Events from 1996 while hospitalized
excerpt from book "5150"
Kathleen vs Kathi
Rather then getting any rest, my levels of agitation heighten on a daily basis.
Patel approached me that morning, stopped and said a single word. “Kathleen”. Not Kathleen with a question mark, or “Kathleen, how are you?”, but almost like a command, “Kathleen”. I casually looked up and informed him my name was Kathi. He looked down at this chart and said it wasn’t Kathi, it was Kathleen. His tone gave way to his insistence, come hell or high water, he was going to call me Kathleen. Patel stiffened. I calmly looked him in the eye and stated I didn’t care what the chart said, I prefer to be addressed as Kathi.
Patel shot back, “No, I will call you Kathleen.” I could see from his regimented stance it was useless to argue further with him. “In that case”, I responded, “I will not speak with you.” Patel glared, “FINE” and walked away.
MEDICATION REFUSAL
Dec. 26, 1996 – 10 AM
Patient’s reason for refusal – I refuse to discuss or take any new medication until you call me Kathi.
Nursing intervention – Verbalized to patient that her legal name is Kathleen Stringer
Patient’s response – My name is Kathy and all my credit cards.
Nurse – Mark Braden
Consent to Receive Mood Stabilizers
R. PATEL MD
Dec. 26, 1996 – 10 AM
Lithium 300 mg to 2400 mg / Day or Tegreol 100 mg to 80 mg Day
Patient refused medication and refused to sign consent. Medication Information given.
R Patel MD
Witness: Mark Braden, RN
ORDER - MD
Dec. 26, 1996 – 10:10 AM
LEVEL I
Trilafon L mg PO AM & HS
Cogentin 2 mg PO AM & HS
Start AM Dose now –
Please Add GD Goal –
Patient regresses, becomes child on floor, not able to care for self, unpredictable, paranoid.
R Patel MD
PROGRESS NOTE
Dec. 26, 1996 –10:15 AM
Psych MD Note:
// this symptoms –
Patient did not want to discuss this with me and refused to talk to me. I will try again tomorrow to explain the meds.
*Patient’s old chart // patient has taken and // antipsychtic in past and has been diagnosed as Bi-Polar + Psychosis / Depression NOS.
MPD diagnoses clinically // not // patient // manipulation / splitting with staff
Needs firm limit setting.
R. Patel MD
Patel refers to ‘splitting with staff’ here in his progress note. It might help if I explain the dynamics of this primitive defense mechanism.
[Splitting begins in infancy. An infant fears that once mother is out-of-sight, she is destroyed, not having the capacity to visualize a permanent image of her. This can be demonstrated by the developmental tool of a game called, peak-a-boo. When the hands of mother are pulled away, viewing her face, the infant is delighted and saddened when not in view.
Adults who are splitting relate much in the same way that the infant sees reality as all-good or all-bad with polarized view points. The mental representations of good and bad are not integrated and prevents them from seeing the one they destroy is the same one who soothes and comforts. They do not have a tolerance of loving and hating toward the same person, unable to see them as some good and some bad. They cannot tolerate ambivalence hence the term, splitting.
The individual who causes the frustration is seen as all bad, and if pleasurable, then all good. In the same way, these traits are often seen with those who are depressed one minute and elated the next. This behavior can be seen in toddlers who throw temper tantrums. The toddler is frustrated with both poles of thought, dependence / independence and hate / love. For this reason the parent / therapist would do well to provide a "holding environment" and contain the unintegrated feelings, metabolize them and give meaning. Once they have the cognitive equipment and skills, able to achieve good and bad in the same individual, then the internal struggle is relieved. Ultimately, client / toddler needs to experience the good-enough-partner / good-enough-mother while holding feelings of "bad" primarily toward that person.]
What I have explained about ‘splitting’ is a deeper sense of the meaning. Nursing staff uses the term loosely as pitting one staff member against another, not understanding the full fundamentals of this dynamic. The correct use of the term would suggest that I could not tolerate good and bad aspects in the same nurse. That I either liked the nurse or hated the nurse. Since I could not perceive any ‘good’ in a nurse that I hated, I would then ‘split’ the need for good and bad. I would exult the mostly good nurse to all good nurse and the mostly bad nurse too all bad nurse. Then of course this would create two camps, the all good nurses and the all bad nurses. One was pure evil to be hated and the other could do no wrong.
Looking at this explanation, Patel was in error when he wrote that I am staff splitting. At this point, I did not see any nurse as helpful and I was extremely isolative from all staff. Patel’s use of the term was a mistake. I was capable of seeing both good and bad qualities in individuals. The only problem is, I had as yet to witness any good faith attempt from nursing staff during that admit to observe, listen, and demonstrate some slight vestige of empathy. Patel wrote to be aware of staff splitting as if he were a superior mystic who warns his blind followers. That which is not understood by staff becomes an element of failure in the nurse-to-patient relationship. As a matter of fact, it could be said that staff was splitting and not I. Staff was instructed to view my venting as all bad / splitting, without reasonable or appropriate merit. I had no chance in a camp that viewed my venting as all bad.
Mark works with Patel’s agenda
Later that day Mark, a nursing staff personal picked up where Patel left off. He approached me the same way Patel had. Although Mark wasn’t as tense or condescending in nature, he did continue with the Kathleen power struggle. I just shook my head and asked him why he insisted on this method of addressing me. He said Patel told him that he was not allowed to address me as Kathi. With that, I said, “Well Mark, I guess we don’t have anything to talk about, because if you cannot at least respect my wish to be addressed as Kathi, then our conversation is over.” Then Mark walked away.
You would think it’s over right? Put to rest…. but hardly. Those guys are a sadistic and relentless bunch. Out of the corner of my eye I see another figure approaching me. Now came John Capsavage with a chart. John of course had a wonderful opening line. “Kathleen, I need to speak with you.” Shaking my head, not knowing whether to scream or laugh – I just stared at him, wondering how I could possibility get him to understand this method of ‘treatment’ was doomed for failure. Finally, after drawing my thoughts together, I ask John, “Why, within the last half-hour of seeing all three of you, why do you keep approaching me and calling me Kathleen?” He said, “We were told to call you ‘Kathleen’”. I just looked at him, pondering how I could convey how ridiculous this method of useless ‘intervention’ was. Then it came to me. “John, that guy over there, what is his name?” I was pointing to an individual on the nursing behind the glass barrier. “Sam”, came John’s response.
“But, why do you call him Sam? I enquired.
“Because that’s is his name.
“Really? Did you know that his real name is Samuel? Why do you all call him Sam?
“Because he told us to call him Sam.”
Composing myself, my voice at a whisper, hoping the words would sink in, “Then why can’t you extend me the same respect?”
With that, John left.
Then finally one of them approached me again and told me they discussed it and agreed to refer to me as ‘Kathi’. There, can you believe that? Unbelievable! This sort of activity went on, on a daily basis. I never had a ‘rest’. Staff would engage into power struggles or had thoughtless disregard in critical areas that would foster extreme levels of agitation. Least a person is acutely psychotic or mentally retarded or had achieved transit levels of Zen, this sort of ‘treatment’ would activate anger, a mechanism to alert that one is being taken advantage of. Myself, being an internally strong individual who understood this obvious disrespectful level of interpersonal communication, I would not tolerate such treatment from staff. I attempted to maintained my standard of dignity without their support. It’s my nature. It was how I survived childhood and held it together to succeed. This ‘treatment’ was unacceptable.
Do you think I’m finished with the Kathi – Kathleen episode yet? No, it appeared not. As a final act of defiance, Patel approached me later, even after staff told me the issue was settled. Just like before, his stiff stance. He said in a commanding tone, “Ms Stringer”. As I looked up, I thought, what the hell, and just shook my head. I didn’t respond to him.
PROGRESS NOTE
Dec. 26, 1996 – 12:00 PM [NOON]
S – “I refuse to talk to anyone or discuss anything until everyone calls me Kathi.
O – Sitting a table in dayroom area writing entries morning – patient was approached by this writer with new consents and medication. Patient stated “Tell Dr. Patel I’m not doing anything.” Patient was cleaning stuffed rabbits ears. Stated that I have to let Little Kathi have her way 1 to 2 hours a day. Patient stated also “Little Kathi can’t take care of herself. Patient has changed her clothing three times today. Very quiet and isolative. Was found lying on the floor cuddling her stuffed rabbit. Patient has made several complaints that she has Patients’ Right’s looking into her case.
Mark Braden, RN
Extra Note – Patient refused new medication and began rambling on who little kathi is her only reason to live and if she takes medication it will kill little kathi and that she will fall into a deep black hole.
Mark Braden, RN
It was sad to read this subjective progress note written by Nurse Mark. Mark related to my attempt to explain, that which he does not understand, as rambling. I was hoping to convey what ‘lil kathi meant to me. Neither Mark nor Patel could relate to the idea that ‘lil kathi was a fragmented part of myself. Rather, it was their conclusion that I was Pi-Polar and when I cycled down into a deep depression, I would regress into this repulsive state.
‘lil kathi, as I, she would articulate to anyone who would listen, was a part of me who was extremely vulnerable. She was also a receptor of love, meaning that as an adult, I had shut myself away from nurturance, love and kindness. I was distant and hurt. I had gone through a traumatic ordeal and my emotional plasticity had severely deteriorated. As an adult, I had nothing to work with at the time except this fragmented component of myself which I had identified as ‘lil kathi.
It was strange that ‘lil kathi understood the phenomena more then I did at the time. It was though her pictures that I began to gain various insights.
Figure 1
In this picture (figure 1) she has drawn herself in a well precariously holding onto my hand, as if barely holding on. With her other hand she dangles at the end of a rope. Holding the rope is the symbolic representation of love. Love is in grave danger because she has drawn a monster with a club. It translates in this manner – Love holds up ‘lil kathi and, ‘lil kathi holds up Kathi with Love she receives. When ‘lil kathi falls, so does Kathi. The monster is symbolic of Rejection, her trigger.
This makes sense to me. As a child I was not receptive to hugs, holding or any type of physical demonstration of love. It felt like a sign of weakness, a virtue my dad disapproved of. I had no parental model that established a foundation for nurturance. I was afraid to be touched and touching set off feelings of embarrassment. As the picture suggests, ‘lil kathi, age 2 ½ is receptive of love. It was her that felt the warm glow of love, I could not.
Now, at this critical and vulnerable place in my life, I had basically shut down. I was emotionally gone, destitute and barren. ‘lil kathi was my life raft. She was a receptor for that, which I wanted no part of, love. And when this defense mechanism, however primitive was activated, it was met with scorn, intolerance, ridicule, sarcasm, detest, loathing and hatred. That resentment, that essence of intolerance that surrounded me for which I had no escape, began to fuel rage, because to think of it, I had nothing left. They could destroy love, they could destroy the nurse-to-patient relationship, they could destroy any fantasy I had for some form of a loving world, but what they could not destroy was my rage, my hatred for their treatment of her. She was so vulnerable, she was so defenseless, that I dare not give up my rage least they destroy us both.
Reflecting back to Mark’s progress note.
[Patient refused new medication and began rambling on who little kathi is her only reason to live and if she takes medication it will kill little kathi and that she will fall into a deep black hole.]
Yes Mark, at that point in my life I was so depleted of the love that ‘lil kathi needed so much. My heart sink as I realize you had viewed this as rambling. As it was, no amount of drugs could have taken her away from me. What was killing us was not the drugs, but the attitudes of staff. You heard us, but you did not listen.