A few days ago, I met with my prescribing psychiatrist. She was trying to convince me of the potential benefits of switching from my current, extremely mediocre antidepressant to a different drug. Among the symptoms it might reduce, she said, was my “irritability.”
“I don’t feel irritable,” I said, surprised. I’d been a bit rude with her, admittedly, when she asked me about my family earlier in the session. But I hadn’t been feeling any more irritated with her, or with the world in general, than usual.
“You’ve been pissed off and irritable every time you’ve come in here,” she said.
Well of course, I thought, you’re a psychiatrist. Being hospitalized against your will three times tends to produce that kind of outlook. The first time it happened, I was a teenager and scared to death. They had me on suicide watch, and I kept arguing with the nurse about it, saying I couldn’t sleep with someone coming into my room every 15 minutes. What if they did things to me — sexual things — while I was asleep? That was my fear. My upstairs neighbor had been accused of sexual assault by a teenage girl who was a patient at the mental health facility he worked at — the charges were dropped. I knew about it because my parents had told me to still be friendly toward him; they believed his story over hers. The nurse said I was yelling and would have to be given something to “calm down.” When I spit out the pill the nurse made me take, she called in four other people who came in with a needle, grabbed me, held me down on a table, pulled my pants down, and injected the needle into me. It felt like sexual assault. Not the kind that could be prosecuted, though. The other two times I was hospitalized, no one injected me with anything because I took whatever I was told to take, acted calm, and pretended to be as sane as humanly possible so they’d let me out.
I don’t lie quite as much to my current psychiatrist as I did to the psychiatrists in those inpatient wards. I do want her to help me, after all. To use her expertise to find me a drug that will at least allow me to function a bit better. But I don’t tell her everything. The trust level is not there, and will probably never be there, unless the laws on psychiatric hospitalization are changed.
“I’ve been pissed off and irritable practically since the day I was born,” I told her. “I’m just trying to get rid of the depression.” She continued to insist that my anger was part of the depression, even after I told her that my depression had started at age 15, while my anger problems had been present throughout my childhood.
(Saying it that way — “My depression started at age 15” — was in itself a misleading oversimplification. It made it sound like my brain just broke when I reached that age, and I started feeling sad all the time for no reason. That is not even remotely what happened, but I wasn’t interested in telling her my life story. I’d told it too many times before to various therapists and psychiatrists, none of whom seemed to find it at all relatable, and by this time I was sick of the whole enterprise. This one in particular was not the worst by any means, and was in fact considerably more caring than my last psychiatrist, but I knew from our previous conversations that, like most prescribers, she fell pretty firmly into the “your broken brain can be fixed by drugs” camp. I guess that if all you have is a prescription pad, everything starts to look like a disorder.)
I told her that I didn’t like mental health professionals very much. I was trying to make the point that she shouldn’t judge my “symptoms” by what was really more of a reaction to her than anything else. I don’t think she got it.
“You don’t have to like me for me to help you,” she said. Well, OK. But was getting rid of my anger, especially my anger toward mental health professionals, something that would help me? Or just her?
To some extent, she was right about my “pissed off” attitude being a problem. My quick temper had caused some major problems in my life, including getting me kicked out of college. But it wasn’t a symptom of depression; it was a symptom of trauma. Having recurring nightmares that your dad’s trying to rape you, to which your dad, when confronted about it, replies, “You want to think I molested you, so you can play the martyr,” tends to produce a state of overall pissed-off-ness.
I want to learn how to control my anger. But to get rid of it would be to get rid of a part of myself. It would also feel like swallowing down injustice. Such a drug probably doesn’t exist, but what if there were an antidepressant that could make me stop disliking mental health professionals? The idea felt scary to me, like some kind of mind control pill.
If I’d spoken the above paragraph to my psychiatrist, would she have written down “paranoid ideation”?
I replayed our conversation in my head the next day, trying to think of ways to make her understand:
“Imagine you were kidnapped and assaulted, and never even came close to getting justice for what was done to you. And then you saw someone, a member of the same profession as the people who hurt you and got away with it, and this person told you your anger over it was a psychiatric symptom, fixable with drugs. How would you react?”
It’s probably just as well I never told her that. It could’ve taken the conversation in a direction that would’ve led to me getting locked up a fourth time. Like I said, I never even came close to getting justice.
My point in writing all this is not just to share my story, but to make any mental health professionals reading this take a look at their own practice. Whether you’re a psychiatrist, a social worker, or anyone else working in this field, you probably have at least one client who “displays irritability.” The easy thing to do when someone like that is snapping at you, is to dismiss it as “just their symptoms.” It preserves your own sense of calm detachment and prevents you from losing your temper back. But it’s also a form of disrespect toward the people you’re supposed to be trying to help. It denies the legitimacy of their emotions, as if there could never be any reason for them to feel upset about anything. It papers over the very real reasons behind people’s rage, such as sexual trauma, abandonment trauma, poverty, sexism, racism, classism…and it creates a new form of anger in your client: anger at not being taken seriously.
Imagine that the person in front of you were not “mentally ill” in any way. If you thought about them that way, you’d be curious about how they got hurt, and about what could cause them to react the way they’re reacting. You’d try to understand the “why” before rushing to the “fix-it.” And once you understood the “why,” you’d see their behaviors as relatable — not “patient displays symptoms of X disorder,” but “there but for the grace of God go I.” And the person in front of you, having been heard and recognized as a human being, will be more able to recognize your own humanity.
It has become a meaningless cliché for therapists to announce that they’re “client-centered.” But at the core of client-centered therapy is an idea no one in the “helping professions” should ever lose sight of: what your client wants comes first. If they’re not sure what they want, you can try to help them figure it out, but you should never be imposing your own preconceptions, because who knows if they’ll fit? Maybe the angry person in front of you wants to learn how to turn their anger into useful action, but not to get rid of it — and that’s OK. Maybe the “schizophrenic” in front of you wants to get rid of the negative voices in their head, but not the positive ones — and that’s OK. Maybe the person in front of you feels like not cooperating with the mental health system, even to the point of self-destructiveness, is the only way they have of asserting control over their life — and that’s an attitude that may have some very solid reasoning behind it. Your job is not to change the person you’re working with into someone more accommodating to your needs. Your job is to help them get to where they want to be.