Open Letter to the Psychiatrist in the Community Hospital ER

Dear ER Psychiatrist:


It has been well over ten years since you "treated" my child at the community hospital ER, where she was sent from the partial program where they had lied to me, before accepting her as a client, telling me they were equipped to treat adolescents like her, and that they understood that not all self harm was suicidal, and she'd "be fine" there.  Her first day, they sent her to you, because she had cut herself - not deeply, not in a way that could be construed as an attempted suicide, just a scratch, really.  But she wouldn't promise she wouldn't do it again.  She was honest - she knew she couldn't swear it would never happen again.  She knew what you wanted her to say, but since she'd been cutting, on and off, for years, she wasn't prepared to commit to "never again."  She had integrity.  I had to watch the police handcuff my child and transport her to your ER, where we met you.


You tried to be nice, I guess.  You told me that if she didn't pull herself together, she'd be borderline (personality disorder).  Unfortunately, I'm one of those parents who actually knows what that means.  Also unfortunately, I was distressed enough not to be able to focus enough on some of the realities of the situation.  My daughter was 15 years old.  You said, several times, "she's not old enough for me to diagnose her with borderline personality disorder, because she's not 18 yet, but if she were ..."  Well, Dr. Genius, there's a reason you can't diagnose 15 year olds with borderline personality disorder!  And if I had been thinking more clearly, I would have told you that, steadily, surely, and clearly.  As it was, I was just overwhelmed and trying to hold it together.


When I got home, I called a couple of my good friends; friends who, as it turns out have a good deal more expertise than you, a psychiatrist in the ER, have about such things.  One is also a psychiatrist; but she actually works with patients for more than one and done.  The other is a therapist who has worked with the entire range of people, from the "normal" walking wounded among us, to the released from the hospitals without adequate supports and can barely function out in the world types.  They both know their stuff, and, they know a whole lot more about my daughter and my family than you do.  "What?" they both said, separately.  "You can't diagnose a 15 year old with borderline!  And there are really good reasons for that!"  As one friend put it, "half of teenagers would be diagnosable with borderline!" 


Let me be very clear:  I made the mistake of saying something along these lines to the wrong person, who looked at me with horror.  That parent would not have understood what I was dealing with, the absurdity of your almost-diagnosis, or the pervasiveness of self-destructive behavior in teenagers.  Nor would that parent have been the appropriate parent for me to talk to to seek support.  But so many kids have a rough time when they are teenagers, and such a small percentage of them grow up to have borderline personality disorder, that what you said to me served no useful purpose.  


If you thought you were warning me, to what end?  Was there something you thought I could do, to ward off this, admittedly difficult end point?  There is nothing that psychology or psychiatry is aware of that prevents borderline personality from forming when someone is at risk, at least not that I am aware of.  I suspect there is nothing you are (or were) aware of either, since you made no suggestions or recommendations.  So what were you trying to accomplish by saying this to me, when you were sending my child to an inpatient facility, which she did not need?  What, exactly, was the point?


I don't remember your name, I don't remember what you look like, but I definitely remember you, Dr. Psychiatrist-from-the-ER.  You had an opportunity to do something decent; to say to the partial program: you blew it - this kid wasn't suicidal; she's got issues, and that's why she's in your program!  Get a grip.  Instead, you sent her to an inpatient facility where she didn't belong.  You could have said almost anything to me, her mother.  You chose to scare me even more than I was already scared - and I was plenty scared.  


I would love for you to know how things "turned out."  My daughter is great.  She's happily married.  She's a mom.  But it wasn't in that order.  You were right that she was in trouble, but I knew that.  I'm her mom!  Her issues were not a chemical imbalance, or the product of my screw-ups as a parent.  They were the product of the horrors of her early childhood trauma, from before I was her mom.  They were the product, in a sense of a very screwed up, ineffectual child welfare system, which fails to protect the children in its care.  But you were ready to write her off - for whatever reason.  Thank G-d, we found people who could help her, who were not quite so ready to write her off.

The Internet Is Destroying Parenting

OK. So I'm being a bit hyperbolic. But let me explain. When my oldest child was young, there was no internet. I couldn't go online to find things out or get support, so when things came up, I spoke to other moms - real life moms! I know, that's so ... 20th century. And it was the 20th century. It meant that I couldn't find only other moms of kids with her exact diagnoses. It meant I spoke to whatever other moms I found and connected with. Sure, there are some real benefits to being able to find other parents of kids who are struggling with the same issues you're slogging through. And if you've got something rare, or unusual ... the internet can be nothing short of a lifesaver.


But, and this is where the internet sometimes makes me totally nuts ... it is not your left-handedness that made you autistic (or your autism that made you left-handed); the length of your second toe is not related to autism; ear lobe attachment is not related to autism. I think you're getting the idea. When people break down into totally diagnosis-specific groups, they start thinking that absolutely everything they see or notice is related to that diagnosis. Parents start thinking that every "issue" they have with their kid is related to the diagnosis.


It isn't. Kids are, first and foremost, kids. They will have bad days at school, sometimes, just because they have bad days at school. It won't always be about the diagnosis. Let them. They will have fights with friends because they are kids and kids have fights with friends. It's not always about the diagnosis (yes, I know the diagnosis complicates things - but sometimes we parents complicate things even more). We have to let them learn to work it out. We can offer to help them figure it out, we can offer to role play, we CANNOT get involved in every mini-drama that unfolds. It's not fair to them, and it's not healthy.


Sometimes kids who are well-past toilet training age have regression issues. Some of those kids are autistic, some are not. But if the only parents that parents of autistic kids ever talk to about "issues" anymore are parents of other autistic kids, we think it's an "autistic" issue. Surprise! No one wants to talk about it, but it's not necessarily an autistic issue. And if we "blame" the autism for everything, we can miss something else ... and it could be something more important.


I love having other "autism moms" to talk to. I don't know what I'd do without the internet. But I miss having the "real" community that seems to have dissipated with the emergence of the virtual world. The real world was so much more nuanced, had so many more sides to it - and there was always such a wonderful jolt of surprise when you found out something new and unexpected about someone you'd known for a long time in a different context. Somehow, the online relationships tend not to be quite as dynamic.