Depression Marathon Blog

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Diagnosed with depression 17 years ago, I lost the life I once knew, but in the process re-created a better me. I am alive and functional today because of my dog, my treatment team, my sobriety, and my willingness to re-create myself within the confines of this illness. I hate the illness, but I'm grateful for the person I've become and the opportunities I've seized because of it. I hope writing a depression blog will reduce stigma and improve the understanding and treatment of people with mental illness. All original content copyright to me: etta. Enjoy your visit!

Thursday, January 29, 2009

A letter to Emergency Room

Dear Emergency Room:

I am writing to inform you that people with mental illness are tired and angry. We are tired of entering your doors with urgent needs only to be passed off as faking, attention seeking, or nuisances. We are tired of your changed attitude toward us once our chart arrives. In that instant, we experience a shift from "real" patient to "borderline, schizo, or depressed" malingerer, with all the negative attitudes which accompany such a label.

We are tired, ER--may I call you, ER? We are tired of the disdainful whispers outside our cubicles. We are tired of the suspicious nature of your questioning. We are tired of the knowing glances and rolling eyes. Do you think we cannot feel this callousness? We'd have to be real idiots not to notice. But that's the intention, isn't it? You think treating us this way will deter us from coming again.

You're right. It has. It does. Are you okay with that? How many overdoses, drunken accidents, or suicides would have been avoided if you'd treated us with compassion rather than disdain? Of course, we'll never know the answer to that. But we can tell you, ER, our suffering is typically increased, not decreased, once we exit your doors.

ER, you may think this is not true, that we are treated differently, but I can tell you from multiple experiences, it is true. From the moment our 'past medical history' is viewed, we are treated very differently. Just the other day, a woman approached me, "You know," she said. "I haven't always had a mental illness, but because of my physical disability, I've been to the ER a lot. I noticed," she continued, "after I was diagnosed with depression, I got treated totally differently in the ER--even though I was there for my other, physical disability! Can you believe that," she asked? I could only nod, ER. I've experienced the same thing.

I think the problem is likely worse than that to which this woman attests. I'm willing to bet those of us with mental illness are not only treated more rudely--yes, in some cases, we've been treated downright rudely. I'm willing to bet we also have fewer face-to-face provider minutes, receive fewer diagnostic tests, have positive diagnostic tests read as negative more frequently, and get discharged without so much as an aspirin far more often than those without an MI diagnosis. Has anyone ever looked at that, ER? I'd certainly love to. Maybe I'm wrong. I'd be happy to be proven so. Unfortunately, ER, experience tells me I am all too correct.

I'm sorry if this feels confrontational, ER. I hope defensiveness doesn't entirely close your ears. Someone needed to stand up. Since I haven't been to see you in awhile, I felt I should be the one. You see, ER, that's another problem. We know we've been dismissed. You know we've been dismissed, but if we spoke up while we were visiting, it only reinforced your beliefs. If we questioned, complained, or simply asked for what we needed in your presence, it only fueled your disdain and suspicion--further proof that we were not "real," rather we were nuisance patients. The word seemed to go out, "See, I told you so," and our experiences only worsened.

It's frustrating, ER, to be treated with stigma and stereotype by an institution which is supposed to know better. What can we do about this, ER? We need to change this situation. It doesn't do any good to bring experiences to light if no discussion ensues. Perhaps some staff education would help. Perhaps some real-life stories from those of us without an ax to grind--those of us who only want the situation reversed for the better of all. We can listen to you. You can listen to us. Wherever, whenever you wish to meet, ER, I'll be there. I'll bring others for an open, respectful dialogue. I pray for all who've yet to grace your doors, ER, we can effect change. Please consider our offer.

Thank you-


Fram said...

I am certain fear on the part of Emergency Room staff is an element involved in some instances of the shoddy treatment you describe.

In many ways, I'm a jack-of-a-few-trades, and my work experience includes having moonlighted as a security guard at a hospital. There were instances during that period when I was called to the ER and asked to inconspicuously keep an eye on particular patients because they might be "unstable" or were "agitated." This might be accompanied by a wink or a finger tap on a file.

How do you train people not to be fearful of what they don't understand? And, even if they do understand, still not to be wary or to be able to control their uncertainty? This, of course, is a different matter from ER staff being rude or not treating all patients in a professional manner. Training certainly should help to alleviate that situation, but the overall issue has many elements.

Anonymous said...

You're exactly right. I hate when people think I am faking my depression as well.

Sid said...

One of the best blog posts I've ever read. Whenever I go to the ER for some physical ailment I refuse to even discuss my mental health. They try to bring it up when they see the scars on my arms or the list of medications I'm on, but I shut them up by simply saying that my mental health is irrelevant to the reason why I'm seeking treatment today.

Just because I need medical attention does not automatically mean it's somehow related to my mental illnesses. I'm human, just like every other person that walks through those doors, I get sick.

My mental illnesses did not cause the severe pain and nausea I experienced that turned out to be gall stones that required surgery. They didn't cause the severe uterine bleeding that resulted in my needing an emergency D&C to get it to stop. They did not cause the negative prescription drug interaction that left my whole body numb and shaking for hours.

Yet in all these experiences, I've had to basically convince the staff that this was a true medical crisis. Had to convince them I wasn't making this stuff up. For the drug interaction, they wouldn't even believe me until they finally got the blood test results that showed I wasn't on any illegal drugs. Would they have reacted the same way to someone without a mental illness in their records? HELL NO! They would have worked immediately to help the person instead of letting them suffer until the staff had proof they weren't lying.

There is definitely a double standard. And I'd love to be there to have this discussion with the ER, but I doubt they'd ever be willing to listen. We're sick in the head. To them that means we can't possibly be intelligent.

etta said...

Thanks Sid!
Yours is one of the best comments I've ever read!

Simon Jester: said...

This was a good article/post/blog/whatever.
I feel your pain like only someone else fighting this damn mental health monster could.

David Clark said...

I've blogged on your blog - important to get these messages out. A great piece of writing with real feeling.

Molly said...

I recently was diagnosed with anxiety disorder and have been to the ER several times with chest pains and other symptoms that turned out to be anxiety related. I'm tired of being treated like I'm just there for drugs and wanting attention. I have been to this one ER and this one nurse keeps going, "Oh your back again?" She acts so rude to me, which makes my anxiety even worse. You're there to help me, not to judge me.

The Dogfather said...

Thank you. I saw one of your videos and it struck a nerve. I have been running this marathon for more than sixty years. As a child one of the major symptoms was the relatively frequent occurrence of sudden and uncontrollable temper tantrums with no obvious cause. I knew that something was not working right in my head, but I did not know what to do, and the prejudice against persons with mental illness strongly suppressed my willingness to seek help.about fifteen years ago I finally got professional help and have since been running on a pretty even keel. Don't get me wrong, I still have severe depressive events, but I am honest with myself and those around me, and I have learned to cope with the "blue fog" in a rational manner. I allow the hopeless, dark and confusing periods run their course while I persue my treatment, work to resolve whatever triggering situations I am experiencing, and relax while my mental humors restore their equilibrium. I am lucky, as I can see crises coming and take evasive action. Not everyone can do this. But I will always run with an obvious mental limp. I appreciate what you are doing, Ms Etter, and I hope each of your readers is able to use your efforts to gain insight into effective methodologies for alleviating the oppressive burden that is depression. Thanks again.