A slight twist on our stigma

[PMHNP10]

So as psych nurses we're painfully aware of the stigma that is still alive and unwell within psychiatry from the general public towards the patient, the patient with X Dx towards the patient with Y Dx, the patient's family towards the patient, the non psych nurse (and sometimes even the psych nurse) towards the patient, the non-psych nurse towards the psych nurse, the insurance company towards psychiatry, and even the medical community in general towards psychiatry.

Well this weekend while with some in-laws I experienced one that I'm guessing many of us have experienced, but it never really occurred to me until I was analyzing the encounter while driving home from this outing.

So there is a serious history of substance abuse with this family (vast majority EtOH). Well last night while one in-law was on a drunken rant he became particularly agitated with me and amongst other things he made the statement: "I see you over there analyzing me". So the truth is that there wasn't much to analyze and I was feeling particulary uncomfortable in this setting because I knew the conversation he was having with others (I was mostly a bystander) was not going well. So why feel threatened about me "analyzing him" (which, I wasn't doing); like anything I "uncover" during my in depth analysis will impact his addictive behavior in a way they would rather not experience.

So the moral of the story is that in addition to dreaming of the day when none of the other stigmas mentioned above exist, I now look forward to the day when a family member looks at their FNP/CRNA/WHNP/etc. loved one and says "I see you over there analyzing my physical health."

Give me a break people; it really does not require that much effort (i.e., analysis) to realize you're miserable. So go hate your life on your own time; I have my own troubles.

[lucianne]

I've never had anyone get belligerent about being "analyzed" or diagnosed, but some people have been a little uncomfortable when they find out I'm a psych NP. If they say anything that suggests they are uncomfortable, I smile and tell them I only diagnose people when I am being paid to do so. (I also tell this to people who want to tell me about a friend or family member and have me give them a diagnosis).

[PMHNP10]

hmmmmm...I never got an email telling me anyone had responded

anywho, funny you should mention about the family; I have a cousin who has a child with ADHD and tourettes; she lives in a rather podunk town and so healthcare access isn't so great; the kid's on a stim and it does ok with ADHD symptoms but supposedly the interpersonal and social anxiety is a nightmare and getting worse; he's also saying he's seeing lizards with red eyes coming after him, and is hearing voices, and he is distressed by this; I suggested he needed to see a doc pretty quickly and might need to get off the stim and try something like intuniv or the like (he was on tenex before, and it was very helpful, but was taken off because he was always sleepy, but he was also taking it QID); she happened to have an appt booked with his neurologist and the MD switched from 1 stim to another and added lexapro; she decided she didn't want to follow the neuro docs orders so now she has to wait until her pedi doc comes back from India in August before he can be seen; in the mean time, I guess her sister who happens to be a nurse for a pedi got a couple month supply of intuniv samples and gave it to her (forget about the legalities and such; that pedi doc 's just one big mess from the horror stories I've heard); point being, as a novice, I allowed myself to get trapped, but the situation was pretty serious and she just doesn't have many resources, unfortunately; stamp sucker on my forehead; on the other hand I really didn't think the answer to anxiety and hcns was to switch from 1 stim to another and add an SSRI to treat the anxiety

I would never feel comfortable about treating a family member, so now, should a similar situation occur, if you don't mind, I'd like to use your response about not Dx'ing or Tx'ing unless getting paid; but then what if they say they'll pay...I'll have to think of a witty response for that, or just be more blunt if I cannot come up with something witty

[elkpark]

It's generally considered inappropriate and unethical to treat family members (or anyone with whom you have an existing personal relationship) anyway, regardless of whether they're willing to pay you or not.

[TCASII, ADN]

So there is a serious history of substance abuse with this family (vast majority EtOH). Well last night while one in-law was on a drunken rant he became particularly agitated with me and amongst other things he made the statement: "I see you over there analyzing me".

That was probably more about him and his faults. He knows he's an alcoholic and is insecure about his behavior, ect... He expects you to recognize those faults and "ruin" his state of denial and fun. You will always be a party pooper to those types of individuals who have maladaptive behaviors such as addiction (ETOH a biggie) or certain personality disorders.