Well, things are not going very well with my outpatient psychiatrist. He’s hinted at throwing be back into VNA services a few times over the past couple months (“Do you feel comfortable managing your own medications at home?”), so I don’t feel like I can safely be fully honest if anything goes wrong. I described in my complaint to DMH regarding HBM why a VNA was not an option. So Dr V the psychiatrist doesn’t have this information, but it’s easier for me to copy and paste than to re-write everything:
When I saw Justina for the last time, she seemed happy for me, since I was so much
“better” and ready to go forth and prosper thanks to her hard work and concern. She actually
seemed relaxed enough that I interpreted something she said as her having changed her
mind about the VNA. I had originally agreed to the VNA because, as I’m really trying to
underscore here, people behave differently when you are a threat to them. But, now that the
VNA seemed to have dropped off the treatment plan on its own, I took the risk and was
honest with her. I said I was so glad she’d changed her mind on that, because I’d actually
had a VNA in the past and it increased my risk of committing suicide by quite a bit. I
explained that, normally, I don’t think about suicide over the course of a day, so when I look
at my medication, I’m not thinking about killing myself. But when I look at a lock box,
obviously that’s about suicide. And when I can’t go to work when I need to because I’m stuck
at home waiting for a VNA to come and ceremoniously unlock the box, what am I supposed
to be thinking about while I’m waiting? How do I explain to myself where all this lost
productivity came from? It’s because everyone assumes I’ll eventually kill myself. My life was
once happy and okay, and now I’ve been reduced to having services that are usually
reserved for the very elderly… who are about to die. And now I spend large chunks of my
day doing nothing but consciously admitting that everyone assumes I would jump at the first
chance to kill myself. VNA services do absolutely nothing to make me safer, because we all
know I could attempt suicide in a hundred other ways that would be honestly much more
likely to actually kill me than an overdose. Instead of protecting me, all it does is make me
spend outrageous amounts of time waiting around, thinking about what my life has become,
how I have to go through this every day now as my punishment for being “mentally ill” when I
could have had a life worth living. VNA services are a formalization of society demanding
that I kill myself and do it quickly, before government health insurance has to pay too much
toward my “hospice” care. Much like my entire admission at HBM, they increase my risk of
death, while decreasing other people’s risk of liability. And maybe not in those exact words,
but this is exactly what I told Justina.
So, anyway, threatening me with a VNA is insulting to my intelligence, completely ignores all the progress I’ve worked hard to achieve over the past several years, and severely undermines my ability to trust and convide in Dr V. And, while he doesn’t have the quote above, I think it’s ridiculous that he’s a psychiatrist at a big-name hospital and he hasn’t figured this out. Like, remember the “safety contracts” they used to make us sign? Yeah, we all knew the whole time that they were just a waiver of liability for the clinician, or in other words, they were giving us the green light to commit suicide. The VNA is the latest version of that. Once they’ve totally given up on us, they throw a VNA at us to cover their own butts if the unthinkable happens.
So, the relationship was already definitely very strained. Then, a few appointments ago, I asked him to get the Borderline Personality Disorder diagnosis off my chart. His line is always that we don’t have time to talk about this, maybe next time. So about three weeks ago, I sent him this document:
Dr V didn’t comment on whether he’d received this letter, which I suspect is because he’s convinced that this isn’t actually that important to me. Like, yeah, I’m here lying awake every night stressing out over this, but the meds you’re going to give me are going to work so great that they’ll actually counteract the stress you’re adding to my life by forcing me to live with a diagnosis on my chart that isn’t true. This is the same person who said he wanted me to be taking the lead (as I mentioned in my last entry), and when I tell him, “This is by far the single most important thing I need from you,” he has no time. He doesn’t even have enough time for me to communicate to him how important this is, and why it’s important.
A couple of months ago, I had COVID. At first, it manifested as an earache. I went to the NP at my PCP’s office, and told her I was in severe pain. She said there was nothing she could do, and I needed to “set realistic expectations around pain.” I cried, because sometimes I get to that point when I’m getting really bad news from a doctor. In my case, I had symptoms of what turned out to be COVID, and she was suggesting that they could last forever. However, she 100% thought I was trying to manipulate her, because she just kept saying there was nothing she could do. Like, I wasn’t crying on purpose in order to get something from her. But I can’t even get basic healthcare from the PCP because I have a personality disorder on my chart. I also strongly suspect that the BPD diagnosis played a huge role in my being detained at HBM, which was beyond traumatic. And despite the extreme harm that this diagnosis causes me, V is convinced that it isn’t a big deal and I will forget about it if he doesn’t talk to me about it.
Years ago, I think 2018, I had a roommate. We were friends, and I know she had BPD because she shared her neuropsych testing results with me. Like, I literally read the original document. But I thought nothing of it, because I’m not scary, so I figured that somebody else with BPD wouldn’t be, either. Fast forward a couple of months, I’m trapped in my room calling 911 because this woman is about to break down my door and murder me. The cops said they couldn’t get in unless I let them in, I told them that I couldn’t let them in because I was trapped in my room, they demanded that I come out, and the second I did, this woman is chasing me homicidally down the hall. By the time I found the cops, I was hyperventilating and sobbing like I can’t describe. I still get freaked out when I have to interact with someone who has their hair in a bun, because that’s how she was wearing hers at the time.
So if you want to tell me that BPD isn’t such a big deal, I object to that.
When I was a kid, nobody listened to me. Now, as an adult, I have PTSD from that. Unfortunately, the PTSD is misdiagnosed as BPD, which means everyone continues to not listen to me. The misdiagnosis prescribes the exact behavior that hurt me in the first place. This makes it a lot harder for me to interact with providers, because absolutely nobody understands me better as a result of the BPD diagnosis. And I certainly don’t feel like I can be open and honest with Dr V, because he’s seeing me through the lens that I have a personality disorder. So if I’m angry, I can’t communicate that, because when someone thinks you have a personality disorder, showing even gentle assertiveness becomes dangerous- it’s misread as aggression and feeds back into the BPD diagnosis, and they listen even less. Another example of not being listened to, I told Dr V that a previous provider who knew me really well didn’t think I had BPD, but V said he would need the notes. Like, I don’t know if he thinks I’m stupid or that I’m lying, but either way, this is one more thing flying in the face of “We need you to tell us how to help you!” How am I going to take the lead if you can’t believe what I say?
I keep asking why the diagnosis is there, and he just always replies that I have trauma. But if trauma automatically means that I have BPD, why are they separate diagnoses? I’m not an idiot; I know that PTSD and BPD are different things. Yes, they both stem from trauma. But BPD is when someone was affected by trauma and has responded by identifying with the aggressor and becomimg harmful to others. It’s the opposite of posttraumatic growth, or using trauma to help prevent other people from being traumatized.
Given the fact that the diagnosis is neither descriptive of me nor is it helpful, I don’t understand what he thinks the benefit is to having it there. It’s as though he thinks it’s a moral imperative.
So, this is where I’m at. I think he’s excellent at med management. He also has been working with me for several years without dropping me, which is very nice, because providers usually pass me around like a hot potato. There have been times he’s advocated for me, especially when I was in the group home, and when I got assaulted in spring of 2023 he was literally the only mental health provider on my team who expressed tenderness or concern. For the most part, he’s a really good doctor. But I am at a point where I don’t know if we can keep working together, because he just fundamentally doesn’t understand me or see me as a competent human being. So, I sent this email today:
I will genuinely be very sad if we part ways. However, it might have to happen. Because right now, the main thing that I need is someone who I feel respects me and who I can speak openly with. Because I have goals for my life, which I’ll share in the next entry!
