Knowledge is power. And it's time for the balance of power in this thing to shift.

[HereSince1628]

9. Interesting that those are the questions you identify.

Last edited Sat Nov 10, 2012, 04:48 PM - Edit history (2)

I think getting validation that the psychiatrist violated your legal rights would be the critically important issue.

Maybe it's my unfamiliarity with MI's legal rights for mental patients but it's unclear to me if a violation of trust is a violation of a mental patients' rights.

With respect to question 2, psychiatrists make records of what they do. There is probably some information on what she did and maybe why she did recommend part-time in-patient care in the case notes of your medical record. You may have the right to see the contents of your medical record, a lawyer can answer that.




Sometimes I have trouble following pronouns, and that leads me read into things that aren't meant. So I'm wondering if you meant that the 'they' who asked about hygiene habits refers to 'society' that you feel views you as defective?

In trying to be sure about what you meant I thought it seemed to me that as society on the whole can't ask you a question it makes more sense that 'they' refers to some staff in a clinic you attended. Did several people ask you about hygiene, or just one?

When I thought about the relationship of the number of staff of a clinic to the population of society at large, the staff of the clinic seemed to be a very small subset of society. That's logical, whether I considered society as the population of Detroit metro or something bigger like the entire United States. And if "they" refers to just one staff member then "they" would be a smallest non-zero subset possible.


You wrote that you are guessing about what "they" are assuming. If you've been in therapy for ten years (as you seem to say in #6) you have probably picked up the concept of projection. Projection is psych jargon for when we impose what "we" think or feel into the thinking or feeling of other people. If I understand the relationships of the subjects of the sentences you wrote correctly, you appear to me to be projecting onto all of society quite emotional thoughts about what you are feeling about your undermined dignity.

That's pretty consistent with other things you've written in many posts about fear/anxiety of stigma.

But if it's projection then maybe not everyone in society, or even all the 'they' in the clinic really think those things about you. Maybe it's just your thinking that they are thinking the things that you fear.

If that's true then maybe your projection doesn't even explain with certainty what even one clinical staff person was thinking when (s)he asked you about your hygiene. Maybe if you can see an alternative to what the staff member was thinking the generalization of your assumption about what society is thinking about you can be put in doubt?

If there is doubt there is a possibility that the clinician, the clinic, and society onto whom you've projected your assumptions may not be out to humiliate you or strip you of your dignity. The clinicians, clinics and society could possibly be less hostile than you state in your posts.


I'm not a mind reader, so honestly, I can't tell you what a staff member was thinking. But, as you said up in #6, unless I've been as dumb as a piece of lumber, years in therapy do leave me aware of some of the things that go on with clinicians in psych clinics. And maybe there is a hint of an alternative explanation about why a clinician would ask you about your underwear hygiene. Maybe there is room for doubt.



One of the things I've learned about all health-care is that in doing their jobs practitioners make observations. One of the things they make observations about is 'overall functioning". If a person's overall function is good, that person doesn't need treatment. If a person's functioning is, overall, poor then they need treatment, if it's poor enough maybe in-patient treatment.


The APA came up with a way to "kind-of sort-of" standardize the measurement of overall function. It's called the Global Assessment of Function (GAF). It ranks examples of features of psychological function from serious impairments to freedom from impairment (and lots of places in between). By observing or asking questions of their patients, clinicians collect information used in the assessment and give a patient a GAF score based on where the patients WORST symptoms appear.

At the end of this there is list of the topics on the GAF and their 'scores' that comes from the DSM-IV. I call your attention to the bottom of the list where serious impairments are ranked. Notice that in the last two categories there is discussion of -FAILING HYGIENE-.

Now, the things on the bottom of the list are serious, so clinicians seriously want to know about them if they are present. Not because they think everyone sitting in front of them has those symptoms, but because IF those symptoms are present then the patient is in need of urgent care.

I'm pretty sure you can see where I'm going...

So, the question I pose is this:

Is it possible that when you were asked about your underwear the staff member was gathering information to make a global assessment of function?

If the answer is at least a "maybe", then "maybe" your assumptions about how "they" and "society" feel/think about you isn't really the way "they" feel. "Maybe" getting questioned about underwear wasn't about undermining your dignity but rather it's about assessing you just like they assess other patients. "Maybe" it was done with the intent of getting you to the correct level of treatment.

Maybe.



91 - 100
No symptoms. Superior functioning in a wide range of activities, life's problems never seem to get out of hand, is sought out by others because of his or her many positive qualities.

81 - 90
Absent or minimal symptoms (e.g., mild anxiety before an exam), good functioning in all areas, interested and involved in a wide range of activities, socially effective, generally satisfied with life, no more than everyday problems or concerns (e.g., an occasional argument with family members).

71 - 80
If symptoms are present, they are transient and expectable reactions to psychosocial stressors (e.g., difficulty concentrating after family argument); no more than slight impairment in social, occupational, or school functioning (e.g., temporarily falling behind in schoolwork).

61 - 70
Some mild symptoms (e.g., depressed mood and mild insomnia) OR some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, has some meaningful interpersonal relationships.

51 - 60
Moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) OR moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers).

41 - 50
Serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) OR any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job).

31 - 40
Some impairment in reality testing or communication (e.g., speech is at times illogical, obscure, or irrelevant) OR major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood (e.g., depressed adult avoids friends, neglects family, and is unable to work; child frequently beats up younger children, is defiant at home, and is failing at school).

21 - 30
Behavior is considerably influenced by delusions or hallucinations OR serious impairment, in communication or judgment (e.g., sometimes incoherent, acts grossly inappropriately, suicidal preoccupation) OR inability to function in almost all areas (e.g., stays in bed all day, no job, home, or friends)

11 - 20
Some danger of hurting self or others (e.g., suicide attempts without clear expectation of death; frequently violent; manic excitement) OR occasionally fails to maintain minimal personal hygiene (e.g., smears feces) OR gross impairment in communication (e.g., largely incoherent or mute).

1 - 10
Persistent danger of severely hurting self or others (e.g., recurrent violence) OR persistent inability to maintain minimal personal hygiene OR serious suicidal act with clear expectation of death.

0
(Not currently defined.)