In Stitches

There was a letter in The Daily Mail/Hate/Fail/Misogynist from someone who claimed that his sister had ‘the worst possible case of depression’ and managed to get up every morning to go to work. That’s funny but when I had my ‘worst case of psychotic depression’ I could barely move off the couch. I could do nothing but rock backwards and forewards, shaking and crying while a disembodied voice in my head told me that I was an ugly, evil witch and that, by rights, I should burn at the stake. I was eventually sectioned and taken to hospital. I wonder if that Mail correspondent suggests that people who have been hospitalised for depression should get up from their hospital beds and work.

I’ve lost the appetite for doctor-bashing but I downloaded two free books written by young doctors on my ipad. Now these newly qualified doctors seem as though they are sweet, sensitive little souls but they can’t write for toffee.

From In Stitches: The Highs and Lows of Life as an AandE Doctor [Paperback]
Nick Edwards (Author)

‘Patient says : I’ve got a personality disorder’
Patient means: ‘I used to be known as an attention seeker. Now I am medicalised by a hippy psychiatrist and you have got to be nice to me.’

Oh, well, I guess humanity has always needed its scapegoats and for the foreseeable future the personality disordered is it.

Here’s another little tidbit:

Chaviest/ugliest girl ever: someone spiked my drink.
Doctor: People only spike your drink if they want to sleep with you

I expected something a little more sophisticated from a doctor. At least Dalrymple is laugh out loud funny, charmingly self deprecating (on occasion) and he’s also a damned good writer.

They Just Can’t Win

First we have this and then we have this.

I usually avoid clichés but why does the phrase ‘in between the devil and the deep blue sea’ enter my head at this point?

But then again maybe that’s what you get when you create an entire category of labels you can assign to the patients you don’t like so that you can avoid having to treat them.

Or is the life of a person suffering from a personality disorder of less value than the life of a person suffering from bipolar disorder?

Can’t treat, won’t treat.

A Product of My Paranoia?

What I about to write is so sickeningly cynical that I am reluctant to commit it to print. But it is something I simply have to articulate. I am compelled to. I just hope it’s not true. I hope it’s just a product of my own paranoia.

A couple of weeks ago I submitted a post entitled ‘A Conversation With a Friend’ in which I explored the unfavourable treatment received by those who have the misfortune to be diagnosed with any form of personality disorder. I had dealt with this issue on numerous occasions in my diary (the pen and ink variety). I came across an entry in which I described how a friend of mind had a ‘psychotic breakdown’ in her second year at university. She was hospitalised, sectioned and forcibly medicated. She tells me that, on one occasion, a senior male nurse sat on her while another nurse went to fetch the needle. The section was eventually rescinded and she returned to college. In spite of several relapses she managed to graduate. She resented the way she was treated in hospital but conceded that it may have been necessary. A few months after she graduated, as a result of her condition, she was allocated a housing association flat. Then, suddenly and inexplicably, all local authority support was withdrawn. She was told that she was no longer entitled to a community psychiatric nurse or even a twice yearly visit to a consultant psychiatrist. When she demanded and got access to her notes she found out why. She had been rediagosed. She was no longer ‘psychotic’, she now suffered from a personality disorder known as schizotypal personality disorder and, as this was untreatable, she was no longer entitled to any support. She had, overnight, become a member of a group regarded by the psychiatric profession as nothing short of untermenschen.

Since then I have come across many similar cases. These people have the same problems they have always had, the same low self esteem, the same despair, the same social exclusion but all the support that had hitherto helped them to cope with this is withdrawn. A diagnosis of ‘personality disorder’ supersedes any other diagnosis you have ever been given. At the stroke of a pen, at the click of a mouse, public expenditure on the mentally ill has been reduced. Now that’s what I call genius.

These people may well be ‘untreatable’ but I just don’t see how this makes them any less deserving of sympathy, if not empathy. If someone has a physical disorder that is considered untreatable they are not belittled, they are not scorned, they are not viewed as outcasts and, even if they do not receive ‘treatment’, they still receive ‘support’.

I have been told that ‘mental illness’ and ‘personality disorders’ are separate categories and require very different approaches. If this is so then why call them ‘disorders’ at all? Just chalk their problems up to plain old fashioned character defects but I guess if they did that then psychiatrists would have to section the entire human race, including themselves.

21st Century Witches

A Conversation With a Friend

In 1998, while in a psychiatric hospital, a friend of mine was verbally attacked by a nursing assistant. It was a stinging, remorseless attack. One, she claims, that was completely unprovoked. She was told that she was undeserving. A ‘waste of resources’. Ironically, she was sitting in the same room as a woman who had once tried to burn her boyfriend to death and a man who had a history of violent behaviour. This nursing assistant was looking for an easy target and, like any self-respecting coward, he selected the easiest target in the room.

And the reason he chose her to focus his pent-up aggression on was her diagnosis. She was, according to her consultant psychiatrist, ‘suffering’ from Borderline Personality Disorder.

If you should ever find yourself in need of psychiatric treatment there are two words you should dread hearing: ‘personality disorder’. Somebody once gave me this definition of a personality disorder: ‘the patients the psychiatrists dislike the most.’ For many this diagnosis is the kiss of death. It is a catch-all term that psychiatrists use when they can’t quite work out what is wrong with you. It is also used to define what they used to call moral insanity or maybe character defects. ‘Personality Disorders’ are often more value judgements than diagnoses. In a world with limited resources they are not usually a priority. Society is arranged hierarchically and this is replicated in psychiatry and mental health nursing. Some are regarded as less ‘deserving’ than others. Psychiatric patients with personality disorders are the ‘undeserving mentally ill’. This is a view unashamedly endorsed by some prominent psychiatrists and some have even advocated the denial of any kind of treatment.

One issue that is rarely addressed is that many ‘sufferers’ of personality disorders have endured severe trauma. Many have been abused. There is a clear and extensively documented correlation between a history of abuse and personality disorders. Did their flawed personalities contribute to their original abuse? Perhaps they invited childhood sexual abuse, physical abuse, domestic violence. Perhaps they asked for it. There is little acknowledgement that these people are products of their histories. They are detached from their context, a strangely superficial stance for people attempting to understand how people’s minds work to adopt.

The claim that personality disorders are untreatable has been refuted but media coverage of the issue does not reflect this. For many in the media experts are infallible. There is an unwillingness to admit that they may be wrong. The truth is that everyone is fallible and psychiatrists are more fallible than most. All medicine is to some extent an art and psychiatry is more of an art than most.

Many also seem to forget that personality disorders do not preclude the possibility of co-morbid disorders. The system rejects them not because they are likely to harm others but because they are not. They are maligned because they are easy to malign. They are complex and difficult to treat. In a profession enslaved by the pharmaceutical industry those who do not respond to medication are ‘untreatable’. They serve as mirrors to the fallibility of psychiatry and ‘the medical model’ and that is why they are hated.

Addendum: http://bjp.rcpsych.org/cgi/content/full/180/2/110

http://www.iop.kcl.ac.uk/departments/?locator=600

http://www.psychminded.co.uk/

And a little inhouse catfight between medical specialisms on the subject of self harm can be found here. Entertaining stuff.  One wonders how, given the frequency with which they fight amongst one another, they ever get around to treating anybody.