No apologies

When I was in the hospital program I had two really bad staffings in a row. In this program, we had staffing once a week, with our psychiatrist, therapist, a dietitian, and usually an intern or student. (I believe the UK calls these "ward rounds".)

In the first atrocious staffing, I was confronted for not following through on a commitment I had made. I was confused because I was fairly certain I hadn't made any commitments I hadn't followed through with. I tend to be very reluctant to make absolute commitments because of the possibility of extenuating circumstances. I am even more reluctant to make absolute commitments within mental health care because I do not trust the staff to believe me if there are extenuating circumstances.

I learned that when I had made a grocery list the week before that the staff thought I was committing to going grocery shopping over the weekend. I was making a hypothetical grocery list all. It was, to me, a list of the sorts of things I might buy and I also listed some of the sorts of things I might cook. I never said I intended to go purchase the contents of that list because I didn't intend to do so. If I was making a grocery list for shopping that weekend, I would have approached it differently; I would have planned specific meals and I would have based my list off of those. And really, it was an inappropriate list if I meant to buy all of it that weekend. I was eating two to three meals a day at the hospital; that list would have given me more meals than I could have eaten before the food would start spoiling. I had discussed grocery shopping with a therapy intern. She asked me to make a list before I left the program that day and to review it with a dietitian, so I did. If the dietitian thought I meant to go shopping with this list, shouldn't she have noticed it was inappropriate?

When I was confronted about not following through on my supposed commitment to go grocery shopping, I explained all of that. We eventually came to the agreement that it was a misunderstanding. I took responsibility for my role in the misunderstanding, even though there was nothing I could have done to prevent it. I tend to frame things as possibilities because I do not want to commit to knowing things that might end up untrue or commit to doing things that I might not do. I avoid absolutes to an extreme because I am uncomfortable with unduly excluding possibilities. The staff made assumptions that are maybe usually appropriate assumptions to make, but that do not apply to me. At one point I had said, "I am thinking about going grocery shopping." From that, the dietitian assumed I intended to go grocery shopping. The dietitian asked what I would think if she said, "I am thinking about letting your weight stay where it is." I suspect she meant to catch me making the same assumption she had made, but I told her I would think that meant that she had not yet decided whether to let my weight stay the same, that there was some aspect of it that was unsettled, that she was actively considering the possibility. She seemed surprised by that.

When I left that staffing, I felt crummy and I was angry. Being confronted about something I've done wrong doesn't feel good. Whether it was or not, it felt like a reprimand; it felt like getting yelled at even if no one raised her voice. No one apologized to me for confronting me once we agreed it was a misunderstanding. I took responsibility for my role in the misunderstanding, but no one else did. I don't think anyone actually told me to take responsibility for my role, but it felt somewhat compulsory, it felt expected of me, I felt they would blame me for it anyway. It also seemed like the right thing to do and I would have done it even if it didn't feel compulsory. I value respectful, open, and honest communication, which they teach us to value in the hospital program, but which I learned to value on my own. I think taking responsibility for my role in a misunderstanding is a part of that communication style. When no one else took responsibility for their role in the misunderstanding, it felt like I was being blamed, whether I was or not. The only responsibility for the situation that was assigned was assigned to me, even though I took that on myself, resting the whole mess on my shoulders. That felt crummy. That also felt hypocritical coming from people who were trying to teach me good communication skills, but who made me miserable when I used them.

Later that week, I talked to the therapy intern who had originally suggested writing the grocery list. She had not been at the staffing. I told her that I felt blamed for the misunderstanding. We noted that there was nothing anyone involved really could have done to prevent it. Despite that, she did take responsibility for her role. She apologized for misunderstanding me and for how that factored into my atrocious staffing experience. We came up with a way to prevent future misunderstandings: if she thought I was making a commitment, she would double check with me. To prevent all misunderstandings would probably be impossible, but commitments seemed the most important to keep clear. I felt really good about that.

When I went to my next staffing, I confronted the staff. I said that it didn't seem right that I didn't get an apology for their having confronted me, making me feel crummy, once we agreed it was just a misunderstanding. They told me that they couldn't know that being confronted made me feel crummy. They gave me a lip service apology, but they still didn't seem to think an apology was warranted. I was stunned and angry, but could see I wasn't going to get any further with that. I told them that it felt blaming for me to have taken responsibility for my role in the misunderstanding when no one else in the room did. The dietitian said that there was nothing she could have done to avoid the misunderstanding. She said she was told that I was going grocery shopping when she was asked to review my grocery list. She eventually said, "I'm sorry I misunderstood you, but..." and reiterated why it wasn't her responsibility. It was a lip service apology; she didn't seem to think there was any reason for her to take any responsibility, even though her primary excuse applied equally to me and to the therapy intern and we took responsibility for our roles. I was stunned and angered and again saw I wasn't going to get any further. I was livid about how the whole thing went.

Later, as I thought about this situation more, I only got angrier. It is fine for them not to know absolutely that I would feel crummy about being confronted, of course they can't. However, it is absurd for them not to be sensitive to that possibility. Even I am confident that being confronted like this usually feels crummy for most people. In their job, they are confronting patients everyday, for them not to be sensitive to how hurtful that can feel for the patient is a serious oversight. They also seemed to feel a bit crummy themselves when I confronted them; they seemed rather defensive. Furthermore, whether or not being confronted felt crummy for me, an apology was warranted. That is the sort of communication skill they teach us but do not use themselves, which I deplore. That the dietitian was unwilling to take responsibility for her role in the misunderstanding, but despite the therapy intern and me taking responsibility, was also deplorable. Again, taking responsibility is a communication skill they teach me, but do not use when interacting with me, as a patient. I found the lip service apologies insulting. It was disingenuous and I suspect they did it more to stop me from further pressing the matter than anything else. That does not square with the good communication skills they try to teach their patients, either.