Beyond Blue

Beyond Blue

Blame the Illness, Not the Patient

posted by Beyond Blue | 10:00am Thursday November 6, 2008

blame the patient2.jpeg

One of the most hurtful comments made to me during the worst of my depression was this: “You must not want to get better.”

I’m having a hard time forgiving the person who said that, even as I know she didn’t intend to be spiteful or mean. She’s just plain ignorant regarding mental health issues.

Comments like that are why I’m so passionate about educating folks on mental illness and eliminating the isolating stigma of our condition. Because it’s hard enough fighting all the negative intrusive thoughts within our head. We don’t need additional insults and negative opinions–confirmation of our weakness–from folks who have never wanted to die and consider all suicidal thoughts self-absorbed and pathetic.

But boy do we hear a lot of them, even from the persons who are supposed to be on our side: our doctors and psychotherapists.

Richard Friedman, M.D. penned a compelling, salient piece for the New York Times a few weeks ago (thanks to my editor Holly for forwarding it to me, since I don’t read anymore) on why so many doctors and psychotherapists blame their patients if they don’t get better. It beats blaming themselves!

Friedman writes:

Doctors and psychotherapists generally don’t like it when their patients don’t get better. But the fact is that lots of patients elude our clinical skill and therapeutic cleverness. That’s often when the trouble starts. 

I met one such patient not long ago, a man in his early 30s, who had suffered from depression since his teenage years. In six years of psychotherapy, he had been given nearly every antidepressant under the sun, but his mood hadn’t budged.

Weeping in my office one day, he explained that he was depressed because he was a failure and a whiner. “Even my therapist agreed with me,” he said. “She said that maybe I don’t want to get better.”

You can’t see me, but I’m nodding right now, as I read that. Because I’ve been there, done that, bought the t-shirt, and shrank it in the wash. I can honestly say that my current doctor, number seven, is the only psychiatrist who didn’t look at me with some speck of skepticism in her eye, as if I might be playing sick to prove that she should have never graduated from med school when she doesn’t know a thing about the brain, or how she and the entire field of psychiatry is a sham–a well-contrived conspiracy to get the people’s money, or that I just was on a mission to make her miserable. Because … I have nothing else to do?

One therapist told me that he knew people who wanted to get well, and he knew people who wanted to stay sick. It’s no wonder, then, that he couldn’t understand why I lost control of myself during a panic attack, why I couldn’t access that “happy place” in my brain, to stop me from shaking, losing my grip of the steering wheel, and ultimately finding myself with a flat tire up on the curb of main road in Annapolis. In retrospect I know exactly why that happened: I wanted to stay sick!

Thank God for doctors like Friedman and Dr. Smith who honestly get it–they realize that their patients don’t get anything out of misery. In fact, the misery is miserable! Dr. Smith has never once looked at me with scorn after I’ve had a setback–like I framed it to get on more Zoloft because that drug is sooo good for my sex life.

The patient that Friedman described above finally responded to a treatment. Free from his depression, the guy no longer felt like a failure. Friedman writes:

I decided to challenge him. “How come you’re feeling so much better despite the fact that nothing in your life has really changed in the past few weeks?”

“Well, I guess I just think like that when I’m down.”

Exactly. His sense of worthlessness was a result of his depression, not a cause of it. It’s easy to understand why the patient couldn’t see this: depression itself distorts thinking and lowers self-esteem. But why did his therapist collude with the patient’s depressive symptoms and tell him, in effect, that he didn’t want to get better?

For an all too human reason, I think. Chronically ill, treatment-resistant patients can challenge the confidence of therapists themselves, who may be reluctant to question their treatment; it’s easier — and less painful — to view the patient as intentionally or unconsciously resistant.

Friedman goes on to say that he believes that some patients do really want to be sick. According to Friedman, some “go to extraordinary means to defeat doctors who try to ‘treat’ them.”

I don’t think the patient wants to defeat the doctor. I think he is merely too sick to get well, meaning he can’t do all the hard work that’s required to maintain recovery when his feet are cemented in his disease. That cycle–which I know all too well–is a pernicious one that I no longer judge.

Or maybe some folks are just more driven and more disciplined to get to Sanity Island. Either way, I’d like to blame the illness, not the patient. Friedman does, for the most part, too. He concludes the article with this: “A vast majority of patients want to feel better, and for them the burden of illness is painful enough. Let’s keep the blame on the disease, not the patient.”

Amen.

To read more Beyond Blue, go to www.beliefnet.com/beyondblue, and to get to Group Beyond Blue, a support group at Beliefnet Community, click here.



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stapplingittogether

posted November 6, 2008 at 12:34 pm


Thank you for sharing! I concur. NAMI needs moore pepole like you.



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marilyn

posted November 6, 2008 at 3:16 pm


thanks for the article.ihere all the time that iam just a crybaby or ifi just had more faith.the doctor i have now is very understanding and chalangeing.we have come along way but still have a long way to go.thanks for all you share with us.



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Mary Anne

posted November 6, 2008 at 5:08 pm


YEAH THERESE!!!!!!! whoo hoooo, talk about timing, serendipity, coinicendce, fate…..
Just TODAY I had an appt at my psychiatrist’s ofc with a NEW therapist. The one I grew so close to, we felt the same about alot of things particularly spiritually left to begin her own practice across town. But NOT before she suggested I get the book “The Celestene Prophecy” and the one following it “The Eleventh Insights” To any of you who have not read these books or seen the movie Celestene Prophecy I strongly suggest your doing so. It is about how things happen in this World by divine intervention, everything for a reason and WHEN they are suppossed to happen. I do not believe in coincidence. I heard a woman in a 12 step program say something once that I want to pass on to all of you here on Beyond Blue. Coincidence is God’s wish to remain anonymous! Isn’t that the truth?? The more I thought about that the more I liked it.
I shared all of that with you to share this, today I had a similar experience regarding Dr’s and thier treatments, thier thinking that we are resisting help or not wanting to get better. I learned today that one of the 2 women at the center I have been going to (about 6 mths now since I was put back on Medicaid with my SSI due to my perm. disability) is not even a psychiatrist! She is only a therapist and she saw me on 2 visits because the other Dr. was not in at the time. She is the one who treated or mistreated me unfairly. She insisted on trying me on more bipolar medications in addition to the antidepressant that I have been taking for about 2 yrs now, Cymbalta. I told her over and over again that I have NEVER had a Bipolar diagnosis and that the one time I agreed to try that type of medication when I lived in Dallas and was under another Dr’s care…it was a nightmare!I tried to commit suicide, I did not just think about it, talk about it, I had crying spells, I became very aggressive, throwing things which I had NEVER done before in my life. Next I found myself sitting on the floor of my bathroom in my townhouse trying to slice my wrist with a razor. Later, I got in my car and was about to drive it off the road into White Rock Lake when it occurred to me. I don’t want to DIE, I am not mad at myself I am unhappy with the X husband, the medications, the Dr. I am seeing etc. I need to hurt THEM not myself! That is the only thing that saved me, a moment of sanity and I had taken myself off of the Depokote and Tegretol that the Dr had experimented with me on. I felt like a guinea pig and told him that. I suggest to ANY of you reading this to PLEASE talk to your Dr’s. you have the right to refuse treatment and medications that you do not think are in your own best interest. Today I had to have the girls at my Dr’s ofc put a call into my Dr. to let them know that a GI doctor who just performed a colonoscophy on me on Tue. and I have only seen ONE time told me to go off of my Cymbalta and to begin taking something he prescribed for me. When I went to Walgreens to get it filled I read the computer print out on the medication with the warnings, etc on it. Thank GOD I took the time to do so. The medication is one which is prescribed for anxiety, depression and acts as a sleep aid also. It said NOTHING about the Colon or Irritable Bowel Syndrome which is what I was needing treatment for. When questioned about it, the pharmacist called the Dr. to which he replied that it keeps the colon from having spasms and will also help with the depression. He is NOT a psychiatrist, he should NEVER tell someone with reoccuring depression, SEVERE depression to go off of thier medications. This is not only unprofessional but inappropriate as well. I did NOT quit taking my Cymbalta and I refused the other medication which I had never heard of. Today when I showed the name of the medication and the Dr’s follow up instructions after my procedure to them at my appt. the Dr. my psychiatrist who has me in EXTENSIVE therapy at present due to the last yr I have lived through with being physically assaulted and then abandoned by my Bipolar husband she had not heard of it either. She was not familiar with it and told me NOT to stop my Cymbalta, that I had done the right thing. She like Therese’s present Dr. is humble and will listen. Not all Dr’s are like that, as I have already shared I have had some who did not monitor me after prescribing things for me that made me worse rather than better. I am among those who DO want to improve and continue to recover. We do NOT enjoy the depression, the side effects of the medications or the attitudes of people who don’t know thier butt from a hole in the ground. Thankyou Terese for this timely post, I am with ya and you remain in my thoughts and prayers. Much love especially during this time of the yr!
Mary Anne



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Marquos

posted November 7, 2008 at 5:43 am


“We think you need to change your lifestyle”
“You got yourself into this mess, you can get yourself out” (I asked to borrow a little money from my very rich “best friend” after a manic episode left me in a financial bind, I needed the money to get my truck out of the body shop, which I needed get my job back. I mentioned if I had diabities or cancer rather than mental illness, he and the rest of my “friends” from church would be having a sausage feed to raise money and putting out coffee cans at the grocery store, no response)
“We’ll help you but you have to help yourself first”
“Just put your nose to the grindstone”
“All she needs is to get back to work”
“I like Marq but I don’t think I like Marquos”
“We all been real busy but if you really need us we’ll be there”
“I know you’ve got ‘issues’ but you’ve got to get your life straightened out, bite the bullet, get your act together”
“Your Dad really does love you, but he wants to see you to get your life straightened out”
“You know, that really sounds psychotic!” (My therapist of three years upon reading an account I wrote of two previous psychotic episodes that were in my file)
“You cut your hair?” (My nurse practitioner the first time she saw me in a dress and heels and wearing makeup, my hair had not changed)
There’s lots more, these are the more subtle ones. Mental illness is seen as a character flaw. We take thousands of dollars of medications a month, go to psychiatrists (who have more training than MD’s), often wind up in the hospital, have medical diagnosis’ painstakingly identified in a very thick book, which qualify as disabilities, we suffer as much or more than any illness group, but yet we simply “don’t have what it takes”, and we are weak.



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Richard

posted November 7, 2008 at 2:31 pm


” In retrospect I know exactly why that happened: I wanted to stay sick!”
I have a wording problem with this statement. How about this?
” In retrospect I know exactly why that happened: The DOCTORS explained that I wanted to stay sick!”



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Keith

posted November 9, 2008 at 9:51 pm


I say blame the patient because depression is simply the suppression of God in you. You won’t be depressed when your light is shining. Don’t hide your light. As many of us do not feel safe and/or confident to simply be who we are, i.e., children of god, we end up depressed. Don’t suppress your God given nature.
keith



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Dawn

posted November 10, 2008 at 4:09 pm


Keith does not belong on this web site. I am a born again Christian and was told once that my depression was because of sin in my life. Obviously, Mr. Keith, you have never had bonified depression and your response goes along with, “Just snap out of it”, that I heard for so many years, so you truly don’t know what it is like. We wish we could just “snap out of it”. Fortunately, my husband of 40 plus years did not have your attitude when I was hospitalized.



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Caryn

posted November 10, 2008 at 11:11 pm


Ditto to what Dawn said above. Keith’s comments are literally sickening. For years I believed that something was “wrong” with my faith — that if I just believed more strongly or more thoroughly, I would be happy. This twisted method of thinking quickly leads to the following suppositions:
1. It is my fault that I’m depressed because I don’t believe in God enough
2. It is GOD’S fault that I’m depressed because if he made me feel better, I could believe more easily.
3. God isn’t making me feel better because I don’t believe strongly enough… see number one
Yes, some people are depressed because of situations. But clearly Keith does not understand depression as a mental illness. As a counselor who was also a co-worker once said to me, “It’s chemical. It’s like having cancer except that if you had cancer, you’d get sympathy.”



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lisa

posted November 11, 2008 at 8:40 pm


I agree with the ladies ,keith does not know deep depression .I am a prayer warrior so i spend time with God often and it is thru his love that gives me the courage that yes,this too will pass ,those comments only judge and hurt people struggling with depression .They are not very compassionate like you said ,like i want to feel bad ?Keith doesn,t seem to understand and seems like he;d rather judge .But that;s not his job but God;s .



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jjosefina

posted November 13, 2008 at 11:48 am


Ineed help



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LizJ

posted November 13, 2008 at 1:38 pm


Thank you for the article. It is simply wonderful. I suffer from depression and I am learning more and more from this site. Thanks



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