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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Racer on March 18, 2004, at 9:39:19
Here's a question for you all, whether it be psychological or philosophical or practical, it's creating practical problems for me. You all, ironic as this may seem, will constitute a Reasonable Person test for it. If you, as reasonable persons, consider me to be too sick to have any insight into my own mind, then I'll believe you.
It involves self-awareness and insight, and I'm going to give a very specific example of something that happened with this pdoc, and ask you to tell me your thoughts. Deeper thoughts, not just the "get over it, Racer!" or the "he's an idiot" thoughts. I want to know if this is another example of me being without insight into the extent of my illness, or if it's a sign that I have insight and just need a little support to start living by it. 'K?
On the first visit to Dr EyeCandy, as we were discussing my history, I said that I had a history of an eating disorder. He dismissed it -- if an MD hadn't diagnosed it, it was only some weird patient self-report that really wasn't meaningful. When I tried to get him to take it seriously, he went straight to the DSM IV criteria, and said if my periods hadn't stopped, it wasn't an eating disorder. (Let's not get into how you diagnose a male with anorexia, eh?) So, we've now established that I never had a 'real' eating disorder, right?
Let's talk about that faux anorexia. I knew, at the time, that my body image was distorted. I knew that my health was being damaged by the eating patterns I followed. I knew that it was probably not good for me to work out so much. I also knew that, while I *felt* humongously fat, I was thinner than I thought I was. Get the distinction? I *knew* I wasn't as fat as I *felt* I was.
Here's my Reasonable Person question: with that information, that I was aware of my own skewed image of my body, and aware that it didn't really fit reality, does that mean that I had some insight into what was going on? Or is that a sign that I had some sort of delusion that I had insight? Does knowing that you're hurting yourself mean that you're faking it? Making it up? Mind you, I did feel overwhelmingly huge, and would see nothing except huge thighs, rolls of belly fat, etc, every time I looked in the mirror. I also felt the outlines of my hipbones frequently, to make sure that they still stuck out. So, I was living in my body within the same time zone, if you get what I mean, I knew some of what was wrong, but I still couldn't stop it.
Was I so entirely lacking in insight tha I couldn't even see that I didn't have insight? Or did I have the requisite insight required to recover, but no help in accessing it?
And, if that makes no sense at all, let me know that, too.
Thanks, all!
Posted by Racer on March 18, 2004, at 9:41:21
In reply to Question about insight or lack thereof, posted by Racer on March 18, 2004, at 9:39:19
Posted by coral on March 18, 2004, at 14:11:06
In reply to Question about insight or lack thereof, posted by Racer on March 18, 2004, at 9:39:19
Dear Racer,
I think you're on the money. Following this "doctor's" thinking, we'd all have to be chased by the guys in white jackets for there truly to be a problem. Thankfully, most of us have recognized something is amiss and voluntarily seek help via therapy, (psych or otherwise again,) before reaching the "ducking the butterfly net" stage. Your situation brings back such memories for me. I KNEW something was wrong w/my thyroid but because I didn't present with "classic" symptoms, the doc refused to order the blood tests even though he was seeing me monthly and I continued to ask. Finally, I ordered the blood test myself and my thyroid levels were seriously out of whack. When the doc reviewed the results, he was so blasted cavalier... "Oh, we'll just tinker with your synthroid." I asked if he'd want another blood test in six weeks and he said, "No. There's no need to unnecessarily poke you." Pardon me? Last time I saw that doc.
I tend to get a bit sarcastic under the circumstances you've described and probably would've asked him if all of his patients evidenced all symptoms listed in the DSM, per their diagnoses.
Coral
Posted by Racer on March 18, 2004, at 15:00:26
In reply to Re: Question about insight or lack thereof, posted by coral on March 18, 2004, at 14:11:06
This is short, because I"m too traumatized to concentrate on what I want to say, but you just injected some sunshine and breathable air into my lungs. Yes! I get sarcastic, and withdraw, and generally do come across as Oppositional and Defiant and Otherwise Not Very Nice when I run into this sort of treatment from anyone. That really doesn't help get me taken seriously. And you know what else? It makes me feel worse, too. And you wanna hear something else? Because withdrawing and not trying to communicate is so alien to my nature, it means that I'm more traumatized by the interaction.
So, thank you. That was a reality check, and I needed it. And it's so damned good to know that someone else experiences something similar. It's nice to think that I'm not alone in the universe.
(One of my cats will start wandering around and just howling if she thinks she's alone. It's as if she's singing her soul to the universe, so heartbreaking. That's often how I've been feeling. With Miss BimboCat, we know she does this, because she'll go into the next room and "discover" that she's Alone In The Universe, and then stop as soon as one of us walks in to comfort her. She is rarely so alone as she seems to think...)
Thank you.
Posted by shar on March 19, 2004, at 0:11:04
In reply to Question about insight or lack thereof, posted by Racer on March 18, 2004, at 9:39:19
How old is this 'therapist?' It sounds like you know 1,000 times more than the therapist.
Do you still have an eating disorder? It's not something I know that much about, and does it just go away if you have the right meds?
Shar
Posted by Racer on March 19, 2004, at 0:39:39
In reply to Re: Question about insight or lack thereof » Racer, posted by shar on March 19, 2004, at 0:11:04
Do I still have an eating disorder? That's a really hard question to answer. I can tell you that I still have a distorted body image, that much I 'know', but I feel as if I'm eating a lot, and I feel as if I'm fatter than I was. My scale doesn't seem to show it, and -- while I feel about 20# heavier than I did last month, zenhussy told me she thought I'd lost about 10# in the last two weeks. So, I can't tell if I still have an eating disorder or not. (Besides, Dr EyeCandy says I never had an eating disorder. He's the expert, right? -- some of coral's sarcasm coming out there, eh?)
Does it go away with the right medication? Kinda. The distorted body image doesn't really go away, but its importance in my life diminishes. The ADs I've been on have put so much weight on me, that trying to fight my way to a reasonable (ie: very low) weight doesn't seem worth the effort. And I stop exercising, too, when I'm adequately medicated. Whoops! I don't stop getting exercise, but I stop devoting three hours per day to the endeavor of 'trying to get to a reasonable weight'.
Again, this is probably a sign of my lack of insight, but it really seems to me that if I keep my weight above a critical point, I don't have the same compulsions to restrict food or exercise frantically. Either I'm a poster child for Set Point weight theories, or at that critical point I feel so humongous I just can't make myself care. Know what I mean?
Thanks, shar. I know that you're going through a rough patch, and I wish I could offer you as much as you've offered me. Good luck go with you, to keep company with my warmest wishes.
Posted by noa on March 19, 2004, at 19:50:41
In reply to Question about insight or lack thereof, posted by Racer on March 18, 2004, at 9:39:19
At the very least, you showed insight by knowing that your perceptions of being fat were a distortion of reality, and that you needed help with this.
I don't know whether you've developed any further insight about why you see things in a distorted way, how this tendency developed, etc. My hunch is that you do have some insight into that and have a good capacity to develop even more insight into the problem and your feelings, etc. but that these kinds of insights are not easy to come by for anyone without a little help.
Racer, I know this diagnosis/arrogant doctor thing is very powerful, but my advice is to not let yourself get too caught up in it. It isn't worth the aggravation.
I am sure you are a very insightful person. Move on to some professionals who can show you some respect. Lord knows you deserve it.
Posted by noa on March 19, 2004, at 19:55:50
In reply to Re: Question about insight or lack thereof » shar, posted by Racer on March 19, 2004, at 0:39:39
If he thinks that the most salient criteria for diagnosing an eating disorder is that your period has stopped, he's an idiot. Period stopping might be one sign of the severity of the physical symptoms of it, I would suppose, but gimme a break---
Maybe, because this is a public psych. clinic, their criteria are basically "razor on the wrist" and nothing milder kind of criteria.
Posted by Racer on March 19, 2004, at 23:58:13
In reply to Re: Question about insight or lack thereof » Racer, posted by noa on March 19, 2004, at 19:50:41
I can't recreate it, so I won't try. Thank you.
Let's see, I know a lot about why I'm in this state, and it has a lot to do with sucking in my emotions. It feels a little like the only way to keep my emotions sucked in is to hold my breath, and that means not eating much. I know, it's weird, I'm nuts, etc. And I've got that whole bootstrapping thing going on, too, where I say, "Well, fixing it is so easy -- just eat. You don't need help, you don't need therapy, you just need to eat more. You're totally unreasonable, because you are the one who has to eat, and no one can do it for you and no one can force you." In other words, it's all my fault, including my lack of recovery, and I'm doubly wrong for expecting that anyone can or will help me.
The only problem with all that is that I can't seem to do it alone, without help, because if I could, I wouldn't have this problem in the first place. Kinda recursive, but it's also my reality.
At this point, since my new therapist doesn't want to address anything emotional with me, and keeps "redirecting" me any time I start to express anything that isn't framed in calm, rational speech, I feel even more as if I have to suck back my emotions in order to survive. And the damned case manager, with his, "You've got a roof over your head, there's plenty of food here for you, and so all your needs are being met. You just need to concentrate on your therapy, and don't expect anything from me." Sure, there's plenty of food here, but I'm at war with it. Some days I think, "Today, I will eat as much as I want, with no thoughts of self-indulgence, lack of discipline, excess calories, etc." But then, when I'm faced with food, I can't do it. I can look at the food, and know that I want it, that it will make me feel better, that I need it, but I can't eat it. When I try, I get so sick to my stomach that I can't go on.
Making this more complicated still, my stomach really is hurting. Has been ever since starting the Zoloft, but it hasn't really gone away since stopping all meds. The pdoc says, "maybe your gallbladder, but that's not my concern. Go see an internist." Sure, if I had access to one. Whatever is causing it, there's some background pain all the time, and every time I eat it gets worse. Then, as soon as I'm finished eating -- if not before -- I have to go to the bathroom right away. Not a lot of fun.
And here's a catch 22 for you: that diagnostic criteria that I don't meet? You know, continuing to have my monthly punctuation? Because I don't meet the criteria for anorexia, my weight loss is not psychiatrically significant, so there's no reason to do anything about it. That's right, since it's non-DSM weight loss, it's someone else's problem. They only deal with that which is catagorically related to the DSM diagnoses listed on my chart.
Oh, I am so not doing well. I'm not happy to be banging my head against the wall this way, but my reality is that I have no other options for treatment of any sort. That's not a perception thing, so much as a reality -- I don't qualify for medicaid, there are no local psychiatrists who will accept self-pay patients, and even if we could find one who would see me, we really and truly cannot afford to pay for it. Sure, it's as easy as changing priorities, and my health should be a priority, but then there's the other little thing: my husband being out of work for two years has left us with damned little to go on with, and we are at the edge of the abyss. Losing my health or losing our home? Them's hard questions, but when I have -- in theory -- access to the necessary services at no cost, it just doesn't make much sense to take those risks. (Especially since I distrust doctors in general, and know that I can find worse doctors out there -- I know it because I've been tothem.)
As for your other post, 'razor on wrist' isn't serious, you know. That's *only* attention seeking behavior. And, by definition, all men must be anorexic, since they do not have their periods... Yes, it's ridiculous. I have a solution, though. It's time for a Modest Proposal for Solving The Mental Health Crisis. I'm thinking a nice, well thought out exploration of humane euthanesia for all mentally ill. That way, no one would have to suffer this way, and no one would ever be homeless. (And no, that's not meant as a real solution, only as a modern analog to Swift's Modest Proposal to ending hunger in Ireland.)
What's your doctorate in again? Just being nosy.
Thank you for all your support. I always know that when I see your name, I'll get good stuff. You're the bestest.
Posted by noa on March 20, 2004, at 12:23:44
In reply to Doh! I wrote a long reply, and lost it! » noa, posted by Racer on March 19, 2004, at 23:58:13
Doctorate?? OMG, you are mixing me up with Shar and others! No doctorate here. I barely got through college--changed my major 3 times!!! Avoided classes requiring term papers, LOL!!!! Dropped classed cuz of depression, had to go to summer school, etc. etc.
Posted by noa on March 20, 2004, at 12:32:01
In reply to Doh! I wrote a long reply, and lost it! » noa, posted by Racer on March 19, 2004, at 23:58:13
OK, back to the insight question.
Insight? Baby, you obviously got it.
For some reason you are pushing the pdoc's buttons and he's not listening to you. He's gotta listen to you to be helpful.
As for the super-cognitive therapist you got there--she seems a tad rigid, I'll say! What if you asked her to strike a bargain with you---she lets you emote for 1/2 the session and then for the 2nd 1/2 you'll agree to talk about these rational thinking strategies she wants you to talk about.
Another idea--is there a chapter of NAMI near you? Maybe they can lead you to some sort of MH advocate to help you deal with this system you're stuck in.
This is the end of the thread.
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