Today I am sitting in the Waiting Room of the Outpatient Clinic in the Department of Psychiatry in the Upstate Medical University Hospital of the State University of New York—they are a self-important clan, these OC/DP/UMUH/SUNY people, and they think of themselves in capital letters.
I am in this Medicaid clinic because I am impoverished by medical damage. Around age 40, a bad psychiatrist poisoned me with unmonitored medicine and I never worked again. My father was a college professor. At an early age, and on a regular and frequent basis, I was taken to concerts and theatrical productions. I hated the concerts but loved the theater, Eugene O’Neill’s Long Day’s Journey into Night being my favorite play. I read Dante at age 12, Freud at 13 and Sartre at 14. My College Board scores were high enough to get me into medical school.
At this point Anna comes for me. Anna is tall, pale and underweight. She holds a doctorate in philosophy, a license to practice psychology, and a clinical assistant professorship in the Department of Psychiatry at the Upstate Medical University Hospital of the State University of New York. Her office in the DP/UMUH/SUNY is located on the grounds of the New York State Office of Mental Health Hutchings Psychiatric Center—NYS/OMH/HPC.
Anna is an embed, a person so deeply embedded in a system of injustice, inequality, imprisonment and degradation that it is unlikely that her soul will ever again see the light of day.
By contrast, Paul holds a doctorate in philosophy and a license to practice psychology, but he did not work for DP/UMUH/SUNY. He did, however, work for NYS/OMH/HPC but had the good fortune to get his ass fired. Actually, in a proper professional manner, the handwriting was put on the wall, he read it, and fell on his sword before he actually had to be fired. His crimes and misdemeanors included taking a child to jail to visit his mother because she was deaf and could not visit with him by telephone. Therapists in the system are not supposed to take sick children to jails, even to see their mothers.
In Paul’s first year of private practice he made four times as much money as he did when he was an embed. Now, in addition to psychotherapy, he is a trained practitioner of hypnotherapy, and eye movement desensitization and reprocessing (EMDR). He is also an activist and capable of radical thought. He reads a lot and brings to his patients out-of-left-field ideas that provoke reflection and lead to better diagnosis and treatment. He has been known to hug his patients, take them out for coffee and use their services to assist in office accounting.
Paul makes mistakes. He screws things up, gets into trouble and has to work his butt off to extricate himself from the messes he makes. He learns a lot that way. I know because I’ve been watching him do it for ten years—take chances, screw up, straighten it out, learn-learn-learn. I am responsible for a significant portion of his learning curve. I am a tough taskmaster. Sometimes he expresses pleasure about that; other times he cringes and begs for protection.
When the Embed and I first met last week, she extended her hand and said, “Call me Anna.” Since I was expecting a medical resident and a medical resident would sooner eat bad Brie than be called by her first name, this was an unexpected blessing. She posed the astounding possibility that a doctor in the psychiatric system might be a viable human being. I thought we were meeting to consider the possibility that we might work well together in her DBT group.
DBT is dialectical behavior therapy, a dreary name for a very exciting methodology. DBT is the creation of Marsha Linehan, a Buddhist psychologist in Washington State. Dialectical behavior therapy begins with a small amount of regulatory breath work and then moves through four units, including regaining focus, tolerating distress, coping with strong emotions, and dealing with conflict. Although Paul and I—to name two—think that DBT is a useful set of skills, at least for every American, it was designed for use with people who have been labeled with borderline personality disorder.
Borderline personality disorder is among the most onerous diagnoses in the psychiatric lexicon. Basically, it means that you are female, have a hyperactive nervous system and your therapist doesn’t like you. Anybody who is anal-retentive applies it to anybody who is emotive-expressive. The traditional “treatment” consists in large part of putting the patient in a behavioral straightjacket. Vigorous attempts are made to restrict and control the patient, and break her into submission to the therapist’s will. Your basic Marine Corps drill instructor is far more compassionate, not to mention more successful, because he understands that his subject must be built up at the same time that he is being torn down.
The Marines tell you that you’re a lousy little piece of squirrel dung but, if you listen up, you will be recreated as a heroic figure who walks on water for the glory of the Corps. Psychotherapists forget the part about heroic-walks-on-water-glory; they just tell you you’re squirrel dung. Consequently, in my forty years in the system, I have never seen a single case in which traditional treatment of borderline personality disorder has made matters better. It frequently makes matters worse, causing the patient to terminate “treatment,” which is then blamed on the patient, not the treatment or the therapist. The patient quits treatment because she knows, however inarticulately, that the treatment is wrong. (To be continued)