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Malpractice Chain (Pt. 1)

What do you do when therapy becomes part of the trauma?

It naturally goes without saying that not all therapists are equally good, any more than professionals in any other field. I suppose most of the lay public—in its relative ignorance of the mental health landscape—probably conceives of therapeutic malpractice in just such terms, as a matter of a mere ineptitude or bad decision-making as it is in the medical professions. So I’m sure it is, in many cases.

However, there is a divide within the mental health profession between regular professionals who specialize in discrete conditions such as mood disorders, phobias, and so forth, and psychoanalysts who specialize in personality psychology. This leads to a great deal of—for the most part completely unintentional—malpractice, as people with personality disorders, especially the planet's neurotic millions, go improperly diagnosed and treated.

Psychoanalysis is a set of theories regarding how the human personality is formed through interaction between someone’s innate drives and emotions on the one hand and the social environment on the other. The psychoanalytic therapist seeks to reshape a pathological personality by stabilizing the patient, resolving any conflicts in self-image from his or her childhood, and increasing his or her capacity for resilience and relationship building. It’s good stuff!

Psychoanalysis fell somewhat into disrepute when the mental health field was overhauled in the 1980s. It happened to be the dominant school of thought in therapy during the period when homosexuality was pathologized, and so was excessively blamed for the oppression of gays, even though psychoanalysts rid themselves of the relevant theoretical and methodological errors in the 80s with everyone else.

The result is an institutional divide within the mental health profession that makes it incredibly difficult for neurotic patients to get the care that they need. Most mental health professionals only take one graduate course in personality psychology, whereas psychoanalysts have entire degrees specialized in the subject. Ideally, regular therapists would have enough knowledge to at least identify a personality disorder and refer the patient to a specialist, but alas, it often does not happen.

By now, dear reader, I’m sure you are quite reasonably wondering: Am I a psychoanalyst myself? The answer is: No, I am a patient, albeit an unusually well-informed one. Actually, I have a dual disorder, NPD/BPD—an ego problem and an identity problem. That’s right, it’s two, two, two ways of ruining your life for the price of one!

Is he dangerous? you may wonder, perhaps somewhat nervously picturing Hannibal Lecter or Hans Gruber. Mostly only to myself! Lucky you!

Picture Long Day’s Journey Into Night instead, and you’ll have a clearer picture of what it’s like. Other accurate representations from film include the classics Of Human Bondage, Witness for the Prosecution, Bad Timing, and basically any Woody Allen film.

The fact that I must stagger through life as a trembling welter of conflicting nervous impulses capable of collapsing like a house of cards in a strong wind is thus grievously exacerbated by the paucity of psychoanalytic therapists. To make matters worse, many regular therapists apparently insist that they are qualified to diagnose and treat personality disorders, even though they are doubtless aware of the vigorous protests to the contrary lodged by psychoanalysts.

I’ve heard a lot of unbelievably arrogant things from prospective therapists:

“You’ll never get anywhere just thinking of yourself as a diagnostic category.”

“According to the rules of my profession, I can treat any mental illness.”

“So what if I don’t have the same level of training as a psychoanalyst? Information shouldn’t be kept in silos!”

I have to carefully examine the credentials of any new therapist, investigate their educational background, and quiz them to test their knowledge. Shockingly, many appear to know less about my condition than I do, and cannot answer basic questions about it.

I can’t imagine how less well-informed neurotic patients can even find a provider. But you would think someone as knowledgeable as myself could easily sidestep any malpracticing practitioner, right?

You would be sadly mistaken. But we will get to that anon...

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Malpractice Chain (Pt. 1)
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