A lot of, if not most, doctors are required to take the Hippocratic Oath when they cross the threshold from student to practicing physician. This oath is a declaration expressing their intent to behave in/with the highest of ethical standards during treatment of patients. Maybe it’s only a US thing? Given the history of doctors in Nazi Germany, I can’t imagine contemporary doctors don’t have to abide by some ethical standards, including the Hippocratic Oath.
Thus, I wonder what went so terribly wrong with my psychiatrist/therapist who treated me for 4 years to then completely abandon any moral compass she may have had when she abruptly discontinued my treatment just at my most vulnerable time.
I’m not sure what happened, and will probably never know, but can only make some hypotheses I won’t go into here. Nonetheless, upon my arrival at the hospital and declaring my current medications I was met with surprise. My (hospital) doctors questioned the cocktail I had been on. The medical staff at the hospital also disagreed with my diagnosis and consider me to have ‘treatment resistant’ recurring, severe unipolar depression, not bipolar. So that, right there, would have killed a medication in the cocktail, not to mention another medicine I had been taking to combat a particular symptom I experience.
At the time I wasn’t too bothered and just wanted to feel better, whatever that meant in medical terms, I didn’t really care. Two medications, of my then four-medication cocktail, were eliminated immediately. It was the beginning of this, second, hospital visit of mine and I also began ketamine treatment. Ok, I’m on board, and continued, onwards.
As previously mentioned, the ketamine didn’t work out for me this time around. After discussion with doctors, I was ready to move forward with the ECT treatments. Around this time, I figured it was a good time to inform my outside/external psychiatrist/therapist. I emailed her. Without any blame, I simply stated the facts – my illness had taken a bad turn after deciding to stop my antidepressant and, now, ketamine wasn’t working, so, I’d be starting the index series of 12 electroshock therapy treatments (ECT). I never received a response to this email.
[ Lesson #1 for psychiatrists/therapists: don’t ignore your patient/client when they are about to begin a series of electroshock treatments ]
I began the recommended ECT treatments. Three times a week, Monday-Wednesday-Friday, for a month. During this period, still, I never received a reply from my external doctor/therapist.
As I began to improve slowly and steadily, discussions of leaving the hospital began. A requirement to leave was having a psychiatrist and also, preferably, a therapist as well in place, externally to carry on treatment seamlessly.
I sent a new email to my external psychiatrist/therapist simply requesting an appointment. I received a reply, with no mention of my previous email, and we fixed a time for my first appointment after leaving the hospital. Excellent. I felt relieved.
The hospital team recommended I continue on with ‘erhaltung’ (German for ‘maintenance’) ECT treatments after I left, especially because of the recurring nature of my particular illness. I agreed and so I continued on with a fixed number and schedule of ECT treatments on an outpatient basis. This is common and under this regimen, I’d still see my external psychiatrist/therapist only visiting the hospital for ECT. Ok, no problem for me.
I left the hospital at the end of May (?) and adjusted quickly to being back home, no problem. I go to the appointment with my psychiatrist/therapist I had scheduled while in hospital. For me, nothing seems out of the ordinary. An appointment with the doctor/therapist I had been seeing weekly for 4 years already.
We sat down to our session and the first thing she said was she disagreed with the hospitals’ view. She felt her diagnosis of bipolar was correct and, in her own words, said she firmly stood by her view. Moreover, she didn’t want to continue treating me anymore. She didn’t say why but did want to see me next week for our final meeting. She wanted me to share what I had learned from my experience with her at this meeting.
I was astonished, speechless, and, thus, at the moment agreed to meet the following week.
I left the doctor/therapist’s office and carried on with my life at the time. As the days progressed, the anger became more intense. Not only did she never respond to my initial email about my new medical situation, she was ‘quitting me’ exactly when I most required a therapist AND wanted to know what I got out of our 4 year ‘therapeutic relationship’. FUCK THAT.
[ Lesson #2 for psychiatrists/therapists: don’t abruptly disconnect from your patient/client, especially if they had just left the hospital and were relying on your care. ]
I wrote a handwritten letter informing her I would not be at the scheduled appointment and had no interest in sharing anything with her again. Then, I dropped the letter in the ever-so-dependent Deutsche Post. End. So I wish it was, but it wasn’t.
Every mental health caregiver, be it psychiatrist or psychotherapist, knows that the average time to obtain an appointment with a psychiatrist or therapist in Berlin is 5 months. On average. Never mind if it’s a fit. Never mind if the seeker also requires an English-speaking doctor/therapist.
[ Lesson #3 for psychiatrists/therapists: consider the care pipeline for any patients/clients who may require help outside your care. ]
It’s now October (4 months after hospital) and I have yet to find a doctor or therapist available. This is not surprising, it’s simply how it is in Berlin and most large cities. Even at various times, I’d hear this particular doctor/therapist mention, over the years, the number of incoming messages requesting treatment and how hard they were for her to manage. Thus, she knew, terminating my treatment, would leave me in the lurch for quite some time. I find this unacceptable.
At the end of the day, what really sucks is that I’ve been undergoing shock therapy, continue to, and have no psychiatric professional to discuss this experience and its side effects with, nor do I know if/when I will. Not to mention, I was supposed to have a doctor and/or therapist to work with post-hospital as part of the exit plan.
This is far from a complaint about the German health care system. It has proven amazing and I’m very grateful for it and that’s another thing (and post) entirely.
It does, however, reveal the ethical deficits of my previous psychiatrist/therapist. I am not ‘cured’ after leaving hospital or undergoing ECT treatments. I’m certain she understands this, thus, her sudden disregard for my care is not just personally appalling but a blatant disregard of medical ethics. And hypocritical, at best.