why are healthcare professionals so shitty

So it’s like this: when you have a chronic illness, a lot of the condescending bullshit you get boils down to two things:

1. people thinking you’re weak, and

2. people thinking it’s all in your head and/or you’re just making too big a deal out of your symptoms/everything in general if you ask for any help/accommodation.

And ESPECIALLY for anyone who’s a lady or read as a lady, there’s a heavy element of misogyny there. Like, did you know that VASTLY more women die of heart disease than men? Do you know why that is? It’s because when women go to their doctors complaining of chest pains, said doctors are FAR more likely to dismiss their symptoms as being stress-related than they’d be if a man was telling them the same shit. And so women die. Because when you’re understood - accurately or not - to be a woman, every single interaction you have with a healthcare professional is laced with the tacit assumption that your pain, fatigue, etc, are all just in your inferior lady-head.

This isn’t individual healthcare professionals being dicks. “Bitches are crazy” is a HEAVILY institutionalized attitude in medicine, and it’s roots go back to basically the CREATION of contemporary “western” medicine.

SO here’s what I’ve found as an ACTUALLY crazy bitch with a chronic illness trying navigate the healthcare system on various levels:

1. Basically every condescending, dubious/skeptical, etc response I get about my endo boil down to, “I WANT to tell you that it’s all in your head and treat you with all the disrespect and dismissal that I’d treat a crazy person with, but I have all this medical info here that tells me otherwise so I can’t just come right out and SAY what I believe here.”

2. BUT when I’m dealing with healthcare professionals in the context of my mental illnesses, that layer of pretend civility just… goes away. There’s no veiled invalidation of my symptoms, no dancing around the assumption that I’m making shit up for attention or to get out of assignment deadlines, because the invalidation of my symptoms and the assumption that I’m making shit up aren’t veiled or danced around, they’re stated outright.

3. I talked to the doctor running the clinical trial I was in about this, actually - he’s still a doctor I see when I can’t get in with my regular doctor, because I like him - and here’s what he said: “It’s true, for many doctors there is this confusion. Because depression, for example, there’s no test you can take for depression like you can take for diabetes. Any test you take for diabetes gives you an objectively positive or negative response. But we general practitioners can’t do such a test for depression. Some places they can give you an MRI and map your brain, but that’s not what we’re doing.”

4. So, most doctors see mental illness as being in an ENTIRELY different class from “physical” illness: “physical” illness is objective, because you can easily and accurately (for given values of “easily” and “accurately”, of course) test for it. But “mental” illness is entirely subjective, and they have no “real” way of easily & accurately testing for it that they don’t trust patients to not manipulate.

5. So they subject patients who present with mental illnesses to all sorts of shit that they don’t DIRECTLY subject patients with chronic physical illnesses to - particularly if those patients with chronic illnesses are white, male, etc - BUT that doesn’t mean that the ATTITUDES that inform the treatment of people with “mental” illnesses and people with “physical” illnesses are not fundamentally the same.

IN CASE YOU HAVEN’T FIGURED YET, I find the whole “mental illness” vs. “physical illness” to be totally bogus and insulting, as a mentally & physically ill person. The brain is an organ. The idea that mental illness is some kind of subjective affliction of the soul and not a concrete thing that takes place WITHIN THE BODY feels insulting on  a whole new level to me (and probs to anyone who’s ever experienced regular panic attacks, too). My pain levels spike when I’m in a depressive episode FOR A REASON. Panic attacks have as profound an impact on my physical abilities as pain spikes. And I’ve written a bunch of academic stuff about how Freud & the construction of “transference”-as-medical-phenomenon are to blame for the suffering and deaths of MANY women (and people read as women), but this is tumblr so I’ll condense it: This shit KILLS PEOPLE, okay. 

The people yelling at me at Concordia Health Services are part of a historical and ongoing tradition that directly and indirectly causes people trying to navigate the healthcare system to suffer unnecessarily and to DIE. And it fucking NEEDS to change. It’s not okay. It’s traumatic and horrible and shitty and terrifying and not okay at all.

Okay real quick

tbellwoods:

anoldladyonfire:

novazembla:

I consider myself a depression lifer. I find it very hard to believe that there will ever be a time that depression is not a factor in my life at all, not even as a dormant tendency. Is this just a depression-induced “feeling of hopelessness”? Because I don’t feel particularly down about it. Often it’s just something I have to keep an eye on, like someone with diabetes remembering to take insulin and not go too long without eating. It’s in my life and it can be more or less prominent, depending on a host of factors.

I see all this language, though (in meatspace, not here), about recovering from it, ending it, moving on from this unfortunate part of your life forever (barring any “relapses,” of course) and all I can think is, “Really? Is that the way to frame a brain-chemistry problem with genetic causes?”

What bothers me is not how self-help’y it gets — corny self-help’y stuff can be really effective at helping people manage their shit and stay more or less functional. Even happy! That doesn’t bother me.

What bothers me is the suggestion that you will ever slay that dragon once and for all, and go on to be A Normal. That does not ring true to me, not even a little, and every time I hear it I think it’s willfully naive and possibly even setting people up for failure.

In my experience episodes end, but the imbalance doesn’t. You just do the best you can. Granted, I’ve had multiple depressive episodes over the last decade, and my mother has a chronic case with ups and downs as well. Maybe it works differently for people like us, for whom it’s so deeply ingrained, than for people who are hitting an unusual rough patch that’s manifesting as clinical depression. I mean no disrespect; this does not diminish the horror of what they’re going through, not one bit.

I just wonder if well-intentioned clinicians prefer the cheerier language of “beating this thing for good!” rather than “managing it so you can have a good, fulfilling life regardless,” without realizing how unrealistic and hollow that is for some of their audience.

It’s definitely more comfortable for them (clinicians) to see it that way. Beyond that I won’t comment—this is just not my area and my blabber is not called for in it—but I’m interested to see what others kick in here.

THIS

I like that term, “lifer”. The first few years after I started getting treatment doctors were really keen on getting me “back to normal”. I don’t even know what that means. I had a super messed up childhood and shit. And mental illness seriously runs in the family. So the docs would start tapering me off the meds, eventually I’d have an episode, and back on I went. I think my current doctor has resigned herself to me.

I do think of it as a chronic condition that needs to be managed. Maybe it’s like addiction, where, you know, stopping drinking doesn’t mean you’re not an alcoholic any more. It’s a blurry line anyway. When I say I’ve accepted it, I’m okay with it, and the depression and compulsion are kinda like part of my personality now…I’m not being defeatist. I’m just being realistic.

At some point it was like, it’s unrealistic to wait till I’m “recovered” before I date, or work, or take on other kinds of responsibilities. Like, this isn’t some linear process of self-improvement. We’re already here…

 Mmyep.

What I’ve spent a lot of time trying to explain to people close to me is that I don’t really have a personal frame of reference for “normal” (where normal = not mentally ill) because I’ve NEVER NOT BEEN MENTALLY ILL. I’ve had suicidal impulses since I was five years old. That’s a long-ass time! Certainly some things have changed over the years, w/r/t how my mental illness affects me, but recovery is a concept I often have a hard time with.

I was actually largely relieved last year when my doctor sat me down and told me that he thought I should consider staying on some form of medication or other for the rest of my life. Because I knew that meant he wouldn’t start pressuring me to taper off it and “get back to normal”, setting me up for another awful unmedicated crash. It meant he was actually open to the idea that my mental illness, or at least a significant part of my mental illness, is chronic, which is something I’ve struggled with in healthcare systems before.

but of course most of my friends, when I told them that, were absolutely HORRIFIED. OH MY GOD HE’S JUST GOING TO KEEP YOU MEDICATED FOREVER? WHAT ABOUT GETTING BETTER? But me, “getting better” has failed so many times, and I have so little personal understanding of what “better” on their terms would actually mean for me, that I trust the idea of managing my mental illnesses much, much more. I feel good about it - GREAT, actually. I’m HAPPY to manage my mental illnesses!

But it’s difficult to explain to a lot of people.

depression is

looking for work, desperately needing employment, finding a job that you’re the objectively perfect candidate for, that fits with all of your experience and education, and thinking that you shouldn’t bother applying for it because nothing is that good, and anyway you’ll never get it because you’re a failure at everything, and then spending the entire afternoon reviewing your resume, agonizing over a cover letter, and psyching yourself up JUST TO SEND IN AN APPLICATION via e-mail.

This is how mental illness makes basic shit like applying for ONE JOB a huge, exhausting, ridiculously emotionally loaded and complicated ordeal. And this is when I’m at my most functional. In an actual depressive episode, just looking at job listings would reduce me to repeated panic attacks and sobbing fits.

Blaaaargh.

like, I basically think that deep down, I am a horrible person, and the only way anyone could ever like me is if I tricked them into it.

Welcome to: Exploring The Psyche Of Someone Who Was Abused As A Child, appropriate trigger warnings apply.

When you’re abused as a child you internalize a lot of shit. It’s easier to think that you’re a terrible, horrible, no-good, very bad kid than to comprehend that the people who are supposed to love and protect you unconditionally are hurting you and letting you down in such fundamental ways because the world is a shitty, unsafe place. If it’s all because of YOU, then the world is still a place where people are good and bad things don’t happen to good people. The only reason bad things are happening to YOU is because you suck and deserve it. If you could just be a better person, things would be okay. If you could just try harder, be more honest, have better intentions, fuck up less, then you wouldn’t be hurt so badly so often.

This is what abuse (and, for that matter, depression, although in a different way) teaches you: that you are a bad person, who deserves for bad things to happen to you, and does not deserve for good things to happen to you, or even for anyone to have a good opinion of you, ever.

Today, every accomplishment that I make is tinged with anxiety. Every time I make a friend, I dread the day that they will figure out my “secret” - that really, I am not the funny, passionate, justice-oriented person they like, but a horrible, twisted liar who tricks people by putting on a Very Good Act of being a funny, passionate, justice-oriented person who is likeable (and even loveable). When they figure this out, they will be disgusted, and rightfully so, because I tricked them, manipulated them into liking me when I knew all along the reality of myself.

The ultimate peril of this is that one criticism of something I’ve done or am doing can send me into big, looping, downward spirals of self-hatred. Good feedback and positive reinforcement makes me feel guilty (because I don’t deserve it); bad feedback and negative reinforcement make me upset at best and suicidal at worst (because it’s just confirmation of everything I knew all along, and now the person criticizing me has Figured It Out - it being my deepest, darkest secret, which is that I’m a bad person masquerading as a good one). I know that, as a human being, I need to deal with this. I need to be able to take personal criticism without falling apart. Often the way I deal with this is by acting utterly impervious - I am by turns sarcastic, defensive, righteously angry. I laugh things off. I stay upbeat. But it’s hard to process things - hard to separate the criticisms that I need to take from the criticisms that I need to let go; hard to draw healthy boundaries; hard to separate my sense of self and self-worth from how other people see me. 

A performance review at work, a dicussion with a prof of a paper I’m writing, can undo me completely.

And That’s Why You Shouldn’t Abuse Kids: we grow up into twisted, confused people who want desperately to be good but feel that we’re fundamentally bad, and feel constant guilt about any redeeming qualities that other people percieve in us.