Thursday, December 17, 2020

Self-Deception Anecdote

We interviewed a woman in her late 20's in 1987 who had been admitted the night before for a fairly serious suicide attempt.  You should know that when I say "fairly serious" most of you would regard it a very serious.  One grows inured. She claimed to be a Multiple Personality Disorder, that therapist-induced variation on either Borderline Personality Disorder or Dissociative Identity Disorder that was more common then. She insisted that she must be discharged immediately, as she was in a special treatment protocol with a very special therapist she had found after an eighteen-month search who claimed that the worst thing that could happen was for her to be exposed to people who doubted her personalities in the slightest. We gave our usual explanation in a flat tone, with only enough empathy to meet the minimum standard for human interaction.  Anything more is simply too much emotion for a borderline in crisis and it destabilises them. One has to be matter-of-fact, or one is being cruel and taunting. We told her as we did not know her and did not have a track record for her safety, we would defer entirely to the court procedures that brought her into the hospital, and a probable cause hearing on the petition that brought her in would be heard tomorrow around 10:30 am, and when we heard back from the judge after that, we would decide what should be done next.

She was predictably furious and felt unheard and misunderstood. BPD is a hard condition to have, and while she was not capable of hearing and understanding us while in crisis, rather than the other way around, her misery was genuine and not to be belittled. You really, really would not want to live inside the head of people who go through this and have to feel what they feel. As infuriating as they can be, they do in some ways display a greater courage than most of us.

Nonetheless, the heart of their condition is that they deceive themselves by attending to emotions over facts. After she had repeatedly described the special protocol that must be observed, or all would be lost and was escorted from the room so that we might deliberate what we should do next, I said "She seems to be trying very hard to find a therapist who will reinforce her pathology rather than help her."* They nodded sadly.  It fell to me by the nature of my role to be the one to call this magical therapist and find out what was happening in this special protocol.  What was being described to us seemed frankly bizarre, that each personality was separately in therapy, hypnosis aided.  I spoke to this therapist and found this was true, and - also predictably - she suffered from this condition herself and so had special insight into women with such problems, and agreed that the worst, worst, worst thing that could be happening to her client was to encounter people who expressed the least doubt to undermine her therapy. I did venture the observation that "worst" might include completed suicide, but winced as I said it, because I knew it was going to be the same rant again. Maybe I secretly enjoyed setting her off, I''m not sure.

So I went into team the next morning and said "This woman has devoted enormous energy into finding the one therapist in New Hampshire who can do her the least good." When people either a) keep shopping for therapists, none of which are quite right, or b) dither for months wondering if maybe they should go into therapy, I recommend picking a boring or average-sounding one out of the list.  Because that is what you really need. Just a regular trained person who knows the main pitfalls and approaches and can give you Basic Therapy - not like fast food, which would be a pop psych thing, or even a chain restaurant like Appleby's, which would be something like that, but more like a family restaurant you stop at for lunch while traveling.  They know how to make food and serve it to you. Therapists like that are gold. It's okay to choose carefully and switch off a therapist when you begin - but just once.  After that, the odds are you are avoiding, rather than seeking therapy.

*I had finally established enough credibility with the team I worked with at that point that they were willing to hear my observation, as they had not been initially in 1985 because I am not degreed, and they were wonderfully credentialed. But they were also actually intelligent and quite secure in their expertise, and thus not threatened by me and able to listen. People like me who came up through unusual channels are sometimes something of a litmus test for which among the credentialed are actually all that good.  And many are, God bless them.  Just not all.

1 comment:

Kevin said...

The therapist you mention prob didn’t work in a team, you did. Hard to stay grounded, credentialed or not, if no one else to keep it honest, and sometimes sane.
As a fellow grey haired sparrow among the peacocks, I laughed to read your last paragraph.