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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by pullmarine on October 22, 2000, at 21:30:32
Ok. the following is the letter I sent to my doc after our last session. Now really i'm apprehensive about seeing him or opening up to him. I'd like to ask him to increase the dosage of dexadrine, but I don't know how to go about doing that. furthermore. I would also like to start taking trazodone to help me sleep. don't know how to ask him for that either.
any advice?john
> As you may well guess. I am not at all happy about our last session (to say the least). To begin with, I think your callous attitude had far more to do with my choice to cease taking medications than with issues that truly matter. and though I will agree that I am in pain, I prefer and choose this pain and anger over a brain that ceases part of it's natural thinking processes.
>
> You were offended, and I doubly so. During the session, you compared me with Harold from the film 'Harold and Maude.' If you had met me a few years ago, then you might have met Maude. Spontaneous, loving, generous, caring, vivacious, and most of all, trusting. but she was gang raped and murdered and left along the side off the road, and what you see is all that's left. So be it.
>
> Am I angry? You bet I'm angry.
>
> I'm angry that my body was pumped full of Haldol during my sleep, without my consent or approval at the hospital where I checked in voluntarily, by a doctor who did not speak to me before pumping my system full of that stuff.
>
> I'm angry that I was not informed of the side effects after it was administered
>
> I'm angry that my therapist showed videos of my therapy sessions to people without
> my consent. If he had asked I probably would have approved, but running into under grad. students who had seen the sessions the way I found out about it.
>
> I'm angry that my sister and my lover did not have peaceful means of taking their own lives.
>
> I am angry that the first had to jump fourteen floors to her death, and that the latter had to hang himself.
>
> I'm angry that when my time comes, it will probably have to be violent as well.
>
> I'm angry that I was taken out of the sanctity of my home, against my will, and this, despite local laws, in order to be treated against my will for a planned overdose.
>
> I'm angry about the forced castrations, lobotomies, aversion therapies that people like me have had to go through
>
> I'm angry that people like me were starved to death and murdered during world war two.
>
> I am angry that I was brought up left, right and center, like some unwanted kitten.
>
> I am angry that I was ever born.
>
> I am angry that if I do choose to 'shuffle off this mortal coil,' that I might be hospitalized and treated against my will.
>
> I'm angry at the hypocrisy, the double standards, and the incoherence of the world.
>
> Yes, I do find life to be an unpleasant and painful experience, and millions of people would agree.
>
> And for those who don't, who are they to say that it is 'nobler in the mind to suffer the slings and arrows of outrageous fortunes' and 'the heartache and thousand natural shocks that flesh is heir to'?
>
> I asked you during the session if you had seen or read 'A Streetcar Named Desire.' It's the story of a murder, though the victim is very much alive (in body anyway) after being killed in cold blood. A more systematically planned out murder of this type occurs in 'dangerous liaisons.' And unfortunately, murders like these are common, and there is no recourse to the law.
>
>
> Now that you have some of the facts, you decide whether my pain and anger are justified or not. If they are, then so be it.
>
> john
>
>
> PS. If apologies were not the foundation for future offenses, I'd ask for one.
Posted by Rzip on October 22, 2000, at 21:52:54
In reply to How sane is my insanity? now what? please help., posted by pullmarine on October 22, 2000, at 21:30:32
> Pullmarine,
Why are you afraid to discuss with your doc about your medication desires? (You do not have to answer this-- How is the therpeutic relationship between you and your p-doc?) What and where is the fear? Why the anxiety?
Of course, you should not feel obligated to answer the above questions-- so, perhaps you could just think them over.
A possible suggestion...At the start of your next session with your doc, you can start off with your anxieties about proposing changes in medication. Then, once he/she alleviate your worries (I imagine), you can then feel fear to propose your opinions. My take on any patient/doctor interactions is that the autonomy of the patient should be respected above and beyond all else. So in your sessions, you really should feel like you have the upper-hand.
Hope that helps somewhat. I am new at this advice giving situations. So, please regard them with a grain of salt.
-Rzip
Posted by pullmarine on October 22, 2000, at 22:12:53
In reply to Re: How sane is my insanity? now what? please help., posted by Rzip on October 22, 2000, at 21:52:54
> > Pullmarine,
>
> Why are you afraid to discuss with your doc about your medication desires?Because I feel like I would be treading on his territory and depriving him of his authority.
How is the therpeutic relationship between you and your p-doc?
I have very little respect for shrinks and authority figures in general.
What and where is the fear?
I guess I worry about his opinion of me, which i suspect is not very high to begin with.Why the anxiety?
I fear that he will chose not to keep me as a patient. >
> A possible suggestion...At the start of your next session with your doc, you can start off with your anxieties about proposing changes in medication. Then, once he/she alleviate your worries (I imagine), you can then feel fear to propose your opinions. My take on any patient/doctor interactions is that the autonomy of the patient should be respected above and beyond all else. So in your sessions, you really should feel like you have the upper-hand.
>
I think so too.> Hope that helps somewhat
More than u can imagine.
Thanks a heap.
JOHN
Posted by coral on October 23, 2000, at 5:50:42
In reply to Re: How sane is my insanity? now what? please help., posted by pullmarine on October 22, 2000, at 22:12:53
Dear John,
Healthy interactions with your doc are crucial to your recovery. My recommendation would be to start your session by discussing your letter. You may find that your doc is delighted with your openness and it becomes a catalyst for improved discussions. I recently went through something very similar with my therapist and had the same fears - (in my case, I mildly attacked him verbally in our last session, expressing dissatisfaction with what was happening) that he'd no longer keep me as a patient. With a tremor in my throat, I started our session with that because if I couldn't get over that fear, it would've been a huge stumbling block. I deeply appreciate his honesty and integrity in his responses. He told me, first and foremost, that my expressing the dissatisfaction was one of the healthiest things I'd ever done in therapy. We examined what and why and it was very illuminating. He also said that if he felt he could no longer be beneficial to me, (which wasn't the case at all) it was his ethical responsibility to tell me so and to assist me in finding another therapist. That gave me a great sense of relief as well as freedom. I'm prone to sublimating my own wishes to keep others happy (one of the psychological factors in the depression) and I came to fully realize that I don't have to "take care" of my therapist. The only person I have to worry about during therapy is me.
Not to be argumentative, but someone used the term "upper hand" which I find detrimental in a therapeutic relationship, whether with a medical doctor or therapist. I am the client and always retain ultimate control in the relationship. However, the working relationship should be teamwork in my opinion, not a competition.
Additionally, if your doc gets upset because you expressed how you were feeling, HE has a problem. On that point, I have unhesitatingly fired doctors who were incapable of listening. I didn't ask that they agree with me, but if they weren't capable or willing to listen, there was NO way in hell I'd continue the relationship.
I recently went through a disagreement with my physician over meds. Actually, we had a knock-down, drag-out fight. LOL He agreed to let me do what I wanted with the meds with an agreement from me to report both negative and positive results so that, if necessary, adjustments could be made. Medicine is an art, not a true science yet. There has to be mutual trust.
Posted by tenuous on October 23, 2000, at 6:40:02
In reply to Re: How sane is my insanity? now what? please help., posted by pullmarine on October 22, 2000, at 22:12:53
> >I feel like I would be treading on his territory and depriving him of his authority.
> >I have very little respect for shrinks and authority figures in general.
> >I worry about his opinion of me, which i suspect is not very high to begin with.
> >I fear that he will chose not to keep me as a patient.Hey, I feel like this all the time too! I find it ironic that I can concurrently
have no respect for someone's position of authority and at the same time be afraid
that they will reject me. Just goes to show that feelings don't need to be logical!
I'm currently trying to get up the nerve to ask my GP to refer me to a psychiatrist.
Believe it or not I'm afraid that I'm not depressed/frantic/worried/crazy enough to
get the referral!
Posted by shar on October 23, 2000, at 8:00:33
In reply to Re: How sane is my insanity? now what? please help., posted by tenuous on October 23, 2000, at 6:40:02
I'm with Coral. Therapists (well, mine at any rate) can be happy to see anger directed outward instead of inward, and you may get a pleasant surprise that your doc isn't angry at you, but may want to work on some of the issues you raised about meds, etc.
Good luck.
Shar> > >I feel like I would be treading on his territory and depriving him of his authority.
> > >I have very little respect for shrinks and authority figures in general.
> > >I worry about his opinion of me, which i suspect is not very high to begin with.
> > >I fear that he will chose not to keep me as a patient.
>
> Hey, I feel like this all the time too! I find it ironic that I can concurrently
> have no respect for someone's position of authority and at the same time be afraid
> that they will reject me. Just goes to show that feelings don't need to be logical!
> I'm currently trying to get up the nerve to ask my GP to refer me to a psychiatrist.
> Believe it or not I'm afraid that I'm not depressed/frantic/worried/crazy enough to
> get the referral!
Posted by stjames on October 23, 2000, at 19:37:59
In reply to How sane is my insanity? now what? please help., posted by pullmarine on October 22, 2000, at 21:30:32
I'd like to ask him to increase the dosage of dexadrine, but I don't know how to go about doing that. furthermore. I would also like to start taking trazodone to help me sleep. don't know how to ask him for that either.
> any advice?James here.....
Try wording your questions this way, so it still allows him to decide.......
"The dexadrine seems to be working but not enough, what do you think about increasing the dose ?"
and
" I am having trouble sleeping and have a friend who takes trazodone for sleep and really likes it.
Would trazodone or something else be a possibility ?"james
Posted by Racer on October 26, 2000, at 13:35:02
In reply to Re: How sane is my insanity? now what? please help., posted by stjames on October 23, 2000, at 19:37:59
Hey, there, Pullmarine, you sound a bit better than you did last week. I hope that's the case. I didn't respond sooner to this because I wanted to wait until I had enough time to do it justice, and I'm glad I did, because I see something now which I didn't at first reading.
That said, let's get on to the wisdom of a fool:
I agree with everyone who said that it's worth discussing the letter with your doctor as a therapeutic tool.
The other suggestion I have is a variation on stjames' suggestions: can you make a spreadsheet of your symptoms, the meds you've been on, the results -- good and bad -- of those drugs, and the suggestions you might have about what to do about them? I did this, and had good luck with it. The doctor I saw had heard that I was a troublesom patient, was ready and willing to believe it, and didn't start out willing to hear me out. I told her, sobbing just this side of hysteria, that I had this list to use as a starting point for the discussion, and she got that 'wow, they do get crazier' look on her face, but let me start. By the end of my little rant, she was willing to work with me, and even gave me the drug I'd suggested.
The list I made, if it helps, included the drugs I'd taken, their side effects, their effect on my depression, and another list expressing my specific dissatisfactions with my recent care. That care, fortunately for me, had been through a county system which was starting to get a lot of flack for its failures. In fact, a few months later, they repeated their handling of my problem: they saw a young man whose family brought him in because he was acting crazy, hadn't been sleeping, etc. Pretty much the same state I'd been in. They said there wasn't anything they could do, he seemed normal enough to them, and sent him home. Three hours later everyone in the house was dead at his hands.
Anyway, the doctor listened to me, I had a reasonable suggestion: the Effexor had few side effects, worked on my anxiety but didn't fix the depression. SSRIs had fixed my depression with horrible side effects. How about adding a low dose SSRI to the Effexor? She thought that made sense, did it, and it worked.
I'm torn about stjames' suggestion to bring these things up as though a friend had had good luck. On the one hand, I think it's a lot less agressive and lets the doctor decide to do it or not, but on the other, I think part of your problem may have to do with autonomy and assertiveness. It sounds as though you feel helpless, and that's not good. Of course, if you walk in and say something like, "Gee, Doc, I'm not stupid, I've done the research, I think more Dex and some Trazadone would help me" he's likely to get defensive. Maybe it's better to take the safe road, get your meds fixed, and then work out the independence issues?
Ah, what do I know anyway? I'm just a crazy chick myself! Whatever you do, here's wishing you strength and success. You have my best, warmest wishes for you.
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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