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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Dinah on July 15, 2008, at 23:14:49
I paused halfway through my standard "And how are you?" opening today, and gave him a searching look. He asked "How do I feel?", then laughed and said he ought to know he can't get anything past me.
I asked him how he can think I'm schizotypal when he acknowledges I'm *right*. One of the reasons he gave for thinking that diagnosis fit was my belief in my semipsychic abilities. But it always bugged me since he acknowledged I *could* read his slightest changes in emotions. Today he acted as if he didn't remember that he ever thought I was schizotypal. He said the entire package might give the appearance of schizotypal, but that he never would diagnose me as schizotypal.
Silly man. We fought for a year over that one.
Still...
It's nice. It shows how much he sees me now as me. I noticed today that he immediately understood something I said, even though I expressed it as idiosynchratically as I always did. But I guess he can now follow my trains of thought.
I'm not saying he doesn't still think I'm weird, or dysfunctional. I have always thought he thinks I'm worse off than I think I am. But at least now I think he thinks I'm weird and dysfunctional in a uniquely Dinah and not altogether bad sort of way.
He has a new way of conceptualizing at least some of my issues. I think parts of what he says are correct, and parts aren't. I need to think about it some.
Posted by obsidian on July 15, 2008, at 23:21:08
In reply to So now he doesn't think I'm schizotypal. :), posted by Dinah on July 15, 2008, at 23:14:49
you know if I had to have a disorder it would be schizotypal, sounds interesting, the dsm description I mean
but those descriptions are always off when it comes down to real life and people as different as they are
Posted by Daisym on July 16, 2008, at 0:26:13
In reply to So now he doesn't think I'm schizotypal. :), posted by Dinah on July 15, 2008, at 23:14:49
One of the things I don't like about phone therapy is that I can't read him as well. I don't think this makes me (or you)schizotypal. We talked about my radar today - I'm usually right when I scan a room. But I'm usually wrong when I try to see if people are annoyed with helping me. We spent a lot of time on projection and expectations.
Isn't it funny how things change and how we remember them and how *they* remember them?
I've decided that the next time there is a lull, I want to ask my therapist what the worst mistake he has ever made was. I don't know why this occured to me on this thread but it did. :)
Posted by Phillipa on July 16, 2008, at 0:46:56
In reply to Re: So now he doesn't think I'm schizotypal. :), posted by Daisym on July 16, 2008, at 0:26:13
What is a diagnosis it's actions that speak louder than words. Love Phillipa
Posted by Dinah on July 16, 2008, at 11:09:50
In reply to Re: So now he doesn't think I'm schizotypal. :) » Dinah, posted by obsidian on July 15, 2008, at 23:21:08
Yeah, I suppose so. He would go down the list of diagnostic criteria, and point out how each one applied to me. And I'd point out that no one before or after he and the pdoc from h*ll ever thought it applied to me. And that my then-current pdoc rejected it categorically. That at most I had some schizotypal characteristics, or was a bit eccentric.
Sigh. You're right, I suppose it's not that bad.
But I always figured he had to choose. If I was right, then my beliefs couldn't be a sign of mental illness. And he kept saying I was right. :(
Posted by Dinah on July 16, 2008, at 11:30:23
In reply to Re: So now he doesn't think I'm schizotypal. :), posted by Daisym on July 16, 2008, at 0:26:13
lol. That mistake did cause a very long term rupture. We got over it, but that's more to do with my tenacity than his skills.
His memory is awful. I realize that he has many clients, and I have but one therapist. I probably remember every word and gesture from our hundreds of sessions. While he's lucky to remember the details of last session. He's worried about that because of his family history, but I reassure him that his memory was this bad the entire time I've known him, and it isn't getting any worse.
I'm pretty accurate about reading feelings, especially with people I know well. In a crowd, my defenses usually filter out the minor stuff, although I get way overwhelmed when others are flooding me with emotions. I don't think I skew them in any particular direction, as far as detection. Where I fall short is interpretation. Naturally I assume that all deviances from the norm are a result of something I said or did. I've gotten a bit better at casually incorporating his reaction into the conversation as if he had spoken, instead of leaping to conclusions. And he'll verbally respond as if I *had* responded to a spoken communication instead of a felt one.
At least I'm getting less prickly. He sent me to google a portion of his current conceptualization of my issues, sexual anorexia. And frankly, the diagnostics were pretty insulting. At one time, I'd have been hurt and angry and come in very defensive. But instead I called and left a message telling him I'm going to give him the benefit of the doubt and assume he didn't know what I'd find when I googled sexual anorexia, and maybe he'd like to google it himself before our next session. All in a very good humored way. Because he's never indicated in any way that he thinks those things are true about me. Quite the opposite really. Now there's a leap of faith on my part. And I can put it aside until our next session and not think about it.
I know your therapist is way better over the phone than mine. But even so, it is no substitute for being there and feeling his presence. I hope you can get back to his office soon.
Posted by Dinah on July 16, 2008, at 11:33:53
In reply to Re: So now he doesn't think I'm schizotypal. :), posted by Phillipa on July 16, 2008, at 0:46:56
Fortunately only the pdoc from h*ll, guided by what my therapist told him, formally diagnosed me that way. All my other pdocs have ruled it out.
I don't worry about diagnoses overmuch. I worried more about how he was seeing me and interpreting me. I'll be the first to admit though that I have schizotypal qualities, and some, but not all, borderline characteristics.
Posted by Phillipa on July 16, 2008, at 20:13:31
In reply to Re: So now he doesn't think I'm schizotypal. :) » Phillipa, posted by Dinah on July 16, 2008, at 11:33:53
Dinah you don't strike me that way at all. Maybe I need to google some stuff. Love Phillipa
Posted by Dinah on July 16, 2008, at 21:59:27
In reply to Re: So now he doesn't think I'm schizotypal. :) » Dinah, posted by Phillipa on July 16, 2008, at 20:13:31
Schizotypal? Well, he walked me through the criteria often enough.
1. Ideas of reference (excluding delusions of reference)
No for this one.
2. Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or "sixth sense"; in children and adolescents, bizarre fantasies or preoccupations)
This is the one I thought he invalidated a yes answer to by agreeing that I was right. But he also included some of my OCD stuff about feeling like I needed to worry about someone to keep them safe. But I really think that's OCD stuff. And I knew it wasn't true, even if I was sure it was.
3. Unusual perceptual experiences, including bodily illusionsWell, I do have some unusual ways of seeing things. Like thinking of things in terms of colors and other nonverbal imagery. I'm not sure those are "perceptual" or if they're expressive. Dissociation also causes some weird perceptual experiences sometimes.
4. Odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped)
Well, I have always had a rather idiosyncratic way of expressing myself that some people find difficult to understand. Especially on some topics. He found a lot of what I said difficult to understand.
5. Suspiciousness or paranoid ideation
I can see where my behavior with him would lead him to believe I was suspicious. (grin)
6. Inappropriate or constricted affect
Ah, now this one gets me every time. I think it's widely agreed that this one is true. Although my therapist has told me that emotional me doesn't show constricted affect, just rational me. I think...
7. Behavior or appearance that is odd, eccentric, or peculiarHe finds my long skirts and tennies, not to mention my braids, a bit eccentric and peculiar. In fact, he is rather revolted by my lack of grooming in general. (Mind you, I'm always bathed and my hair is washed when I see him. But I don't do the makeup or anything.)
8. Lack of close friends or confidants other than first-degree relatives
Somewhat true. I usually have a few close friends, but I think they were mostly geographically separated from me at the time.
9. Social anxiety that tends to be associated with paranoid fears rather than negative judgments about self
Not sure about this one. I've been wary socially since my horrible experiences in middle school. And I always consider myself a social liability and that people don't like me very much. Yet I don't in general judge myself negatively. However, I do think I very narrowly judge myself negatively in the context of social desirability. So I'd say no to this one really. Or if yes, then not paranoid fears, but ones based on experience.
But the thing is that my therapist and the pdoc from h*ll never considered *degree*. What my then pdoc (Dr. Just the Facts Ma'am) said was that it was a question of degree, and that the degree I exhibited any of these things did not come close to the intentions behind the design of the criteria.
And of course context. My therapist now has a heck of a lot more context than he did then, and likely sees that a lot of the things he considered schizotypal were actually offshoots of the OCD and the dissociative disorder.
Still, even though I remember the history and can extrapolate some of his reasoning, it was still nice to see his blank lack of recognition to the schizotypal diagnosis. :)
Posted by Dinah on July 16, 2008, at 22:17:07
In reply to Re: So now he doesn't think I'm schizotypal. :) » Dinah, posted by Phillipa on July 16, 2008, at 20:13:31
Ah, but borderline. The funny thing with this is that every single pdoc I've ever seen has ruled out my being borderline. Yet Linehan's conception of borderline really resonates with me. And my therapist, around whom most of my borderline behavior is centered, agrees that I have my borderlinish moments.
The criteria there are:
1. Frantic efforts to avoid real or imagined abandonment.
Yes, absolutely. But mostly confined to my therapist. Which he says is natural since I have cast him in the mother role.
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
Absolutely not. I have pathologically stable relationships with reasonably realistic views of the other person.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
Well, yes. Of course. I think there should be an exclusion there for dissociative disorders.
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., promiscuous sex, eating disorders, binge eating, substance abuse, reckless driving).
Hard one to reckon. I think I have impulse problems with food and money. But the pdocs who questioned me always ruled it out. Apparently my binges are too well thought out to be truly impulsive in their eyes. Sigh. I'm ever one to carefully plan my impulsive behavior. Doesn't seem to have kept me from becoming obese and diabetic and broke.
5. Recurrent suicidal behavior, gestures, threats, or self-mutilating behavior such as cutting, interfering with the healing of scars, or picking at oneself.
Yes. Not so much any more. At least not so much with behaviors. Yes still for ideation.
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
*I* thinks so. I don't know how much it shows.
7. Chronic feelings of emptiness, worthlessness.
No, not really. Not ever in fact.
8. Inappropriate anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
I don't do anger. Or rather I hate being angry. It makes my head hurt. I try to avoid it whenever possible. And I never ever direct it at others since I knocked Natalie's (my new doll) eyes out when I was three or four by banging her on a wall. My mother rushed her to the doll hospital, and I waited anxiously while they checked to see if they could fix her. I've still got Natalie. And you can definitely see that one eye is slightly different then the others, having been replaced. A constant reminder of the consequences of unrestrained anger.
9. Transient, stress-related paranoid ideation, delusions or severe dissociative symptoms
Well, again, yes. Of course. How can you have a dissociative disorder without answering yes here?
But... I don't think anyone but my therapist would think I'm borderlinish. I reserve most of that behavior for him.
Posted by obsidian on July 16, 2008, at 22:47:16
In reply to Re: So now he doesn't think I'm schizotypal. :), posted by Dinah on July 16, 2008, at 22:17:07
you know I am so terrified of being labelled with a personality disorder
it feels like "oh well, that's just what it is..too bad!"
no pill for that!" and I would say "I've got plenty of fixed maladaptive defenses, uh, if I could help it....I would, sorry about that."
Posted by Dinah on July 16, 2008, at 23:04:57
In reply to Re: So now he doesn't think I'm schizotypal. :) » Dinah, posted by obsidian on July 16, 2008, at 22:47:16
I sometimes wonder if everyone doesn't have a personality disorder. Most of them just don't have names. ;)
Posted by fleeting flutterby on July 17, 2008, at 17:17:38
In reply to So now he doesn't think I'm schizotypal. :), posted by Dinah on July 15, 2008, at 23:14:49
Hi Dinah,
I hope you take this as is intended, a compliment--- No wonder why I can so relate to your posts and so understand them-- therapists have thought me to have various personality disorders-- one being schizotypal. (kindred spirits, maybe??)
I often find your posts easy to read and can relate to them. and you word things similar to the way I think. :o)
YES-- I bet more than half the population around the world has some kind of personality disorder-- after all-- what really is "normal"! :o)
wishing you the best,
flutterby-mandy
Posted by Dinah on July 17, 2008, at 18:55:59
In reply to Re: So now he doesn't think I'm schizotypal. :) » Dinah, posted by fleeting flutterby on July 17, 2008, at 17:17:38
I will definitely take that as a compliment!!
Posted by Phillipa on July 17, 2008, at 20:03:36
In reply to Re: So now he doesn't think I'm schizotypal. :) » Phillipa, posted by Dinah on July 16, 2008, at 21:59:27
Dinah I feel you express yourself too well to have that diagnosis and if borderline means no real friends I qualify and I'm basically a hermit just enjoy brief encounters with others at my choice when out with someone as afraid to be alone so I probably qualify more than you for both. And I think all have some type of personality disorder only because we are all different and I do counting so there is the OCD. Love Phillipa
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