You’ll be thinking of me

Today, a close friend of mine made a post about a comment I made to her that really made an impact, and I thought I’d write a bit more about it at length.

What I had mentioned to her was a concept called forced intimacy. This is a type of manipulation where an acquaintance shares very intimate information with another person in order to create a false sense of closeness, usually soon after meeting. After sharing said information, the acquaintance then proceeds to expect said closeness to be reciprocated, either with personal information shared or with emotional support from the other party.

These situations usually feel uncomfortable for the individual being manipulated, as they feel that they have not established this intimacy through the time and effort that usually is required for that level of sharing/support/etc. and yet they feel guilt because they now feel obligated to respond by the other person’s vulnerability. This is exactly how the person who overshares wants them to feel. What then proceeds from such relationships is often a highly intense relationship that is not based on trust or common bond, but rather on heightened emotions, requiring every interaction to have high intensity in order to be maintained.

I’ll give an example of an experience that I went through recently, where I encountered forced intimacy:

I went to a support group for one of my disabilities, and afterwards, an individual caught up with me afterwards, alone, and started chatting with me about some things I had said in said support group, including the fact that I am autistic and bipolar. They then proceeded to tell me at length about how they had supported a past partner through grad school, who then proceeded to leave them after graduation. They told me about how this partner had bipolar disorder, and told me at length about the partner’s mental health issues. At several points I tried to cut the conversation short, asked no questions, and only gave noncommittal responses.

Eventually this person, after sharing with me for over an hour, switched the conversation over to attempting to extract information from me, about my dating life, about my diagnoses, about my treatment, etc. At this point, I did manage to extract myself, but this person did follow me and continued talking at me until I reached my car, at which point I finally made my escape.

Now, I had done, to my knowledge, nothing to indicate that I had any interest in having a conversation with this person besides perhaps a polite smile and nod, and had not directly spoken to them during the meeting. They had likely chosen me because I was new, and thus likely looking for connections.

Now, let me be clear, I have no idea whether this person did these things understanding what they were doing, or whether they were behaving manipulatively out of habit, as so many of us do. Many people, especially those with mental health issues, behave in manipulative ways in order to get the support they need because they have learned that is the only way that they can acquire it (at least in the form they want, which may be via friends, and not therapists).

I am by no means saying that all manipulators are people who are social puppeteers who know exactly what they are doing when they are doing it and have some big end game in mind; in fact, I would say the majority of manipulators are the exact opposite of this. I would say most manipulators know what they want for the next few steps; they know how to get from Point A to Point B. But this sort of manipulation is still unhealthy at best and abusive at worst.

Becoming aware of manipulative behaviors is an incredibly eye-opening experience, and coming to understand that we all, in fact, behave manipulatively at points has motivated me to become a more genuine person. As much as I may seem to others to be mistrusting or cynical, I believe that learning to see manipulation as it is and to learn not to respond to it, and, in fact, to reject and avoid it, will not only improve my quality of life, but will encourage others to learn to behave in ways that are less manipulative and more genuine in order to get what they want from me.

Mara Passio
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Don’t make me suffer, I’ve got dreams

Growing up, I was taught that going inpatient at a psychiatric facility was a form of punishment for people who couldn’t hold it together, that it was shameful, to say the least. No one ever told me these things, but they were taught to me in the way that my dad insisted that if I let myself get too sick, I’d have to go to the hospital, or worse, that he knew I was strong enough to hold myself together and keep myself out of the hospital.

By the time I was twelve I had a pretty strong case of EDNOS (Eating Disorder – Not Otherwise Specified) where I would fluctuate between extreme restricting and binging. I would lose incredible amounts of weight and then gain it back with excruciating rapidity. I was also self-harming. This is when I first went to see a therapist. My tactic at the time was to deny everything, which, to a certain extent, got me what I wanted, which was to be left alone.

I didn’t return to therapy until I was fourteen, and at that point I was put on Zoloft, and my parents were assured that this was a teenage thing, and it would likely clear up in nine months. Two years later, I was successfully weaned off of Zoloft, and a year later stopped going to therapy. We all assumed they were, for the most part, correct, and that my mental health issues were just adjustment issues.

In the midst of my second semester of my freshman year of college, a few months before my ninteenth birthday, I started to deteriorate again. The symptoms were different, but similar enough that I thought they were the same problem as before, and assumed a couple pills and some tune-up therapy would do the trick.

I only got worse though. And this is where my story truly begins – this is where my distrust of the psychiatric community really grows its roots deep.

It started with my sliding scale therapist, who, to be honest, was sub-adequate at best. She listened to me talk and then I left feeling like I had, well, talked. That’s not enough to induce distrust though, there are mediocre professionals in all fields. What happened, is that I told her I wanted to kill myself, and asked her for her advice, and she told me to wait two more weeks until I could see one of the psychiatrists in her practice.

To add insult to injury, when I went to see said psychiatrist, he prescribed me ten milligrams of Prozac. Now, let me give some insight. I was, at the time, a 300lb, 5’11” woman who has shown suicidal ideation, and ten milligrams of Prozac is the smallest dose one can be given, and usually doctors start at twenty milligrams for adult patients. He told me to come back in a month and tell him how I was feeling. If you’re following at this point, this man essentially gave a pill with the functionality of a placebo to a suicidal teenager.

Two weeks later I was in the emergency room, where my next, and biggest, assault from the psychiatric community came. I had come to the emergency room due to paranoia and hallucinations (that was discovered much, much later to be caused by narcolepsy, not psychosis), and it was discovered that I had been cutting myself. It was 11:00PM on a Friday, the emergency room was packed, and I was escorted to a cell with padded orange walls and flooring, with a table, chair, and medical bed bolted to the floor. My best friend accompanied me, although she was asked to leave during my interviews with the psychiatrist on call.

The interview with the psychiatrist was hellish and, to be quite honest, extremely traumatizing. He manipulated my words, asked me questions repeatedly if he didn’t get the answer he wanted, asking them different ways so that maybe I would answer “yes” to a question I had previously answered “no” to. I would like to note that, by this time, I had not been suicidal for several days. But he kept asking me, did I want to kill myself? did I want to die? did I wish I didn’t exist? And the answer was always no, no, no. Finally he asked after over an hour of interrogation, at 2:00AM, “You sometimes think though that it would be better off for everyone else if you weren’t around though, right?” to which I said, exhausted, yes.

He wrapped up our interview pretty quickly after that and declared that I needed to be hospitalized. Then came the next portion of the manipulation, the guilt tripping. It turned out he didn’t actually have the authority to forcibly admit me, and he would need to get the authorization from the head psychiatrist to do so. He presented this information to me as the following paraphrase:

The head psychiatrist is the only one who can involuntarily admit you into a psychiatric hospital, and he’s off right now with his family, definitely sleeping – it is really late, you know – and I’d have to give him a call and wake him up and go over everything you and I just talked about so he can authorize my decision to involuntarily hospitalize you. Do you really want to have me do that? If not, you can just voluntarily agree to be hospitalized by signing this form right here.

I was very easily manipulated at eighteen. I signed the form, feeling guilty about wasting everyone’s time. It took another eight hours before I was transferred to the psychiatric facility I was to stay at, during which time I was completely ignored in that tiny room, denied food until my best friend nearly assaulted the locked door to get their attention, and denied the bathroom until she assaulted the door again, and then I was humiliated for asking for a maxipad by the security guard, who first berated me for not saying I needed one before I left the locked room, and then shouted across the room to a male security guard to retrieve one for me, all while I sat in an open-doored bathroom, because I was a “risk to myself.”

My first psychiatric hospital stay was mostly uneventful. I was quickly moved to the “low security” section of the hospital, where it was primarily drug addicts and people with low level mental illnesses who were not a danger to themselves. My psychiatrist at the hospital at least could tell that I wasn’t suicidal and wasn’t in the mood to manipulate me into saying I was.

The day before I was to be discharged, I had an anxiety attack and scratched my outer wrist open with my fingernail, probably a circle the size of a penny, and just barely deep enough to bleed. It was a fiasco, and I was sent back up to the “high security” section and my discharge date was postponed. Soon after I was sent back to the “low security” section again, and discharged. I was there a total of two weeks.

I followed up my inpatient stay with an extended participation in Intensive Outpatient Therapy, during which time I maintained close contact with my psychiatrist from inpatient. Now, I mentioned that my psychiatrist wasn’t in the mood to manipulate me. I could more accurately state that he wasn’t in the mood to interact with patients at all. He had, as the therapists described, a “poor bedside manner” and is one of the most impatient people I have ever met. I was terrified of him, but he was highly respected in the psychiatric community as being somewhat of a miracle worker for difficult cases like mine.

Perhaps six months later, after I had been long discharged from Intensive Outpatient and only saw my psychiatrist once a month for medication management (I was still seeing my inpatient psychiatrist), I went in for one of my monthly appointments, and I mentioned that I wanted to die, but had no desire, intention, or plan to kill myself. He had me escorted to the inpatient facility and I spent two weeks there. After I was discharged with a new set of medications and a new referral for Intensive Outpatient, I became actively suicidal, and returned to inpatient a week later. This time, I only spent a week there, as they were worried I was becoming “dependent on the hospital.”

There was a dynamic going on within the inpatient facility that I did not acknowledge at the time, nor long after, that likely should have been acknowledged and addressed by the therapists. I had become obsessed with one of the therapists in the hospital. I had gained his permission to call the hospital on occasion to check in with him, and this quickly became an issue of me calling him several times a day if I did not get in contact with him the first time. When I was inpatient, I would become depressed if he was not working that day, and would become excited when he was, to the point of following him around and creating scenes so he would pay attention to me. This was a huge problem and a major inhibition to my recovery, and no one in the hospital even acknowledged it was happening.

I am by no means trying to claim I had no agency in this situation. I did. I could have chosen to seek treatment elsewhere or to cease contact with him. I honestly don’t know if I had the self perception at the time to understand that I was obsessed with him. Perhaps I did and I was in denial. He was beautiful, cocky, intelligent, patient, and I viewed him as the one who would save me. I believed myself in love with him. I even managed to find out his last name at some point, due to a horrible slip up by a receptionist on the phone.

It was due to this obsession mixed with my psychiatrist being trigger-happy on sending me inpatient that I spent six total stays inpatient at that particular hospital, each between one and two weeks long, over the course of two years.

My sixth and final stay, though, was triggered by something else entirely.

My therapist had been referred to me by the hospital, and I later learned she did evaluations for the hospital herself, and had close ties to the hospital. She was a cognitive behavioral therapist, and I believed her to be the best in the world. She did make a lot of mistakes with me, it turns out, but the biggest one she made was at the end of our therapy.

I had called her a few days earlier telling her that I had started drinking again, a habit I was trying desperately at the time to stop, as I was a heavy binge-drinker. She had seemed distant and said we would talk about it when I came in that week. When I arrived, however, she announced to me as I sat down that she was closing her practice, effective immediately, and that this would be our last session. Shell-shocked, I accepted the news without comment and barely said anything else the rest of the hour. Two weeks later I made my first suicide attempt. I had thought about it plenty before, but I had never followed through on my thoughts before. The one person who I thought was supposed to be the most stable person in my life had just pulled the rug out from under me and I didn’t trust that life was going to be worth it.

After that stay in the hospital I moved back home with my parents, where I found a new therapist, who I am still with now, and who I find to be wonderful, but who I severely distrusted for over a year. My first appointment with her consisted of me telling her that if she wanted to be my therapist she had to never do what my last therapist did to me, and she agreed, so I decided to stay.

After my twenty-first birthday, I started drinking heavily again, and had a brief stay in an inpatient detox at a different hospital, which I have nothing negative to say about, except that I heavily resented being forced to go to AA, as I disliked their mantras and their serious superiority complex.

A good time later, I had a traumatic experience with a teacher that I will not go into here, and I was looking for partial hospitalization program, and the first one I went into was, well, horrifically useless. The majority of the six-hour day was spent in “classrooms” listening to lectures about mental health in a room with forty plus people in it, and no individualized treatment. In each day there was an hour or less of any activity where individuals could even participate. It was disgusting and I viewed it as a complete rip off, and after two days I left the program, and sought out something different.

After hearing of my dissatisfaction with the program, my insurance allowed for me to go to a different program and I was pretty happy with it, but soon after they billed my insurance for services I did not receive, which my insurance didn’t cover, and then proceeded to send the bill to me, and I had to have a big fight with the hospital, literally days after I had just been discharged from their partial hospitalization program for mental health. I felt like a lot of the good the program did was undone by that stress and sense of betrayal.

My final stay in a psychiatric facility was when I was twenty-two. This was at another hospital separate from all the others, and my only complaint about this hospital was that the emergency room literally had no psychiatrist on staff overnight, so I had to sit in a hospital room overnight. But they had me in a hospital room, not a padded room. It was not locked. I was checked on regularly and they took my shoes, but that’s to be expected. The attitude of this hospital was “how can we make sure you don’t come back here” as opposed to the other hospitals I’d been to, where the attitude was “how can we fix your current problem” and that is a very important distinction. After staying at the second hospital I never had another inpatient, intensive outpatient, or partial hospitalization stay.

All of these experiences have led me to believe that psychiatry as a whole tends to undermine the agency of its patients. I have written further on this topic here.

Mara Passio