On Becoming an Articulate Hand-Grenade
Psychiatric strategy and tactics are based on faith-healing, replete with speaking in tongues (language), fortune telling (promises of happiness), and snake oil (drugs). Their model is the ABC’s of selling; “Always Be Closing”…quiet compliance and enlistment, the goal. They know what’s best for you.
Beware infantilization; it is endemic in psychiatry.
You must recognize the existence of your own powers; develop them, know when opportunity presents, and stand ready to act. The harder I worked preparing, the luckier and more confident I became.
Whether or not you are firm in your belief that you have been misdiagnosed or you need to improve your position in the system (private or public health) by establishing a more equitable, responsive, and safe ‘playing field’ (you define safe), insight regarding how you are perceived and how you present yourself is crucial. Language and subdued but resolute behavior will help achieve this. Being drugged during an anger spike, however justified, is a handicap you must train yourself to compartmentalize. It will not advance your cause, it will set you back. You will be perceived as inappropriate, irrational, and threatening. Your chart will be ‘red flagged’ and they will never forget it.
Clearer communications regarding your goal to be collaborative (more power/influence) in your treatment will lead to improved control over your quality of life. If your provider doesn’t agree and, more importantly, behave consistently with that in mind per your expectation of them, it’s time for a change. You might have to kiss a lot of frogs before you get a winner, but here is nothing more important.
This is not an adversarial-minded approach; knowledge brings confidence (and chill), trust is ill-defined in this industry and…you are drugged, a decided disadvantage representing yourself at the best of times, but especially should something go ‘left’. Remember there’s nothing more important than your brain health; your caregiver should concur and encourage your participation and self-advocacy and prove it every day, earning your trust.
A few suggestions… Tailor this to your own application.
- Language: Trust should be earned through actions, not words. Talk is cheap. Learn how to separate them. Listen carefully; they will always have intent, a destination for you in mind for every contact. You will be able to spot it easily with a little quiet practice. Talk less; listen more. Their words are full of ‘tells’. Self-control is imperative; emotional, angry outbursts will set you back and might lead to sedation. I know it’s hard on the drugs; you’ve got to learn not to react so fast. Breathe, you can do this. Qi Gong and Tai Chi helped me enormously.
- Shift your thinking; you are a client purchasing services from a provider. I approach my primary care doctor this way also; respectful, but with expectations of a certain standard of behavior towards me and his services. He’s not a bad guy, but I have gently checked him at times. He noticed and we continued. They are service providers, like a mechanic, dry cleaner, or landscaper. This is a business relationship and there is a quid pro quo implicit in your relationship. Standards and quality matter to YOU, the purchaser/client. You have an absolute right to ask for and receive them.
They are more important as it is health care, which justifies your high expectations of their performance. It matters not at all that you might be on Medicaid or Medicare, old, young, male or female. They understand that your ‘head count’ is significant towards their paycheck. All money is green and spends the same way. BTW, NO ONE will like this POV to varying degrees. Only use it if things get aggressive, gently reminding them of their role. The awareness (in your mind, where it counts) will clean or remove the Dr. God Goggles that some folks wear.
STAFF are NOT ‘medical’; gently remind them if they roam outside their boundaries. Using the word “team” does not change things. You are not their patient. You are a client. They are staff. Don’t be belligerent. I was NOBODY’S PATIENT except my doctor’s. If others push back, calmly explain that you feel more comfortable with those terms. Be respectful, adult, and the client who is talking to a service provider. Don’t be snarky, bossy, bombastic. That will be their cue to label you as AGITATED, DEPRESSED, TROUBLED, often their default. Es no bueno for you. They should drop it. If they don’t, pay attention to their response. Silently. Review it later, it will be invaluable.
Don’t get stuck in an argument trying to be ‘right’. You will have served notice that a shift (of power) is afoot. They will note it, discuss it among themselves, and ‘observe’ you further, approaching you with a new tactic…good.
You have another baby step forward to better care and being regarded with respect, an adult, and a paying customer.
- You should be logging/journaling/recording, EVERY SINGLE CONTACT, however seemingly insignificant. They will be. Research your state laws. If it’s allowed by law, it’s evidence; if not, it helps you form a strategy. DO NOT tell them you are doing this, ever. One of the best tools I had was my little Sony PX333 pocket recorder. I dropped convos into my PC storage. It wasn’t so much recording ‘gotcha!’ evidence, it was the playback later, when I could listen and analyze in my home. I listened hardest to myself; what I should have done, said, behaved to better effect…next time. Listening to BS and provocation ‘in-the-moment’ was much easier for me after that. It had a decided calming effect; I didn’t feel I had to take the bait every time they ‘chummed the waters’. Know that you are (at least) on film when you enter the building.
- Know your handbook and receive copies of EVERYTHING YOU SIGN for your provider regarding permissions, mental health standards, policies, mission statements; what they require of you, what they promise to deliver. Highlight, post it, bring it with, if you deem it necessary, I brought it for every appointment once I formed a strategy. I rarely had to brandish it; they could clearly see it in my (deliberately) slightly-too-small handbag. It is surprisingly easy to follow for you, not so much for them. It will be a very valuable tool. It’s a business contract and you can hold them to every, single, thing…should you need to. Copies of all paperwork go into a dedicated file folder at your home. Stay organized.
- Slow the convo down. Even under time restrictions, you must begin to slow things down. This will give you time to formulate a careful, honest, but thoughtfully worded response. When you start, the reaction might be variations of: “What’s wrong, is everything OK, you seem a little depressed, is something bothering you, do you understand what I said? Be sincere when you carefully respond with “no, I’m fine, I’m just thinking, that was an interesting comment you made, let me think and we can talk about it next time, et al. If you make them more comfortable with YOUR pace, you have started to assert your power as a client; a first significant step.
Being able to ‘cue’ your exit before you are dismissed is a ‘power’ move; not hostile but assertive and confident; gamesmanship used everyday in the business world because it’s effective. Things will start to change. There might be more verbal ‘probing’; if so, you might say “You seem uncomfortable. Is everything OK?” (to them). You could say that you have been thinking about your relationship and feel that it would be healthier for you to become more pro-active and collaborative in your treatment. If they don’t respond with “That’s great!” (not necessarily meaning it is OK… for now), LISTEN carefully to what comes next. “Are you upset with me” is a trap unless you can dispassionately, diplomatically make suggestions that will genuinely support your comfort level. If they aren’t sincere when agreeing, you will hear a little snark from them someday. Their feelings got hurt.
If they don’t get over it, move on; ‘lack of chemistry’ should be your only explanation when requesting change (stick to that answer no matter what). Should they press for details say “A service provider/client relationship in healthcare is an important but delicate intangible; sometimes it’s comfortable, sometimes not. It didn’t work out”” They might respond “Do you not feel ‘heard’? You; “Well, sometimes, maybe; I’d like to try this” might be a good start. “I hope we can work on that”, by either one of you is good. If you are pressed for details on “HOW”; put it off until next time unless you already have some brief bullet points, pulling them out of your handbag or pocket. Your interviewer will be raising their eyebrows (in their minds). Be sweet, be chill, be friendly, a little smile. YOU are welcoming THEM into YOUR collaboration. It’s YOUR appointment. Be inviting, gracious, alert. You are not going to ‘solve’ this stuff in one appointment. As they like to say “It’s a process”.
- You don’t have to answer EVERY question they ask. Hold your emotional cards a little closer to your vest (hard when drugged). Ask them one instead; it can be about a term they used “I’m confused, what do you mean by that word, I’ll have to think about that, I don’t know, I’ll get back to you with a little thought, we can discuss this further next time”.
If they say “What do you think that word means?”, you have just heard one of the creepiest, most insulting manipulations in life; psychiatry should be ashamed of that transparent BS, but it is just more patronizing, fishing tactics to infantilize you. It’s what you say to a 6-year old and a teenager…for a reason. Repeat respectfully “I’m not sure, You used that term, please explain it to me”, etc. Don’t feel it necessary to respond when they’re done. “Oh, I see” is a little enigmatic and good for your position.
Here are some important terms. When I heard these, I either asked for clarity, or noted it, used it later to my advantage, or found a formal definition. Sometimes you are going to look under some obfuscating, muddy rocks to get to the essence in this list. I found most are use pejoratively with an unsupported judgement. It was my experience that criticism and negative ‘observations’ flowed like wine. Positives were perfunctory and given less weight.
This language will be in your file; upon review of my files for 10 years, I found that what had transpired and what was written were often depicted in a very different, negative light. I can only come to a conclusion it was ensuring job security and justification for prescribing, and sustained recruitment. I was shocked and then it broke my heart a little, as I had trusted these individuals to have my best interest as a priority. I had been a perfect client; wide open with my thoughts, never missed appointments, cleaned up and prepared for my meetings, financial, housing, employment stability, no emotional crises, just drugs, and most importantly, 100% drug compliant for 9 years. It was never enough. The clinic notes invariably found something to criticize; it was staggering. This is why language is everything…and your contemporaneous notes/recordings.
Be subtle, non-combative, chill. Don’t try to be the smartest, toughest, angriest person in the room. Choose to be the adult. It is all cumulative.
NEVER, EVER THREATEN A LAW SUIT OR MENTION LAWYERS. You are perceived as ridiculous, desperate, impotent, and agitated.
If you’re able to find an attorney to represent you, ensure it is on contingency; you win, they win. Present yourself as calm, rational, with an excellent grasp of the facts and timeline. Lawyers are businessmen, generally not movie crusaders. They will invest in a $ ‘winner’. Mental health is a legal quagmire. You will have to prove DAMAGES with EVIDENCE, not hurt feelings, fear, or perceived procedural, medical mistakes or rudeness. If a lawyer asks you for money ‘upfront’, run.
Develop perspective. “Pain is inevitable, suffering is not.” That’s a tough one.
I’m proof that you can “Fight the powers that be.”
*A SALUTE TO APPROPRIATE—The Swiss Army Knife of words.
This is one of the most powerful terms in psychiatry not evidence-based, clinical, or depression (I know, that last one’s hard to believe). I use it all the time. It makes me smile; I delight in its effect.
It was used as filler frequently, yet I always felt a little chastened somehow. And then I got it. It’s part of the parent/child paradigm. It can soothe, open doors, deliver a hard check in a velvet glove. It is objective and situational, specific and generalized. It is serious, sober, mature, even-tempered, calming, moderating, corrective, scolding AND ironic. It makes the user sound like a rational adult; reasoned and controlled, regardless of what BS your selling. I observed it having an almost magical effect on the listener. I tried it and it worked the first time. Whoa!
The industry peppers their speech with it. Use it right back. They are uncomfortable when that happens but can’t protest…they know what it signals in context. You are asserting yourself in the craftiest way possible.
It can lead and persuade, reassure and be enigmatic, just hanging in the air. Let it. Learn how to use it effectively, it has tremendous power. I pointed out many times, under attack (as they were wont to do), that I was behaving appropriately (make sure you are), my responses were appropriate. The powerful implication was that they weren’t, without overtly challenging them or droning on by being defensive (know when to stop). Initially, use it a lot, and be aware of the effect; it builds confidence. You will quickly learn how to use it surgically.
Too many of these terms are spoken by the industry; they mean one thing, the client hears something else entirely. They are used routinely as if they own the term; it’s in a medical context. That is often ridiculous, inaccurate, puffery. Take notice, ask questions, hold them accountable for their language. Start using their words when discussing your health.
Their words will be in your medical records, forever defining you; someone reading your file a year from now, won’t have that assessor’s IQ, GAF score, or resume’ to reference. Educate yourself.
This is why your notes are important for every appointment and that you begin to incorporate their language, as if you were in a foreign country. You want to be on their page.
- Doctor, PA, MA, social worker/Service provider- ask about their education, specialization, years of experience in a conversation so way. You’re allowed. I ask at least that much of my Nissan mechanic for my little economy car. My brain and body are a Porsche Carrera S Turbo. If your child needed a specialist, asking this would seem appropriate. It’s the most appropriate question to ask for yourself. If there’s push-back, ask why, use this comparison, quietly, earnestly…and listen hard. Look them up in your state’s data base for ‘actions’, complaints, suspensions. Check “Dollar’s for Docs” for the doctors. Know who they
- Patient/Client-Becoming a CLIENT is a position of strength. Patient is a supplicant, a passive vessel. Always refer to yourself like this. If techs, PA’s, MA’s, case managers call you Patient, gently refer to yourself as a client consistently. Believe me, they will notice. If they question you, tell them you feel more comfortable and let it just hang there, stop talking. Set high standards, expectations, budget, time, and poor staffing excuses should be questioned ceaselessly, appropriately. It’s your BRAIN.
- Agitated-euphemism for irrational anger, it doesn’t matter if your not-could get you sedated; a weaponized word. To them, your expression of anger, however appropriate, will always be alarming, in your permanent file. Make sure you are appropriate.
- Depression–Good grief, this is ridiculous (and dangerous) in its ubiquity. It has become meaningless and far too powerful at the same time.
When they comment “You seem depressed”, take a moment. Anything you mention; a disappointment with a co-worker, a canceled dinner date, a big electric bill will be the justification for that word. That is absurd and yet can mistakenly characterize you.
It lacks imagination. Human beings are far more nuanced than binary in their emotions; happy or depressed. Depression does not necessarily lead to suicide, but nobody wants to be held liable if that’s going to happen. (If that IS going on, completely ignore this)
When asked “How’s it going?”, I learned (too late) to recite ‘rainbows and kittens’, chapter and verse. I had never been irrationally depressed, just normal stuff, yet if I mentioned I had a disagreement at work or with my brother, the frown, the reach for the scrip pad, and the “I’m concerned about you” just annoyed the hell out of me coming from a case manager or my endless stream of community college-educated PA’s. It was just LIFE, the continuum, the ups and downs…RELAX.
Real depression is scary; I knew it as a side-effect, thanks……..
- Side effects-they know nothing about this subject. Like a male gynecologist telling pregnant women how they’re feeling. Psychotropics aren’t understood by the people making them and everybody who takes them experiences them uniquely.
I wanted to scream, “You take handfuls of antipsychotics and then try to tell me how I feel. I’M the petri dish. Otherwise, be quiet and listen to me, I’m teaching you something. And don’t insert ‘commonly experienced in clinical trials’. It triggers my gag reflex”. F*uck off….or whatever.
- Anxiety/anxious-another term that is meaningless and dropped into every appointment just because. Make them be very specific and explain it carefully to them. Don’t let them label you ‘defensive’ because you want clarification. Defensive is like agitated; be careful, it could lead to a pejorative report and additional sedation. They will use it as if their definition is the only correct one; understand that is always used subjectively. It is an implied threat as a negative qualifier. It is a scold and manipulative, warning you be more agreeable. Don’t take the bait; stay calm, ask for an explanation.
- Manic-Boy, do they throw this around carelessly; everybody has different parameters, most apply it to talking fast regardless of articulation and rational thought, or having ‘too’ many interests. Also, if you get angry at them, appropriately, you are manic. It’s used to curb people and mute them with an implied threat of…more drugs.
My exit doctor laughed loudly when I told him my diagnosing doctor had labeled me manic; he diplomatically implied she didn’t know what manic was. She had spoken to me for 20 minutes with sleep deprivation. He had known me for 2 years under bone-crushing stressors. I was appropriate, never manic!!! It was funny. BTW; his education was infinitely superior to hers; I looked them up.
- Suicide/suicidal ideation-According to the industry, everybody in the system.
- Phantom Networking-Despicable practice by insurers/providers ‘padding’ provider directories with phony doctor choices. In my most dire time, I called 40 (FORTY) listings; all were front desk lobby numbers of hospitals, disconnected lines, and annoyed receptionists declaring “What are we doing in that book?” When I tried getting answers from the provider, I was stonewalled and gaslighted. Finally, after months, I was offered 1 (one) other choice who never called me back.
Providers are fined for this con from coast to coast; they don’t stop, as the ‘risk/reward’ is profitable when pitching these directories to state systems for billion-dollar contracts (my state). Who’s gonna’ stop them? Legislators are desperate to push mental health quickly off their desk; “There, that’s done” and never look back.
I was desperate to leave the clinic and very sick; it was cruel. I used valuable energy and time calling them every day for weeks and months. Milo Geyelin/Wall Street Journal uncovered this hustle; I soon found a trail. Magellan, the BH management company was singled out as the most egregious.
- Recovery–WTF-Just stop using this altogether. Nobody feels comfortable defining this; it comes up primarily during contract negotiations involving statistics (manufactured by the bidder & how do you dispute a ‘concept’?) and sales pitches in general. There is no recovery in the psychiatric paradigm; why would they cut loose a revenue source? They reference the AA model defining addiction; once an addict, always an addict. AA’s not the voice of God; neither is psychiatry. The absolutes are asinine. Contemporary challenges to this notion abound.
People are capable of choices and change; with and without assistance.
The following terms can be dangerous. Pay attention when they’re used.
- Substance Abuse
- Mental health
- Self esteem
And finally…my regard for the psychiatric industry is capsulized by this real-life experience in Miami with my private insurance, top shelf psychiatrist-of-the-moment.
Nine months after my diagnosis, well into my homelessness and bankruptcy, I was ricocheting off suicidal ideation for Trileptal. On the way to my job, someone ran a stop sign and totaled my van, throwing me through 5 lanes of traffic. In the ER, my friend whose couch I was sleeping on, walked up to the gurney and told me to get out that day. I just laid there thinking “I have no place to go”; the most pitiful statement I had never spoken in my life. My quiet numbness increased; I was at yet another level of shock. I knew I should be crying and frantic. When I probed, I had nothing….
At my next appointment, this happened;
Dr. Pelta rocked back and forth in his big leather chair, glasses on forehead, ‘tenting’ his fingers and furrowed his brow….
“If you were “Jello”, what flavor would you be?”
I was stunned; I thought he was joking. He was not. I was embarrassed for him and a little panicky.
He waited solemnly, patiently. I finally came down on the side of lime.
To the industry; Well done.