My decline in mental health has brought issues to the fore that I had been more or less successfully pushing to the margins for a long time. Let's not talk about those here (though I will henceforth refer to it as "the icky stuff"). Because of the icky stuff being raised by the decline, it makes me wonder if I should be going back for a bit of therapy. I hate therapy, I fight therapists, but I'm not sure how else to resolve the icky stuff. This is a very complicated proposition for me.
First, there is the decision of whether or not to do therapy at all. I will probably ask my dietitian and my psychiatrist for their input (not that I will necessarily do what they think I should). If I were to tell them about the icky stuff, I suspect they would suggest I go to therapy. (I am not keen to mention the icky stuff to them at all.) I do not like therapy. I expect to have to fight any therapist I would see, to a greater or lesser extent. I had wanted out of mental health care totally, and therapy is a high level of mental health care, in a way seeing my dietitian and psychiatrist isn't (there is much less for me to fight them about, less paternalism, fewer mind games, fewer lies). Even beyond just hating therapy, this isn't an easy decision to make: I can't just go to therapy every time I have a problem (okay, I can, and some people do, but I don't want to, and I think it is irresponsible to do so). I want to learn to solve my problems like a normal person. Some of the problems swirling are ones I suspect I can solve that way (figuring out what to do in terms of conservation education, finding an "in" to change mental health care), but I am less certain the icky stuff can so be solved, they are of a more neurotic sort, a sort normal people don't relate to very well.
Second, if I do decide to go to therapy, deciding where to go and who to see is no easier. The therapist I saw when I quit therapy has moved away, so I have to start from scratch. I went to a lecture at my alma mater on daseinsanalysis recently and told myself afterward that the next time I need therapy I would look for a daseinsanalyst. (The lecture was incredibly exciting; I might write about that later. Daseinsanalysis is an existential psychotherapy, but I'm not finding anything in a quick web search that describes it similarly as it was in the lecture.) Now that the prospect of going into therapy has come up, I realize that I don't have a good way of finding a daseinsanalyst and there is no guarantee there will be any near enough to me. I might ask the man who gave the lecture if he knows of other daseinsanalysts in the area, but I don't want to do therapy with him because some of that icky stuff is icky girly stuff and therapy for that with a man would make me uncomfortable. If I went to a dasiensanalyst, I suspect I wouldn't have to fight the therapist quite as much, which seems like a good thing since I would already be fighting my own demons.
On the other hand, I almost want to have to fight a therapist; it might be a good learning experience for the therapist, maybe then she would have a greater appreciation for what I mean when I criticize mental health care. Because, as they say, the devil you know is better than the devil you don't know, I've thought about going to someone who I met in hospital who is now in private practice (there are a bunch of them, mostly in two different groups, one of which my old therapist was in, the other of which my current dietitian is in). Even if they don't really remember me, my knowing them seems like it would make things a bit easier. (Also, I've sent them all copies of my thesis with letters of explanation in the past year.) Perhaps I could ask my dietitian and psychiatrist, both of who have worked with these people a lot, if they know who in this bunch would be open to me laying down some "jessa's not taking any crap from you" rules for the therapy. Alternatively, I could ask if they have any suggestions for therapists who would be amenable to rules like that outside of people I've met.
Talking to people about this is strange. I have talked to some mental health care professional-ish (former, future) people and when I say that a large obstacle in choosing a therapist is choosing how much I want to have to fight a therapist, they react as though having to fight a therapist is this uncommon and unfortunate thing. I'm pretty sure I would have to fight any therapist to some extent, though, even the ones that they've mentioned "aren't like that". I doubt myself so easily, so these reactions give me twinges of doubt; maybe I wouldn't have to fight any therapist, maybe it would be fine. But I've fought (or not fought but wanted/needed to) every professional whose care I have ever been under, so I'm reasonably confident that I would have to fight. When professionals whose care I am not under say that they would never act in the ways I fight or that their colleagues would never act in those ways, I'm skeptical. It is easy for them to say that when I don't have specific examples from encounters with them to bring up. It is weird. I don't want to be mean to them, especially if they are willing to talk to me, but I doubt that they are as open and flexible as they claim to be when I talk to them about my complaints. Almost every professional who has been willing to talk to me about my complaints has claimed to be as open and flexible as I request that professionals be. It seems impossible that every professional whose care I have been under has been inflexible in ways I've had to fight, while every professional who I meet "on the outside" is already doing everything I am asking the professionals to do. I don't believe that this is the case, rather, I suspect that the professionals I talk to on the outside are not making the connection between my critiques of the mental health care I've experienced and the mental health care that they deliver. Or something.
12.08.2009
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I've never met a therapist I haven't fought at some point. You're not alone in that.
ReplyDeleteMy own theory about the disparity in conversation one finds between professionals who treat one as a patient (at least whilst you are 'under their care') and those who are simply having a conversation is the MH professionals subconsciously allow their responses to reflect the epistemic status of the individual who confronts them about their own practice of care or the practice of MH care in general. One's epistemic status is enhanced outside of a care environment and one's statements are taken seriously as is due in the respect of one person to another. Inside a care environment, an individual is often seen as having a credibility deficit, lowering their epistemic status to that of a child or one who is not fully a person and thus the MH professional responds in a different way.
I have written a little post on the concept of epistemic injustice on my own blog, if you are further interested in the topic. Additionally, simply typing Miranda Fricker's name (the philosopher at Birkbeck University, London UK) will bring up a whole host of articles about her work as well as information about her book "Epistemic Injustice". I especially recommend the podcast she recorded for the excellent series 'Philosophy Bites'. For me, this has been a crucial concept for understanding the gulf between what MH professionals preach and what they practice and a way for me to understand the anger I often feel about it in a more constructive way.
That should be " Miranda Fricker's name (the philosopher . . . UK) into google . . ."
ReplyDeleteForgive me: I have had my pills for the evening already.
I have a therapist I hardly ever have to fight, so I know they exist. But in my experience that is not the rule. I hope I never have to look for a therapist again in my life.
ReplyDeleteThe self-doubt is horrible. When you say “that wasn’t very open,” they reply that yes, they are being very open, they agree with everything you say... and then they do the opposite.
I think the technical term is “gaslighting.”
Good luck!
ReplyDeleteKatherine -- So, when I am a patient, professionals feel it is okay to fight me, lie to me, steamroll me over my objections, but when I am not a patient, they are more willing to agree with me? On some levels that makes sense: sometimes I want to disagree with someone just because I hate them, even if I really agree, or want to agree with someone I like, even if I really disagree. Then, professionals have a predisposition to disagreeing with patients (if they agree with a crazy person, it might mean they are also crazy), but it is okay to agree with nonpatients. I think people also would be predisposed to agree with someone who is pointing out oppression. (i.e. If someone is talking about the concept of white privilege, and I disagree with them about the existence of white privilege, I look like a racist). But, this also means that professionals are lying to me all the time. When I am a patient and they are disagreeing with me, they are telling me lies about the world around me. When I am not a patient and I talk about how mental health care should be different, and they agree with me (not only by assenting to what I say, but by also claiming to already do what I'm saying I wish they would do differently), they are lying to me about what they do. For people who preach open and honest communication, they sure do muck it up. (I'm not entirely sure this was what you were getting at, though I like it and find it very interesting, so I apologize if I have totally misunderstood. Also, I am excited to learn more about Miranda Fricker.)
ReplyDeleteAlison -- Gaslighting! I've heard that before and it describes perfectly what goes on. I have to start remembering that term. They gaslight while you are in care ("of course everyone will respond in kind when you try this open honest communication with them," actually, no, some people are just jerks, and even you refuse to respond in kind). And when you are out of care and confront them with the gaslighting they did while you were in care, they gaslight you some more ("we would never lie to you like that!").
Deamiter -- Thanks.
Of course!
ReplyDeleteThis is a really complex subject! I know there's a huge difference (whether it's openly acknowledged or not) between situations where one person has power over another and where people are interacting (roughly) as peers. I don't have the experiences you do that would allow me to come to more specific conclusions, but you should be aware that the power situation changes both your and the therapists' perception of your interactions. In what way, and to what extent, I can't honestly say, but power relations (class, employer/employee, government etc...) strongly influence interactions even when people are actively trying to prevent bias.
Another quick thing that stuck with me as I pondered your note through the day -- you said you "want to learn to solve your problems like a normal person." It's actually extremely normal for people to need authority figures (parents, pastors, teachers, even friends) to help them work through difficult situations and emotions. Pastors and ministers (etc... depending on sect of Christianity -- I'm not so familiar with other religions) are usually trained to help people with personal struggles (to a widely varying extent) and often acted as primary therapists before psychiatry was formalized.
I'm not saying you should see a minister instead of a therapist -- therapists are much better trained than most non-professionals -- but it's something to consider as you strive toward "normality."
Hmm... the way I ended that comment sounds like I'm saying you should consider talking to a priest even though I'm not saying you should...
ReplyDeleteThat's not what I meant.
You've clearly already been able to share many of your struggles with people you know, and I'd suggest it may be helpful to consider the sharing of some parts of your struggles with one or two close friends to be an integral part of your journey through crazy.
I am not trying to make any strong statements about how much you should share, with whom, or even how helpful it may be to you. I'm just pointing out that this is how it was done before formal therapy, and that fact is probably worth some musing. Of course, it's probably also worth considering that before professional therapists, it would have been MUCH harder to reliably (on the first, second, etc... try) find somebody who both wanted to help and was capable of helping in a real way.
I'd say that you have it, except that you might be assigning a too strong sense of conscious agency to MH profesionals. I'm not sure that it's so much about being willing to agree or about lying because both of those terms imply a very specific kind of intent that presupposes a meta-knowledge of the situation and a further goal (of communication or action) that lies outside the immediate situation of the conversation. To me it seems more likely that it is unconscious and while this does mean that they are saying things that are not necessarily objectively true or correct, I don't think that it is done with the intent to mislead. It's more a lack of critical self-examination combined with a lack of (what would seem to them to be) credible challenges on their grasp of the situation. So, the unexamined self plus context that eliminates dissenting voices.
ReplyDeleteI do hope you enjoy Miranda Fricker - I'm a philosophy post-grad myself and I love her work.
Deamiter -- I've pretty much left the Evangelical Christian groups behind (I've often wondered what you and Rachel might think about that), largely because they used me and abused me. So I won't be talking to pastors because I'm not around any and I don't trust them to be reasonable about mental illness. (I've been hanging around the liberal, unprogrammed Quakers. They are much nicer to me; I like them better and I agree with them more.)
ReplyDeleteI have shared the specifics of the icky stuff with a couple friends, but the icky stuff seems like it would be hard for them to relate to, because I am being rather neurotic about these things. When I talk (or, more usually, write) to friends about things I'm being neurotic about, I always try to leave them an out, I say something like, "I'm struggling and I really want you to have some magic answer, but I wouldn't blame you if you ignored me about this." They have tried to relate a bit, give me something to work with, encouragement, whatever. And, really, a therapist won't necessarily be able to give me any more than that. (And here is where I devolve into defeatism.)
Katherine -- Is there a good word for "tell an untruth, but without intending to do so"? I don't know of one, so I tend to just say "lie". "Lie" seems to include both intentional and unintentional untruths, but the usual understanding tends to be that lies are intentional. In my explanation above, for most of it, I'm not really sure where they are lying or discounting me intentionally or not. I don't really think it is all intentional. However, that it isn't all intentional is, to me, not much better, because it means that they are not thinking critically enough, cogniscent enough of how the power disparity affects the realtionship. That is not okay to me. It is not okay to preach self-awareness and critical thinking to your patients and not do it yourself (and even if this lack of self-awareness comes from the power imbalance, it is still just as hypocritical). It is not okay to harm people because you are not paying enough attention to prevent yourself from harming them (I believe that would be called "neglect").
That's a fair point and, in any case, the lack of intention certainly doesn't make it better and I hope I didn't imply that it did. I also did not mean to imply that a lack of intention should let MH profs off the hook: they are unquestionably responsible for failing to take patients seriously and for failing to examine their own hypocrisy. I was just trying to clarify my point - I don't tend to think of it as lying though, as you point out, lying isn't necessarily connected to intentionality. To me, it seems more like a deep-seated, learned bias that such as racism or sexism and I suppose I'm wanting an "-ism" type of word rather than a verb. Neurotypicalist chauvinism? That's a bit of a mouthful but I can't think of anything better at the moment.
ReplyDeleteI've had much better luck with clinical social workers vs analytic/dynamic therapists. It's just good solid advice/guidance. Not all that deep bullshit that basically has made me anti-mental-health-care.
ReplyDeleteHrm, I've taken us on a tangent I did not intend. I think you should see a therapist. I find it intellectually interesting (and thought you might too) that "normal people" dealt with this sort icky stuff for tens of thousands of years without professional therapists (in general if not in detail -- I don't know and can't comment on the details).
ReplyDeleteAs for Evangelical groups, I am almost universally unimpressed with them, likely for similar reasons. There is something central to their culture that leads them to treat others very differently than they THINK they are treating others. I've not formalized my thoughts on why they make me so uncomfortable (except, as with you, for personal reasons of theology and how many Evangelicals have treated me) so I won't throw us onto another tangent of trying to analyze the Evangelical culture.
I have been quite impressed with at least two Mennonite groups I've been briefly involved with, and I'd love to find a Quaker group, although I suspect travel to gatherings may be prohibitive. There is also a wide variety in Quaker theology so your favorable experiences may have little bearing on what I might find near here.
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