Episode 4: Clinically Unstable

Oh no. So for those who don't know, Preston and I met in school, years ago, and we've been very close friends ever since. That's why we started a podcast! I think this commenter is maybe getting at the fact that we challenge each other a good amount, I would say. I think, you know, maybe I challenge you more, but, you know, like, sure. Sure. Yeah,

Anyways, yes, we like each other, no, there's no blad-- bad blood or animosity, you know, just a healthy amount of friction to keep each other checked and balanced. (chuckling) Okay, um... Alright, next question. Sure. This one is from Ikaros, one of our beloved Patreon supporters, they asked, "Daphne, would you be able to give us some context for the time we skipped over last episode?

There were weeks or months between clips, and I'm curious if there's anything we missed with that, especially in regards to Hazel's antidepressants. Love the podcast!" That's a great question, thank you. Ikaros. So, Hazel was on a whole bunch of different tricyclic antidepressants, and-- Oh,

Interesting, huh. Yeah, I hadn't named them all because, frankly, those notes are kind of boring, and from what I can tell, they're not medications that are really used anymore, so-- Well, you know, if I can speak to that for a moment-- You see, tricyclic antidepressants are really interesting because they were very effective.

Sure. You know, the--the common belief is that the meds we don't use anymore are out of circulation because they didn't work, but TCAs, which is just the abbreviation, worked very well. You know, they work sort of the same as SSRIs, which are what we use now, But TCAs had a tendency, you know, as we witnessed with Hazel, to cause some pretty, intense side effects.

Oh, fascinating, so, wait, is it possible that the reason Hazel felt so bad isn't because she didn't have depression, but instead because the meds made her feel so bad that it was genuinely better not to be on them? Uh, no. I mean, no, they were effective, but, like, you know, clearly not for Hazel, you know, which means she likely didn't have depression. Um, anyway, I interrupted. Um, here, you can go ahead and answer the question.

Oh, right, so, um, most of the clips from that time period were, like, honestly, pretty lackluster. I tried, when I was selecting journal entries and clips, to make sure

I was showing you guys the actual important stuff, and Hazel sitting there talking about a headache and Doctor Burnett taking notes about it wasn't very important, in my opinion, but more of those materials will be made available over on our Patreon at the end of the season, as per usual! (panting) Okay, last one is kind of a sillier one.

Uh, so, if you were tuned in last week, you'll know that Daphne brutally shamed me, a gay man, for never having a girlfriend. (chuckling) So, Holly, another one of our Patreon supporters, asked "Daphne, have you ever had a girlfriend?" (laughing) Holly, are you flirting with me? My DMs are open. (laughing) No, but like, in all seriousness, I don't-- I don't really want to talk about my personal love life on the show, but, like, uh... it exists. Uh, yeah, I'll say that much.

All right, that's it for Mindful Musings this week. If you have questions for us, comment them wherever you find us on the internet, and we might just answer it! So, getting into this week's topics, we were going to discuss Doctor Burnett's psyche a bit more. Mhm, so we haven't touched on this much as of yet, so what do you, or --what if-- have you gathered up until this point? Well, you know, I've touched on a couple of points that I think are worth mentioning again.

You know, I think that Doctor Burnett, as one of the first female psychiatrists of her generation, probably had something to prove, and therefore saw, Ha-- you know, Hazel, as a puzzle she needed to solve.

You know, I'm not saying that's the only way she saw Hazel, but I think that is a facet we have to consider when we're talking about Doctor Burnett. For sure-- I also think that, Doctor Burnett does, to a certain extent, allow her personal affections for Hazel to get in the ways of codes of conduct and common policies.

You know, I don't think we know what this asylum's policies were-- No, we don't have that-- --but I think we can safely assume, based on Hazel's journal entry about Doctor Burnett, you know, doing things she wasn't technically supposed to be doing, that there were several violations of those policies. And, I mean, that's why we're studying this case, right? I mean, we know things went off the rails, but I'm interested in what prompted Like, Doctor Burnett to go against hospital policy for Hazel.

You know, there's no evidence that she did that for any other patient. There's no evidence that, you know, she ever poured this much time and care into another patient. What about Hazel intrigued her so much? I think that it's-- It brings me right back to that idea that Hazel is, to a certain extent, an intellectual problem that Doctor Burnett wants to solve.

You know, I mean, right off the bat, she dismisses Hazel's previous diagnosis of schizophrenia, then they spend, you know, how many months testing different antidepressants? Before dismissal-- before dismissing that diagnosis as well. I think Doctor Burnett got a thrill out of this, and didn't necessarily want it to end. (breaths out) You know, Okay. Um, yeah. On that note, let's get into our first clip. So this takes place in April of 1952, a couple months later. So at this point,

Hazel is not on any medications, and does not have an actual diagnosis attached. (click) (chuckling) You know, Hazel, I used to steal money out of my mom's purse to buy lipstick. Really? (chuckling) Yes.

Except I didn't want her to see me wearing her new lipstick and wonder how I bought it, so I just bought the same three shades over and over. (laughing) She had this routine of falling asleep on the couch around 8:00, after she'd clean up dinner, so I'd wait until she was snoring, then go to her purse, and take out the small bills. The trick was to do a little at a time. A couple of coins here and there, she'd never think twice about.

I think she thought they'd slipped out of her coin pouch at the store. God, I'm so glad I'm never having kids. (laughing) Me too. Oh, well, the real kicker, my first paycheck when I was a resident, I went out and bought her a lipstick. But she didn't know why I was buying her lipstick, so then I had to explain it to her. (giggling) She chased me out of the house. (laughing) Audrey! Did she ever forgive you? Oh, I'm sure, on her deathbed.

She was a good mother like that. (humming) I like seeing you smile, Hazel. (click) (breath in) Do you mind if I start? No. Go ahead. I'd just like to dig in for a moment, into why Doctor Burnett is trying so hard in that clip to make Hazel laugh. Mm. You know, I think it could be a couple of things. You know, You know, circling back, for a moment, to the idea that she may have had something to prove, you know, I think there's maybe something here about Doctor Burnett needing

Hazel to like her. Yes, you know, Doctor Burnett would have had something to prove to her colleagues, but doesn't she also have something to prove to her patients? You know, doesn't she have to convince her patients that she is capable of making them smile again? Uh, I think that-- Alternatively, it's possible that this is a technique that Doctor Burnett is using.

You know, in in an attempt to pull Hazel out of her shell more, you know, to encourage Hazel to share more information that could help lead to a diagnosis, you know, Doctor Burnett is sharing something personal, you know, very personal - vulnerable even - to create the feeling of a safe space.

Then she makes Hazel laugh to disarm her, and it's the perfect recipe to encourage Hazel to share, you know, maybe even overshare, in an effort to learn something that could be helpful. Hmm. (exhales) I'd like to take a stab at a psychological theory here. Oh, yes, please. So it's just-- I've heard this word, and-- and I think it could be relevant here. Yeah, absolutely, go for it.

I think what Doctor Burnett is doing here is a behavioral term called, you know, and I don't know if you've heard of it-- Oh, I probably have-- --called "flirting." (Daphne cracks up, cackles) Ha ha, very funny. If we're ready to move on, I have a passage from Hazel's journal I'd like to read. (pages flipping) Alright, sure. "I think Audrey and I might have something real.

We can't tell anyone about it, for if they knew two women were taking late night strolls through the courtyard, I don't know what would become of us. But the stroll we took last night, just the two of us, was the most alive I've felt in years. It was perfect. It was a full moon, so it was beautifully lit up, and there was a breeze, so Audrey had brought me a blanket to wrap around my shoulders. We walked, and talked, and then we sat under the oak tree.

She put her head on my shoulder, and told me she's never liked a man the way she likes me. It was a wonder I could hear her over the sound of my own heart pounding. We sat like that for a while, then she kissed me again, and I... don't know how to describe it. In some ways it feels very wrong, but at the same time... nobody's ever cared for me like she does." So that definitely goes against some policy or code. It does! I think it's so romantic.

A moonlit stroll in a courtyard? Like, are you kidding me? So, does Hazel say in her journal entry who invited who on the stroll? No, but, I mean, we can safely assume it was an off-the-record discussion, right? I mean, yeah, clearly. You know, I think it would have been-- it had to have been Doctor Burnett propositioning her, you know? Like, like, Hazel couldn't have left her room on her own, and when have we ever known her to ask favors of anyone?

That's true, but, well, like, what's your point? I don't know that I have one, you know, I just think it's worth looking at the relationship from all angles. You know, I think as the more, for lack of a better word, "credible" between the two, Doctor Burnett certainly has more freedom to pursue Hazel, you know. I kind of wonder what prompted her to take Hazel out for that stroll. I mean, Hazel was off any antidepressant at this point, and clearly not actively in a depressive episode.

But also, hadn't those walks been part of, like, her treatment? I mean, it could have been that Hazel just had a bad day. I mean, that's possible for sure. Or again, that behavioral term, oh, what was it again? Okay, okay, I see your point. Are we ready for the next clip? Yep. (click) How are you doing, Hazel? (pages flipping) I'm doing pretty well. How are you? I'm good. I've been a bit busy. Busy?

Well, my birthday is in a couple weeks, and I don't like to make a big deal of it, but my dad's on my case because we didn't celebrate last year. Which day? Oh, it's the 24th. That's coming up quick. Yes, it is. Oh, and I can't get you anything. No, Hazel, that's okay, you don't need to buy me presents. I know, but... can I do anything to make that day special for you? No, don't worry about it, Hazel. But I want to. It's okay.

I won't even be in on the 24th, I'm taking the day off, so you won't see me. What? Why are you taking the day off? I know that it upsets your routine a bit, Hazel, but-- Last year you were here on your birthday, weren't you? I-- Yes. Hazel-- Is it that bad? To be here with me? (crying) (click) Oof. Yeah. Oof. It's rough. There's, um... a lot to unpack here. Before you start, (pages flipping) I think you'll want to hear these notes from Doctor Burnett. "Hazel has withdrawn.

For periods of time, she appears to be non-verbal, seemingly incapable of speaking even if she wants to, and for other periods of time, it's clear she doesn't want to speak to us. Nurse Amelia has noted several instances where Hazel has been so focused on painting or reading that she refuses food for a full day, until she is experiencing hunger pains, and is impatient and irritable while waiting for a rushed dinner. Hazel has also been heard having long bouts of weeping."

Then the couple next sentences I just couldn't decipher, it's just total chicken scratch, but then... (clears throat) "I hypothesize that Hazel may have a disordered personality. Her symptoms and experiences seem to align with the diagnostic guidelines for emotional unstable personality disorder. Assessment appointment is scheduled for next Friday, in the hopes that this episode subsides before then." So, the next Thursday in question... It was the day after Doctor Burnett's birthday. Thoughts?

Uh, yeah, just, give me a moment, I'm just trying to put my thoughts into words. Sure. I think that Doctor Burnett is, quite frankly, grasping at straws. Okay. Oh? I mean, you know, I guess for the time, this was maybe a sound theory, but there's no such thing as emotionally unstable personality disorder these days. You know, I'm not sure specifically what she's referring to, then, you know, in terms of diagnostic criteria.

I believe emotionally unstable personality disorder,- was renamed histrionic personality disorder, you know, which is characterized by extreme, you know, attention seeking behavior. Oh, so not Hazel's vibe. I mean, like I said, a couple of weeks ago, it could be borderline personality disorder, which might be what emotionally unstable personality disorder is called now-- You know, take a shot every time I say personality disorder. (laughing) --but I just don't know about this diagnosis.

I have a theory here. Yes? So, I did a bit of research when I read this entry, because I hadn't heard of emotionally unstable personality disorder before, and I found out that the treatment for it is to lobotomize-- Which, for our listeners at home, is a treatment that is literally just damaging the brain. Yeah, exactly, But it couldn't be performed without the consent of Hazel's husband or parents. Who, as we know, were both dead.

Correct. So, I wonder if Doctor Burnett was attempting to diagnose Hazel with something that didn't have a viable treatment option. There weren't, and-- and I think still aren't, but you can correct me if I'm wrong, any medications that can treat a personality disorder, really. Like, sometimes they'll prescribe, like, an antidepressant or something, but-- but that'-- Yeah, that's kind of it. You know, the main treatment for personality disorders, you know, is therapy in most cases.

And the modalities used now, like DBT for BPD, hadn't been invented yet. Yeah. I mean, so why wouldn't she want Hazel to have viable treatment options? So that Hazel doesn't have to go through more of it. She saw how hard it was on Hazel's spirit to be on and off different medications, and the next treatment the hospital execs would be using is to lobotomize, but there's no way to do that if Hazel doesn't have anyone to consent for her.

So, you know, it's basically a license for Hazel to live her life without further medical trauma. Hmm. Maybe that's why the diagnosis seems off to you. You know, I don't know. Maybe, I'll have to think about it. Well, in the meantime, why don't we listen to the next clip? Alright, sure. (click) Hazel, did you hear what I said? Hazel, I can't leave until we talk. If I leave before we talk, the higher ups will be upset, and I don't know if they'll keep me around.

I'm held to a different standard than the other doctors. Okay. Thank you, Hazel. You haven't been very talkative for the last few days or so. No. Why is that? I'm not in the mood to talk. Is this about my birthday? I've been painting, so I've been too busy to talk, really. What have you been painting? The sunrise. Courtyard. You. Me? I was going to paint you a nice portrait, for your office. As a birthday gift. But you didn't want anything for your birthday, not from me.

Hazel, that's not what it is-- Don't lie to me. Don't I get punished enough? That's not-- Never mind. You don't get it. None of you do. Let's wrap it up here, for today. (click) Welcome back, everyone. I think I'd like to keep discussing that personality disorder thing. You know, Sure. As I said earlier, you know, emotionally unstable personality disorder, it doesn't really exist anymore, you know, it's-- it's not a thing. Mhm.

So, we've talked about borderline or histrionic being potential diagnosises for Hazel, if she were, you know, being treated in the modern era of psychiatric medicine. I did take another look at my books on personality disorders-- But during the break, In the ten minutes? Well, I mean, I just, you know, needed my memory jogged, you know, and-- and I kind of wonder about the schizophrenia diagnosis.

Now, the DSM, which is a manual that classifies many disorders and illnesses, including personality disorders, wasn't published until 1952, so I wonder if Doctor Green and Doctor Burnett had just never come across schizoid personality disorder. Oh, okay, what's that? Well, I mean, it's usually a pattern of detachment and anti-social behavior. Something like 40% of people with schizoid personalities end up with schizophrenia later on, too.

I don't know, I think Hazel very much wants to connect with others and just, like, struggles. Which brings me to my next theory, dependent personality disorder. Basically, someone who is, like, clinically clingy. Oh, um-- Usually they rely on others to fulfill their needs, you know, both emotional and physical. I think that it was probably difficult for Doctor Burnett to pin down-- like to pin down anything in particular because, well, you know, it was the 1950s. Okay,

I mean, like, homosexuality was considered a mental illness for years, right? Mhm. Oh, yeah, for sure. I don't think she was working with very much. Well, you know, and honestly, how much have we advanced since then? Psychology has made huge strides in the past, like, what, you know... 70... 70 years? Yeah, 70 years. You know but-- but I see your point, you know, like, I mean, it's that paradox, right?

If the-- if the human brain were simple enough that we could understand it, we'd be too simple to understand it. Hm? Uh, anyway, yeah, you know, I think it's possible that Doctor Burnett just didn't have the right research at the time, you know, to accurately diagnose Hazel. I also do think that it is possible that Doctor Burnett may have had a personality disorder herself.

You know, something like obsessive compulsive personality disorder, which might explain her intense focus on solving the issue of Hazel's mystery illness. What? Okay, I-I could see that. Go for it. (click) (Hazel crying) Next clip? All right, Hazel, honey, here are the oil paints you needed. Thank you. Of course. Can I get you anything else? Tea and cookies, maybe? No, I'm not in the mood. (Nurse Amelia sits down) Do you want to talk about it, honey? I can't tell you anything. What? Why not?

I can't say. Well, I have something that might cheer you up a bit. (footsteps) (door opening) Hello, Hazel. Aud-- My goodness, Doctor Burnett! I thought you were taking today off? I am, see? No slacks. (giggling) Would you go get ice cream with me? For my birthday? Oh my God, yes. Happy-- Happy birthday! Yes. Here's some fresh clothes. Why don't you go get changed in the restroom? Alright. (walking away) (door opening and closing) Thank you, Nurse Amelia, for helping me with this.

I know you're sticking your neck out. Well, anything for Hazel. She's a sweet girl. She is. And she really benefits from outings. It's not good for someone to be cooped up for so long. Mhm, she does so much better with just a bit of sunshine and fresh air. Besides, I think she deserved a good day. I don't know what you heard-- It's all just talk, Nurse Amelia, I wouldn't worry about it. I don't know where she would go. She's not going anywhere. (breathing out) You're right. No use in worrying.

She's happy today. She is. You're a good doctor. You're a good nurse. (door opening) I'm ready to go! And don't you look like the picture of spring? (giggling) Come on, let's slip out before anyone sees us. Yes, go! (click) Hmmmm. Hmmm? Hmm. So, Daphne, do you know what Nurse Amelia was alluding to near the end there? Right, yes, I believe she's alluding to the talk of the asylum being converted into a nursing home, which, as we know, never ended up fully going through. Right, right, okay.

So, she was worried about Hazel being kicked out of the facility soon. Mhm. Okay, okay. Um, you know, well-well, I think that it's kind of Doctor Burnett to try to, you know, give her an outing, you know, treat the source of that moody episode Hazel was going through. I agree. And, you know-- and I think technically, this counts as their first date, and it's just-- Yes, I mean, this is definitely a milestone in that relationship.

I think we can see perhaps, you know, how Doctor Burnett managed to sneak her away for good, if it was seemingly really easy to sneak her out for an afternoon. But there's something really interesting here in the way Hazel just perks up, and the way Nurse Amelia knows that it's because of Doctor Burnett, even though she didn't-- well-- well, I'm assuming she didn't know about their affair. Yeah, maybe. No, Nurse Amelia didn't know. We'll get to what Nurse Amelia thought was going on, though.

Ah, okay. I just think that was so sweet of her, though. Doctor Burnett never mentions this in her journals, but I think that this was a bending of the rules. My understanding, based on the files I received, is that Hazel was permitted 1 or 2 outings a year, but rarely received them. So I think this was an effort to squeeze in an extra one. Hm, that's interesting. So Nurse Amelia was kind of sticking out her neck, you know, especially since-- Doctor Burnett was off the clock.

Hmmm. Well, you know, I can't wait to delve into more of this. Me too. And, you know, we'll get into some of the more long term consequences of this next week... Exclusively here on "Mysteries of the Mind." I've been Preston Knight, our resident psychology nerd-- --and I've been Daphne St. Clair, our hopeless romantic. Thanks for tuning in! We'll see you right back here, this time next week. Bye bye.

Doctor Love is written and directed by Maya Appavoo, and produced by Maya Appavoo, and Monica Gate. Starring the voice acting talents of Madeline Harsh as Daphne, Jacob Martin as Preston, Abby McDougall as Doctor Burnett, and Emily Lizotte as Hazel. Additional voices by Cleo Birch. Post-production management by Monica Gate. Sound design for this episode by Ace Luke, and music by Ken Kosowick.

The full list of credits and disclaimers can be found in the episode description, or, on our website: appoova.ca/portfolio/doctorlove. Follow us on social media! We are @doctorlovepod on everything. Doctor Love is supported by the Edmonton Arts Council, and the City of Edmonton. Thank you for listening.