Cognitive Dissidents discussion

Ah! So here's my tale for today (excuse a little redundancy): 4 wks ago I twisted my knee. As that was healing my immune system was down & I got pneumonia. This made me very sick. I went to the doctors & got anti-biotics prescribed. I chose the cheap kind b/c I don't have much money, I'm told that they're good but I was warned that there was a slight chance they might not be good enuf. I took them for 2 wks, got better, but after they ran out started getting sick again. I arranged to go to the same clinic I went to the 1st time to get a prescription for a stronger anti-biotic.

It's cold & rainy outside, I rode my bike there. I got there & was shown to an examination rm where I was told the dr wd be right w/ me. I waited for 40 minutes & then opened the door b/c I thought they might've forgotten me. A nurse saw me, reassured me that I hadn't been forgotten. I went back in the rm & about 10 minutes later, a voice over the intercom told me the dr wd be right there. Another 20 minutes or so elapsed, I wasn't feeling very good, I lay down on the examination table.

10 minutes or so later the dr came in & sd: "I'm Dr Valazquez, how are you?" to wch I replied: "I'd be better if you hadn't left me waiting here for an hr & a half." After wch, she refused to treat me. I told her: "Why don't you just apologize & then let's move on." This, apparently, was expecting too much. She sd "Do you need medical care?" I sd "Yes, I have pneumonia." Her reply, "You've just met me, you've attacked me, I'm not going to give you medical care." I sd: "Let me get this straight: B/c I think you shd apologize for being an hr & a half late for our appointment, you are refusing to give me medical care?" At wch point she left.

I then rode home w/ pneumonia in the rain on my bike & proceeded to call other clinics to arrange an appointment to get the anti-biotics. Then I had to arrange for someone to drive me there. A coupla hrs later it was taken care of.

How many times have you waited in a dr's office? How many times have you NOT waited in a dr's office? When I got to the clinic today, I was the only person in the waiting rm. When I left, the dr was standing in the hallway pretending to look at some papers. She didn't look very overworked or even busy to me.

The last time I went to the dr's office they sd that if I had to go to the Emergency Room they'd arrange for me to get "charity care". Now, I'm an intelligent & highly skilled person who does things for free for other people as a matter of course. I've never ONCE thought of it as "charity".

IMO, this dr today saw herself as the "good charitable dr" & saw me as the low-life scum. As such, I was expected to grovel in my low-life scum way to show that I worship this god-like creature for deigning to help my worthless self. When I actually DARED to criticize her for being late - something that wd be entirely reasonable in most contexts - she refused me service b/c I obviously needed to be put in my place.

Pneumonia can be fatal. I've been sick for 4 wks. That's an extraordinarily long time for me. This petulant prima donna cdn't've cared less. All that mattered was that she shd NEVER be criticized by the low-life patients. This is class warfare.

I myself probably have close to a thousand stories which confirm your analysis. I'll just scratch the surface of a few of them here. Most of my experiences are drawn from the arena of the "mental health system," or, as a colleague of mine recently turned the phrase-- "the mental hell system."

Story One.

In a conversation with the lead psychyatrist at Bellevue on the occasion of my first forced admission to a hospital psychiatric unit, I recall providing the gentleman with a very concise & specific class, gender, & "racial" (just a disclaimer here to prevent confusion: I disbelieve in the concept of race as an ontological designator, however, I am very sensitive to the real cosequences of the way this ideollusionary concept is deployed in the service of class warfare & exclusionary biases) analysis of the operation of his ward-- both in terms of the functions, duties, salaries, & authority of the staff members & the network of authority between staff & patients & among patients themselves. Instead of either engaging the discussion as a reasonable discourse, or, what one would be more likely to anticipate, pointing to my concern as an element of my delusional architecture, the white upper middle class doctor became intensely irrate & asked "How do you now what background I come from?" My response, which bore upon the index of his manner of self-presentation, his unquestioning sense of priviledge, his dismissive attitude toward those he seemed to regard as inferior, the ponderous disparity between his limited intellect & his position of authority, his speech, his accent, & his dress, of course, infuriated him still further. He stormed out of the session & I did not see him again until I was taken to court for an involuntary hold. There, among other unfounded claims, he reported to the judge that if I were to be released he feared that I could be a grave harm to society, that I was potentially "a threat both to self & others." Well, I suppose that made sense from his perspective-- HE certainly found me threatening. Fortunately, the judge did not buy it & I got out.

The Bellevue psych ward, by the way, is not a place that I would reccomend to any human being for any purpose whatsoever.

Story Two.

More recently, I began I relationship with psychiatrist here in San Diego. As is typical, I often had to wait beyond my scheduled appointment times for these meetings. Initially, I didn't find that too troubling. I assumed there might be emergencies & higher priorities. However, on one occasion, when I did have an emergency resulting from a brief manic episode & the more troubling consequences of the medication prescribed to treat the episode, I happened to arrive ten minutes late. Not only was I turned away; I never received a reschedule appointment & I was BILLED for the visit! So I understood: MY time was not valuable-- I could wait indefinitely. However, HIS time was valuable-- so much so that if I "wasted" it (which, when you think logically I actually did not, since he was already with another patient anyway) I would have to make the necessary reparation. I have not seen him since. In fact, I have not seen any psychiatrist since, & have no intention of doing so.

& HEY! all of this is coming from someone who works in the mental hell system himself!

Story Three.

Let's not let the Ph.D's off the hook too easilly either. In my second session with my first psychologist, "treatment" focused on two issues: how I was going to pay the bill & my need to repair "my damaged relationship with my mother." This in the context of some very serious PTSD symptoms related to a violent assault on a loved one WHICH HAD NOTHING TO DO WITH MY MOTHER! When I complained in the next session that her plan was wildly missing the point of my emotional needs in that moment-- she dismissed me immediately, claiming that if I would not comply with her better judgment we "might as well end the relationship right now." Her exact words-- no referral-- no expressed concern of my lack of sleep, relived emotional reaction to the memory, startle response, tearful breakdowns, nightmares, inability to focus upon anything but that particular event.

Power mania? Counter-transference? Or just extreme frustration & annoyance at my refusal to recognize her authority, status, priviledge, & power?

Eventually, I worked through it on my own by writing a collection of poems-- probably the only work that I've ever written which I know I will not share with anyone other than its addressee-- Lori Connerley.

That's really how we get well, isn't it? When we take the healing process into our own hands so that it's no longer a part of our demise & compromise within the system of exploitation & degredation.

Working class healers (to turn the phrase of the John Lennon song title)-- whether physicians, psychiatrists, psychologists, shamans, or whatever-- let's begin "training" them-- let's begin being them-- & if they/we cannot survive the ideological indoctrination of the institution & the academy, then let's find a way of training them/ourselves by other means.

There are already exceptions-- my current psychologist took me on in full knowledge that I could not come up with the designated copayment sum. "Well, I don't really need to make any more money than I already do." That was his response. & what's interesting in this relationship is that practically all we talk about is how I can become a more effective counselor. Our converstations are not about my "illness" at all-- they're about building connections, interpersonal relationships, about teaching, reaching out, making meaning & learning how to guide other in the meaning making process. They're about politics, & history, & psychology, & philosophy, & ethics, & experience, & words, & the absence of words, & this & that, & the other stuff that makes life wonderful & interesting & horrible & sad, & glorious & infuriating & sometimes just ordinary & dull-- but always with the implied "so, what next?" It's more a mentorship than anything else & I experience it as the most self-fulling "therapy" that I have ever had.

I like to think of myself as this kind of counselor.

Will the MDs ever be able to accept or even comprehend such a notion? That their real work should not be to "cure" & "treat" but to teach us how to do these things for ourselves?

Well... that would seriously demystify the magic, knowledge, & authority of the physician... that would involve "declassifying" the art of medicine & abandoning the project of the war.

Thanks for sharing yr stories. It wd make a nice compilation if we cd collect a few hundred more from a diverse selection of people. I've always joked that I wd only go to a shrink if they'd PAY ME - preferably at a rate of parallel exorbitance to their own. So, eg, if a shrink charges $150 an hr & I make $15 an hr, that means they charge 10 times what I make. Therefore, if they want me as a 'patient', it'll cost them $1,500 an hr - & they'd better be damned grateful too!

I think that most people in this situation would have also become irritated by the fact that they had to wait so long to see a doctor. In Canada the waiting rooms are especially full of irate people. I spent a few hours in the emergency room last summer with other people who had been waiting for 7-12 hours. Although the Canadian haelthcare system is not the same as in the US, this comes to mind because it is one of my only memorable experiences of having to wait a long time to see a doctor.

I think most people in your situation would have reacted much differently. Because in the end they wouldn't have cared about proving a point to the doctor, they would have just cared about getting medical care. Clearly you've proven the point both to yourself and to us, and I think that there is a lot of truth to what you are saying, specifically about the doctor seeing herself as the 'good charitable doctor' and you as 'low-life scum needing to be put in his place'. But I also wonder if this encounter did anything to prove your point to her - do you think that when she recalls this encounter she will frame it in terms of her being criticized by a patient who had the audacity to undermine her authority and therefore cause her to rethink her position of power or do you think that when she recalls it she will frame it as an encounter which serves to reaffirm how she already thinks about 'low life scum' and therefore also further validate her position of power and to prevent scum like you from undermining it?

And do you think that it matters? Does it matter how she later thinks about this encounter? I think that it does matter because if it did not then you would have put your convictions aside, apologized for your 'out of line' behaviour, and just taken the medical care.

My above comment is a response to tENT's initial post.

To Erin: That's an interesting question (ie: yr last long question at the end of yr 2nd-to-last paragraph). My reaction to her question "How are you?" was simply my direct honest response that'd been brewing as I got frustrated waiting. It was fueled by previous waiting rm experiences I'd had & by general class warfare experiences. As such, it wasn't really a debate (or whatever) where I was oriented around making a point. It was a spontaneous situation in wch she reacted as she did & I reacted as I did. Both of our reactions were framed by our basic natures & class positionings.

What her restrospective take on it was/is, I don't know. The incident didn't end there. I sent out 4 letters regarding the situation: 1 to the overall health care group that the clinic is a part of, 1 to the clinic staff, & 2 to the doctor that I usually see there (at 2 different addresses). I also called & spoke w/ someone who interfaces w/ the employees in that health care system. They told me (perhaps disingenuously) that they took my complaint seriously & sd that it was unacceptable for the doctor to deny me care. They sd that they'd speak both to the head of the health care program & to the supervisor of the doctor. I imagine that the combination of my letters & the phone call may, at least, make the doctor a little more careful about denying people health care in the future. If that's the effect, then, yes, it "matters".

I think that the (toned-down) articulateness of my letter will make it hard for her to "frame it as an encounter which serves to reaffirm how she already thinks about 'low life scum' and therefore also further validate her position of power" - partially b/c I think I was probably expected to either not write something at all or to complain in a borderline incomprehensible or insulting fashion.

I don't expect the doctor to change much otherwise (or to apologize - as my letter requests). Perhaps my more usual attempt to catalyze perceptual reorientation has revolved around getting into conversations w/ people who seem to be projecting idiotic stereotypes towards me & to then, thru the conversation, demonstrate qualities that I think contradict their sterotypes. Such a situation is more effective but it's not exactly the situation I was in. The closest I've come to it has been thru writing the letter(s).

In case what I mean by the above is unclear, here's an example: around 30 yrs ago I was invited to a party by a friend. It was at the apartment of my friend's friend - whose name was Randy. I was wearing an extremely filthy shirt & probably otherwise tattered clothing. I saw (& see) nothing 'wrong' w/ that. Randy, not knowing me & not having been introduced, saw me & immediately assumed I was some sort of street person who'd crashed the party & hostilely approached me saying something like: "What do you think you can just walk in here?" - not bothering to see past his stereotype of what he thought my appearance meant.

Being a rather fiesty sort, I replied sarcastically something like this: "Yes. I broke in to burglarize your home." Knowing that he considered himself to be a poet, I then steered the conversation into a considerably more sophisticated discussion of poetry than he was accustomed to. The result was that his stereotype of who I was gradually fractured since his initial impression that it was apparently impossible, in his mind, for such a 'derelict' person to have a mind was contradicted by my displaying an intellect more developed than his own. It's my hope that he wd think twice before assuming that all dirty people are stupid after that.

Basically, for me, class warfare is an ongoing process - b/c, unlike yr mom, I don't think it's a good idea to not "get caught up in changing the world". I've never (or rarely) accepted that states that I disagree w/ or find disagreeable are immutable. As such, when this doctor treated me as she did, I responded in the way that comes naturally to me: stubbornly refusing to grovel b/c "I think that it does matter because if it did not then [I] would have put [my] convictions aside, apologized for [my] 'out of line' behaviour, and just taken the medical care" - if even groveling wd've produced such care at that point.

In the comment following this one I include the letter I wrote to the specific clinic. I can't include it here w/o exceeding the GoodReads comment word limit. If Doctor Valazquez reads it or has it read to her I think there's a chance that she'll have a clearer understanding of what she may simplify before encountering the letter as simply some sort of adversarial position. There are, of course, redundancies in relation to my original posting here but I include them b/c it's important to include the entire letter.

March 8, 2008

Open Letter to the Staff at East End Community Health

I've been a patient there several times in the past year & a half. In general I've found the staff friendly & competent. I like you. As such, I was extremely offended by what I consider to have been abusive behavior by Doctor Valazquez on Friday, March 7th, 2008. This letter explains:

Four weeks ago I twisted my knee. As that was healing my immune system was down & I got pneumonia. This made me very sick. I went to the East End & Doctor Schlar prescribed Doxycycline anti-biotics for me. I chose the cheap kind because I don't have much money, the doctor told me that they're good but also warned that there was a slight chance they might not be good enough. I took them for 2 weeks, got better, but after they ran out I started getting sick again. I made an appointment for 10:15AM, Friday, March 7th, to get a prescription for a stronger anti-biotic.

When I arrived at 10:10, there was no-one else in the waiting room & I was shown to an examination room within 10 or 15 minutes where I was told that Doctor Valazquez would be right with me. I waited until 11:00 & then opened the door because I thought they might've forgotten me. A nurse saw me & reassured me that I hadn't been forgotten. I went back in the room & about 10 minutes later, a voice over the intercom told me the doctor would be right there. Another 20 minutes or so elapsed, I wasn't feeling very good so I lay down on the examination table.

Ten minutes or so later the doctor came in & said: "I'm Dr Valazquez, how are you?" to which I replied: "I'd be better if you hadn't left me waiting here for an hour & a half." After which, she refused to treat me on the grounds that I had "attacked" her. I told her that I wasn't attacking her but that I thought that I deserved an apology. I said: "Why don't you just apologize & then let's move on." This, apparently, was expecting too much. She said "Do you need medical care?" I said "Yes, I have pneumonia." Her reply, "You've just met me, you've attacked me, I'm not going to give you medical care." I said: "Let me get this straight: Because I think you should apologize for being an hour & a half late for our appointment, you are refusing to give me medical care?" At which point she left.

Now doctors are almost always late. Few are an hour & a half late. Some, like Doctor Schlar, have the courtesy to apologize - at which point I accept the apology & we get down to business. One of the apparent reasons why doctors are always late is because they seem to value their own time & not that of the patient.

I then went home & proceeded to call other clinics to arrange an appointment to get the stronger anti-biotics. I also had to arrange for someone to drive me there. A couple of hours later, after a great deal of stress, it was taken care of.

In my opinion, Doctor Valazquez saw herself as the "good charitable doctor" & saw me as some sort of lesser poor person. As such, I was expected to be slavish in response to her even being willing to help me. When I actually DARED to criticize her for being late - something that would be entirely reasonable in most contexts (including this one) - she refused me service because she apparently thought I needed to be 'put in my place'.

Pneumonia can be fatal. I've been sick for 4 weeks. That's an extraordinarily long time for me. This immature doctor could not have cared less. Apparently all that mattered was that she should NEVER be criticized by a patient such as myself - regardless of whether the criticism was deserved.

Do you think that Doctor Valazquez is a good doctor for a clinic? I don't. Her decision to deny me health care was an act of malignant neglect & reckless endangerment - all because a sick person was irritated by her lack of consideration. Valazquez's refusal of treatment was point-blank criminal. It seems to me that the purpose of a Community Health clinic is to conscientiously provide healthcare for people regardless of their ability to pay. Many doctors realize that health care prices are artificially inflated purely for the sake of profit by people who do not have health care as their main interest.

In the more modern version of the Hippocratic Oath, doctors vow: "To practice and prescribe to the best of my ability for the good of my patients, and to try to avoid harming them." Doctor Valazquez has clearly forgotten this oath.

Doctor Valazquez, at a very minimum, should send me a written apology. More appropriately, Valazquez should no longer work there & her name should be removed from the entranceway to the building.

Almost 2 yrs later I'm revisiting this series of health care reports b/c I'm involved in a discussion group called "Class Class" in wch class differences in health care are being addressed. Rereading this makes me realize that I never followed up w/ what 'happened' as response to my letter. Dr. Schlar (the responsible doctor that I liked) left a phone message for me saying that she wanted to talk w/ me about this & asking me to call her & to leave a message w/ a specific nurse. I did call & left a message, but not w/ the nurse specified. The result was that I never rc'vd another call. It's my opinion that the nurse that I DID speak w/ probably deliberately fielded the call to prevent my talking w/ Dr. Schlar. Whether she also lied about my conduct I can't say but I wdn't be surprised.

I DID get a written reply from the overall health care group that the clinic's a part of. I don't know where that reply is now so I can't consult it directly, but, as I recall, this reply didn't even bother to apologize - it was more along the lines of "These things happen" essentially explaining that doctors are very busy & important. Funny, I wonder how it wd go over if I were to tell a client on a job that I'm too important to 'stoop to their level'. Obviously, if I were wealthy & considered to be an obvious lawsuit risk, I wdn't've rc'vd such short shrift.

Michael Tolson, the last time you paid health insurance was NEVER. The average US citizen of your age pays something like $6000/yr.

Michael Tolson, the last time you paid US Taxes was NEVER. The average US citizen of your age pays something like $10000/yr.

Even in countries like France where health care is 'free' it is paid from by taxes. And you pay NONE.

You went to a free clinic. Your smartass mouth told them that you got treatment too slowly. The fact that you smarted off to them tells them that you are really not THAT sick. You probably should have said "I feel like I am going to die". At least that would have generated some empathy. You think you are 'smart', but you don't really know how to play the system, do you?

There are people in your free clinic with stab wounds and Coke bottles stuck up their asses that get priority over you. And you ATTACK the doctor that was trying to save your life (for free) ??? Then later, you ATTACK the medical clinic and say they violate the Hippocratic Oath ???? You are clearly crazy. They tried to save your life, and you didn't appreciate it. You are clearly an ungrateful nutcase.

Believe it or not, I have some empathy for you. I hope you will die in some quick way. Like getting hit by a car. Like getting stabbed by some jigaboo. I hope you die quickly. But don't blame the medical establishment for not providing you care that you clearly have not paid for.

It's like reading a script for a propaganda talk show bully isn't it? It's full of ignorant & incorrect assumptions. Its basic purpose is to intimidate & insult. It's like reading the dialog given to black people in the racist novel "The Turner Diaries": one has to wonder whether the author has ever even met an African-American.

Unfortunately, this is the kind of hate postings & threats that a public person, even an extremely obscure one like myself, gets subjected to from time-to-time. This person, who I think is probably the same person who wrote the 5, 7, 9, & 10 postings under the "Museums" topic, is probably someone who works at one of the museums where I work. If I'm correct about who this person is, they're someone that I've never been anything but polite to & they're someone that I see from 100 feet or so away once or twice a year. Their hatred seems to be based on a general hatred of my 'type' or probably on envy of whatever reputation I have as an 'artist' or as a 'smart guy'.

As is typical w/ such folks, my given name is referred to both as a way of rejecting referring to me in the way I prefer to self-contextualize AND as a way of 'outing' me even though my given name is public knowledge & has never been kept a secret by me. I prefer "tENTATIVELY, a cONVENIENCE" b/c it's more conceptually akin to the way I think AND b/c it's a name (or, rather, the answer to the question: "What's yr name?") that I chose myself. It's all part of my project to take control of my own life - as I encourage others to do.

This person pretends to knowledge of my life wch they don't actually possess. These claims may be rooted in rumor, assumption, or legend.

"the last time you paid health insurance was NEVER" I have actually had health insurance. It ceased when it became too expensive - something like 20 yrs ago.

"the last time you paid US Taxes was NEVER" Alas, for better or for worse, I work for a living at jobs where taxes are taken out. As such, 20 to 25% of my pay is taken by the government. Of course, there're all the other taxes too: sales tax & the like. If I had more control over this situation, I wd choose to have none of this money go to war (my biggest complaint against the way such money is used) & wd choose to have much of it go to education & health-care.

"Even in countries like France where health care is 'free' it is paid from by taxes." Right - but health care isn't denied to people who don't pay taxes. If one were a tourist in France & had appendicitis, I don't think the doctors wd say: "Sorry, no operation, you're not a French tax-paying citizen!" Obviously, the purpose of socialized health care is to provide health care for all who need it - regardless of their economic status.

"You went to a free clinic." Actually, it was a sliding scale clinic. People who go have to pay unless they're completely indigent. This is typical of clinics. I pd $15 - wch was then refunded to me when I didn't receive care. To me, paying $15 for what wd've been a stethoscope to my chest & the prescription of pills wd've been adequate compensation for something that wd've taken 5 to 10 minutes. IMO, health care prices are extremely overpriced - esp in the US. Doctors in other countries, in my personal experience, agree.

"You probably should have said "I feel like I am going to die"." Given that I didn't "feel like I [was] going to die" I didn't say that. "[P]lay[ing] the system" in that way are the hallmarks of a dishonest person - wch I deduce the author of message 9 to be.

"There are people in your free clinic with stab wounds and Coke bottles stuck up their asses that get priority over you." More ignorance posing as knowledge. People w/ emergency situations go to Emergency Rooms not clinics. People make appointments to go to clinics. Imagine someone calling a clinic a mnth in advance & saying: 'I'm planning on being stabbed next mnth on Tuesday, the 3rd? Will you be able to take me then?"

"Coke bottles stuck up their asses"? Well.. this is, presumably, a sexual reference - possibly a gay one. That wd fit the profile of the person that I think posted this. It's at least interesting that this is the example of an emergency situation that they chose. Might I suggest using a rubber dildo instead? It's safer & kinder to the body. Or, maybe I misunderstand? Maybe people drink Coke thru their asses? & I just haven't noticed?

"And you ATTACK the doctor that was trying to save your life (for free) ???" If saying to the doctor: "It'd be better if you hadn't left me waiting here for an hour & a half." is an "ATTACK" then I reckon we might as well enclose the entire world in razor wire b/c it follows that everyone in the world is 'guilty'.

"They tried to save your life, and you didn't appreciate it." If trying "to save my life" is denying me medical care then you have, IMO, a most peculiar view of what constitutes "saving my life".

Of course, the crowning moment here is: "I hope you will die in some quick way. Like getting hit by a car. Like getting stabbed by some jigaboo." Wishing my death b/c I've written something that the poster dislikes strikes me as considerably more "nutcase" than anything I've ever written. As for "getting stabbed by some jigaboo"?! I reckon that speaks volumes: the writer just cdn't pass up making a racist comment too! & what type of racist comment? When I quoted this to a friend of mine she sd: "What's a jigaboo?" If only we cd leave behind such racism for good - but, clearly, there are still people around, EVEN ONES WHO PROBABLY WORK IN A MUSEUM ENVIRONMENT W/ A (DESERVED) REPUTATION FOR OPEN-MINDEDNESS, whose minds are still w/ the KKK of 1930s Mississippi.