Saturday, May 13, 2006

The Angry Patient

[posted by dinah]

Maybe this should be titled The Angry Psychiatrist.

The patient has had a rough time of it, he's a widower who tragically lost his wife, his only child is a disappointment to him, his boss is demanding and unpleasable.

I would listen sympathetically, but the patient won't talk. He stares at the ceiling and says he doesn't know what he should talk about. I make suggestions; they are all wrong. He's already talked about those things, and why don't I remember? Or he doesn't want to talk about them, it won't help. I ask about something I hope will be benign-- weekend activities, how things are with a family member, even a TV show I know he likes, but anything that isn't charged, he's deemed a waste of therapy time. "What's important to talk about?" I ask, trying every angle I can think of. "You're the doctor," He replies. But it's not a matter-of-fact, or even a slightly annoyed, reply--it's a hostile, you're failing me, dig and he knows right where to aim.

When he does talk, it is to rail at me. I'm not helping him, the medications aren't helping him, the side effects suck. He logs my failures: the time I didn't call his meds in fast enough, the time he was certain he'd left a message I didn't return-- it doesn't matter that I tried and couldn't get through. If I make any reference to the future, one he insists won't come, he uses it as an opportunity to angrily tell me how I haven't been where he's been. He stares at my wedding ring and asks how I'd feel if my husband died, if my kid had the problem his kid has? He makes many assumptions that I've never suffered, and certainly, he announces, not the way he has.

The Angry Patient never misses an appointment, in fact, he arrives early, and he sometimes calls between sessions. He comes, he says, because he is hanging on to his last remnant of hope. He's never had a kind word for me, never even an ounce of tenderness to his tone. I've tried to suggest he see someone else (pleeeease...), for at least a consult. Empathy, I've said, is a necessary part of the psychotherapeutic process, and he feels I have none; perhaps he might find it with someone else? Even I'm giving up on him, he's quick to point out, and I'm not surprised-- I knew he'd see my referral as a rejection. He's not telling his story again, not starting over, and I'm as good as the rest of the quacks (he's test driven quite a few). Gee, thanks, I think.

The Angry Patient stares at the ceiling and I glance at the clock. I keep my tone gentle and even. I listen and I try not to say the wrong thing. I remind myself that he's still grieving, and I try to garner some sympathy for his disabling narcissism, his Cluster-B-ness which he wears like a coat of armor.

If the Angry Patient were just angry, that would be fine. Why does he have to be angry at me? Don't answer that; for the moment, I'm just striving for survival.

17 comments:

Spiritual Emergency said...
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Dinah said...

e) I wanted to vent and thank you, I do feel much better.

Until now, I've written about my work and whatever all it inspires in me through my fiction (I'd sing, but I'm tone deaf, so that hasn't proven to be a useful creative outlet). I'm experimenting with this an a venue to talk about, well, whatever, but that includes some of the clinical stuff. I'm still ambivalent about doing this, and while the patients are heavily disguised; the issues at hand and the feelings they inspire are not.

If someone wants to commiserate with me, that's fine. Empathy is great. Sympathy is uncalled for: I chose this career, I love it, and I consider myself very fortunate. I'm not looking for treatment suggestions from strangers over the internet--I have wonderful resources and access to very gifted psychiatrists (ClinkShrink & Roy included) at my fingertips. I do, however, sometimes find it fun to complain and you'll forgive me if I lapse into a whine.

Roy said...

I had this same patient once (or, an identical twin). He was also alcoholic. For two years we struggled with his goals (which was, really, to try to figure out why everyone else is such a fucking asshole). The anger got hotter and hotter as I calmly took it, strategically reflecting it back to him ("I notice you sound angrier after seeing me look at the clock"). I eventually took a different tack and told him how I felt being the target of his anger. His emotional response took a 180, and he finally opened up about *his* feelings of inadequacy and fear of rejection. He made some progress but later dropped out. He remained sober throughout, as that was my condition for treating him.

Dinah said...

Angry patients seem to be the theme of the day, check out Shrinkette: http://shrinkette.blogspot.com/2006/05/im-suing-that-doctor-im-going-to-make.html

Spiritual Emergency said...
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Dinah said...

I'm doing my best, I wear a few hats. I've pulled my last name from the blog, but if my patients really want to find it, it will give us something to talk about. Really, the whole point of psychotherapy is to have an honest interaction.
See my original post on the issue:
http://psychiatrist-blog.blogspot.com/2006/04/persona-who.html

Roy said...

spiritual emergency said:
"...allow for some honest exploration and criticism between the "doctor" and the "client" that ideally runs both ways."

There's that "client" word again. See the comments in Trick-Cyclings blog about "patient" vs "client" vs "health care consumer", including a published survey about what name patients prefer [yes, that's a clue].

Spiritual Emergency said...
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Spiritual Emergency said...
This comment has been removed by a blog administrator.
Dave_MSW said...

I like Roy's comment. While the client pays me to be there, I'm not available for his/her abuse. All the training we get about unconditional positive regard is lost on someone who is using the relationship to feel powerful. I've found reacting assertively gets us back to business, or the client out the door sooner. Either way works for me.

Sarebear said...

Hmm. Maybe I'll have a bit more patients (typo on purpose for a really BAD pun) with my iatriast.

I see an ologist for therapy, but my iatrist . . . well, I've been told he's the best. But direct is an understatement. He makes Dr. Phil look like a kitten. Meow!!

Anyway, he IS on thin ice with me, but I, after reading about your experience with your patient (which I'm nothing like, not that it matters!), understand more about why he railed at me for 25 minutes last time; about where he was coming from with his frustration, even if I disagree that I was doing or being what he said. He also blamed me for making this appt. last over an hour, when he's the one who went on for 25 mins . . . lol!

Still, I am renewed in my view of him as maybe not being all good or all bad, so thanks. I do that too much.

jw said...

I've been an "angry" patient. I'd like to tell you why.

My experience with therapists is 32 out of 34 bad! REAL BAD ... Bachground:

1) In 1981 I was attacked and nearly killed by a woman. It was a sexual assault. 32 out of 34 DEMAND (not state, there's a difference) that there are no female offender sex assaults against males so I could not have been hurt.

2) I spent a lot of years speaking fulltime for fathers with custody of small children. It's left me with an anger hole which will not heal. 32 out of 34 demand that fathers with custody have never been discriminated against so I could not have been hurt.

I could go on with this list ...

Try dealing with such crazy making insanity from a mental health professional and you too will be angry.

Therein lies my primary point.

Psychiatry, psychology and therapy in general have become so violently anti-male that sanity no longer exists: At least from my point of view. I'm sure there's plenty of sanity for the female or male who fits into the nice little gender box created by modern therapy.

My son, who is gay, makes the same point. A gay man, raised by a lone father, whose mother was a big problem ... but he refuses to speak out against those vile "men." Therefore, he must have something wrong with him!

It is so daft that it is ... I do not even have a word to describe how daft the therapists now are. Sexist should be in the place of the word "daft" but modern psychiatrists seem incapable of seeing sexism when it is misandry, so we'll have to live with "daft."

I might note that one of the two therapists I listed as not-bad, is a woman who ran from the room crying after I had told my whole story ... She actually helped me ... in a way. At least there was no sexism and some REAL human emotions. That is a start.

The other one ... I've met him once, so he is a "we'll see." At least he'd bothered to read some of the material on male sex assault survivors.

So? Angry??? You betcha. Angry for VERY good reason too. That percentage of bad is dangerously high.

I'm not typing this for sympathy or in any expectation of therapy. Rather, I expect and demand change in the psych community. Damaging people for sexist fun and profit is wrong: And that applies to male people as well as female people!

Spiritual Emergency said...

jw: modern psychiatrists seem incapable of seeing sexism when it is misandry, so we'll have to live with "daft."

The unfortunate truth is that therapeutic professionals are as much a product of their culture as anyone else and I would agree, misandry is alive and well in our culture -- a matter that should concern us as much as misogyny. I can understand why it would anger you to have had your pain repeatedly dismissed and invalidated. Quite honestly, it angers me to hear of it. If no one's ever said it to you, I'm sorry. I say that from the position of having loved and been loved by some remarkable human beings, both men and women.

I sincerely hope you find some resolution for yourself. Yes, indeed, a man can be raped and sexually assualted by a woman. Yes, the courts and those in the mental health field can be blind to or biased against a male in your position. How very disturbing that you have sought help from so many and been consistently dissappointed.

I would imagine that the web can provide both a means of connecting with others and supportive information. One site I've frequented on occasion is .

Spiritual Emergency said...

Rats! My link didn't show up. Here it is again: Men Web: http://www.menweb.org/

jw said...

spiritual emergency: Thanks. A few online have matched your words. I've yet to see those words echoed in the personal "face to face" world, but we'll see.

I've written for Menweb back in the days when it was run by Dave Throop and am familiar with almost all men's sites.

For me and as I see it, the "mental health" political situation is getting worse, dangerously so. (I find focusing on the politics of the thing is better, given my own hurts.)

As you may know, some within the men's movements believe that the mental health community crossed the line from indifference to males into intent to apply upward pressure to the male suicide rate. I recently crossed the floor and now side with their opinion, (I wish I could say otherwise).

The mental health community counters by saying this opinion is psychotic or the result of a (wide spread) personality disorder. Which is typical, given the politics at hand.

At the same time, some women stand up to misandry. Moreover, these women are being heard.

The dualism is striking, the paradox intense. Where it will go is anyone's guess. As I see it, hope and despair balance on a razor's edge. The lives of millions being weighed in the scale of politics.

foofoo5 said...

I was telling students the other day, "you will forever be on the receiving end of some patient's projection." A few dutifully wrote it down, but the majority looked at me with that "whatever" look that only students can produce. Damn I feel old.

BPLadybug said...

"The Angry Patient" has also been my client. They are not just in your practice. They abound in all aspects of life. And most of us are "The Angry Patient" at one point, in some moment of our lives.
Finding tolerance while setting boundaries to protect myself from their wrath is my objective. It is a delicate balance. BPLadybug