It started, of course, with a nightmare, which led to a long train of memories, none of them pleasurable or comforting. It ended with this: tomorrow afternoon I have an appointment with my therapist and her supervisor. Dick Gottlieb and I, in the context of our workshop on “Treating the Psychiatrically Maltreated,” have explored the issue: if the therapist and the patient are not working well together then the therapist can request a meeting with her supervisor—so why shouldn’t the patient also be able to request a meeting with the supervisor?
And so, tomorrow afternoon, I am meeting with the therapist, who is a psychologist, and one of the managing partners of her agency, who is also a psychologist but a generation older (and more experienced). The agency is operating and/or maintaining an office that does not meet the standards set by the Americans with Disabilities Act (ADA). I am a disabled American. Ultimately, the issue became this: the therapist failed to effectively advocate to get the agency to make sure the property met ADA standards.
When asked why she failed to press the issue with her superiors, she said, “I had to think of my job.” What she meant was: I put myself first, and I was afraid.
Dick Gottlieb, a clinical social work supervisor, told me that when he was still in training, he had an experience which led him to the understanding that the patient must always come first. In his words, “If I wasn’t in the business to put the patient first then I shouldn’t be in the business at all.”
My therapist previously had told me that she worked for twenty years at Elmcrest Children’s Center (formerly Onondaga County Orphans Asylum). Elmcrest is a residential facility for at least 130 kids, mostly with “emotional, behavioral, and psychiatric disturbances.” About once a year she would have to escort a child to CPEP, the Comprehensive Psychiatric Emergency Program, wherein absolutely horrible things happen to children (see also “About Michael,”
Consequent to what the therapist saw happening, she wanted to file a complaint against CPEP. Her supervisor told her not to, so she didn’t.
So where does that leave us? It leaves us with government funded patient care that does not meet government standards. And it leaves us with institutional managers who won’t file complaints to get substandard services upgraded. And it leaves us (“us” being the plural of “me”) with a therapist who is both a coward and selfish. She put herself ahead of her patients. She is paid to put her patients first for forty hours a week. It’s not a lifestyle; it’s a job—and her job is to work for the betterment of her patients.
So what do we do now? Can the therapist be rehabilitated? Can she become a person of courage? Can she learn to put her patients first? If she can learn, who will teach her? I tried and failed. I spoke to her direct supervisor, who did nothing. Will the managing partner take on the challenge? The fact is that this therapist is Every Therapist. Virtually all of them kowtow to their superiors and do as they are told. Whatever happened to people who stand up for what is right? Whatever happened to people who know what is right?
For me, “right” is explicitly spelled out in the sacred writings of the major religions, e.g., the Bhagavad Gita, Holy Bible and Holy Koran. My willingness and ability to stand up for what is right is based on two things. First, the sacred writings that teach me what is right and, second, the Divinity who will support and protect me in the doing of right. However, I have a friend who likewise “does right” without any apparent reference to sacred texts or the Lord.
If I am doing right then I am doing God’s work and I know he’s got my back. That helps a lot but apparently isn’t essential for the doing of right. How is it that a person can know what is right but not do it? To me, the functional definition of “sin” is knowing what is right but not doing it. How can people fail to do right? How can so many people walk upright without any apparent backbone? How can people fail to do what is right when what is right is spelled out in civil law?
I don’t understand any of this but what I am sure of is that I don’t feel safe with this therapist—or most of the others. The reasons the “Treating the Psychiatrically Maltreated” workshop came into being were because so many therapist—be they social workers, psychologists or psychiatrists—aren’t doing what is right. They aren’t creating safe treatment environments for their patients and their patients are getting hurt.
It’s not just about meeting ADA requirements. It’s about having the courage and moral rectitude to stand up for vulnerable patients whenever and wherever they are put in danger by the psychiatric system, which happens everywhere on a daily basis. The psychiatric system has become a corrupt purveyor of injury, and what are we to do about that?