people's clothes off them, and for the record, I don't.  


Another commenter asked if I do this to my patients, this 'yes, but' thing.  Sometimes I do.  If a patient is telling me a story about an interaction with another person that sounds unlikely to me, I may ask the patient why he thinks he got the reaction he did.  Would it be honest to sit there and listen to something that doesn't sound right without challenging someone to think about it in new ways, or to propose some other possible explanations?  Let me give an example from a recent Shrink Rap topic.  If a man talks about how his adult son has estranged him and he has no idea why and he presents theories that sound unlikely (my son wants to control me, he's jealous, he always favored his mama,  you name it), and I have a sense of what might be part of the issue from other things he's told me, I might ask, "Do you think the fact that you don't approve of his wife and the way that they are raising their children might be making him uncomfortable?"  Or I might ask if the son may have found it difficult to get his approval when he was younger, or if how the father used to treat him before he stopped drinking might be a part of this.    But it a patient doesn't want to hear this, if they need me to be all in their court, and if they insist I'm wrong (and after all, I wasn't there, so my theories may well be inferior theories), I back off.   The truth is that no matter how troublesome the patient's behavior is or has been, they are my patient, they are the one I am obliged to help, and sometimes I feel around for the best way to do this.  No, I don't always get it right. 

I don't know if this helps, but I suspect it will inflame things.  Commenters may say I'm getting defensive again, and they'd be right.  I read some of the comments and think, "You'd say this in my living room?" Because if you're someone who might behave in this manner, there is no way you'd be invited in to my living room.

80 comments:

Anonymous said...

LOL

Carrie said...

Chin up, Dinah - perhaps those of us who don't feel negatively towards you or the blog need to speak up a little louder from time to time! Xx

jesse said...

The rudeness that surfaced during the survey blog surprised me, too, and perhaps it surprised a number of Dinah's readers. The politeness of the living room had been forgotten, or at least circumvented. The number of venomous Anonymous replies were ascendant, and many of the regular commenters were absent.

I'm going to venture an observation. It does not apply to all posts, and if it does not apply to you, dear reader, please do not take it as if it did:

Dinah had blogged on children divorcing their parents. Is it possible that the first blog unearthed negative feelings towards parents that were then "acted out" in the following blog? Dinah, after all, is the parent figure in this blog.

Anonymous said...

Dinah, don't forget that this is your "house" and you get to choose the topics and set the rules.

Simply delete those comments that insult you or are just plain rude.

With respect
RH

Anon8 said...

I'll just say that I think a lot of the commentators - or at least, myself - feel the same way that you described...only in regards to you. It's something that's increased in recent weeks/months. Maybe it's on me, us readers....maybe it's on you, as well.

Something to think about.

Anonymous said...

^bump. Yeah, something to think about and a lot longer than since the post that Jesse mentioned. Unless you wish to privatize your blog, please remember that the internet is not actually your living room and that you do profit from some of the "controversy" and pot stirring. Dinah as the parent figure? Um, no.

Solderbeard

Karen said...

Dinah--I also have been surprised by the recent hostility here, and I don't understand it. You have done nothing to anyone here and are always gracious and fair. Everyone needs to realize that this IS Dinah and Roy and Clink's living room, and should act appropriately. If people want to be hostile and rude and disrespectful, they should open their own blogs and discussion sites.

Yes, many here have had traumatizing experiences--I get that--but that is not Dinah's fault. There are good mental health professionals and bad ones--Dinah gets that. I for one think Dinah is probably among the very best there is. Of course she respectfully challenges attitudes. What decent mental health professional doesn't?

I could say more, but will stop here. Just wanted to put my 2 cents in and to tell Dinah that though some of us have remained silent, we do support her, but unfortunately she doesn't realize that because we stayed out of the pie fight.

Anonymous said...

Add my vote to the "Dinah rocks!" faction.

I've been reading this blog for years, and I've always thought Dinah was thoughtful and nuanced. Have I always agreed with her? No. But I certainly respect her, as I do all the Shrink Rappers.

Blue

frenetic said...

Go Dinah! A real person and a psychiatrist. Let it roll off your back.

As I like to say, "I'm not for everyone, and everyone is not for me."

Anonymous said...

My therapist once finger-wagged me for a "yes but". I can't remember what it was about, but I've found it difficult to work with him since; I feel as though I can't open my mouth and properly address my issues, silenced without my ability to question whatever it is that's been put in front of me. For me, the way I best learn things is with "yes but". In order for me to get to a resolution there's going to be many "yes buts" along the way, sometimes numerous occurrences during a single discussion, in order for me to see what the other person is seeing and actually understand why and how I'm right/wrong/whatever and how to change. A problem isn't always as simple as "just think/do this instead", and those of us whom, for whatever reason, are accustomed to having to analyze everything from every possible angle just aren't going to reach an end result without our "yes but".

To others though, and clearly to my therapist, "yes but" is an excuse to keep thinking my way is the right and only way, to think in the same damaging ways I've been doing for so long. For these people, "yes but" can be hard to swallow, seen as stubborn and combative. "Yes but" has a value to us that I'm not certain they'll ever really be able to comprehend.

---------------

As for the less-than-pleasant attitude of late, I think you need to (re)learn to ignore some of the obvious cajolers commenting on the blog. They're trying to coax you into a lopsided argument, and you keep eating into it. By following along and responding you're simply encouraging them to continue; they believe they're getting a rise out of you and they enjoy it and keep coming back for another fix. It doesn't take much to figure out the difference between a person actually up for discussion and a stubborn troll, give your attention to the kind of person you want to see commenting and less to those looking to do nothing but shoot you down.

Anonymous said...

When asked if when it comes to involuntary hospitalization we would "do it again," I said no. I am one who commented on how forced stripping makes victims of sexual assault relive this assault, creating even more trauma in someone who has problems because of a h/o trauma. While I understand the psych hospitals' reasoning behind the policy (and as pointed out not all have this policy), it doesn't make the policy any less abusive or traumatizing to patients. You mentioned that I could have suggested other less damaging means of addressing the same issue - I would have to go back and sift through the posts to be certain but thought I did mention that other hospitals who don't strip search have patients empty their pockets, not great but certainly preferable.

You make a good point in raising the possibility of decreased violence when patients aren't enraged (and I would add terrified which I think is more often the case). I would be interested if there is any research to look at if this practice of forcing patients to strip actually leads to increased agitation and violence. The case Sampson versus Beth Israel is a good example of how doing this to a patient can end up turning into a very volatile situation, traumatizing the patient, and costing the hospital a lot of money.

I also wouldn't be surprised if a lot of the violence that does occur in psych hospitals occurs because staff kept on when a patient said stop. While it wouldn't be my response, I can understand why some would lash out in response.

Do I expect that my opinion will change policies? No. Maybe a small part of me hopes that there will be more psychiatrists in the hospitals where this is the policy who will consider that the harm outweighs the good and do as one psychiatrist I mentioned did and write an order that it not be done.

I also think it's good that at the very least people who may not have been aware that some hospitals have this policy are aware of it so it wouldn't come as such a big shock if it were to happen.

It's not universal that all psychiatrists and therapists agree with involuntary treatment.
My therapist refers patients to a particular psychiatrist if she feels it's warranted, and she wouldn't send patients his way if he did forcibly treat.

Personally, I don't have an issue with the Yes, buts. I sort of expect in a debate we're going to have a lot of differing points of view.

Anonymous said...

""One commenter was distressed about being strip-searched and made the statement that other hospitals don't all do this. Not my field of expertise, but it does seem to me that if one can say "I understand why it's done, I want you to understand how damaging it is," and then go on to say that other institutions don't do this and propose other, less damaging means of addressing the same issue (?metal detectors, drug dogs, pat downs, body scanners, whatever) perhaps there is some power to this. ""

Dinah, you may think I am nitpicking but this is a perfect example of my feeling about how the issue of "Seeing the other side" is taken to the extreme in our society.

Since many people with psych issues are sexual abuse victims, do you really expect these folks to be able to say, "I can see why this is done" Would you or Jesse or any of the other shrink rappers be honestly able to see the other side if you found yourself in the unfortunate position of being strip searched?

AA

Chrysalis Angel said...

I have been reading for a bit here. This was a well written post. Well said. You aren't to blame for the ills in psychiatry or the past failings of other practioners. Instead you seem to be a compassionate doorway for others to look in, and see what it is like on the other side of the room. Most are there to help, not harm.

I think one of the most frustrating things we as humans feel, is when we feel we are not being heard and understood. And that happens on both sides of the fence. The only way to find solutions to some of these things is to know both sides, but this can only be done if both sides are respectful and receptive.

I hope the blog calms down a bit and friendly exchanges - where growth is possible - are allowed. My best to all here.

rob lindeman said...

Wow, Dinah, for Tu B'Shevat I'm gonna buy you a suit of thicker skin.

What I'm about to say, I say in the spirit of constructive criticism, because I respect you and your blog: you could examine some of your arguments longer and harder before you hit 'publish'.

wv = trismiga; my three shrinks, shrunk

Mary Katherine Parker said...

I've found validation is something we don't do all that well or frequently...When we say "Yes, but..." the other person may feel we haven't heard or understood his or her communication.

In improv, the action ends when when say, "Yes, but..."

What if you were to try, "Yes, and..." It still gets the same point across, and it has the power of acknowledging and valuing the patient's (or responder's) voice. Maybe it might even tone down the stridency in the blog comments...

jessa said...

I hope that I have not come off as combative. I am someone who is very much more willing to deal with a situation/policy/whatever when I understand what motivates it. I might disagree with its necessity, and I will still voice that, but I will be more willing to comply. I do word my criticisms of mental health care strongly because I think they represent major and unreasonable failings. I'd be more understanding and willing to deal with those if they were explained to me.

One of the very biggest criticisms I have of mental health care is that the professionals have been completely unwilling to engage in these sorts of conversations with me. (This, of course, doesn't apply to this blog, only to face-to-face meetings, and particularly when I am "actively" in the patient role.) I've mentioned before that I have tried to get the professionals to engage with me like this and get brushed aside and told to focus on my recovery or something similar. I know you can not speak specifically for any of those people, but I come here to try to understand why they did what they did. Since you largely seem to agree with a lot of us on the terribly negative aspects of mental health care, you can't speak very well to why those things happen. Sometimes, though, you do seem to disagree with me on similar issues, and they seem to be ignored.

Just as you feel we sometimes refuse to understand your perspective, I feel sometimes that you refuse to understand ours. Perhaps we can all say, "please try to understand my perspective on this!" to indicate when we feel unheard in this way?

CatLover said...

I am the person who stated that many hospitals do not strip search, and it has to stop.

After I got out of the hospital, I complained about the policy to the hospital administration, and they changed their policies. You can undress in a bathroom and hand out your clothes, as you change into hospital garb. Then later, you put your own clothes back on. Maybe it has gone back to the way it was, but for awhile, it was changed, anyway. And along with my complaint, I gave the hospital some trauma awareness paperwork, and a de-escalation form and other resources.

I frequently saw staff escalating patients. One dementia patient was escalated, then stripped and thrown into seclusion, despite being no threat to herself or others (she ripped up a piece of paper). The staff were CRYING as they did this. They had no idea what else to do, due to lack of training on deescalation. I put that in my letter, that the staff were crying.

When I complained about the searches and seclusion policies at the hospital, you bet I saw the other side, and gave them alternatives. There are always going to be weird outlier problems, but the problems that I reported about appeared to be routine.

I am not going to post on this topic anymore, I think - it is pretty distressing. I talk about it to educate mental health professionals on how ordinary procedure re-traumatize patients, and I warn patients with trauma histories to have an advance directive, and find hospitalization alternatives. I would have not even bothered complaining, but bad stuff happened to a lot of other people, too, and they couldn't communicate with all the flowery words and my social worker said most patients are too afraid to speak up. I was terrified, but angry to, so I did it.

I don't like all the negative tone on posts here either, but I was never one that did that.

Anonymous said...

With reference to the graphic, and its origins, please note the moral : http://en.wikisource.org/wiki/The_Blindmen_and_the_Elephant

rob lindeman said...

moral.

So, oft in theologic wars
The disputants, I ween,
Rail on in utter ignorance
Of what each other mean,
And prate about a chemical imbalance
Not one of them has seen!

(sorry, I changed it a little bit)

wv = notypo (I kid you not)

Anonymous said...

I went back and read the comments to the posts you referenced and I have to say, that compared to other mental health blogs I read, things were pretty civil all and all. People were talking about their honest experiences and you were responding. There seemed to be an honest back and forth. For example, on the "I'm Sorry" post there were 21 comments and only 1 of them I would consider to be attacking.

I have a lot of opinions about hospitalizations. I've had a lot of bad experiences with psychiatry and medication, but I don't post on blogs about it, because in general, blogs like Shrink Rap will make comments like "Three psychiatrists complaining about a system won't work, these complaints are too broad, too varied, and things I have not seen in person." I thought the complaints were pretty specific. And I'll be snarky and say, you could do something like say, write a book! Probably not constructive, but you are public figures in your field and I found that comment to be pretty ridiculous.

By pure luck I've worked for a few years with a therapist and psychiatrist who were both Directors at psych hospitals/wings and became so disillusioned with the state of the system that they left for private practice and teaching. They have really provided me with good perspective as to why things are the way they are, at least with the local hospitals in my area. And what is happening is to the detriment of patient care and staff morale.

So I respectfully disagree with you. There is a problem with psychiatric hospitalization in this country and it is not a matter of "perspective". It is pervasive. It is systemic. Too many people not enough beds. Running a hospital for the benefit of the bottom line and not the patient. Not giving staff the resources and time needed to do their job. Using psych hospitals as the first stop to drug treatment facilities. And all the other things other commentors have mentioned.

And I found ClinkShrink's post "The Privileged Patient" to be incredibly negative and reactionary, so I think that you set the tone for your site.

ClinkShrink said...

Oh my, I'm going to keep trying here to keep the discussion going in a positive tone. The intent of my 'Privileged Patient' post was a plea to treat all patients---forensic and non-forensic---humanely.

For followup I'd like to mention that these discussions and my "What We Need" post have now been tweeted and retweeted through the medical twittersphere, to an audience that includes literally thousands of medical residents and psychiatrist educators here and in the UK. (And to at least one occupational therapist who responded!) In other words, people are listening. What this will lead to I don't know. But Anon, you're right, if being a blogger counts as a 'public figure' then maybe we can do something. By providing a forum and increasing awareness, we did do something.

Anonymous said...

Rob,

Please don't change the moral to suit your tastes. That only serves to prove the point!! Take it for what it is. From my perspective, the moral reinforces that the shrinks here have their opinion which is but one and no more valid that anyone else who who is feeling up that elephant. My voice counts as much as any docs, which in the great scheme is : not so much.

Anonymous said...

@ClinkShrink

Now THAT's the attitude I think most of us were hoping to see, recognition that you're not just a few small nobodies. Being a blogger, and not just any blogger but a well-known blogger, you have a greater ability to change the way things are than you realize. Being an author you have a greater ability to change the way things are. Combine the two and you have even more strength. Compared to a number of patients, compared to one psychiatrist nobody really knows, you have a lot of power when it comes to affecting change. You have the ability to plant seeds in others' minds, thoughts of how things could be better, how they should be better, where things are just downright awful, the ability to prod the people in your field toward really thinking about change and the many ways - big and small - that they might be able to apply it.

Will change happen overnight? No, but talking about it and the various ways to fix it is a great place to start, and the more you get people talking the greater the likelihood that change will slowly but surely happen.

And I think that's also part of the reason some might have been feeling a little peeved. You didn't recognize just how capable you are.

ClinkShrink said...

Anon: Wow, that was a more energizing speech than the State of the Union address I just heard! Thank you and frankly I'm humbled by your confidence.

Anonymous said...

CatLover, you did a good thing.

Anonymous said...

Clink,

Thank you for tweeting these issues and spreading awareness. That is exactly what is needed.

AA

jessa said...

It occurred to me that part of what limits our coming to an understanding as a group is that each conversation is rather short. There isn't a lot of back and forth. Once there is a new post, the commenting on previous posts drops off significantly. So we end up with post, comment, post author reply, maybe a commenter reply, and not much more. That doesn't give a lot of room to resolve our clashing perspectives. Whenever a new post shows up on a similar topic, we as, commenters, tend to start off in the same place as the last time. Not to mention that there are always newcomers, so even if one group resolves something, the next similar post will still probably start with the same sort of comments.

This is a blog, so that is sort of the nature of the medium, while a forum would probably be better suited to more extended conversation. Not to say that you need to start a forum, but know that there are limitations to the blog format.

Anonymous said...

I know this is coming in late, but when I read this post earlier this week it really struck me. I keep telling myself to be the bigger person and not respond, but I really just can't. Dinah, if the real-life-you is represented accurately by all the "yes-buts," by the inability to see more then one side (though I think this is newish...I really do remember comment conversations in which you heard, responded, and specified that you heard, and that you had not meant x but rather y, etc...), and the minimizing of issues experienced by psych patients, then not only would you not be invited into my living room, but you certainly wouldn't be paid to my psychiatrist. And I'd like to point out that it's okay for you to say something (exactly) like that, but not for me. Just think about it.

Anon Anon said...

I thought you started posting about the controversial issue of involuntary treatment and incarceration, purposely, just to get people all worked up, because you like to do that sometimes. I mean, as soon as I saw the post, I thought, oh, here we go, she wants to agitate the crowd. If that wasn't it, seriously, what did you expect? You know it's a sore point with many people here.

Samstolemyspot said...

I mean this respectfully, the way I would speak about any business person. Your blog is a business, or has taken on that sort of life, feeding into book sales, feeding into other sites for which you write and which you heavily advertise. I would not be at all surprised if there is now more of an element of wanting to stir something up, get people going. That makes for terrible shrinking but is not a bad business practice if you are selling something. So it is likely that with the people you see in your work, you can do a better job of seeing their point, as well as your own, and that is probably, as others have said why you have not been coming across to some readers as a person they would like their living room, let alone their brain. Of course, you will counter that no one needs to come visit the blog. While true, do you wish to use this as place to cultivate a fan club or to generate important discussion? To the Anon who thanked Clink, thank you for thanking Clink.

Anon Anon said...

Something has just ocurred to me. Statistics show that the mentally ill are not any more violent than the general population. So does every ward of every hospital strip search patients entering or is that treatment reserved for psychiatric patients due to the stigma and prejudice that they might be violent?

Anonymous said...

I agree, either all hospital patients should be strip searched or none of them should be. Anything else is discriminatory. Let's see how long the general population tolerates being treated like criminals when seeking medical care.

Sarebear said...

I haven't read any comments yet, sorry, just want to comment based on the post itself and I'll read comments later . . .

Perspective can be an unusual animal.

Recently, my husband overheard almost an entire therapy session, and it happened to be just about the worst one he could have overheard.

Read more here for more details etc. http://sarebear.typepad.com/blog/2012/01/overheard-psychotherapy-intensely-complex-painful-fallout.html

Anyway, for him, it was a really hurtful thing to experience, at the time. For ME at the time, I was actually trying to do the best thing for myself AND him (as I had planned to discuss my anger with him, not hide it, but only after I'd aired it all out in therapy towards the goal of gaining a healthier perspective/view etc. about my anger etc.)

And yet, afterwards when I learned of what had happened, it was so confusing because of the two vastly differing perspectives, and my feelings that I'd done nothing wrong, but also my feelings that, despite that, I'd seriously hurt my husband. Nothing could get around that and I collapsed from the overwhelming pain of that.

I had an emergency session the next day which helped me gain a bit of distance (a little) and a bit of perspective, but while I'm not trying to say that this experience is anything like being hospitalized and the indignities that happen there, what I AM trying to speak to is just how important perspective is.

You know, a very miraculous thing to me is that several days after all this happened, my husband forgave me. I still can't imagine much of the perspective that helped him get to that point (he's still hurting, he says, but one doesn't have to be pain-free to forgive).

I'm guessing that he had to try to work out how some of this was experienced from my perspective; in fact, it was after a discussion where I had mentioned that it was really confusing to me because I know I hurt him, no matter how good my intentions were in talking about what I did in therapy, but that I was trying to do good by us by working on it in th erapy (not that I HAD to justify what I talked about in therapy but . . . I was just opening up to him about my conflicting feelings since the milk was already spilt . . .) and yet it was by doing this, for a positive purpose, that he got hurt (well that and my therapist needs a white noise machine, but that's a whole other issue and doesn't change the fact that the horse had got out of the barn).

So after this discussion, it was an hour or two later when he came to me and forgave me, that I thought perhaps him seeing a bit of my perspective, even while I was acknowledging that I'd hurt him, that helped . . .

Anyway.

After reading Dinah for so many years I think I can make a pretty educated guess that she NEVER means to diminish anyone's experiences by talking about a different perspective; that she NEVER means to minimize what anyone has gone through when she talks about things from different angles and does the "Yes, but" thing.

Sarebear said...

She is a psychiatrist, who likes to blog about psychiatry-related (and occasionally unrelated) things. Her perspective is naturally going to be different than that of the patient, and while I again can make a pretty educated guess that she respects people's stories and experiences, I can also guess (and have sort of seen) that it can get kind of frustrating for her when it seems like she has to apologize for her seeing a variety of ways to view a situation (which, if you think about it, is a very big plus for a psychiatrist to do; it helps them help their patients ALOT; at least, my therapist helps ME greatly because of his ability to see a wide variety of perspectives; he even has his own version of Dinah's "yes, but . . ")

No, this blog isn't for providing therapy, but when you naturally as well as because of your job are prone to seeing a wide variety of perspectives (not all of course, no one's perfect and no one can read minds), well, then that's just what you're going to get when this type of person blogs.

I think she just wants a bit of the respect that she gives, as well as the fact that, people, it is her blog, you can't expect everyone to like everything she says all the time . . .

Yeah, Dinah, I've probably gone too far, I know I can't speak for you. These are just educated guesses based on things you've said and from reading you all these years.

Just, readers, try not to take things so personal. She's A psychiatrist, not YOUR psychiatrist.

I enjoy reading her perspectives, even on the couple of occasions I may not have liked some of it. It's her BLOG, she's airing her VIEWS, THOUGHTS, OPINIONS, etc.

This isn't a medical journal, and this isn't an advocacy organization either.

Sarebear said...

Um, shoot, the first half of my comment, was done in two parts, and only the 2nd part showed up, so it's out of context . . .

shootmenow said...

well, that was...........?

ClinkShrink said...

Ah Sarebear, we've missed you. Sarebear is one of our most senior readers having been with us from the beginning. Dinah and I were just wondering where you were and how you were doing. And you are a genius. I'm embarrassed I never mentioned forgiveness. It's sad we (society) don't seem to talk about this anymore do we? Unless it's a politician admitting infidelity or a celebrity entering rehab.

ClinkShrink said...

Sare, here's the first half of your comment (I rescued it from my email). This is the half that talked about forgiveness:

I haven't read any comments yet, sorry, just want to comment based on the post itself and I'll read comments later . . .

Perspective can be an unusual animal.

Recently, my husband overheard almost an entire therapy session, and it happened to be just about the worst one he could have overheard.

Read more here for more details etc. http://sarebear.typepad.com/blog/2012/01/overheard-psychotherapy-intensely-complex-painful-fallout.html

Anyway, for him, it was a really hurtful thing to experience, at the time. For ME at the time, I was actually trying to do the best thing for myself AND him (as I had planned to discuss my anger with him, not hide it, but only after I'd aired it all out in therapy towards the goal of gaining a healthier perspective/view etc. about my anger etc.)

And yet, afterwards when I learned of what had happened, it was so confusing because of the two vastly differing perspectives, and my feelings that I'd done nothing wrong, but also my feelings that, despite that, I'd seriously hurt my husband. Nothing could get around that and I collapsed from the overwhelming pain of that.

I had an emergency session the next day which helped me gain a bit of distance (a little) and a bit of perspective, but while I'm not trying to say that this experience is anything like being hospitalized and the indignities that happen there, what I AM trying to speak to is just how important perspective is.

You know, a very miraculous thing to me is that several days after all this happened, my husband forgave me. I still can't imagine much of the perspective that helped him get to that point (he's still hurting, he says, but one doesn't have to be pain-free to forgive).

I'm guessing that he had to try to work out how some of this was experienced from my perspective; in fact, it was after a discussion where I had mentioned that it was really confusing to me because I know I hurt him, no matter how good my intentions were in talking about what I did in therapy, but that I was trying to do good by us by working on it in th erapy (not that I HAD to justify what I talked about in therapy but . . . I was just opening up to him about my conflicting feelings since the milk was already spilt . . .) and yet it was by doing this, for a positive purpose, that he got hurt (well that and my therapist needs a white noise machine, but that's a whole other issue and doesn't change the fact that the horse had got out of the barn).

So after this discussion, it was an hour or two later when he came to me and forgave me, that I thought perhaps him seeing a bit of my perspective, even while I was acknowledging that I'd hurt him, that helped . . .

Anyway.

After reading Dinah for so many years I think I can make a pretty educated guess that she NEVER means to diminish anyone's experiences by talking about a different perspective; that she NEVER means to minimize what anyone has gone through when she talks about things from different angles and does the "Yes, but" thing.

Anonymous said...

For the record, Dinah doesn't hurt my feelings. Nothing to forgive. It's a blog. I may be scratching my head at how there is any comparison whatsoever between a child removing her flipflops at the airport to a depressed adult being forced to remove her clothing, stand there in nothing but her panties, and then get billed for it, but that's just me.

I keep coming back to wondering if there is any research out there that these sorts of policies actually reduce violence. That whole evidence based practice thingy. Is there?

Anon Anon you asked if the strip search is just reserved for psychiatric patients due to the stigma and prejudice that they might be violent? The answer to that is only in certain hospitals. In the city where I used to live the hospitals that had mostly insurance patients did not strip voluntary or involuntary psych patients, the county hospital forced both voluntary and involuntary patients to submit to a strip search. In that city, being a psych patient and keeping your clothes on was income dependent. I had insurance but was shipped to the county hospital because I refused to answer any questions about my income, thus the strip search.

Sarebear said...

Aw shucks. Thanks Clink! A compliment like that couldn't have come at a more needed time.

I've not been around because I've been overwhelmed with the curve balls life is throwing us; potential heart problems, husband out of work, of course the intense and complicated overheard therapy thing, and other stuff.

When I did pop in, it was mostly involuntary hospitalization stuff and I've never even voluntarily checked in to a psych ward let alone involuntarily, and the little bit my non-experienced opinion could add to the subject was added long ago. Of course I always reserve the right to add it again at some point, ;).

Just been having a really really hard time.

It bouys me up though to know you guys care! Thank you.

Sunny CA said...

I thought maybe I missed something, so I went back and reread the comments left in response to the posting asking if people would be involuntarily committed again if they could help it, and I still do not see any comments aimed against Dinah or the other bloggers. In response to sharing our stories, first we were accused of being "priviledged patients" who are against associating with those who are uneducated, use drugs and go to jail (and I could not find that content in our stories either), and now there is this very long posting telling us that our description of our hospital experiences does not sufficiently take the hospital staff point of view into account.

I wonder if people who are sexually abused as children commonly take the point of view of the abuser (example: well, I can understand that he really is attracted to preteen girls and he did buy me presents). Do women who are raped commonly take into account the needs and feeling of the rapist? (example: Well, he was a socioeconomically underpriviledged guy who had grown to hate women, so I understand where he was coming from when he jumped me at the ATM machine and raped me. Perhaps a better social welfare system would have prevented this). And yet there is now the stance in this post in response to a heart-felt story of how it feels to be stripped forcibly when supposedly being sent for "health care":

"One commenter was distressed about being strip-searched and made the statement that other hospitals don't all do this. Not my field of expertise, but it does seem to me that if one can say "I understand why it's done, I want you to understand how damaging it is," and then go on to say that other institutions don't do this and propose other, less damaging means of addressing the same issue (?metal detectors, drug dogs, pat downs, body scanners, whatever) perhaps there is some power to this."

Why is it that the victim of abuse at the hands of hospital staff has to (a) sympathize with the staff's plight and (b) submit a list of suggestions for improvement?

Why is it not enough for a former patient to just tell his or her story? Why does the patient have to (1) empathize with the staff's "need" to be brutal/demeaning/etc and (2) make suggestions for how to fix the situation other than the implied ...stop stripping people and stop brutalizing people and (3) do not say anything that implies we do not want to have our roommate and fellow group therapy members be criminal/drug using/uneducated people.

I think it is valid to just report how we feel about how we were treated. I do not understand why you can't just read the stories and not expect more. I do not see the stories as expecting you to fix the system. They just are our experiences and feelings about those experiences. Instead of attacking the patients who post, it might add to the dialogue if the staff of these hospitals would comment on why they treat the patients the way they do. It is not that we would not want the system changed. I for one would. I just do not expect you to do it, and in this political climate, I expect rights of mentally ill patients will decline not improve (consider how the attack on Gabrielle Giffords might affect the rest of people who have mental illness).

Sideways Shrink said...

Dinah,
I think I understand where you are coming from--or at least I relate. I think psychiatry is like any other practice in medicine: no practitioner would ever try to defend the history or current practice by others of their specialty area. While there is a lot of hostility that comes from some people posting on this blog, they are not caught in the actual practice of psychiatry or psychotherapy.
When you spend all day trying to both understand the feelings of the person you are talking to, get insight into them and then try to communicate with that person, feeling attacked on your own blog would, well, suck, in my opinion. Some patients may feel victimized by psychiatry and express it freely on this blog, being a shrink is not a picnic of professions. My father was a sheet metal mechanic and there are days when I feel that given the comparable rate of pay, he might have been getting off easier and with more satisfaction.
Given the enormity of my student loans which REQUIRE THAT I CONTINUE IN THIS PROFESSION and the fact that some patients feel they are experts in psychiatry because they "know how they feel", coupled with the low reimbursement rates of treating a stigmatized group of patients, I, personally would take umbrage in Dinah's position. I would want to say exactly what I think, but would feel constrained as a "representative" of psychiatry. That's just me. Dinah has a more measured disposition or approach than me.
So when someone posted that she should pause before hitting "publish" I say Pthaeeeww!
I laud your efforts, Shrink Rappers. I don't have the patience to consistently respond "positively". This is a hard job and people blame us for things all the time-sometimes with therapeutic benefit and sometimes NOT.

Anonymous said...

I took my umbrage to the bank; they looked at me funny, called 911 and hauled me to the hospital. Once there, the nurses searched me, sealed my umbrage in a plastic bag and locked it in a cupboard. I have not seen my umbrage since, and have missed being able to take it out for a spin.

Crumsita?

Sideways Shrink said...

Anonymous,
I appreciate your re-working of the notion of "umbrage". What a horrible experience. I hope you have changed banks--their press is worse than psychiatry's lately.... I don't know what "crumsita" means but I can guess....

Anonymous said...

Crumsita was my word verification. Whatever Rob says it means, it doesn't mean that. I am waiting for Tina and Angelina to chime in because I think Crumsita might be a member of their club. Otherwise, I liked the way it sounded in my head, being more musical than my current wv, which is sestic and which somehow activates the olfactory more than the aural receptors.

Sideways Shrink said...

Anonymous,
You're funny and smart and I like you. DO NOT listen to Rob.....

XOXOXOX to Rob

Carrie said...

Hey Sarebear,

Thinking of you always!!

Carrie

Anonymous said...

I suspect umbrage is iatrogenic.

Anonymous said...

Other Anon,

There are not enough physicians in the world to have induced all of the umbrage that exists in the world. I must disagree with your assessment.

Alison Cummins said...

Sunny,

When Dinah asks a question, she doesn’t always want to hear the answer. Way back, years ago, she asked whether her child watched too many video games. I gave an answer and defended it. It was not a bad answer. Dinah was EXTREMELY HURT and defensive. So, now I know what to expect and not to expect. She’s good at a lot of stuff but — like the rest of us — is not perfect.

I get it whem Dinah says to complain. It might not be easy or even possible, but it’s the only way. Sucks but true. (What I don’t recall her saying is that there are patient advocacy/ antipsychiatry etc groups who will accept a patient’s point of view and may provide support in complaining. She tends to accept that it’s up to the individual, which ultimately means that any failings in the system are the fault of individual patients.)

That said, even I was stunned when Dinah pulled a “tone troll,” derailing her own discussion, that she started, from the experience of involuntary hospitalization from a patients’ point of view to whether people with psychiatric illnesses and disabilities are suffiently nice to hospital staff. Again, placing the responsibility for mistreatment on the patient. Astonishing, but good to know.

This is a site by psychiatrists, for psychiatrists. Patients hanging around the blog can gain insight into the workings of the psychiatric mind, but we aren’t the primary target audience.

Psychiatrists spend a lot of time with patients. They know all they want to about us already.

Anonymous said...

"Other Anon,

There are not enough physicians in the world to have induced all of the umbrage that exists in the world. I must disagree with your assessment."

I was responding to another anon's catty, supposed to be humorous? post about nurses taking the umbrage away - which appeared to be aimed at patients who have spoken up here. I wan't speaking to all the umbrage in the whole wide world. Oh, the drama!

I work in the medical field myself and believe the harm outweighs the good with this practice. So, no, I don't believe this applies to all physicians - because not all physicians defend this. The umbrage IS iatrogenic with forced stripping of patients who have not done anything wrong. They're patients not inmates.

Anonymous said...

Dear Other Anon,
As the Anon who posted about the nurse taking taking my umbrage away, that post was a metaphor, not mean to be catty and not directed at anyone. It was inspired by nothing more than Sideways Shrink's use of the word umbrage. I like words. They spark associations in my brain and I fly with those. It was not aimed at patients who have spoken up here. It was not aimed at nurses. It was not aimed at the bank. It was not a response or message. It reflected how I feel the experience of hospitalization and medication left me unable to feel anything at all for a very long time.
My umbrage was stored away along with all other feeling, as well as the ability to formulate thought or play with words.
I have experienced the forced stripping, first as a person who was sexually abused in childhood and then later as a psych inpatient, so I feel as qualified as anyone to speak on those topics.
My own doctors,and here I speak of my primary care physician as well as my psychiatrist/therapist, are not the sort who would advocate forced stripping. One has spoken out against this and other practices. They have gone to great lengths to keep me out of hospitals even when many other doctors would have
seen I was admitted straight away. At the same time, there are situations over which they have no control, especially if a patient has a breakdown in a public place and 911 is called. All that is to say that while the system does suck, not everything or everyone that I have encountered in the medical profession is a cause of the problem. My point about there being more umbrage than could possibly be caused by all the physicians is, in my opinion, valid. Long before any culture dreamt of diagnosing or treating anything, we had umbrage in the world.

Sunny CA said...

to Alison Cummins:

Thanks for your response and insight. As I watched this unfold it seemed the patients were solicited for their stories, then criticized for not embracing the viewpoint of the staff and offering ways to fix the system. We were not asked how we would fix the system. We were not asked if we saw it from the staff's point of view. We were asked if we would go back. I tend to think neither Dinah nor anyone else would go back either if she had been through what I went through in the hospital.

Anoymous9086754312234 said...

Alison and Sunny,

Thank you both for clearing up something that needed to be made clear. When another psychiatrist,who posts and comments here,suggested that commenters were somehow responding to Dinah as the "mother of the blog' because we have mother issues that were stirred up by the parent shunning post, I thought that had that tack worked, it would have been such an elegant reworking of reality. It kind of sunk to bottom of the lake and no one really came up with an explanation that made sense until you two put it as you did.
I often make the same mistake here of responding honestly to something that is put out there and then being told that my perspective, often shared by numerous others, is wrong and to even have brought it up is grounds for being ejected from the living room. I think that the "blog mother" needs to understand that people do not feel negatively toward her or the blog itself as another commenter suggested but that some of her actions and reactions elicit reactions in others.

Anonymous said...

To the anon who wrote a post about umbrage,

I completely misinterpreted what you wrote. I took umbrage at a metaphor about umbrage. My apologies.

Sarebear said...

Thanks Carrie! Think of you alot too. Email me if you like, listed at my old blog linked thru my name here.

Anonymous said...

I've been reading your blog for a while, but I don't comment much, in part because a lot of the commentors seem to feel so personally about things so I feel a bit wary of commenting. But I did want to let you know that I do like your blog a lot.

-MM

Anonymous said...

I'm another anonymous who rarely comments, usually because my thoughts come together long after the topic is dead. But this topic's been hanging around a while.

My voluntary and involuntary admissions have been pretty tame, but I'm APPALLED that some facilities would strip-search incoming patients as a matter of routine. We're forced into the hospital because we're (supposedly) not safe to be on our own: what a
therapeutic contradiction! Even if we allow that some sort of invasive search might be necessary in some (very rare) cases, it's not hard to come up with some common sense safeguards (hey, only female staff present for a female patient).

Here's a case of a Boston hospital successfully sued for allowing a sexual abuse survivor to be held down and searched by five men.

I'm going to do more research on this topic -- at the very least, hospitals should have to track and report their use of strip search & justify their policies, just as they do for restraints.

Thanks to those who spoke up about their experiences.

insideout said...

if safety was all society cared about then every high schooler would be searched before entering school every day and maybe more than once per day if they leave the premises for lunch. More students go to school with knives taped to their legs than psych patients brought to inpatient units. More kids are beaten at school than nurses or staff are attacked by patients. School is far more dangerous a place to work than a psych unit. Some schools have guards and metal detectors. Most do not. I haven't heard of any doing strip searches although locker searches are common practice. Let us extend this to people who board city busses in high crime areas. By the logic of a shrink, we ought to enact a bill that allows all people to be strip searched because imagine the outcry if someone were stabbed by the guy with the knife taped to his leg. In the name of safety, search everyone. We have this at some level at airports. We all submit to going through security. The psych ward search is done less to increase safety and more to establish the power of the hospital staff and the complete lack of power of the patient. If they really cared whether patients were safe, they would care about psychological safety and they would give everyone a private room. From what I know, a person does not need a knife to strangle another person. A good beating will do it too. Men do wander into women's room and if they have any sex drive after being fed a diet of antipsychotics, what is to say that rape will not happen? Oh, it does happen. Oh, it even happens to women when no male patients are in sight because the truth is that some hospital staff rape some patients.This is not routine but to protect patients, staff should also be searched and should take medication to control their impulses.None of what I have written is living room talk unless the living room is the common room of a psych ward. patients never get to choose who to let into their living room.Heck, patients have to have a nurse come shine a light in their face every two hours. They don't even get to choose who to let into their bedroom.

Anonymous said...

And one more thing. So many psych patients have a history of sexual or other abuse in childhood. of course, so do a good number of people not in receiving psych treatment, but at what point does it begin to dawn on anyone that there is a connection? What does it take to get someone to realize that so many people do not need the drugs because their "insanity" is a reaction to trauma and while it can look like mental illness it would be more sick to not have a strong reaction to terrible things. At what point do we recognize a person's humanity and need for dignity? Two messages before I hear that I have left something out: To Clink, yes I also mean that this applies to a great number of offenders, who have been offended against as children. To Rob, no one is absolving anyone of responsibility for their actions by addressing these needs of human beings.

francine said...

Nice post. I guess the bottom line is that everyone of us deserves to speak and be heard. I appreciate how good you are in your profession, and I salute you for helping your clients find a better path in life.

anonymous clinician said...

Welcome to Axis 2 without borders on the internet. Gee, when people can attack and demean without accountability, where does that usually come from? I've read this kind of stuff at many sites about mental health, and watch out when you are a professional forwarding an honest and direct opinion. Think of it as a wounded animal looking for support out in a field. The predators are quick to show up and start their growling as they prep for attack!

Another example of "the more things change, the more they stay the same." Sheesh!

Anonymous said...

Axis 2 for not being okay with being forced to strip? Predators? Ok, anon clinician, whatever you think. I guess a good psych patient would say, "thanks for the memories." Hope it never happens to you.

Anonymous said...

Um, Dinah, I take it back. I still might not invite you into my living room, but if I had to pick between you and anonymous clinician for a shrink I'd be in your office in a second. At least you have the guts to give your opinion, as unappealing/immature/one-sided as I may find them, under your own name.
Anonymous clinician, I am troubled by your assumption that anything not-pretty must be an axis 2 dx. If you've read all the comments, you'll see dozens of folk with severe MDD or bipolar who experienced serious trauma at the hands of psych units. It disturbs me that you write all of that off. Sigh. Sadly, bad mental health care is all over the place.

Axis2grind said...

To Anonymous Clinician,

I need a vet;please post your particulars. Other than that, what makes you think that the shrinks are the only professionals offering an honest opinion on this site?
No matter what issue I have with some of Dinah's opinion and sometimes tone, I do agree with Anonymous that you are a prime example of what we all fear in the medical system, and why we do not want to go back to any hospital,if in fact you are even in the medical system. I trust that you have checked out sites other than mental health ones. Anyone who reads a newspaper, online or in print, knows that there is often much dissent wrt any topic that could possibly be written about. It is interesting how quickly you slap Axis 2 onto people about whom you know nothing. The equivalent in an ER setting would be to assume that a heart attack victim on the floor is a drunk who cannot stand up and the person with a seizure is someone who is withdrawing from drugs.You will manage to kill a lot of people with that kind of attitude. Of course, you have also highlighted why stigma remains in the world of mental health. People who do have Axis 2 disorders did not ask to have them anymore than someone with an Axis 1 disorder. If there is any disagreement about who qualifies for Axis 1, there is far more about Axis 2. have you been reading about the DSM revisions fight?

anonymous clinician said...

How validating people are quick to attack an opinion. That is what characterological people do. It is unfortunate my colleagues do not call this behavior for what it is more often.

Sometimes I wonder if the internet has not morphed into a safe haven for certain cluster diagnoses.

by the way, not commenting again further on this thread, so have a nice day.

Anonymous said...

anonymous clinician meets his/her own criteria for a character -o-logical disorder. Probably went off the meds.

Anonymous said...

Previous anonymous, as one who shares your frustrations with psychiatry, can we please refrain from the name calling? Trust me, I wasn't happy with what anonymous clinician posted but when responding, we need to stay classy and not lower ourselves to their level.

Thanks!

AA

Anonymous said...

Anonymous has left a new comment on your post "A Matter of Perspective":

I'm disappointed that things went down hill so badly. As Dinah pointed out it's one thing to disagree, but there is no reason for it to get mean.

This is an emotional and painful topic for many. I do think Dinah's comment about complaining is important, although when the problem is bad policy such as forcing psych patients to strip, I think it may take more than a complaint to change things (e.g. Sampson v. Beth Israel).

Ultimately, patients do have some power. They can choose who they confide in. Not all therapists and psychiatrists share the same views about forced treatment. At the first appointment, find out about the psychiatrist's views on involuntary treatment, if they support patients being forced to strip, etc. Ask what hospitals they admit to and find out the hospital policies - not all hospitals do this to psych patients. If you don't like the answers, go see someone else.

sadcat said...

Dinah,
I am so sad to see the vicious attacks on you on this site.
As a medical practitioner (not a psychiatrist) I dread going to work because of similar attacks from angry people, who have not had the outcome they wanted.
Thank you for your great work.

Teufelhunden said...

You already know this answer. This is about agency, and many psych patients' lack of in their many repeated (and often disappointing) interactions with psychiatric professionals. These comment sections become a place where they can try to retaliate, with verbal lacerations, for the many wrongs they feel they've suffered at the hands of our profession. I commend all of you for much thicker skin than I have. I'd probably melt down after a week of angry blog commenters. The solution, IMHO, would be to heavily moderate the comments section. I know it can stifle dialogue, but no more so than repeated digression into vitriol. Some of the commenters likely are Cluster B types. I don't say that as a pejorative; their suffering is legitimate. Yet, this is not a healthy place for them to reside, know what I mean? Some Axis II patients, as you well know, simply crave the affect that a heated comments section can bring out. It's a chance to sit on equal footing with a psychiatrist. The dynamics here complex, and I don't think comments sections following controversial topics (read: anything related to psychiatry) bring out the best in many (most?)

Teufelhunden said...

We are responsible for everyone's safety on the ward. If someone brings in a weapon, or meds to O/D on, etc, we're held accountable. If someone was stabbed to death by another patient on the ward, a law suit would follow. If a patient overdosed on meds she brought from home, there would be a law suit.

How do we ensure ward safety without searching new admissions?

(I have some thoughts that would be expensive, i.e. airport-style scanners.)

Anonymous said...

http://www.youtube.com/watch?v=-saMZaooAbE&feature=related

Different Sides, Leonard Cohen. Have a listen.

Anonymous said...

Teufelhunden,

Maybe I've misinterpreted, but I don't think people were arguing for doing away with all searches in a psych hospital. It's the level of the search that seems to be the bigger issue. I would guess most if not all psych hospitals and hospital psych units search patient's belongings and have patients empty their pockets, but not all of these hospitals take it to a higher level and strip search patients. One could argue that if they don't strip search patients, they might miss a patient who hid weapons or drugs in their clothing, but the same patients could also hide it in their body cavities and as far as I know none of the psych hospitals including those that do a strip search have taken the search to that level - yet. There might be an exception with forensic patients, I don't know. There are hospitals that don't strip search psych patients yet still keep the ward safe.

I do think the discussion was an important one. It gives patients info about what could happen and with this comes the power to make decisions beforehand. If this is of concern to a patient then before they ever make an appointment to see a psychiatrist they can find out where the psychiatrist admits patients and the hospital policy. They can then avoid the psychiatrists that admit to hospitals that strip search psych patients and instead choose a psychiatrist that admits to a hospital that does not have that policy. There are a lot of those hospitals out there. If patient in a particular location only has access to a hospital that strip searches, well at least they will know what to expect.

I understand what you're saying about accountability. I would imagine in any hospital if a patient gets hurt there is always the possibilty of legal action even involving non-psych patients or visitors. However, Beth Israel was held accountable for strip searching a psychiatric patient and they learned that's not without legal risk either.

Although I feel passionately about this issue, I am definitely not excusing the behavior of those who made personal digs at Dinah. That was unnecessary and uncalled for. People should be able to argue a point without attacking.

jesse said...

It is to me exceedingly sad that the tone of conversation became so unpleasant that Dinah felt the need for a break. And I do think that the use of Anonymous leads some posters to speak in a manner they would not do if identified, even by a pseudonym. There are several ways of making a point that feed into this, the most difficult to counter being that of using terms such as “all” and “every” when what is described has been experienced in only a limited manner: all or none descriptions in which subtlety is lost.

It is understandable that some posters are quite passionate about the points they make. Yet if they (and if my description does not fit whoever is reading this, please do not respond as if I was referring to you, because I am not) exaggerate their point to the maximum extent it only, in my view, makes it weaker and limits how they are heard.

In a number of her posts Dinah was trying speak to the other side of a question, trying to explain or at least raise one’s consciousness to the viewpoint of others. She was, in my view, castigated and demeaned by some posters for her efforts.

So, please pay attention to the tendency to take a point to extremes. If one has had a bad interaction with medication, it is one person’s experience; if one has been mistreated, yelled at, or abused in one hospital, it may be the staff in that hospital which is at fault, and one should be at least cautious about talking about all staff and all hospitals.

Frequently posters, in their understandable wish to show the problems with psychiatric hospitals, ignore that the alternative is actually a far harsher consequence. There are many examples of a person who was acting in a way frightening to others being arrested and sent to jail. The treatment a disorganized and helpless person receives there from the guards and other inmates can be horrific.

We who have chosen to try to help those with emotional problems do not think we know everything, or at least most of us do not (I’m being careful to avoid speaking for all psychiatrists. I’m sure there are some who do act as if they know everything). Yet those posters who blast “psychiatry” because of the imperfect knowledge we have might consider whether such complaints are justified: is it the fault of Medicine that there is still illness in the world, the fault of those working to help the impoverished that poverty still exists, or the “fault” of physics that the universe is not perfectly understood? So is it the fault of those who work to help those who cannot afford the best private care that state hospitals do not have the resources of the finest private hospitals?

I have valued Shrink Rap because of the multiple viewpoints expressed here. Dinah, Clink and Roy have done a remarkable job of explaining psychiatry, with its faults, and in their explanations not shying away from facing and talking about what does not work and what needs to be improved. Please let’s bring back the civility of the living room.

jesse said...
This comment has been removed by the author.
Maggie Maguire said...

This problem of strip searching patients is similar to many problems people with mental health issues come across when they want to access services.

I have come across this when people wanted to attend a self help group. Because a mental health service provide owned the premises a worker with that group "had to be on the premises at the same time".

This was a group that had previously been run with no provisos.

The "duty of care" was mentioned however from observation this was a group that had no concept of duty of care towards its clientele in the sense of reasonably forseeing that harm would occur from their own actions.

The duty of care only came into play when considering people with mental health problems as potentially dangerous.

In other words they had a high perception of risk when considering the actions of people with mental illness but no perception of risk as far as their actions towards the person with the illness.

Basically we need to be treated just like everyone else. The way to get around this problem is to have people with mental health problems who have no history of violence admitted to normal wards.

Those who are at risk of suicide, violent behaviour could go to "surveillance" wards like we have here for dementia. One person - one surveillance person (half way between a nurses aide and a security guard).

I can see why this topic has incensed so many because it is in this area where we are not treated like other people that the true nature of the client-provider relationship is revealed and often it is a very polarized and negative one.

Treatment for depression said...

Hi Dinah,

It strikes to me that you bring your point very respectful and polite. If people are that silly to leave stupid comments just don't care. They seek for attention, the clever people will always react respectful!

Nice informative post!
Kind regards
Tasha Smith
Treatment for depression reviewer

How to beat depression said...

People can indeed be very rude Dinah, I would just ignore them. A comment, even given in someones 'living room' should create a positive vibe, no place for being unfriendly.

Kind regards
Tasha Smith
Treatment for depression reviewer

Get Rid of Mold said...

Just like the title of Dinah's post, It is in the matter of perspective of us readers how you see what she means in her posts. Stop bashing the poor girl.