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DBT 26: Being STRONG and the Canadian medical system

Yup, another one of those acronyms. There’s a lesson and the end part is discussion on medicine in Canada.

My last day in ERPS was spent talking about STRONG and it was nice to have a refresher, except for the fact that it trigger the shit out of me.


As you may recall I took last week off, and cancelled my trauma series. I write it for me, but I don’t post it. So what the hell is this STRONG stuff and why does it upset Not bad for a Robot?

STRONG is essentially a set of skills designed to take care of you. It’s all the stuff you need in the ever day to reduce your vulnerabilities so you don’t freak out at things that usually don’t bother you.

S - Sleep

T - Take care of yourself - go see the doctor

R - Resist urges (Drugs, impulse shopping, self harm etc)

O - Once a day work on mastery

N - Nutrition - eat well, and eat regularly

G - get exercise.

Well that doesn’t seem all that bad, now does it? Makes sense.

Let’s just go through this like a check list.

S I’m very good at sleeping. I know very well that if I don’t sleep I kinda of want to murder everyone. I try to keep the same schedule. It’s been hard because of the switching back and forth between night and day shift.


R - resist urges, well I don’t do drugs so I’m okay there too, right?

O- once a day work on mastery, yup I love building new skills and learning something. I working on two units in codecademy and taking a Udemy course. I’ve got learning shit down.


N- Nutrition - fluctuates based on my mood. I tend to forget to eat, and will eat garbage when I have a case of the sads. Neat fact, apparently yummy fish like salmon, herring and mackerel can help with depressing and social anxiety. EVEN the delicious pickled versions, I guess my sad food is a jar of pickled herring. There’s a new branch of study in charitably that’s looking at how food can be used to manage symptoms of mental illness. It makes sense, food is chemicals, and life is better through chemistry.

G - exercise... ya I’m okay with that....

Oh wait, I forgot one. It must have be R right? I forgot R. Okay, okay, you got me, I have an impulse shopping habit and a former severe videogame addiction. I need to work on that. Part of it is I don’t know how to sooth myself without buying myself a present. If I can work on that, I’ll be better at not buying things I kinda need.


What? That’s not what I forgot? It must have been G. Okay, you got me. I tend not to stretch after a run and let myself sit in horrible pain. But I only do this when I’m in a bad mood and realize that the only pain I really understand is physical pain. I know I need to take... I mean be good to myself!

So those are the STRONG skills.

What do you mean I forgot something? SRONG? pronounced strong.


Okay, okay, fine. You got me. T - Take care of yourself. Fuck.

I don’t like this one, because I fail at it. It makes me feel like a failure. Even though when I’m practicing my skills I can work on all the other ones, Take care is the one I can’t do to the level required. Even when I do manage to do it, I still feel like a failure because half the time it’s pretty easy stuff and was easy stuff for me a few years ago, and now I avoid it.


Take care is doing the basic stuff like sleeping, eating well, but it’s the finisher. It’s the going a littler further and going to the doctor. I can’t do that. I did get my blood work done, and as I mentioned my doctor is on leave. I also avoid taking my medication, which is really just iron. I need it, because I purge blood like a vampire from The Strain, except I don’t look messed up.

Talking about this homework make me break down in private therapy and in group. Breaking down in group was surprising, I’m usually the over achiever and have been there the longest. I felt a little bad that maybe I scared people, I don’t think I did. Which I finally admitted that I don’t want to be physically healthy at all. Health isn’t a reward to me. That I want to very passively fade away because I can’t do it again. I don’t see the point in trying to make a meaningful life in a world where my life has no value. Taking care of your self is an impossible feat when you think you are worthless.


It’s something I need to work on, because I can’t get passed it.

Here the lesson ends and I discuss why ‘Take care’ is so difficult to for me and deeply connected with my PTSD and healthcare. TW medicine, malpractice, hopelessness, PTSD, anger


If you a new to this thread, I have PTSD from medical negligence and malpractice. I have the flashbacks, even bodily ones, nightmares (which aren’t so bad as I’ve always had nightmares),emotional dysregulation, etc. PTSD is partially a moral injury. You find yourself casting people out of your world because you completely distrust them and perceive them as a threat because they in some way have caused you harm. I can have a normal conversation with someone who works in medicine, I can see them as a person, I can partially believe they may help me, that they might be different, I might even like them as a person, but immediately when it becomes about me, they become danger. I can’t believe that they could solve my problem. Even if they could, I know their colleague will hurt me, and I know they will lie about it and pretend it never happened and blame it on me for being crazy or a woman. I cast everyone out immediately to protect myself because I’ve been ruined by the system.


All of this is combined with an intense sense of injustice. In Ontario, Canada it is nearly impossible to sue. If I did, I would be kicked out psych and refused treatment at the hospital because it would be a conflict of interest. I would also lose the trial, need to pay the legal fees of the hospital, and would need to move to another city or province to get medical care because I would be ‘the one who sued.’ I am now evil in the eyes of the Canadian public, because our system is perfect and doctors really are doing their best. We don’t have burnout or high physician suicide in Canada, that’s clearly our terrible American neighbours who have those problems. Our system is not poorly managed, that once again is our American neighbours. Not us, you’re a Bad Canadian for even thinking something could be wrong. It wouldn’t matter that the lawsuit was for a good reason. In Canada it is the patient who is wrong.

The CPSO (College of Physicians and Surgeons) is largely useless, unless you’ve experienced sexual abuse and even then it’s laughable. At worst, typically if you are found out to have committed sexual abuse, you get your medical licence taken away and the victim may receive $16,000 in counselling, which isn’t very much. There are no criminal records. It is basically a public shaming that is largely regulated if the media happens to read the CPSO website and see that you are up on charges of alleged sexual abuse.


If you are like me and it’s malpractice and negligence. Your doctor will be investigated, might need to take a course, get a firm explanation from the CPSO, and pay a modest fine of maybe $4667 - $20,000 to the CPSO. No counselling is offered or paid for if you weren’t sexually abused. You will probably get an insincere non-apology about how this was a misunderstanding on your part. Apparently this a very harsh punishment and humiliating. I think having PTSD is a really harsh punishment for needing fibroids removed. My life has been put on hold, changed permanently, and if my therapy wasn’t covered by OHIP, I would have spend well over $30,000 on it. This doesn’t include lost wages or things like trying to learn pain management. When I finally get the courage to hire a sex therapist or physio therapist for sexual dysfunction caused by malpractice and the butchering, I’ll have to pay for that myself.

I know, but he’s a really good doctor right? It must have been a horrible mistake. Think of his feelings! He tried his best didn’t he? You must have misunderstood. You know they all wanted to help you. Why do you have make them feel so bad? Are you sure you didn’t do anything wrong? Did you say the right things? Why are you so difficult!?


Healthcare is tied so much to Canadian National identity that some Canadians don’t want to hear it critiqued. It’s expressing a critique is a disruptive opinion which is perceived as a very American thing to do, and as anti-Americanism at times can be a big part of CanCulture, you are seen as bad because you are acting very un-Canadian. Part of it is shame, no one wants to believe that there are healers out there who are dangerous. The other part is to protect this part of national identity, if Canadian’s don’t have the greatest healthcare system in the world (we don’t) then what are we other than passive aggressive?


I found out that my butcher surgeon has been butchering and mistreating patients and staff since the 70s. (He also hangs out with Captain I’ve been sued many times and have never lost.) I am merely one of many who have been harmed. No one has ever liked working for him because he is horrible. He gets away with it because he is a star and charming and the traumatized can’t get our shit together for long enough to stand up. We know very well that a well worded statement from an opposing lawyer would destroy what little we have left. No lawyer would touch him anyway, because he’s got more expert witnesses and colleagues to say he was right, than any patient does. Also, the insurance for doctors has basically an unlimited supply of money to throw at the problem and will do everything to draw things out, so the patient will run out of money. Justice is hopeless.

For those good not butchering doctors, you know what would have stopped it? If you actually told on your piss poor colleagues. If you stood up and said “No my patient will not go there, it’s a safety issue.” No one believes patients because we allegedly are profoundly stupid and haven’t been through the hardship of medical school so we can’t know what it means to turn in your colleague. Also, women, people of colour, and the mentally ill are rarely believed because we are perceived as over reactors and unreliable witnesses. When I described getting the wrong test done on me, a doctor told me she was sorry I felt that way. As though having something done to my body was an imaginary thing that only my lady feelings felt. I wasn’t physically abused, but perceived it as an insult to my feelings. She shut up very quickly when I asked her if having her consent breached, the wrong tools shoved up her vagina into her uterus without proper drugs would only hurt her feelings rather than physically hurt?


The other thing that could have avoided this whole mess is if my doctors had A) believed me that something was wrong. B) Once they committed the malpractice treated the pain I was in C) Apologized to me, and then didn’t proceed to make fun of for being upset D) Didn’t lie to me about my treatment. E) Actually believed me when I discussed my family history. F) If walked away when people tried to convince that butcher surgeon was really a good guy.

Everyone is going to fuck up. I respect that, I worked in quality control I know people will make mistakes. Manufacturing the earlier you catch a mistake and do something about it, the better off you are. Sometimes you have to fire your friend because they are a fuck up. Don’t hide it, don’t pretend it didn’t happen. Don’t protect those who regularly screw up. Apologize and take care of your patient, because when you don’t you create monsters like me. My PTSD doesn’t make me a monster, but the rage caused by injustice makes me have a profound understanding of why people harm their doctor. That makes me feel monstrous. I didn’t always have the gift of murderous rage, now I do. It feels inhuman.


So, when I’m asked to take care of myself. I often don’t see the point it in. I live in a world designed so poorly, that it really doesn’t matter what I do. I’m the bad person for pointing out that the system is failing. I’m bad because there is so much darkness in me. I’m bad because I am mentally ill and even worse I am a woman. I fantasize about moving to Massachusetts and not being Canadian anymore. I’m not sure how to heal that moral injury.

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