Not That Good

It's pretty clear to me now that I am in the process of winding down my practice.  I've been in a "private" practice in this city since 1981.  The reasons for my starting to close down and move along have been discussed here in several ways, and will be again.  But not today.

But, I have been looking back as well as forward and I can see that having a practice like this as mostly what I wanted to do.  My first choice would have been to be part of a real community mental health program, such as the one I was sent to school for, and where I had my first job.  These were places where people could go for evaluations and treatment of social, emotional and learning problems, and also for neighborhood problems and community issues.  We were just learning how to do preventive work, educational work and consult with other agencies when President Reagan decided that this sounded like Socialism and his government wouldn't pay for those things.

So, we got licensed and went into private practices and then we got paid by insurance companies.  That model was good for treating the kind of problems people brought to us, but  treating them one by one, which was often kind of frustrating, since many of them really were caused by what was happening in the community, or society at the time -- still true.

Also, looking back I can see how successful I was at treating people with relationship difficulties, with anxiety and panic problems, with many forms of depression, with loss, loneliness, addictions, and many of the other things that disrupt and deplete people's lives. Often that was very gratifying.

But we, mental health professionals: Psychologists, Psychiatrists and all the others, still have very little  success treating the real destructive kind of "mental illness," the kind that rips families and communities apart.  That is we offer very little help to the person who is angry, obnoxious, aggressive, upsetting and destructive.  These are people who get about six diagnoses during their lifetime, including Borderline Personality, Major Depression, Bipolar Disorder, Antisocial personality, Oppositional Disorder, and other such names that don't identify an underlying cause as much as they are just descriptive.

We offer these people many medications, dialectical behavior therapy, cognitive behavior therapy, and many other kinds of treatment that don't work, mostly because the people don't attend, don't follow, get angry and frustrated easily and leave.

There are many people who are afflicted, if that is what it is.  They bring heart-break and havoc to their families, they take too many drugs, make bad decisions, and cause problems in the community. I feel, that because so many of the tasks required in today's society are complex, and demand much more interpersonal interactions, and at a quicker pace than previously, that more people break-down and reach their breaking point.  Then they get angry, stop functioning, don't pay their bills, get in arguments and fights, and end up either in legal trouble or in bed for weeks. When they get out of bed they are further behind, angrier, and cause more problems.

I have seen many for therapy, and then they don't return.  I hear about so many more because their families suffer come to me for help.  They don't know whether to try to help or cut ties, and neither strategy is successful.

It's very sad.  We have all kinds of labels, but no real treatment.  The cause is probably a combination of genetics, family, community, timing, diet, toxins and luck.  But then what?

That is the real problesm in mental illness, and we don't have a clue.