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.