Dear Imprudence: I’ll Tell the Doctor On You!

Reader bzzzzgrrrl reads Dear Abby so I don’t have to; Friday’s Dear Abby column featured this question:

Dear Abby: A friend of more than 40 years, “Myra,” delivered a letter to my physician outlining her observations of what she claims were “changes” in me. I was called into my doctor’s office to respond.

Myra has also told me I should see a psychiatrist. I am disappointed that a friend would say these things about me, and I don’t think she should have contacted my doctor without telling me. I have asked others if they have noticed any dramatic changes in me and no one else has.

Myra may have my best interests at heart, but I am upset about this, to say the least. Am I wrong to feel that she has overstepped her boundaries? — Perfectly Fine in Ohio

I was reminded immediately of the story our abby jean linked to on Thursday, about a young man with depression who dared to talk with his friends about suicidal feelings, and got the cops called on him.

How does syndicated advice columnist Abby respond?

Dear Perfectly Fine: Your friend must have been extremely concerned about you to have taken the step she did. And I wish you had mentioned in your letter WHY she thinks you should see a psychiatrist. If you have no family nearby with whom she could discuss her concerns, it’s possible that she did what she did out of love for you, so please try to forgive her.

P.S. Was what she did out of character for her? If so, consider discussing it with her family — or physician.

Ah, yes, a little ‘furnish the details!’ plus ‘you should turn the tables on her and talk to her family or her doctor!’ I mean, seriously, Abby not only supports the concern trolling, but seems to suggest that Perfectly Fine should feel guilty. ‘She meant it for your own good, you know!’ And then demands that Perfectly Fine detail whatever it was that made this ‘friend,’ we’ll call her Busybody, tattle-tale to the doctor. Then, she follows up with ‘well, maybe you should talk to Busybody’s doctor in case there’s something wrong with her.’ Of course, Abby ignores the fact that Perfectly Fine might well already be in treatment, and just not feel like sharing it with the world, and that’s not Abby’s business, ours, or Busybody’s.

How many things are wrong with this story, and with this response? It’s kind of hard to start enumerating them. But both of these stories, Perfectly Fine’s and the story abby linked to, reflect a generally held idea that it’s perfectly acceptable and even advisable to directly meddle in the lives of others ‘for their own good,’ especially when it comes to mental health. Contacting someone’s doctor because you think that person has ‘changed’ is incredibly intrusive and violating. Calling the police on your friend when ou tries to reach out and talk is a pretty awful thing to do. Both things happen a lot, and sometimes they end in very ugly ways, like involuntary psychiatric holds. As soon as someone is suspected of mental illness, the words and beliefs of the people around that person matter more than ou own statements. That is a really, really, really scary place to be in, to know that no matter what you say, people will ignore you.

What ever happened to ‘you seem a little down, do you want to talk about it?’ Or,  if someone tells you that ou is having suicidal thoughts, ‘is there anything I can do to help?’ There are all kinds of reasons why Perfectly Fine might have been experiencing a change in mood. Perfectly Fine might be really busy, might be irked at Busybody for something and not ready to talk about it, might be having a medical problem ou doesn’t feel like talking about, might be grieving a loss, having a tough time at work, or any number of other things, although it’s telling that ou friends didn’t notice anything. The first step when someone you are close to appears to be behaving out of character is not to run and tell the doctor or call the police, but to make it clear that you are available to talk if that person is interested.

I am very disappointed in Dear Abby’s response. It reflects a profound lack of respect for personal autonomy, and reinforces some very upsetting social attitudes.

About s.e. smith

s.e. smith is a recalcitrant, grumpy person with disabilities who enjoys riling people up, talking about language, tearing apart poor science reporting, and chasing cats around the house with squeaky mice in hand. Ou personal website can be found at this ain't livin'.

15 thoughts on “Dear Imprudence: I’ll Tell the Doctor On You!

  1. I wish that response was sarcasm, but I’m afraid iw as not. Where I live, it would be highly unethical for a doctor to talk to someone else without the patients’consent. I’m not sure whether that is the case in the U.S., too, but I hope it is.

  2. Count me as someone who was just floored by Abby’s response.

    I had a complete o_0 moment… read it again to make sure…and yup…it was still there…

  3. Astrid, in the US, it is unethical for doctors to talk about patients with other people (without the patient’s permission), but a friend or family member could talk to the doctor about the patient. As long as the doctor didn’t respond to the friend/family member, they would be OK.

    Dear Abby’s response was horrid though, as was the nosy friend’s nosiness.

  4. What you said…and an extra WTF goes towards the LW’s doctor. Doctors must get letters like this all the time as “revenge” for some slight perceived by the “avenger.” The doctor should have told the meddling friend to fuck right off, that she had no business butting into the LW’s treatment. Or if not that, at least not taken the letter so frigging seriously that the LW had to be hauled into the doctor’s office right away like she committed a crime. Jeez.

  5. This is so… wow… just wow. I am inclined to agree that contacting some one’s doctor or calling the police is out of line except for the most absolute extreme of circumstances. If someone i know seems a little down or out of sorts, i would reach out and ask if they are ok, let them know i am here to listen or do anything else i can. If they say they are fine, i let it go. I can only imagine a really extreme circumstance where i would push it further, like if i found a suicide note, and this person stopped making any future plans, and started giving away their beloved cats suddenly, all the while insisting they are fine.

  6. “What ever happened to ‘you seem a little down, do you want to talk about it?’”

    The stories about the guy who got the cops called on him and the people forced into psychiatric holds are horrifying and frightening and heartbreaking, and I condemn them. But, well, if you don’t mind my asking: what if you notice that your friend seems to be exhibiting textbook signs of depression (say, not talking to friends, letting grades plunge, losing all interest in her favorite activities, changed eating and sleeping habits, etc.) for no apparent reason, and you say, “You seem a little down, do you want to talk about it?” and she says no… then what should you do? Not talk to her doctor, sure, I get that; and respecting people’s boundaries is hugely important to me, so of course you shouldn’t press her to talk about it if she doesn’t want to. But if you reasonably believe that you have good cause to be worried, is there *any* acceptable course of action you can take? I hope this doesn’t come across as trying to lead anyone into arguing against the post, because I agree with it, and I honestly want to know.

    (This happened, by the way, to a friend of mine. They were in high school and she told the school counselor anonymously that she was worried about her friend, and the counselor called the friend in to talk to her, and the friend was furious and stopped speaking to my friend. Which I am not going to judge, because I’m not her and I don’t know every single detail of the story, but I just wonder if there’s anything you can ever do besides worry — especially if, as in the case of my friend, your community has had a recent rash of suicides.)

    “Or, if someone tells you that ou is having suicidal thoughts, ‘is there anything I can do to help?’”

    I am appalled that any “friends” would neglect to ask this and instead call the police. But let’s say you know that calling the police is not an option unless your friend is actually, like, standing on a rooftop threatening to jump. What if you tell your friend you will do anything you can to help, and they’re like, “No thanks, I don’t want/need your help, but by the way I’m still having suicidal thoughts and there’s nothing you can do about it”? Is there anything you can do then, or do you just have to suck it up and live in terror that you will wake up one morning to the news that your friend has killed himself? Again, I’m sincerely sorry if I sound like I’m trying to underhandedly argue against this post’s points, because I’m truly not. It’s just, if my friend told me she was having suicidal thoughts, I am honestly not sure how well I would be able to function in my daily life. And I honestly want to know: in your opinion, is this something I just have to learn to deal with, or are there acceptable, respectful things you can do that are definitely, categorically NOT calling the cops or otherwise violating people’s boundaries and autonomy (besides offer to listen and help however possible, which of course I would do but which I doubt would do much to ease my terror, and yes, I realize that this is primarily Not About Me, and yet the prospect of living in helpless terror is not something I can ignore)?

    By the way, I am willing to accept the possibility that I emotionally overreact to this issue because of my personal experiences of losing several schoolmates to suicide, and that I just need to learn to deal with that.

  7. @Rayne:

    A stunning amount of depressed people have suicidal thoughts. The vast majority never act on them. Confessing that you have suicidal thoughts is a far cry from actually being suicidal, and even that doesn’t ensure a suicide attempt. One of the most annoying things to me, before I found (knock on wood) a med combination that worked was people trying to make me not suicidal. Thanks, but I’ve got it under control, and there is really nothing you can do! It sucks, but you’re not a trained therapist, you have to accept that when your friends tell you there’s nothing you can do, they’re probably telling the truth. My advice would be to give them your phone number and tell them to call you whenever they need to talk–and stand by it. The best thing you can do is be there at 2AM when they need someone to talk to.

    “Myra’s” actions are horrendous. It’s patronizing and invasive. I’m completely grossed out and offended by it; I can’t believe Abby would be so forgiving!

  8. I think Dear Abby’s response is horrible. I had similar thoughts to rayne’s about the suicide situation, though. I think people have this horrible sense of helplessness when someone they love says they don’t want to go on living. Like “what if I do nothing, and then ze kills zirself, and I could have stopped it in some way?” So people think privacy in this case should take a backseat to the survival of their friend/loved one. I’m not sure if I agree, but then again, I’m not sure I would be able to do nothing if someone I knew wanted to kill zirself.

  9. I have to echo Rayne here. I had a friend – an admitted alcoholic who refused to stop drinking – who would call me up late at night, threatening to kill himself. Usually I would just try to talk him down; and the next day he would not even remember the call. but I would be up for hours, terrified he really would do. I did come close to calling the police – when he would talk about getting in his car and driving it into a concrete abutment. I was worried not only would he end up dead, but maybe take someone else with him.

    After many years of this, and other verbal and psychological abuse, I finally saw a counselor myself. I needed out of this relationship but always felt guilty because I would be leaving him in the breach without someone to talk to about his suicidal thoughts. So I understand why someone might be pushed to call the police about someone who says they are suicidal. (I never approached his doctors but asked him to do so; he ignored them when they told him the alcohol was killing him. And his family was just in denial – it was against their religion to drink, therefore he didn’t drink and so wasn’t depressed. So, no, I didn’t go to his family either. I just kept answering the phone.)

  10. First of all, if someone is having suicidal thoughts or feelings, it doesn’t mean they are going to do it. That doesn’t mean friends and family should ignore talk of suicide, but they should talk to the person experiencing those feelings and offer help in whatever way they can. If the person with the suicidal feelings doesn’t have a therapist, helping them find one is a nice, helpful gesture. Calling the cops? Not so much, as the police are most likely able only to put the person in the psych ward for 72 hours and, in my experience, psych wards are not great places to get real help.

    I am huge believer that each person with mental illness has the right to seek or refuse treatment for hir mental illness. I was forced into treatment for four years and, because I was forced and not given a choice of therapist or treatment facility or medication, I dug in my heels and refused to try to get better. When I decided I wanted to get better and was given a choice who to see and what to take, I started to get better. Because I was in control and, as an adult, could make my own damn decisions about treatment. My family, by taking away my choices, likely prolounged my illness. The message in all of this: respect that the person with the mental illness is an adult and let him or her control the treatments they receive.

  11. KJ, I agree with you that psych wards are not great places. (I had to spend just a few hours at one while someone I knew got evaluated, and it was horrible just being there as an outsider.) But I don’t know if most people know that. That’s what I mean about the helplessness surrounding suicidal ideation–people think “that’s too much for me to deal with, so I should call the professionals, because they know what they’re doing.”

    I don’t know, I feel like I’m making excuses for people here, but I’ve been on both sides of this issue–trying to help a friend with mental illness, and having mental illness myself–so I feel like I understand where this mentality comes from. Most people have no idea how to deal with someone who’s suicidal, and it often seems like a problem that must be dealt with RIGHT NOW, which can lead to some bad decisions like calling the police.

    I agree that people should be able to make their own decisions about treatment, including refusal. I even think a person should have the right to suicide. But I understand why this kind of thing happens. I’m not sure how to keep it from happening, besides getting more information out there about what to do when someone is suicidal, and what NOT to do.

  12. notemily said:

    “Most people have no idea how to deal with someone who’s suicidal, and it often seems like a problem that must be dealt with RIGHT NOW, which can lead to some bad decisions like calling the police.”

    Exactly. I’ve been there. My best friend from online, who I’ll call D, was in America, I was in the UK, he was IMing me expressing his plans to kill himself later that night, and I had no contact details for anyone who might help him.

    As I tried to talk him out of it, another UK friend of mine who was also online began, at my request, Googling depression/suicide helplines in America and phoning them to see what help there was there. And it did no good whatsoever.

    Most of them couldn’t understand her accent (a regional one probably not heard much on American TV). And the one helpline operator who did understand her, took a call from abroad and the involvement of the internet as signs that the situation was either not that serious, or a practical joke, and he didn’t engage with her helpfully. Nowadays I think the reaction would be different: everybody’s on the internet, and it’s not seen as some nebulous other-world but as a place where real people post meaningful, true things that reflect their intentions/state of mind.

    At this point, D said he had to go offline and gave the impression that his suicide was imminent. I agonized briefly, aware of some of the potential consequences (but not all of the actual ones), and called the police in D’s town. They, for the record, had trouble with my accent too. I had to resort to spelling things out. But they took my call seriously and said I could call back later to find out the outcome. The outcome was major for D – he was able to deter any police action by telling them he was safe and wasn’t going to kill himself, but the police went to his home and work, so he had people in his face in both places. And for all that I regret that, I acted in the only way I could live with.

    I’d love to know what all the people crying, ‘bad friend, bad person!’ would actually have done in my shoes. Waited? Taken the risk that he might kill himself?

    And I notice in the overall debate a generally uncontested but massive assumption that every person who hears ‘I’m going to kill myself’ or ‘I’m feeling like I might want to kill myself’ is TAB and acting from TAB privilege and only from TAB privilege. This was not true in my case (anxiety, depression, chronic physical health problems). Nor, I think, in all other cases: vulnerable people gravitate to each other and some people hearing ‘I may/will kill myself’ will also have been depressed or suicidal. And that doesn’t mean they’ll magically know the right thing to do, or whether or not the other person is really at risk of doing it.

    And… in the years since, I’ve kept quiet about certain mental health things when I desperately needed to talk, because I was afraid of what other people would do, who they’d report it to. So I’ve seen this thing from both sides and it has become no less intractable for that.

    One more important thing.

    In the last ten years or so, I’ve read a lot of advice from mental health organisations and helplines about what to do when someone is suicidal. And the one message that they repeatedly drummed in was: (paraphrase)

    “There is a pervasive and dangerous myth that people who talk about suicide never act on it. That it’s a ‘cry for help’ or ‘attention-seeking’. THIS IS NOT TRUE. You can’t treat it as less serious just because they’re ‘only talking about it’. You should act on what they’re saying.”

    And that was absolutely in my mind when I was in that situation, but it’s utterly counter to what many people in the social justice blogsophere have been saying. I don’t doubt that either statement is true. That is to say:

    TRUE:
    1. Talking about suicide does not mean you’ll actually do it.
    &
    2. Talking about suicide does not mean you won’t actually do it.

    Those statements don’t contradict each other. Number 2, I think, is in all the leaflets and literature because for so long there was a default societal belief about suicide that people who talked about it were ‘just seeking attention’ – and thus people ignored them and they didn’t get any support and maybe there were more suicides because of that. Because people, society, wrote off the very real and serious feelings of depression and hopelessness that others were experiencing. And sometimes those feelings still get written off. Ignored.

    But… (reaching the end of my spoons/word power here)… I do realise that does not mean that we should treat every incidence of suicidal feelings as proof that someone will kill themselves if we don’t stop them. I just don’t know where the balances lies between the two approaches, and I suspect that, once again, it is very dependent on the individual variables in a situation…

  13. Hmm… I think all of this frustration thrown toward these individuals should be targeted to the lack of resources for mental health in our society. I have had a close friend commit suicide, so I can understand how his friends would be desperate to help him but would be unsure of the next step to take. If this guy did commit suicide, all the tables would be turned, and people would be outraged that his friends did nothing. We see this all the time in the media: condemnation of people who avoid the “warning signs.”

    Here’s the deal: we don’t have avenues or resources for friends or family members who are concerned in the real world. In college, you can go to your RA or the counseling center, but after that, there’s very little available. I’m not sure what these services would look like. I know Suicide Hotlines exist for the individuals, and that the friends can encourage the individual to call it, but otherwise, we have nothing. We are cutting mental health services left and right, so friends who want to help their friends have nowhere to go. We don’t talk about mental health in a positive or productive way, so people have no idea how to support their friends. It sounds like these friends are trying to reach out and support the people they care about, but unfortunately we have been given no tools to do so appropriately. While I agree that their actions were more hazardous than helpful, I think the culprit is society’s lack of resources and education about mental health for families and friends.

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