The only reason for giving someone a diagnosis is in order to treat. If you’re not going to treat, then it’s just name-calling. Generally speaking, I refuse the diagnosis of borderline personality disorder but I will accept it if it will get me some “treatment” that I find useful. DBT is useful. The format is half academic classroom and half group therapy, and I took the course five or six years ago. Unfortunately, that was a long time ago and I was heavily drugged, so I don’t remember much and have been trying to get into another course for review, which brings us back to Anna the Embed.
Our first interview went very nicely and I was pleased with her. We did my history, which meant I got to talk about myself a lot, so of course I was pleased with her. Today I thought we were meeting to consider the possibility that we might work well together in her DBT group, but it turns out we are meeting for her to judge whether I am acceptable in her group. There’s a significant difference.
The Embed starts by telling me that the two commonalities of people in the group—aside from being female—are an unusual level of sensitivity and being invalidated from childhood on. The sensitivity, she says, oftentimes exists from birth and may have a biologic origin. You bet your sweet bippy, I think to myself. My mom would send my sisters and me out in rotation to sweep the sidewalk. I’d get blisters and they wouldn’t—that’s biologic sensitivity existing from birth.
There is a brand-spanking-new field of medicine called psychoneuroimmunoendocrinology (PNIE). It is about the interplay between the four systems of psychology, neurology, immunology and endocrinology: sugar hits the exposed nerve in a tooth (neuro) that results in a burst of adrenalin (endo) that causes tearfulness (psycho). The seminal research on PNIE was done twenty years ago and ninety miles away in Rochester, New York, by three smart guys. The top guy was smart enough that he is now living in sunny California instead of snowy New York. Of the remaining two, one is an academic and the other doesn’t do clinical work. I’ve followed their research and wonder if the Embed has, but figure it wouldn’t be politic for the patient to ask the professor. If I know something she doesn’t, it will antagonize her.
The Embed goes on to talk about ways in which hypersensitive people are invalidated. We are told, for example, that we are not feeling what we are feeling, and do not need what we do need. For example, children who will later be diagnosed with borderline personality disorder may be told, “You’re not really depressed—now, put your shoes on and go out and play.” Or, for another example, as recently as three weeks ago a therapist told me that I wasn’t unbearably uncomfortable in an 80-degree room—after all, everybody else was bearing it, so obviously I could, too, right? Validation is one of the most important concepts of DBT: the way you feel is the way you feel and no one has the right to tell you otherwise. Your world-perception is to be validated.
In the first five minutes of our meeting, the Embed tells me to stop externalizing, which comes as a rude shock to me. Externalizing is about the locus of focus. Contemporary America is all about I: we have magazines called I, Me and Self. We do not have magazines called You, Them or Others. The psychiatric system believes that if there is a problem between you and the world you live in, you fix it by changing yourself. The essential premise of psychiatry in America is that the patient is wrong. How do you get to be a patient? By calling a doctor’s office and asking for an appointment.
Psychiatry rejects the possibility that what needs to be changed is the world in which the patient lives. The Embed points out that there aren’t any people in my life who drop in at my home to say “Hi.”
I ask her if there are such people in her life.
She says she’s not comfortable answering that. This is a basic tenet of all people who work in psychiatry: hide. Spend as much time as you like telling the patient what she’s doing wrong and why her life isn’t working, but never admit that your life doesn’t work either. In short, we will make reference to the patient being overweight but we will not comment on the therapist being underweight—or schizophrenic. I had a schizophrenic psychiatric resident once; it was not a pretty sight.
I’d be willing to put money on the fact that the Embed doesn’t have anyone drop in at her home to say “Hi” either, but she has obviated the necessity for that by spending long hours in study and work, and becoming a Doctor of Philosophy and Clinical Assistant Professor. If you’re never at home, you don’t notice that no one comes to visit you there. I’m always at home and I notice.
I point out the following to the Embed:
- Most people are connected to society by their families. My fiancé died, falling to earth under a closed parachute, therefore I never had a husband or children: absence of connection, part I.
- Many people are connected through their place of work. Ever since a doctor poisoned me twelve years ago, I have been unable to work: absence of connection, part II.
- All people are connected by their ability to travel to where other people are. I have been in and out of a wheelchair and unable to drive for three years: absence of connection, part III. (To be continued)