The Mitchell-Martha Warning
In the United States, the Mitchell-Martha[1] warning (sometimes referred solely as "Martha warning") is a type of notification customarily given by medical professionals to patients being seen for physical or other health-related issues.
During the initial health assessment, information updates, and symptoms review (“What is your chief complaint and reason for your visit today?”) with the prescriber’s MA (medical assistant) or CNA (certified nursing assistant) in the clinician exam room, (or in a hospital setting), patients and their families are advised of their right to refuse to answer questions or provide information that might later be incriminating or compromise their future healthcare.
[1] The Martha Mitchell effect refers to the process by which a psychiatrist, psychologist, mental health clinician, or other medical professional labels a patient's accurate perception of real events as delusional, resulting in misdiagnosis.[1][2] Patients may be diagnosed as delusional when their grievances concern health care workers and/or health care institutions, even when the patient has no history of delusion. "A patient arriving claiming to have been injured by another health care professional is regarded as a crazy person who potentially could ruin the career of an innocent colleague."[4]
Mitchell-Martha Rights
These rights are often referred to as Martha Rights.[2] The purpose of such notification is to preserve the admissibility of their persons into hospitals, medical clinics, doctors' offices, or urgent care facilities without prior prejudices from often uninformed, negligent, or criminally ignorant physicians, who may use a patient's current and temporary mental or emotional state to cover their own asses or explain-away why they don't know what in the actual fuck they're talking
about.
[2] Named after Martha Mitchell, wife of former U.S. Attorney General John Mitchell who served in the Nixon administration. When Mrs. Mitchell alleged (correctly, it turns out) that White House officials were engaging in illegal activities, she was deemed "mentally ill," and subsequently, her credibility was destroyed, despite later vindication during the aftermath of the Watergate scandal.
Description
HISTORY
Named after Martha Mitchell, wife of former US Attorney General John Mitchell in the Nixon administration.
Despite Mrs. Mitchell’s outspoken nature[i], “frank and uncensored talk,[ii]” her customary evening drink[iii], her penchant for snooping and eavesdropping[iv] — generally her disinclination to be a “pretty-little head”— along with her ability to metaphorically “add two and two[v]” while rifling through her husband’s official papers, she was not, in fact, a drama-loving, hysterical loon, and the language used in a Martha warning is derived from the 1975 admission by former CIA “spook,” James McCord, who admitted, as reported in the New York Times, that Martha Mitchell’s account of being kidnapped was true.
[i] See Nasty women, Martha the Mouth, The Mouth from the South (aka: if you have a vagina, then NO: intelligence, senses of humor, “fun” personality, informed opinions, or thinking allowed. Not ALOUD, allowed. Nice try you clever-ish MD.)
[ii] DSM-5 Bipolar I Disorder Manic Episode B. (1) Inflated self-esteem or grandiosity (3) More talkative than usual or pressure to keep talking (aka: arguing with prescribers or nurses and using multisyllabic words that only they’re supposed to know. Like “hypomania.”)
[iii] DSM-5 Alcohol Use Disorder (AUD): 2. Wanting to cut down or stop using the substance but not managing to because your crooked AG-husband’s going to jail. 3. Spending a lot of time getting, using, or recovering from use, of the substance (DC traffic in the evenings — “just horrid, and the liquor stores, why just busy, busy, busy!” according to Mrs. Mitchell) 6. Continuing to use, even when it causes problems in relationships. (“Works better than ‘I have a headache, John!’” - Martha Mitchell, clip, courtesy Laugh-In, June 3, 1970, ABC)
[iv] DSM-5 Schizophrenia Spectrum and Other Psychotic Disorders A. Characteristic symptoms: (1) delusions (2) hallucinations (3) bizarre delusions (not to be confused with common, normal, ordinary, reasonable, sensible, standard, or usual delusions.) B. Social/occupational dysfunction: Well, her husband certainly taught her a lesson about opening her yap, didn’t he? And all of her best friends wouldn’t return her calls. But to be fair, their husbands were being indicted, so obviously, Martha didn’t take it personally.
[v] DSM 5 Narcissistic Personality Disorder A. (2) a. Empathy: Impaired ability to give two shits about how doing the right thing would affect her husband, and you know, the crooked-ass government of the United States of America at the time, the selfish $*#&. Oh, sorry, she’s “mentally ill,” is it now? Yes. #EndtheStigma B. Pathological personality traits in the following domain: 1. Antagonism (omg, is the DSM-5 projecting onto….ME?!?!) a. Grandiosity: Feelings of entitlement (so feeling like not being kidnapped, maybe?) either overtly or covertly (pretty sure it was a covert-op thing, not an overt-op thing.) self-centeredness; firmly holding to the belief that one is better than others; condescending toward others. (Also see bipolar disorder, intelligence, self-awareness, well-bred insolence, and wit, specifically if you have a uterus) b. Attention[sic]*seeking (*so there should be a hyphen there, but there isn’t, NYU "edu dept. of philosophy," so, the grandiosity-thing (above) doesn’t apply here because, for the record, I, J.A. Carter-Winward, don’t think I’m better than others, but I’m clearly better at hyphen-usage than you. Yes, that means I am being condescending( toward certain types of medical professionals.) That means I’m talking down to you. And for another record, grandiose is saying something like "I am the greatest writer there ever was." So, self-confidence is more... "I'm a good writer." And much of the time, "good" and "prolific" are inter-fucking-changeable. FYI. Oh, and I don’t want your attention. In fact, I would love it if a few of you would retroactively go back in time and fuck yourselves. But one mustn’t get lost in magical thinking, must one?
Modern Use
The specific language used in the warning varies between HMO’s, but the warning is deemed adequate as long as the patients’ rights are properly disclosed in large, bold print instead of 6 pages of fine, tiny print they can’t read, and requisite initialed release forms to protect and cover (CYA)MD-ass rather than the person paying their fucking salary’s ass.
The possible ramifications of a waiver of those rights by the patient should be made abundantly clear so that they are knowing, voluntary, and informed of all the ways they can, and may, get roundly fucked if they disclose any personal, non-medical information without being properly Marthinalized.
For example, the warning may be phrased as follows:
You have the right to respectfully decline questions irrelevant to today’s doctor visit unless we or the prescriber explain the relevancy, and disclaim any/or possible misdiagnoses in your chart, but not to your face, using the “pull out of our asses technique” we learned in one, single chapter in med school about “problem patients.”
Remaining silent is in no way suggesting assent to any irrelevant questions (“Have you felt blue or sad most days? Hm, cat got your tongue? All righty, that would be a ‘yes,’ then.”) Anything you say cannot be used against you in any other medical setting, especially when the doctor, prescriber, nurse, the wheelchair-pusher person decides, based on your “presentation” that you’re “doing it (whatever “it” is) wrong” because they have a cousin, are in med school, they know how to Google, or they’ve worked there for years or are a respected _____.
You have the right to talk to a MEDICAL ADVOCATE for PATIENTS [3]for advice before we medicate you, diagnose you, take away your driving privileges, ruin your reputation/future medical care on your medical chart, and/or recommend any course of treatment that involves pharmaceutical kickbacks or publication biases. You have the right to have an MAP with you during any or all parts of your consult and exam, and they will be an independent patient advocate who keeps up on the latest research and medical science to bridge the gap between “what we knew when we graduated from school” and what changed in medicine literally 5 minutes after graduation from the former education system, up until now.
If you cannot afford an MAP that’s okay! Insurance companies cover them, 100%, so we don’t have to worry about being sued — I mean, worry about you, the patient, becoming permanently disabled, sicker, or god forbid, dead due to our arrogant ignorance/ignorant arrogance.
If you decide to ask questions without your MAP present, we will answer, to the best of our knowledge, but will admit when we have no idea, will not engage in the disgusting “victim-blaming” we’re so fond of, and will not act like passive-aggressive assholes (i.e. “Well, if you know so much, why did you come in to the ER? Hm?” “Oh, did we attend The Google School of Medicine before today’s visit? Because I went to Baylor.” “Oh, well what a FUN study, but it’s irrelevant because ‘blah blah [doctor-ese for medical/publication bias ] blah blah.’” “No, there’s no way medications did that to you. They are safer than driving on the Interstate!” “Uh, akathisia doesn’t HURT, m’kay? It’s a little uncomfortable, but it isn’t, you know, why you’re so…well. Agitated.”) when we don’t know why you’re ill, in pain, etc.
You have the right to stop a doctor’s (our)mouths from moving and show us the newest medical literature on the bullshit we think we know about already, but don’t. And at any time, if you feel like we’re going off-track in a direction you know for a fact is bullshit, aka “psychogenic, “functional anything disorder et. al.” you may respectfully disagree and ask us to please take a leave of absence and learn our jobs. Again. We’ll vacate the premises and find a doctor or medical professional who has their “listening ears” on that day.
[3]Medical Advocacy for Patients (MAP) — An independent advocate with a medical background, preferably a disillusioned medical professional or someone who has been stripped of their license to practice medicine until they prove themselves a human being again, whose sole purpose is to advocate for Patients and their rights, who is responsible for checking contraindications for medications,, herbal supplements, etc., and who is there to balance-out the power between physician and patient until they stop saying things like “Welcome to ____ School of Medicine. Here, you will learn how to be gods.” — told to yours truly, secondhand, a “friend” who attended medical school and “swears to GOD” that is what the instructor said, first day of class, and yes, it’s in its correct context.
Iatrogenic & Pharmacological Harm Reduction
The Martha warning is part of a preventive measure against criminal and reckless disregard for patients and their rights that all medical personnel are required to administer to protect an individual who is in pain (physical, mental, emotional), who is clearly ill, or in need of actual, not “managed” care and are subject to direct harm or its functional equivalent from a violation of human rights as stated in the 5th Amendment of the Constitution of the United States against compelled self-incrimination via mental health labels and the pathologizing of being a perfectly sane person by the medical profession.
Thus, if medical professionals decline to offer a Martha warning to an individual in their care, they may question and counsel the patient and act upon the knowledge gained in cases of medical or other emergency and when not acting would be a clear violation of the Hippocratic oath. In cases where true empathy, compassion and humane actions are all that are required, they may not use that patient’s statements as evidence against them in either verbal or written records.
*end* “If the World Made Sense Pt. I”
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WELL! What a fun writing exercise this was.
It began, I’ll confess, as research for the novel I’m writing. I came upon the rights, Miranda rights and warning, to be specific, given to suspects when they are arrested. Innocent until proved guilty, is it? It is.
My FAVORITE part of reading about Martha Mitchell was this:
According to Bell et al., “Sometimes, improbable reports are erroneously assumed to be symptoms of mental illness (Maher, 1998)”, due to a “failure or inability to verify whether the events have actually taken place, no matter how improbable intuitively they might appear to the busy clinician”.
The “busy” clinician. The “everyday heroes” who show up, get paid to do their jobs, and then go home at night. Wow, heroes indeed. Because no one is as busy as the busy clinician. No one. So you know, cut them some slack if they are too busy to, you know. Do their jobs.
I’m a “highly published author” you know, and that’s “code” for bipolar, personality disorders, all kinds of nasty labels that force my husband to take time off work to come to all my very, special doctor’s appointments because he was wily enough to never get a “mentally ill” label of his very own. Well, having a penis helped.
It’s just so unfortunate he can’t bill them for HIS time. Because he’s there, in his capacity as my husband and attorney. But we don’t really flex that last one because why bother? We just want my doctors to listen to me — their patient — and it seems that is beyond their purview.
Go ahead. Read up on the Miranda rights and imagine what it would be like to walk into a doctor’s office and have a say. A SAY.
In any of it.
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**For those who don’t understand satire: The above is all fictionalized, except for parts that are not. Those parts are quite literally the most sickening. And due to the depraved indifference of the medical profession, too many of us will read this and wonder why our character is imprisoned by medical professionals; convicted and pronounced guilty of being insane just because we’re sick or in pain and they don’t know why.
With no protections, advocates, no appellate court of appeals or even possibility of parole. And absolutely no speaking up in our own defense, because when we do that, we’re in the ultimate Catch-22. We “protesteth too much.”
Funny. Who are the arbiters of sane, exactly?
Why, folks who don’t seek out help for mental or emotional problems--or trauma, because you know, they got this. They're tough. That’s who. Which means that the folks making all those decisions and in positions of authority over you, me, all of us, are either 100% mentally sound, based on their own self-assessments, they only believe they're stable and therefore, don’t need help, or they've buried their "traumas" soooo deep, why, they just think they won't ever come bubbling to the surface.
Or, you know, they go into the mental healthcare fields to sort it all out, subconsciously. Using us.
I’ll let you decide how that sounds.
Meanwhile, I’d like to pose a question to all MDs — (and I’ll admit here, I can’t include PAs or NPs in this category because these healthcare professionals, from my experience have a whole lotta heart and more knowledge-bases than most MDs I know. But that’s likely a bias. There are great prescribers and healthcare professionals on both sides of the aisle. But the rotten apples are ruining it for all of you) all right, back to the one, single question:
Please explain to me, hey, to all of us, what a "non-pathological response" to trauma looks like—specifically trauma inflicted by, or sustained from, medical professionals and/or treatments that became mistreatments.
We're your patients, remember? So we have no problem waiting—patiently—for your responses, and in fact, we're looking forward to one.
