Professional projections.

Standard

One of my better psychiatrists (“better” is relative, of course) wrote this about me at one point:

We worked to help her realize that these were understandable and natural feelings for an adolescent girl to have if she was stuck at home on a Saturday night with her father and had no prospects of having a real life.

Sounds really empathetic, and normalizing, and all that, right? The problem is, it isn’t true. It might be what the average adolescent girl would’ve been feeling like on a Saturday night. I personally didn’t conceive of Saturday nights as any different from other nights in the first place. There was no particular significance to them for me. It was just a crappy night in general from what I can, vaguely, recall. But I definitely was not making any special associations with the Saturday part.

I didn’t say it, either, or a lot of the other things that ended up in that report. What happened was my psychiatrist guessed. He sat there and talked to me about what he thought I must be feeling, and then waited for any sign of assent, or at least lack of dissent. I remember clearly him talking about romance and how it was missing from my life. I remember not understanding the word ‘romance’ at the time, so not having any clue what he was talking about.

It’s considered really important to make sure to acknowledge that disabled people are feeling what anyone else might be feeling in a certain situation. And in many ways it is important. But there’ve been a number of times when it just hasn’t worked. My brain works differently. Not totally alien to typical brains, but different enough that my frame of reference is often different. Saturday night still means nothing to me. There’s still a lot of words I hear and don’t understand. People still attribute all kinds of emotions and motivations that just aren’t there because I’m not built like that.

What’s important for professionals to realize, when they write things like this, though, is how much more impact their words have than our reality does. What they write on paper stays in our permanent record. What they write on paper, in fact, will often be believed by other professionals above whatever we have to say about ourselves:

“I felt this way.”

“No, actually, this paper says you felt that way.”

I think there’s something somewhere else in my records where it is said that I made a major breakthrough for wellness in declaring that I wanted to be a psychiatrist. My psychiatrist was always telling me to be a psychiatrist and eventually I got to repeating it. I didn’t want to particularly (not that there’d have been something wrong if I did, but I didn’t), I was just doing what I nearly always did at the time, repeating what I thought was required of me. I can’t count the number of times I see in my records where a doctor, well-meaning or otherwise, writes that I said something, when as far as I know, the doctor is the one who said it. I have no clue if I repeated it or not, it’s likely enough, but that should be kind of suspicious to a doctor. I go over these things, and go over my memories of my actual thoughts and feelings at the time, and there is often no match at all, even when I remember with perfect clarity.

About Mel Baggs

Hufflepuff. Came from the redwoods. Crochet or otherwise create constantly and compulsively. Write poetry and paint when I can. Physically and cognitively disabled. Anything you hear in the media or gossip is likely to be oversimplified at best and wildly inaccurate at worst, the only way to get to know me is to actually know me. I'm not really part of any online faction or another, even ones that claim me as a member. The thing in the world most important to me is having love and compassion for other people, although I don't always measure up to my own standards there by a longshot. And individual specific actions and situations and contexts matter a lot more to me than broadly-spoken abstract words and ideas about a topic. My father died a couple years ago and that has changed my life a lot in ways that are still evolving, but I wear a lot of his clothes and hats every day since he died and have shown no sign of stopping soon.

26 responses »

  1. I have a feeling a lot of psychologists will be learning things from people on the spectrum in the coming years. I remember starting my last series of sessions with something like, “You have no idea what’s going on, do you?” I’m not sure the psychologist knew what I was talking about.

    By the way, this fellow has a book coming out soon that looks promising.

  2. That has been my experience with professionals as well, and the frequency of such brazen mis-reporting on their part is something I’ve often found to be downright terrifying, even though the consequences to myself have thus far been minimal.

    In terms of motives, I think it’s rarely more than carelessness, however gross or pervasive it may be in their professional conduct. But intentional or not, I do consider it a form of abuse.

  3. The words ‘Saturday night’ remind me of The Drifters song – “Saturday Night at the Movies”.

    Maybe your psychiatrist told all his patients, whom he thought had an aptitude and attraction to psychiatry, that they should become psychiatrists.

    If you had come up with a song about being stuck at home on a crappy Saturday night, I don’t imagine him telling you to be a singer/songwriter.

  4. Even if the Saturday night stuff were true, what kind of therapist would describe a client as someone with “no prospects of having a real life”?

  5. I agree with Charles. Whatever the psychiatrist meant, the way he phrased it made me angry. The fact that someone doesn’t go out on Saturdays doesn’t make his or her life any less “real” than that of someone who does. He’s insinuating that there is only one way to live that is normal and acceptable.

  6. This is kinda confusing to me. Aren’t those of us on the spectrum “supposed to be” asexual or something? Or are we now required to have some vague sorts of romantic needs and urges that must never be fulfilled because we can’t live “real” lives? There’s something to strive for. /snark

  7. I think that as long as they think they can tell (without more chemical understanding how Brains/nerves/systems really work) whats going on ‘in our heads/bodies’ I have a feeling a lot of psychologists/psychiatrists/doctors will NOT be learning things from people on the spectrum in the coming years.

    Unless they change their ‘We know what counts’ attitude.

    Not trying to pick on you Kev, but I tried reporting my Asperger’s problems like 30 years ago. The yayhoo’s back then told my dad that I looked at them like they were full of Sh*t. (Which we now know they were!)

    In my opinion, if these folks weren’t smart enough to figure us out back then, (Though Hans Asperger Did, kind of, and Kanner too) and all the cockeyed research going on today still hasn’t pinpointed anything they can understand about what makes us US (whether its Genes or PCBs or ???), then I don’t give them much chance of self/(group/corporate) enlightenment over the next 10 years.

  8. I’m with Madeline. “no prospects of” having a real life doesn’t suggest a temporary condition, like that of a frustrated teenager. It suggests an inherent condition.

  9. Patrick: I’m definitely not a psychologist but hopefully if the culture surrounding psychologists/psychiatrists/etc. change – thanks to upcoming books by John Elder Robison, Kristina Chew (I haven’t read much of Autism Vox but she seems cool), and hopefully myself (I’m working on one) and maybe even others here (I hope!) – then maybe psychologists will begin to change their ideas/practices.

    I don’t know how psychologists weigh anecdotal evidence versus hard science, but at least we’re getting a clearer picture of what the spectrum is really like nowadays.

    No offense taken.

  10. Yeah. He didn’t seem to think I had no prospects at all though, just no prospects then. (From what I remember of him telling me.) He thought I had to “get better” to have a real life, though, which is an unfortunate prejudice a lot of people have.

    I’d left the house that day, as usual for when I did that, because I was offered only two choices, one of which was horrible (the psych system), and the other of which was becoming more and more impossible the harder I tried (due to shutdown).

    I wanted more choices.

    I tried to make some for myself by walking around trying to figure out if there was somewhere else I could live, but I never found it, and eventually the cops usually picked me up, either for being outdoors looking unusual or for having a meltdown.

    Then people would want to know what I was doing, and I couldn’t tell them (not didn’t want to, couldn’t), so I’d either stay silent, or reply with anything that sounded vaguely like it made sense. I could see the systems in my head and I could see that one future was closed and the other was awful and I wanted a third option that didn’t happen to be suicide or a fantasy world, but I didn’t know how to say any of that, that kind of communication was completely closed off. I remember vividly though the daydreams I had about other possibilities, usually involving outdoor survival of some kind.

    I found that third option (and I’m sure there’s a fourth and fifth and so on), but people shouldn’t have to find it the way I found it.

  11. Maybe your psychiatrist told all his patients, whom he thought had an aptitude and attraction to psychiatry, that they should become psychiatrists.

    Quite possibly.

    He himself was neuro-atypical (ADD) and participated in a good deal of research in that regard from what I’d heard, and was known for it at least locally.

    Even when I went to university at 19 and decided to major in mathematics, he still wrote a letter to the university about what wonderful contributions I’d make to neuroscience and psychiatry. I suppose he’d probably be glad I am doing stuff with MIT now, but that wasn’t exactly a plan I had, it just happened.

    I did have a psych major at the time he was trying to encourage me, but it was kind of an impulsive mistake. I’d raised my hand along with everyone else before fully processing the “Who’s going to major in psych?” question. I’ve really only completed one very basic class in the subject.

  12. Kevathens- I hope to be one of that new generation of psychologists that is better at listening to what autistic advocates have to say.

  13. “My brain works differently. Not totally alien to typical brains, but different enough that my frame of reference is often different.”
    To me, this is the most important part of your entry. A lot people out there cannot fully understand that. I think that if people were able to better grasp those core differences, people with disabilities would be offered more options, and treated with more dignity and respect.

  14. To follow up on captain blog’s comments re Amanda’s sentence “My brain works differently. Not totally alien to typical brains, but different enough that my frame of reference is often different” … except, to take it in a different direction:

    The whole sentence (including the part about brains working differently) could apply to anyone with a neurological difference. As a little girl with attention deficit disorder (though it wasn’t actually diagnosed until I was much older) I can remember being utterly mystified when adults seemed to believe that it ought to be possible for a person to focus on their assignment and stop day dreaming just by deciding to do it. This was so completely outside my frame of reference I couldn’t parse it; I was convinced they had some secret for HOW they stopped themselves from daydreaming that they could share with me if they just stopped and thought about it. What I, and they, didn’t know at the time was that my brain was simply operating differently from theirs.

    And, of course, any person with a disability, even if its not necessarily neurologically based, will have a different frame of reference. For example, even though most people do understand my speech pretty well most of the time, I still run into enough difficulties to be aware that my speech is not quite perfect. People who learned English as a second language, for example, tend to have more trouble understanding me even if they don’t seem to have problems understanding other English speakers. But I’ve learned to avoid actually SAYING to hearing people that I know my speech is “imperfect” Or at least, I don’t just come out and say it in passing because even if it might be a trivial side note to ME, I have found it isn’t for most hearing people. Because if I say anything that sounds “negative” about the quality and clarity of my speech, then most hearing people seem to have this tendency to want to rush in and “reassure” me that my speech is “just fine” and they have “no problems” understanding me. All the while failing to realize that, one, it’s kind of insulting after 37 years of assessing just from my own observations how well other people understand me to be told that my judgment is completely wrong: true, I can’t hear my own speech as clearly as a hearing person does so I can’t judge it directly, but I *do* have other indirect ways of evaluating its quality (just from noticing who understands me) and I have a lot more experience at it than someone who has only heard my speech for 5 minutes and with only one pair of ears–their own. Two, they seem to be assuming that my perception of my speech skills is somehow going to be tied up with my self-esteem and that it’s their job to improve my self esteem by pretending my speech is perfect (or assuming that it IS perfect just because THEY understand it fine — ignoring the fact that not every hearing person seems to have their experience with my speech). But I don’t need to believe that I have great speech, or even any speech at all, to feel good about myself as a person because I simply don’t attach the same value to “good speech” as a hearing person does. My frame of reference is just too different.

    The above examples don’t really respond to captain blog’s very important points about offering options, dignity, and respect to people with disabilities. I think those points are crucial also. And it makes sense that people might offer them more if they had a better grasp of the concept that brains do function differently; and that not everyone (same neurological wiring or not) has the same frame of reference.

  15. You can’t expect everyone’s brain to work the same way… but professionals unfortunately do assume this way too much. Just because a theory works for 95% of the populace doesn’t mean it works for the other 5%–and that’s 1 out of 20 of your patients, so you really, really can’t assume it does.

  16. “In terms of motives, I think it’s rarely more than carelessness, however gross or pervasive it may be in their professional conduct.”

    Don’t think so David. I’m becoming fonder of the notion as times passes that very few people have any capacity whatsoever for empathy with autists.

    Look – folks get conditioned into the forms of socialisation that elevate the socialising night of the week, Saturday, to the top of the calendar from the age of 4. How can they deal with people who have not been so conditioned? Kathleen’s made a point of the kinds of people attracted to psychology and psychiatry – generally social butterflies, which is why the professions have gotten precisely nowhere with autism. They can’t get out of their own envelope.

  17. Actually, many other people attracted to psychology and psychiatry are people who are trying to figure themselves out.

    That particular shrink (who remained my shrink, except for a brief period in which I was taken out of his main care for insurance reasons, until his recent retirement) was not a social butterfly to my knowledge. He’d grown up painfully shy and with some kind of learning disabilities, and part of his reason for working in the system was to help people who were now where he’d been in the past. Still doesn’t mean his empathy was always spot-on for an autistic person, though.

    He’s a really good example of someone who had good intentions and got mixed results with them (some of them very good, some of them terrible). One good thing about him was that when he did find out he’d made a mistake, he often admitted it. He’s the one who saw that my PTSD as an adult was primarily due to “treatments” he had either prescribed or at least been in an ostensibly supervisory role on. How many shrinks would admit that they’d made mistakes of that magnitude? (He also I think at one point sued the institution he worked at.)

  18. alyric-
    I can’t comment on global trends in why people are attracted to psychology, but I can tell you that a lot of the psychology students I know are of below average social skills and are somewhat introverted. I think this may be a trend of scientists in general.
    I personally am interested in psychology as part of a larger interest in the human condition, and as part of my life purpose of understanding that condition on both a scientific and a personal (i.e. through one-on-one empathy) level, I’m becoming a therapist.

  19. Kind of a digression on “prospects of a real life”…

    One thing we’ve always wondered: Do some autistic people get depressed over not having a “normal” social life because they *want* a “normal” social life, or is it just as likely that some of us get depressed over lack of it because we’re *told* that we want and need one, see “normal teenage social life” and “romance” glorified constantly in the media, and have our own attempts to relate to others criticized as “not real friendships” and told that we will never have emotionally satisfying relationships with others unless we can do it in a “normal way”?

    I mean– we basically live in a society that tells us, from day one, what we want. That’s pretty much the basis of the whole consumerist ethic. Tell people that they need things and they’ll want them, whether or not they actually do need them. The whole way that “romance” is marketed, and the idea that your teenage years are the “best years of your life” and that if you don’t have a “great time” during those years and make lots of social connections, you’ll never again be able to have as good a time as you would have had as a supposedly carefree teenager, etc, etc… well, it’s a bunch of crap. But it was a bunch of crap that we, at one point, for a while, bought into.

    Someone in the comments on this blog a while back posted an article in the New York Times about autistic girls and women. I don’t remember the exact quote or study, but there was some mention of autistic women being more likely to become depressed over inability to form social relationships and of course there’s the inevitable question of whether this is an innate gender difference, etc etc. I think it’s probably true that women are *taught,* growing up, that their ability to form relationships with others, particularly men, is part of their worth and self-definition, in a way that it isn’t part of male self-definition. Up till a certain point, too, the article’s description of the supposedly typical autistic teenage girl whose biggest dream is to have a “normal social life” could have fit us very well.

    But– we think nowadays, looking back on it, that a lot of that desire was something imposed on us from outside, and we thought we wanted it only because we didn’t know there were alternatives, that there was a way to make and have friends besides the “standard” one we were constantly being told we needed to learn. If we had ever seen any kind of model, in media or in person, for the kind of friendship that we could handle– that could have made a huge difference. All I know is that we don’t think about wanting a “normal social life” any more, or think every time we walk past chattering groups of girls that we should be like them, or feel that what social life we have doesn’t count as a “real” social life because it doesn’t look like that. We do have a desire for a certain amount of connection with others, and we definitely spent most of our life with that desire being frustrated, but we know a little more now about what terms we actually want it to be on. It’s similar to how a lot of women think they can’t be attractive unless they’re tall skinny supermodels with disproportionately sized breasts– because that ideal floods the media and is nearly impossible to get away from. (Although, random side fact, a majority of models have their photographs computer edited in some way nowadays, before they appear in advertisements or whatever.) So we think most of it was artificial to begin with.

    All we knew, when we were a teenager, was that we were miserable and nothing we did seemed to be able to change that, and therapy wasn’t helping it either. We thought that maybe happiness would come from being “normal,” or what we saw at the time as being “normal,” which was kind of a weird, distorted parody of the stereotypical teenage social life (which we saw at the time as involving nonstop parties, drinking and sex). Would we actually have wanted anything like that if we hadn’t seen that the media glorified it and been exposed, for a few years, to an environment where some people actually did talk about parties, drinking and sex like these were the highlights of their life? I don’t think we would have to the same degree, at least. We were *curious* about some of these things, but without the outside influence, I think we would have been *just* curious and maybe even had an idea of how we might want to explore any of it on our own terms– rather than feeling as though doing those things would complete our life, and that without them, we could never experience the happiness that people who did them supposedly had.

    If we had actually thought about it on a practical level, we would have realized that we didn’t enjoy ourselves even at family parties and quickly went into sensory overload, didn’t like the taste of alcohol, and were afraid of most men. We had as much of a fantasy about actually wanting those things as we did about having them. But we weren’t really thinking about it; we were just going along believing that what everyone else said was a good life would make us happy, even though almost all of our attempts to get into things like that, and we did make attempts at various things, ended in a wide variety of bad ways. It was hard to keep our priorities straight when surrounded by people who constantly bragged about indiscriminate sex, drinking and drug use and similar things.

    So, we did have more than one therapist who got us to agree that “to have a social life and a boyfriend” was a goal for us, because they had never questioned the assumption either that the natural goal of any teenage girl’s life was to have those things, and *they* also thought that any teenage girl who didn’t have that and who spent Saturday nights alone at home instead of out at a party or on a date must be very lonely and unhappy. Which, yeah, was definitely projection on their part, one of them in particular, but by that projection, they encouraged us to believe *more* that we would be unhappy without those things. And there were a couple who got us to agree that part of the goal of therapy for us would be to “reduce social anxiety” and “learn normal social skills” and to “feel better about yourself.” For some reason there seemed to be this assumption that as soon as we could be made to “feel good about ourselves,” then “normal” social skills would just magically follow or something. Which never hapened, of course.

  20. I would think that neuro-atypical psychiatrists would in general be empathetic to their patients who are also neuro-atypical. The idea of the wounded healer occurs to me. But I always thought that psychiatrists were extraverts, ‘people persons’.

    I didn’t go out socialising on Saturday nights (or other nights) when I was a teenager. But in my early twenties, when I had left my parents’ home and was living alone, for a few weeks I went by myself to a pub (or pubs) where there was folk singing on Saturday nights. I didn’t speak to anyone there, I was very shy, and always left there feeling unhappy. I hoped that I would meet a hippy like young woman there and romance would follow. That didn’t happen.

  21. “This is kinda confusing to me. Aren’t those of us on the spectrum “supposed to be” asexual or something? Or are we now required to have some vague sorts of romantic needs and urges that must never be fulfilled because we can’t live “real” lives?”

    A lot of autistics are asexual, but when they discuss sexuality at all in autistics, most ‘experts’ seem to assume that every autistic has a normal sexuality – often they don’t even acknowledge homosexuality, probably the most common sexual difference.

  22. often they don’t even acknowledge homosexuality, probably the most common sexual difference.

    Because you can only have one difference at once! (Liek duh.) And you can’t be autistic and transgendered either, or autistic and anything else.

  23. My sex education classes in grade 5 also ignored homosexuality, even though, in a class of 30 kids, you’d estimate about 3 were gay. And this was aimed at NTs, so it’s not just ‘only one difference each’.
    I saw a poster put up by some gay activist group that showed a baby with the words ‘Presumed Heterosexual’.

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