Me Again, with a Report on My Intensive Outpatient Program

April 3, 2010 at 3:05 am | Posted in Dealing with Mania, My Fascinating Mood, Rage, The Heath Care System | Leave a comment


Like me, this guy may be subject to irrational frenzies, but he's still furry and wistful.

As I’ve noted, I’m now involved in an intensive outpatient program at a nearby hospital. It’s a huge commitment — nine hours a week — and it’s necessarily eating into my blogging time. I’ve given myself permission to write a good deal less, partly because of the IOP, and partly because I hate the trappings of the 21st Century (as you know).

As I was buzzing around the house cleaning obsessively (a new hypomanic symptom for me — I’ve spent much of my adult life living in squalor), I figured out a couple of things concerning my loathing of the mental health system.

As I’ve mentioned, two-thirds of our therapy sessions in the IOP are run by a gentleman whom I will call A, who is the best therapist I’ve ever worked with. I mean, this guy beats the godlike Dr. B who treated me when I was in graduate school (though Dr. B was dashing and handsome, and the IOP therapist is not especially attractive). Oddly, the remaining third of the program is run by a woman, V, whom I would cheerfully strangle. She easily ranks among my worst therapists, and I’ve endured sessions with counselors who were so incompetent that they presented a public health menace. I spend much of her hour disassociating, which I haven’t done since the last time I was hospitalized.

Why does she rile me so? For that matter, why does my soon-to-be-former shrink drive me nuts? I often puzzle over this as I drive home from evening sessions. I figured part of it out two nights ago, and more while organizing my junk drawer this morning.

First, V is a crappy listener. She spends her sessions with us pronouncing all-too-familiar 12-step and therapeutic truisms. “Take it one day at a time” is undeniably excellent advice, but we need concrete coping strategies, not general rules. A, on the other hand, asks questions, expresses empathy, and helps us to explore how to cope with our lives and illnesses. The contrast is striking.

What’s more, whenever I do speak V flatly contradicts me, essentially saying that my experience is uniformly wrong or mistaken. This enrages me so much that I snap my mouth shut for fear of snarling ugly imprecations. For example, V thinks my shrink walks on water, and I’ve reached the conclusion that said shrink is a quack. It’s not surprising that V should favor this doctor — they both recite irritating cliches instead of engaging with patients. The real horror is this: the arguments between me and V reproduce the tiresome and seemingly inescapable dialog in my head. No wonder I’m angry precisely one third of the time at my IOP — it’s like seeing my most misery-inducing interior monologues come to life.

Of course, some of you are probably thinking that I should be more grateful for the help I’m getting. I’m sure this is true. It burns my ass, though, when people who are not in a position to know suggest that I’m too cynical and negative about the health care system. I hate being told that I should be grateful for crappy care. I approach each new drug, shrink, and therapist with buoyant hope, and my anger is largely a product of intense disappointment.

It’s interesting that A and V subscribe to the same theoretical model. Many clinical studies have reached the conclusion that the form of therapy matters less than patients’ perception that their therapist genuinely cares whether or not their quality of life improves. I may be wrong in feeling that V is uncaring, but the mere semblance of arrogant indifference is profoundly disillusioning.

Enough. I actually am grateful for A’s help, and the handouts and techniques have proven valuable, not just in the group, but in everyday settings.

Love to all. I will likely write more this weekend.


The Trouble with Control, The New York Review of Books on Health Care Reform, and an Outlet for My Rage

February 23, 2010 at 4:40 am | Posted in In the News, Links, Rage | Leave a comment


Petty criminals who drive down my property values will feel my wrath, dickweed.

Like just about anything you’ll find in The New York Review of Books, <a href="“>this article on congressional attempts at health care startled me with with its insightful analysis of our nation’s legislative climate. In fact, it’s so insightful that the author agrees with me, arguing that the Democrats should not have taken Scott Brown’s election in Massachusetts (Ha! Spelled that correctly on the second try!) as a thumbs-down vote on our pathetic, mired-down health care bill.

Now. I’ve been wrestling in this space with the issue of control, asking again and again whether I can do anything to ameliorate my moods. It came to me that this is bound to be demoralizing: If I can control my moods, then it’s my fault that I’m not well; if I can’t, then my situation is hopeless. Neither conclusion is particularly alluring, so I tend to tell myself that I can control them, but I haven’t figured out how yet. Of course, this means failing again and again at all sorts of self-improvement initiatives, which is demoralizing in itself. To which I say, Grumble!

A month or two ago, I saw a flasher standing in the parking lot behind my condo, and I lamely resolved to give him the rough side of my tongue if I saw him again. Imagine my delight when I spotted him two days ago, this time shining a flashlight down on his penis. I threw a U-turn, rolled down my window, and barked out a couple of profanity-laden threats. He shot me an incredulous look and loped off. My only regret is that my prevailing mood has changed, and I may not have summoned the proper air of psychotic rage. But that incident made me smile for a couple of hours.

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