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Notes from Hinge and Bumble's Unpaid Psychiatry Services
Right. Putting doctor/psych trainee in my bio may or may not have been a mistake. I wanted to make it clear that I'm not going to be in India for more than like 3 or 4 months, just about long enough to die from heatstroke and land when it's wet and drizzly in Scotland.
The GMC frowns strongly on a violation of a doctor-patient relationship, especially when the doctor is screwing the patient. In India? Who gives a fuck? A friend of mine, a lawyer, reported that she went with her mom to see a shrink for her depression, and the horny bastard said she didn't need treatment, just an ice cream date.
Now I'm certainly not going to date someone under my care, even in India, only 30% because they're usually grannies with terminal cancer. And their cute granddaughters are probably too distraught to appreciate it, not that I'd be so uncouth as to try.
Unfortunately, I've become convinced that either I'm drawn to crazy women, or they're drawn to me. Or at least 80% of the female population on said apps needs a therapist more than a boyfriend.
Sadly, I nurse a weakness for cute girls who desperately need my help, and my dad-energy manifests so strongly that I've matched with med students to yell at them for being on the apps when their finals are ongoing. More than once. Certainly more than twice.
In no particular order:
Med student I yelled at for being on the apps. Turned out to have abruptly discontinued her SSRIs and having a meltdown. She got yelled at more, since I've been on that campus and know there's a pharmacy outside her dorm. Proceeds to inform me she suspects she's autistic. I say, sure, you're a final year med student giving said finals, you can probably tell, not that a diagnosis is going to do you any good. She then goes on to reveal to me that she's been formally diagnosed with BPD. I'm screaming and reacting with a 💀 emoji. Proceeds to tell me it's not that bad, to which I earnestly disagree. Then reveals that she harbors thoughts of stabbing her classmates with HIV contaminated needles. If it wasn't obvious to you, the deal was off the moment I heard BPD. There are many kinds of crazy, but that is what I'm not going to fuck with. Then "she" proceeds to tell me she's trans, which I genuinely couldn't tell at first on a quick skim (it was obvious later, presuming you knew what to look for, but I mostly matched to yell at her). Shoulda guessed from her being 5'10 in the bio, but at any rate, time to dip. Don't stick your dick in crazy, especially not when they can stick theirs back in you.
Another med student. Clearly in need of therapy, my attempt at psychoanalyzing her after a brief conversation was hilariously accurate in retrospect. Sadly, in the end, all I could provide was a good time. I was kinda serious with her (before I found out that against all odds, I did match into psych), even saw a buddy of hers, yet another med student, admitted to the ICU. Cue her falling for me after seeing my counseling skills with the distraught family and friends (it's a good way to dodge the malpractice suits). Sadly the buddy died, pontine hemorrhage and rebleed, no comorbidities or predisposing factors. Barring a love of biryani, and if that alone was lethal, I'd have passed away a decade back. Anyway, the girl had failed an exam from a prior year, and I was losing sleep trying to convince her to study for her next attempt. She told me not to worry about it, though my genuine concern meant I still did. Lo and behold, a 55 yo married professor with a daughter her age wrote her paper, in front of the entire exam hall, and submitted it in her name, this, in combination with her family being filthy rich and politically connected, meant that I left my concerns about her academics at the door. Then it turned out that she was the kind of party girl who had both a low tolerance for liquor, and a tendency to get frisky with anyone in sight. And said person wasn't necessarily always me. Some drama later, we weren't a thing, both because I simply couldn't trust her, and because she was growing crazy over the fact I was inevitably leaving. Long story, cut very short. I think I lost my most expensive watch, and she hasn't been so kind as to check.
Gyno final year trainee. I hit her up primarily because I was bored, and wanted to see if the uptick in market value from me being a post grad trainee extended that far. Older than me. I was justifiably incensed on her behalf and talking to her when she told me the orthopod she was seeing had dumped her over a text after seeing her for 6 months. Further conversation revealed that she's probably autistic, or just plain weird, being infatuated with me two phone calls in. Still dodging her calls with excuses of being too busy doing unpaid surgery with my dad (he's a Gyno surgeon who also happens to teach laparoscopic surgery to gyne trainees and even other consultants, I wanted to get him a new student if nothing else). But I understood why the previous poor bastard ran for the hills and didn't leave an address.
Fashion designer. Very cute, very sweet, very depressed. I had to talk her out of committing suicide, over the phone at 2 am after counseling another, actual suicide survivor, who wasn't my patient either. But working productively with her issues, seeing a therapist, actually listening to my concerns. Nice girl, I'm kinda sad she has to see me go, especially when she said I actually look good in Hawaiian shirts. I always suspected, but it's good to have a second opinion from an authoritative source.
Law student. Cute. Top of her class. Survivor of multiple suicide attempts, because she didn't take biology lessons past tenth grade, and Google wisely doesn't return results for "painless ways to commit suicide". Asked me on the first date how much paracetamol it takes to off oneself, for purely academic reasons. I had the sense to tell her I categorically refuse to answer that question. Has multiple psychiatrists and therapists. Refuses to see them, or follow their advice. When they do see her, they get depression, mine only gets exacerbated. Also, I suspect they're incompetent, or consider international consensus more of a suggestion. I've seen some absurd prescriptions, including longterm use of a combination of an SSRI and a benzo. Her anxiety is bad, but only in episodes, whereas I think she'd be way better served with a normal SSRI and benzos rarely on a PRN basis. Bunch of other medical comorbidities, but thankfully dodged the genetic mutation causing ADPKD that killed her father early and will probably get her siblings. She's pulled my hair and slapped me on a first date, the only saving grace being she's so weak only the former kinda hurt (and I need to keep my hair). As allergic to medical care as I am to textbooks, and prone to turn violent and call me old should I express any concern for her lack of care for her health.
A rather sweet psychologist doing a fellowship in Psycho-Oncology at another hospital. Met up after work for a date and to talk shop. Then she sees a text from her ex, and proceeds to have a full blown panic attack.. Slept with said ex recently, in the on call doctor's room at their hospital. I could tell she wasn't in any position to date from the moment we met, so I wish her well in figuring her shit out.
And so many more. And some of them, I assume, are good people, who do need a date more than counseling.
Yeah, I'm going to administer all my future dates a mental health questionnaire in the future, I pray that doesn't constitute a therapeutic relationship in the UK, especially when I get up mid date and run myself.
I resent this remark. I've been formally diagnosed with BPD too. To be fair, in my case it's probably a misdiagnosis (I definitely have tendencies in that direction, but you have to stretch to get to 5/9), but it's not like that's unheard-of.
So you have borderline Borderline Personality Disorder?
Look, it's not personal, I'm not one to blame people for their mental disorders or personality problems. Mainly because it doesn't help, or make a difference. But trust me and my far more senior colleague @Throwaway05 that people with BPD can be dangerous. The severity of the symptoms can vary greatly, but even with my proclivities towards waltzing into people's lives with my sleeves rolled up and eager to help, that would be a moth heading right for a naked flame.
When they're good, they're great. When they're not, well, the risk of them ruining your life is frankly unacceptable, and one of them already had a good crack at that from a full degree of separation, didn't even get the crazy good sex bit as compensation.
The more flagrant cases have my profound pity, as do people with certain other mental issues, like my buddy with schizophrenia (as I mentioned elsewhere, it was him who was dating the chick, and I've already mentioned how I had to save him from a suicide attempt not that long ago). I'm more than happy to see people like that in a consultation room, but not in my personal life.
Worst part is that, as far as I'm aware, medical and psychological intervention doesn't make much of a difference. It's largely just the way they are, for factors out of their and my control. All I can do from my end, especially when looking for dates and not patients, is keep them several miles away.
Yes, I figured that pun out several years back. Didn't seem like the best time to make it.
I will admit that I'm significantly more inclined to Drama than average, but while I flounce off forums often enough and occasionally get mad enough to post revolutionary screeds the way some of theMotte does (though not on theMotte itself; after 6/1/2021 I realised that doing this was reckless and have made an effort to stop), to push me into the dreaded escalation spiral IRL takes something major enough that it's typically illegal itself (in the last ten years, I count two: one from being stuck around someone threatening to go spree killer, and one from being blackmailed; I was worse in my teens but I'm only in my early thirties now).
Part of the reason I think it was a misdiagnosis is because I actually have done a course of DBT (which as @Throwaway05 said is the standard treatment), and found it misaimed/counterproductive while the others taking it seemed to find it helpful.
Look, backing off your #1 is probably the right call*, and I've seen borderlines that are that bad or worse myself. Just saying: while it's obviously Bayesian evidence of "run away screaming", the diagnosis isn't a guarantee of such.
*Since she mentioned she's potentially autistic, from what you've said I can't rule out the possibility that her "murder random people with HIV" thing is just low-level intrusive thoughts that she easily ignores and also talks about (when most people wouldn't) because autistic hyperhonesty. If it's not, yeah, absolutely run away screaming. And obviously there's the other issue as well.
Mild symptoms complicate both diagnosis and treatment - much of what DBT is designed to help is for moderate functioning people (can be great) and low functioning people (where it isn't likely to).
Your diagnosis could be wrong, but I'd guess what's happening is that you are well enough, and the underlying biological reality of a borderline brain gets in the way sometimes.
However also possible you are what you are and don't meet criteria for anything.
To give the most obvious example, there was an emphasis on meditation, but all that accomplished for me was sending me catatonic.
Oh, I absolutely meet criteria for HFA/Asperger's and (currently) for depression. And I absolutely do have tendencies in the direction of borderline; I hit two or so of the nine with no question and there are quite a few with at least some question marks. The most obvious thing I categorically don't do is that I've never been a "splitter" (quite the opposite, to be honest), which means I avoid the most severe and characteristic borderline failure mode of "has both the tendency to incorrectly conclude that people are cardboard villains and the temperament for vigilante justice, causing repeated and unwarranted murder attempts and other hostile actions".
It's also worth keeping mind that mental illness almost always impairs insight - your ability to understand and read your mental state may be hampered (not that the average person is truly good at this, but it can be more important in someone who struggles).
Many borderline patients hear the diagnosis and its description and go "thank god, that's me! it all makes sense now." Many go "no that's bullshit I AM TOTALLY FINE LALLAALAL................."
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Look, I won't actually runaway screaming when someone tells me they're BPD. Or they're schizophrenic. I just consider it an absolute deal breaker in romance, going off personal experience gained very painfully.
At most, I will be mildly concerned, but they're not an imminent threat to me unless I'm a close friend or relationship partner, so I intend to avoid that. I don't react to schizos by pulling out a gun, the people they hurt the most are usually themselves, but in my experience, people with BPD are a menace to both themselves and others.
That isn't my impression at all, I feel like she was very serious about it. I have screenshots because, goddamn, people wouldn't believe me if I didn't, at least IRL, and going over them makes me think she's going to end up messing things up very badly. BPD, trans and potentially autistic? That's a recipe for disaster if I've ever heard one.
If you're doing okay, that's great, I'm genuinely happy for you. Manifesto posting on this underwater basket weaving forum is a healthy alternative to cutting yourself or chasing your SO with a knife, and your mod record is pretty clean, so I can't imagine that you act worse IRL than you do on a pseudonymous website.
Yeah, I figured that was a real possibility; it was just that from what you initially said I wasn't clear on that and as such I couldn't give a definite "aieee".
I'm actually still dealing with the social fallout of the blackmail Drama two years back (I miraculously avoided legal trouble, but my uni is mad at me), so I wouldn't say I'm doing okay. But I'm safe enough to be around for people who don't think holding me over the volcano's edge sounds like a great idea (even during Drama I'm pretty good about avoiding harm to bystanders).
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Borderline is better conceptualized as more like depression or anxiety than schizophrenia when it comes to severity. Many people with depression or depressive thought process never present for care, nor do they need it. Some of these people kill themselves.
The same is true with Borderline. At state hospitals in the U.S. you often see a mix of psychosis and severe borderlines who won't stop hurting themselves. It can be very bad. You also have borderlines where the symptoms are so rare or mild that you'd have to have a long relationship with a therapist to catch it.
Don't underestimate how "harmless" it can be.
When it comes to treatment it is treatable. Certain kinds of therapy work (chiefly DBT). Patients accumulate coping skills and calm down just by aging. Medications don't work great but can be helpful for symptomatic management.
Hmm.. I assume my experience here is markedly different primarily because the general level of awareness surrounding mental health in general, and BPD in particular, is so poor that anyone who still manages to get the label is absolutely fucking insane.
And of course, there are plenty of people who keep things under control or are barely worth the diagnosis. And it's the flagrant cases who get signal boosted. Would we know Freddie De Boer was schizo, or Scott had OCD, if they didn't tell us?
That's about as reassuring as the same effect in violent criminals, who do age out of their tendencies. I'd rather not have to wait that long, so I hear BPD, I'm fucking out, at least romantically.
Yeah don't date one, but you gotta keep in mind that if you are seeing them (at this phase in your training) it's either so bad they are on an inpatient psych unit or in the ED, or they are in the hospital for other reasons and they are such a pain in the ass that the diagnosis makes itself clear.
In training you'll get the skills to pick up more mild cases in the community, and presumably also see more mild cases in therapy clinic.
This also is true for things like depression and anxiety (early in training you'll only see total shit shows, but more mild cases exist they just don't need you).
This is also, also true for things like hypertensive emergency vs. generally outpatient family medicine seeing mostly controlled shit.
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