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Tuesday, November 29, 2016

Paying For Care, Impressing My Loved Ones to Care and Failing to Be Cared For All the Same

I am sure most of you would agree that repression is not any good for the soul. With that in mind, repressing my account of the story below has taken strong medication to make me keep it to myself lest I anger people - making people around me upset is one of the motivating factors behind many things I do - but it has merely calmed the physiological trauma symptoms. So here I am, writing all of the hurtful things I experienced yesterday night.

On that note, in the light that undergoing psychodynamic therapy has cast on many aspects of my life, I realise that many actions of mine are postured with the fear of making J upset. I have in fact been trying to impress the people I love since I was young. I tried to impress my parents, so that they would find me worthy of their love. Because of that, when I was asked to do something I would likely do badly in (by my own perfectionist standards), like play the organ for them to listen, or speak Mandarin, I refused to, until they gave up asking. Instead, because my parents were proud that I was proficient in my mother tongue - English - thus I made sure I tried my very best to read every book they bought for me even if it may have been a bit beyond my age range of understanding. I believe that this proficiency in English was something that helped me gain some love from my parents. I managed to get some verbal affirmation from them for this, and that helped me feel worthy of their love. On the other hand, crying because I was emotionally hurt, was so prohibited by my parents that I never felt safe to cry in their presence until I was 17 years old. The repression of crying and negative emotions made me often hide away to cry, for my entire childhood. When I had to start seeing a psychiatrist, I felt I let them down, and only revealed this to them reluctantly, because negative emotion was something that would make me even more unworthy of their love.

As I grew into adulthood, I did the same posturing with my boyfriends. The fact that I was unworthy of love was pummelled into me with hurtful actions and words from them, H being the main perpetrator among all my exes. Even C, who said hurtful things towards the end of our three-year relationship, praised me verbally when I did something well in his eyes. With J, I get extremely anxious about him being upset. All I want is to make him happy. I fail most of the time. Every time he is upset, I feel it is my fault. I try my best to make him feel better. This is so even when he is the one in the wrong. And yet, I am not worthy. Why is my very being, not enough for my other half?

This sets the stage for the story I am writing about today.

My new psychiatrist at CGH - Lim - assigned to me when I was admitted to hospital on the day of my suicide attempt this year - is incompetent; I feel unsafe and traumatised by every single of other five times I have had a consult with him. I will now list the reasons why he is not a good doctor.

  1. In the place of having a conversation with me, his patient, he prefers to pontificate. There is no room for me share how I feel, my concerns; he rarely even asks questions, and when he does, he does not give me the courtesy of paying attention to my replies. Three of the five times I have had a consult with him, he spars with me verbally. My mother told me that on the day I was admitted and talked with him, he was arguing with me. My mom and dad are bewildered by the fact that a doctor behaves like this. Such behaviour is not right when talking to someone without a mental illness, and much less so when talking to someone with post-traumatic stress.
  2. He is no bedside manners at all. When I talk to him, he is looking at the computer screen, typing. No eye-contact. Closed body language. If I start to cry because of intense emotions, he ignores it completely. Every psychiatrist, psychotherapist, counsellor I have met will offer me tissue. He never does. No tissue offered is not as bad as someone stopping what they are doing and offer to listen in order to calm me down. 
  3. He has no understanding of me as a patient. After I had already started psychodynamic therapy for a while, he decides to inform me why I should go for psychodynamic therapy. It is simply incredulous, to ask me to do something I am already doing on a regular basis, as if I was uncooperative, when in fact I enjoy my sessions with Dr T a lot, and in fact the only reason why I am still seeing Lim is because that enables me to see Dr T on a subsidised rate. He did the same verbal theorising to me about my sessions with my psychologist while I was inpatient. I had already been having sessions with my psychologist weekly. He spoke at me to verbally strong-arm me into attending sessions with my psychologist. This is like saying to someone who is busy eating a burger and already halfway through, to exhort him to eat a burger. 
  4. When I ask him whether Lexapro, my first-line antidepressant I had been taking for years and with tangible effects in the past and also helps with anxiety, that he had struck out of my psychopharmalogical regime, could be reinstated - he said no. Fair enough, he is a doctor. But when I asked him for reasons why I shouldn't be on it, you would reckon the doctor would explain with medical reasons: why it is harmful to go back on it, or why with my present state of health I no longer need it. His answer was neither of these, but, "Who has a better track record with making decisions, you or me?" If you ask a GP for antibiotics for the flu' and he says no, you would likely get a reply like, "This is a viral infection, antibiotics are for secondary bacterial infections and therefore won't work, so it is no point taking them, unless you show signs of a bacterial infection." I hardly believe you would get the reply that Lim gave me. 
  5. He has seen me for a total of five times. I might have miscounted; maybe it was six times instead. Nonetheless, compared to the years I saw Dr Kong before, and Dr Marcus after, he definitely does not know me as well as they did. Furthermore, they are private doctors, their salaries are directly impacted by their performance as doctors, whereas public service doctors don't suffer from a loss in income if their patients aren't treated well. Kong, who wrote a thesis on only-child environments causing mood disorders in the 70s, attributed my symptoms of depression an anxiety to being an only-child raised by a slew of foreign maids. He also believed that my symptoms were due to emotional trauma in childhood - something based on the attachment theories by John Bowlby. Dr Marcus had also said before that he believed my depression was organic, and not a personality disorder. However, after the grand total of five or six times Lim has seen me, he decides all these years those two doctors were wrong and what I have is borderline personality disorder. I have read BPD symptoms over and over, think of people I know who have BPD, and I really do not identify with the disease. I told Lim that I don't agree with his diagnosis, which is based on very little information he has on me. He said that "We shall have to agree to disagree" and continued typing on the computer. 
  6. In our last consult - that was when he said I have BPD - I broke down and cried in his consultation room, because he refused to listen to me and why I believe that he was wrong. I break down and cry when I see Dr T too, during therapy. However, Lim told the management that I was causing "loud altercations." In a psych clinic, almost every patient would be prone to breaking down into tears. How could this be construed as causing "altercations"? If you term it as a nervous breakdown and corral me into a safe/isolation room, it would be far less a betrayal than saying I caused "altercations".
  7. The management was informed that I caused "loud altercations" because we were in correspondence with them. Lim suggested in my last consult with him, whether I would like to change doctors. He then later said, when I went to the clinic for my regular appointment with Dr T, he failed to find any doctor within the entire psych clinic at CGH. We wrote to the management to appeal to them to find a way we could change doctors. The management declined, saying at first that they cannot find another doctor, then saying that I had caused these loud altercations when I had broken down in tears, that I disagreed with his diagnosis, so they no longer want me to see them for my psychopharmalogical needs. The fact that Lim can impress upon the management that these are characterisations of my behaviour when I have done nothing wrong, is a low blow indeed. 
  8. Because of his behaviour and actions I feel unsafe being in a consultation with him alone. He may not be physically violent but he is meting out dictatorial emotional oppression. I feel as fearful being in a room with him as I would in the presence of someone who is close to violently attacking me. 
Another letter came from CGH yesterday, stating that I should go back to seeing Lim - that was their way of resolving the matter. It was so hurtful. The healthcare industry, doctors, nurses, therapists - all of these are meant to help patients feel better. But all this has caused me mental anguish instead. I broke down and cried because of this letter and how badly it hurt me emotionally.

Then J got angry with me, he wanted me to shut down the crying and hurt and eat dinner instead, so he walked out the room saying he will eat outside (we normally eat in the bedroom). This was another blow, that hurt me even more than the letter. His walking out and intolerance of my tears, gave me flashbacks to hurtful events in my past, when I would get scolded for crying, when my mother would push me aside when I went to hug her because I missed her for coming home late. 

Is it really so difficult for someone to just stop everything and hug me while I cried, or simply offer me tissue? I have a fear of abandonment: is it that difficult to not walk away while I am upset about something? My whole life I have been trying to impress people close to me so that they would care about me emotionally, but I am still unworthy of a hug and tissue. I am still to blame for being hurt by the healthcare practitioners that we pay to care for me. I am still to blame for being hurt by the people I love. I must never cry, because it irritates my husband and makes him angry. 

When I first met J eight years ago, he would comfort me when I was down. Today, I can't even get him to place his hand on me as a show of comfort, something that any normal person would do to comfort someone in distress. In fact, because I still don't have good balance, whenever I nearly fall, he wouldn't come to check on me to see if I am okay. I have run out of ideas to get affection from people I love.

The events of yesterday: being hurt by CGH, being hurt by the man I love, made me so despondent. I haven't felt such mental anguish since before my suicide attempt at the bridge. I don't want to live, but I also don't want to abandon my children, I also want J to get the flat we will co-own in 2 years, and frankly I am out of energy to coordinate the necessary factors for a successful suicide attempt. I am done, I will just live through this lack of affection, concern - love, even - for as long as possible. 

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