
There are so many people in need of assistance and we often tend to forget that the people helping us figure out our fractured psyches. They carry the burden of the patients pain and rage long after a session.
Redditor u/bondmemebond wanted to give psychologists a chance to shake it off a bit by asking.... Psychologists/psychiatrists of Reddit, what patients are usually the hardest to work with and why? [Serious]
1-
You know, I've come to think of mental illness as being something like a person being encased in blue glass, when the outside world looks at that person they see them through the glass and so see them as being blue, but when that person looks at the outside world, everything but them is blue. In this way, most mental illnesses have an internal way for the sufferer to conceptualize them and an externalized way of conceptualizing them that projects internal qualities onto surroundings.
A paranoid person generally does not experience themselves as a paranoid person, rather they experience society as conspiratorial and dangerous. In much the same way a depressed person may not experience themselves as depressed, but will externalize that in the form of life being worthless, people being cruel, etc. Often we make a mistake in educating people about mental illness by focusing too much on what it looks like, as opposed to what it feels like from within, and perhaps that makes it harder for people to recognize signs of mental illness in themselves.
So, rather than pick a specific pathology or diagnosis and say that that is the "worst" one, I think it would be more accurate to say that people across all diagnoses who don't or can't recognize that they have a problem and can only project their condition onto their surroundings, always have worse outcomes and will benefit less from interventions. Psychiatrically often times the goal is to tip the scale just enough so that you can enable that shift in someone where they do have the increased self-awareness or objectivity to have that insight.
2-
I know psychiatric nurses who always found the ones with personality disorder really tough. They said there was a lot of manipulation there in conversation, which made it incredibly difficult to know how much progress you were making, if any.
3-
Personally I worked in inpatient mental health facilities and I found the patients with personality disorders the hardest to work with because they can be so manipulative- they can make you feel like you're failing them because you don't care and you're a bad person. I had the insight to recognize that I couldn't personally handle personality disorders and so left that line of work.
I never found patients with paranoia, schizophrenia, bipolar etc too hard to work with because their distrust of you is more understandable- its self preservation.
In personality disorders (e.g. EUPD), patients can make you feel like they trust you and are confiding in you only to turn around and verbally cut you down. I couldn't leave that sh!t at the door, I would go home feeling like I failed them and myself. It was tough. It's also really tough because it's hard to tell if you're making progress, and the feeling that these people will never get better stays with you.
I did a full 180° and I'm much happier cutting out organs now!
4-
Depends on the clinician. I think depressed people with low motivation are the hardest to treat. I love working with people with OCD, but I have colleagues who feel the opposite.
I had a doctor that specialized in OCD and anxiety disorders. I saw him for general anxiety disorder and panic disorder.
I was extremely motivated and with his help (and medication), I was able to graduate from therapy in about 4 or 5 months. I owe my quality of life to him and think about him often even though he treated me 3 years ago.
5-
Psych nurse here. Staff splitting, really getting personal in their verbal attacks on you, always looking for an edge. And often they are my favorite patients, too, because they can be great. But it's hard. If a schizophrenic calls me an ugly witch, eh well, no big deal. If someone with a personality disorder calls me an ugly witch, it's usually followed up with minute details, often something I'm self conscious about. We're human too, it's hard to ignore.
6-
Those who benefit from their disease in my experience, for example Munchausen. They tend to get to the point where they don't like where they are in life (for example loneliness), so they get help, then realize that if their life will improve, the help will disappear. They don't want that. So they start playing a game of cat and mouse. Throwing little breadcrumbs saying things are going better, only for it to magically become worse again.
In which this pattern repeats multiple times. You usually notice somewhere halfway treatment cause no progress is made.
As opposed to my colleagues here, I do not find those with Borderline to be that particularly difficult. You just gotta be very upfront with them. One interaction with a client of mine went as followed: "stop lying to me Karen and tell me what really is up" - "yea yea... I know... I know... "
7-
My mom had a hard time with people who had borderline personality disorder. These people are very insecure and can treat you badly in their efforts to seem superior and well-adjusted. Yet when you set limits or call them out, they get defensive and often angry. Some will even act out by harming themselves or others.
Borderline personality disorder is generally regarded among psychiatrists as very difficult to help someone with. Not recommended for inexperienced doctors.
8-
Help Rejecters are the toughest in my opinion. They might even cognitively understand their predicament, they know you are trying to help, and they start out seeking help but then reject it. Then the cycle begins again. It requires a lot of energy and time investment to show them how genuine you are, and even then it doesn't always lead to a positive outcome.
9-
Borderline personality disorder (though I have only worked with them as parents of my actusl patients) If you can even get them to show up to the appointments, they usually have very little capacity to reflect on their own actions and how it affects how other people react to them, usually blame everything on everyone else, take zero responsibilities for their actions and demand an awful lot of you in terms of "fixing" their kids.
10-
A lot of people mentioned people with personality disorders- especially borderline, as patients they find difficult. I have found them much easier after attending an APA conference a couple years ago where a speaker was describing how for people with borderline everything can feel very unsure and chaotic and all their emotions feel very intense.
The speaker really liked the "emotion disregulation disorder" instead of borderline because it was actually explaining something about it. Thinking about it this way really helped me. Especially as someone who at times met enough to be diagnosed with BPD ( I don't now, it was due to a lot of attachment trauma in my childhood that lots of therapy and secure attachments have solved.
I would say I have a hard time working with patients I can't communicate with well. But it's mostly because I feel like I am being a bad doctor by not being able to connect or be able to work well with what I am able to understand of what is going on for them.
11-
Psychopaths. They have no desire or intent to change their behavior, they don't care about you or others, and they are harmful or even dangerous. There's nothing to empathize with because they have no empathy themselves, and there's nothing to work with.
They are the predator, and everyone else, including you, is the prey.
13-
Borderline, Narcissistic, and Antisocial personality disorders.
My reason for this opinion is that these folks have one pathway that every single stimulus follows as it enters their brain... eyes, ears, taste, all the senses. That pathway goes directly to the place where they try to figure out how to use every situation to get what they want. There is no empathy. There is no concern for others. There is no genuine humanity. There is only "I want" repeated over and over.
The impulse is virtually impossible to treat because the treatment effect goes to the same place. Some believe that Dialectic Behavior Therapy can work. I disagree. The pathway remains regardless what anyone does or says. Being held accountable for dysfunctional comments or actions doesn't make a bit of difference. In the end, they go back to their impulse. The only strategy I have seen that works even a smidgen is to teach them how to get what they want without hurting other people. Even then, it is still about getting what they want.
I am quite sure that my colleagues will disagree with this opinion. Remember it is just that... anecdotal and my opinion.
Life and relationships are about give and take, sacrifice and intimacy, love and belonging. To some degree we all want what we want. But we also give of ourselves and cry at the movies and love little children. These integral emotional parts of living aren't possible for some people. It's good to know that before you get involved.
Only my opinion.
14-
Psych ward....
-Some girl thought she was a werewolf and would wander up and down the halls all night howling
-Another girl would walk inside of the toilet, like literally in the toilet, then complain about not being allowed to wear wet socks
-A lot of people wanting to start fights with each other
The main thing I remember was this overwhelming sense that things weren't going to get better for a lot of these people, which made me really sad.
15-
I think the realization that a lot of the people aren't going to get better, voluntarily or not, was really bad. I know there was one kid weaning off his insomnia meds and he would just start singing in the middle of the night. Wild stuff.
16-
This was early on in training but a mandated client had dropped acid before the session and it started coming on while we were talking - he didn't want to be there as it was and was much larger than me (5'0"). Once he got to threatening me for being the reason everything was wrong with the world I ended up needing to get up and leave my own office to get a supervisor. I definitely thought he would hit and/or strangle me if I stayed.
17-
Used to be a therapist at a behavioral health hospital. I had some patients who genuinely scared me in theory, but nothing ever happened with them. I was significantly attacked twice at work. Both patients were young women. Neither of them "scared" me beforehand. Both were incredibly quiet, withdrawn, and unassuming. One strangled me with my keys- my lanyard was a breakaway for that very reason, but she had tried to steal them several times that shift in attempt to escape the building and run into traffic, so I stupidly knotted off the breakaway portion. We carried panic buttons on the lanyards and I was able to press it while being strangled with it.
The other attack occurred when I was fairly new and on a low-security unit, in view of other staff. I was walking away from the patient and she grabbed me by my hair, pulled me to the ground, and dragged me for several feet down the hallway where she began kicking me in the chest and stomach. She was sent to a higher security unit as a result. I guess I was afraid of her after that, but she wasn't there long. There was law enforcement intervention after she assaulted a pregnant nurse, pulled her to the ground as well, and stomped on her stomach.
18-
The only one I have felt a little scared of was one who threatened to kill me. I knew she meant it. She had already assaulted a number of other staff. She got sent to a higher security ward and I heard she had broke staff's fingers first day she was there.
She held staff and other patients hostage in one of our rooms threatening them but circling the table as if playing with them first. I see violence and aggression regularly and it doesn't phase me but she did. I would purposely avoid eye contact and look straight ahead avoiding her and pretend I wasn't intimidated, as that's what she wanted.
19-
My SO (mental health nurse) tells me that BPD (Borderline Personality Disorder) is very difficult to work with, because while it's a totally legitimate disorder, it often presents as someone being a brat.
20-
I used to work with multi-disabled youth in a school. We had to sign a waiver that we wouldn't press charges or sue or anything the school, the students, or the other staff while working there. I could have sued at least two students (concussion/whiplash/bites/sexual assault...). I left after needing to be taken to the ER a 2nd time.
21-
I am encouraged by some of the new research with psychedelics etc (disclaimer I am not advocating them for anyone, merely saying they look promising in the research) but it is nice to have something new for non-talk/behavior therapy. Metacognitive therapy is also promising as an effective variant of CBT that I have also found compelling. I wish you all the best.
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It's highly believed that it is important to learn history as a means to improve our future.
What is often overlooked is that what is taught in history class is going to be very different depending on where you went to school.
And this isn't just internationally, even different regions of the United states will likely have very different lessons on American history.
This frequently results in our learning fascinating, heartbreaking and horrifying historical facts which our middle or high school history teachers neglected to teach us.
Redditor Acherontia_atropos91 was curious to learn things people either wished they had learned, or believe they should have learned, in their school history class, leading them to ask:
What isn’t taught in history class but should be?
The Irish Troubles
"The troubles."
"Too many people in America do not understand why a wall straight through Ireland would be a BAD idea."
"I’m referring to the Brexit referendum and possible outcomes."
"If people were wondering why we were talking about walls through Ireland in the first place."- CLCVS.
Forgotten elements of World War II
"What the Japanese did to the Chinese during WW2."
"Unit 731."- CaptainMcBoogerJew.
"Japan gets off easy for their war crimes in WW2."
"They killed an estimated 16mil Chinese civilians and another 8mil soldiers"
"Also, Pol Pot."
"Didn't know who he was until I was like 25."
"Worst dictator all time (in terms of percentage of population he decimated)".
The truth about the American Revolution
"That the American Revolution was part of a wider cold war type of conflict with France."
"The American Revolution was basically the UK's equivalent of the US version of Vietnam."- vinsant7.
The Dark side of Swedish history.
"As a Swede, I'd like to know more of all the horrible sh*t my country has done throughout history."
"It's a damn shame we're trying to hide our history."
"For example, Swedes killed a metric sh*t ton of all Polish people when we were at our strongest."
"That's the kinda sh*t we don't get to learn."- mogwandayy.
Colonization
"Basically what Belgium did to the Congo."
"A lot of people are telling me that they are taught about this actually."
"I'm glad to hear it because I wasn't taught about this in the USA during my public school days (1995-2008)."- EconArch.
The truth about "heroes".
"While teaching about historical Heroes they should also tell students about the unspeakable things some of them did."
"Many famous figures throughout history who are pillars of morality actually did many terrible things." - User Deleted
Intolerance for Mental Illness
"The dark history of mental illness treatments."
"I think it's worth learning about."- 7dayexcerpt.
Slavic Mythology
"Slavic mythology in Slavic countries."
"Don't get me wrong, I love both Greek & Roman mythology and as a person from the Balkans both of those cultures are part of my country's history and had great influence over not only my region but the entirety of the continent & the western world but I wouldn't mind knowing more about Slavic mythology as well."- ShorsShezzarine.
The truth about the CIA
"How the CIA was made and all the shady things they did over the years."- ALargeChip.
There is a lot about the history of our world, not to mention our own country which shouldn't be ignored.
And it's from learning from our mistakes that we really improve our future.
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So apparently we are in the endemic phase of this nonsense.
We have light at the end of the tunnel.
So what now?
Where do we go from here?
Normal seems like an outdated word.
How do we get back to normal though?
Is it even possible?
What are reaching back to?
Life pre-Covid.
Those were the days.
If only we could bring them back.
Redditor hetravelingsong wanted to discuss our new normal in this hopeful "endemic" phase. So they asked:
"What’s something random you miss about pre-COVID times?"
I miss people being sane. Though that maybe election cycle issues not COVID. We'll never know.
I thought I was Alone...
"Being able to grocery shop after 11 pm."
Reading_Rainboner
"Hell yes. I miss the days where the Walmart across the street was open 24 hours."
Small_Tax_9432
let's just go...
"I miss spontaneity... everything now seems to have a barrier of difficulty."
iidosee
"I live very close to Disneyland so I have an annual pass. My friends and I would just go there after work and hang out and grab a bite to eat."
"Now, we have to reserve a day to go. And most of the time, the days are at 'full' capacity so we couldn't even reserve. I don't want to schedule to hang out at Disneyland for a couple hours for July. So yeah, I definitely miss the 'lets go eat at Disneyland tonight?' texts."
mymymissmai
Not til 24-25
"Functioning global supply chains. Ah, the product you want has got microchips in it? 9 month wait."
richard-king
"Minimum, I'd been saying for a while now that I wouldn't expect a true return to normalcy in terms of electronics prices till 2024-2025. Although Crypto crashing through the floor really took some of the pressure off graphics cards which I really appreciate."
statiiic
WTF?!?!
"How affordable everything was!"
Disastrous_Hour_6776
"Yep. Today I was bagging up my things at the grocery store and I heard the cashier say to the lady behind me 'thats $78.12.' She had -- 2 boxes of Kellogg's corn flakes, a carton of 12 eggs, milk, strawberries, raspberries, blue berries, a small cheese cake, English muffins, coffee, and a small whole frozen chicken that could maybe feed 3 people if the meat portioning was small."
SnowyInuk
Sushi
"My favorite sushi place. It was good quality, close by, kid-friendly, and not too expensive."
InannasPocket
All of this... it was a simpler time.
NASTY
"As a retail worker, just how f**king NASTY some people have gotten."
DmitriPetrov*itch
"They applauded you for being an essential worker but won’t vote for policies that’ll raise minimum wage while insisting a wage cap for heavily paid employees."
sketchysketchist
CHANGES your DNA...
"Some of the people closest to me became very bitter and petty over the last 2 years. So many people have the 'crazy eyes' now."
__--__7
"So true and holidays with the family is like who has the biggest tinfoil hat building contest. How many jumps does your brain have to go through to think that the Covid vaccine CHANGES your DNA into the patented DNA so that the government now controls your body."
"So like vaccinated people now have a singular DNA set. I feel like I still have a chunk of my brain just broken off due to that comment alone. I was also told by same family member that I could never donate blood again due to the vaccine. I guess it is so my patented DNA doesn't affect people?? FYI my vaccinated butt just donated today fine and multiple other times after the vaccine."
tyreka13
Homeward Bound
"House prices."
adrianinked
"I'm resigned to never thinking I have a chance on owning property where I live. I'm 30 and just can't imagine it anymore. And I don't want to live anywhere else so, whatever."
Osdab2daf
"That didn’t happen because of the pandemic. That was already happening regardless."
CH11DW
Oh Mickey
"All Day Breakfast at McDonalds."
hutch2522
"It was honestly hell to do, and not very popular. ITs margins aren't anywhere dinner and lunch specials. ON top of that, the temperatures are such that They require its own grill, meaning that if you have 2 grills in shop, you are down 50% of lunch capacity."
Freyas_Follower
Way back when...
"Hanging out with friends. And I mean waaaaaay before Covid. Like 2006 back when I had some friends."
LoocsinatasYT
I miss the old days. Maybe we'll get back there.
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What do you believe?
Is there a GOD in the sky?
Is he guiding us and helping us?
Life is really hard. Why is that is a big entity is up there loving us?
Atheists have taken a lot of heat for what feels like shunning GOD.
What if they've been right all along?
Maybe let's take a listen and see what they really think.
Redditor __Jacob______ wanted to hear from the people who don't really believe all that "God" stuff. They asked:
"Atheists, what do you believe in?"
I'm waffling between G-O-D and nothing. So please give me some education.
911
"We need to look out for each other because help isn't coming."
cknipe
Peace Out
"More than 2 decades ago, a priest was giving a sermon in my church and he said 'our faith requires you to believe without question. Why call it faith if you have to ask questions?' I haven't returned to church. Not until my wedding day but you know what I mean."
asiangontear
Delusion
"When I was young I used to think that after death you would have access to a PC that you could see absolutely anything about your life. Stats, any question you had no matter how obscure, replays of moments, perspectives of others in relation to you. No matter what you wanted to know, if it was relatable to you, you could see it. I know it's silly, but as time goes on I just want it to be real, and I don't think I'd have any issue allowing myself to fall into that delusion."
eggwardpenisglands
I think nothing happens...
"Realistically, I think nothing happens. We literally experience nothing after death. Same thing that we experience before birth. We don't exist, so it's nothing. I think the tenant that we should follow while living is to try to be happy and healthy while minimizing the damage we do to each other."
"What I would LIKE to happen after death is whatever you believe in, exists. I think Christians should get to go to heaven if they truly believe in it, Hindus and Buddhists get reincarnated, and everyone else also gets to experience what they believe they will experience."
"'I would still experience Nothing. Maybe it's one of those things where at the moment of death their brain makes them experience what feels like an infinitely long moment in time where they experience their afterlife. I just think it would be neat for everybody."
Better_Meat_
Shrug
"Best advice I received from a dear senior on their way out. 'You win some, you lose some' shrug. Nothing divine, life is that simple and wonderful, accept it and move on."
Tune_Kindly
It all sounds pretty simple. Why are people so up in arms about Atheists?
Whatever
"I believe in a universe that doesn't care, and people that do."
imCIK
Cool with Empty
"Nothing. [Serious]."
rumblingtummy29
"I feel this way about death. When I was 5, my grandfather died and my cousin simple said, he is dead, that means you are gone forever. Everything ends up dying, even plants and animals. I'm now in my 40's and still have this simplistic view of life and death. People think I'm ambivalent to life and death but it's just what it is."
thepigfish82
puppet-masters...
"I think a lot of religious people struggle with the fact that we are all just swirling units of chaos. There is no grand plan or great orchestrator. I think that’s why people who are prone to religion are also susceptible to things like Q anon and the Cabal and all that. They REALLY want to believe that there is some almighty puppet-master who determines all of humanity’s fate."
Lngtmelrker
“we’re living in a society!”
"Just be a kind and empathetic person not because you’re worried about some cosmic justice, but because it’s the right thing to do. If there is some being that created us there’s no way they actually care about believing in it or adhering to some rules from over 2000 years ago."
"Also a big thing for me is that I find the idea that you need religion or the Bible in order to have morals and ethics pretty dumb. It’s pretty f**king clear that most evangelicals have neither. But my main thing is being a good person simply because, as George Costanza once said we’re living in a society!' If you’re only a good person in order to make it to heaven you probably aren’t actually a good and moral person."
conservative_genius
That's All
"You're born. You live. You die. That's it. After you die you cease to exist, the same as before you were born."
serefina
Believe what you want. We're all here together. So let's focus there.
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The list of what irritates me is endless.
I mean... breathing too loud or dust can set me off.
I'm a bit unstable, yes.
But I'm not alone.
So let's discuss.
Redditor Aburntbagel6 wanted to hear about all the times many of us just couldn't control our disdain. They asked:
"What never fails to piss you off?"
I feel like this article can go on forever. Let's get some highlights.
Wasted Time
"Meetings that could and should have been an email."
Sirena609
Lotto People
"Getting stuck behind people playing the lottery at a corner store."
thenuggetlover
"I also used to work in a gas station and you’re SO right. I f**king hated the lottery people. Especially since my store had a small staff and there was usually only one of us working at a time, which meant that I couldn’t get any of my other work done as long as they were there."
"And you’re right, it’s also pretty sad to watch. I had one lady who used to come in every day and spent hundreds and HUNDREDS of dollars on scratch tickets. One day, she won $200 after spending probably around $600 and she was so excited and saying she can 'finally pay her bills.'"
i-am-your-god-now
Aware...
"No situational awareness. Job, home, shopping, driving. Think for one minute and go about. OBSERVE!!"
Dizzy-Foundation8122
"My mom is one of those people who leave the shopping cart in the middle of the damn aisle and proceed to walk twenty feet away. After correcting her a million times to no effect I just walk away now so people don’t know I’m with her."
OutrageousEvent
Shut Up!
"Endless barking in the middle of the night, I love animals but that sh*t I can't stand."
Acceptable-Lemon2924
"Endless barking in general drives me up a wall. One of my friends dogs was barking almost an entire gaming session the other day. I wanted to reach through the computer and smack him for letting it go on."
bangersnmash13
Kindness
"People being mean to service workers, especially if the workers are very young."'
scaryboilednoodles
All of these things. I hate them all.
Admit It
"People who never accept fault when they mess something up. Like, why blame a million people when it was clearly you who did it???"
Quirky-Area-8978
From Above
"My upstairs neighbors."
lutzow89
"I had terrible neighbors at my previous apartment. It was a one person studio for students, but her boyfriend was clearly living with her illegally and he was loud."
"One night we knocked n the door at 3 AM because of the loud music and an unknown girl opened the door. I just thought they were having a little party. But the next door I saw the girl living there come home with a suitcase after having been away for the weekend... Her BF was cheating on her in her own apartment."
Th3_Accountant
Move Away
"People who sit directly next to me at the airport, movie theater, any other place where you can choose a seat when there is PLENTY of other seating."
BacardiPardy33
"I can’t YES this enough and the ones who can’t park for crap so they park so close you can’t open doors on one side of the car or the ones who park directly behind when you pulled through so the door won’t open to load groceries."
BacardiPardy33
It's Over
"People who try to restart old drama. Like I'm done with you, just leave me alone."
Tired_Potatos
"Yep, half the reason I've basically quit playing one of my favorite online video games. People keep bringing old crap up or sh*tting on on someone who used to be our friend. I got tired of it so I just ejected the game out of me."
CaucasianHumus
AHHHHH!!!
"People walking too slow in front of me with no way to get around them. It’s even worse if it’s a couple or group taking up the whole sidewalk. HAVE SOME SPATIAL AWARENESS FOR THE LOVE OF GOD!!"
_-v0x-_
Life in general pisses me off. I'm easy.
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