Tuesday, August 18, 2009

More Diagnostic Troubles

Last time I mentioned how getting labeled, getting a diagnosis, is often part of the problem. It gets people into the mode of thinking there is something wrong with them. Often when people know their diagnosis they begin to feel that have something that needs special treatment and they can't fix it themselves.

Well the American Psychiatric Association is in the process of writing the new edition of their Diagnostic Manuel. The is one of the few branches of medicine that gets to make-up and then vote on whether something is a disease that needs them to treat it.

Some of the new categories being considered are "shopping addictions. internet addictions, excessive sex balanced on the other end by apathy, and also prolonged bitterness.

This sounds like a bunch of 60 year-old, pissed-ff psychiatrists who want to label 75% of their own 18 to 29 year-old children as having some kind of brain disorder. Who spends most of their time on Facebook, shopping, having sex, not looking for work and being angry at their parents. Almost everyone!

I guess that would be great for business. But I don't know if Obama's health plan will cover it.

Tuesday, August 11, 2009

On the beach, a treatment plan

I'm on the beach now, taking a few weeks off from driving up to the office, spending too much time indoors, listening, grunting, mumbling, a few slight of hand tricks, you know, the usual.

Today, I was standing in the water, up to my knees, just kind of taking it slow. A friend comes up to talk to me. Friends are important in keeping the mind going. I like friends, at least a few of them.

She begins to tell me about the daughter of a friend of hers. The kid is nineteen, anorexic, depressed, sometimes lost and suicidal. "Probably a cutter, too" I added, just to show that I was listening. Yep, she's that too.

So, I was thinking, happy to be here in the water, happy that she's not on my list.

Then my friend began to describe how this young woman's parents were trying to get her into a hospital, but there are problems with the insurance, problems with the screening, problems with the girl. She has already been on and off six kinds of medication. None really helped.

What is the best plan for her? my friend asked. I answered in my summertime, mostly ironic way, so that my friend thought I was being my usual oppositional self --except that I really wasn't.

What I said was -- get her the hell away from doctors and hospitals and medicines. Tell her that she is better, and that she had to go get a job and take care of herself. Don't call her sick anymore. The label is doom. It like Wittgenstein said, the meaning is caused by the language. If you call her that, then everyone thinks she's that, and then she is that. So don't call her that.

Of course, my friend hadn't read much Wittgenstein, so she thought I was nuts. I feel badly for the young woman, but she is in the system. Unless she gets up and runs away, she's fucked.

Tuesday, August 04, 2009

What he said, but what he did...

Two weeks ago I was sitting with Paul, who was forty-five years-old and had been a binge drinker since he was eighteen. His drinking had cost him several jobs, a marriage, and his driver’s license for a while. He had been totally sober for almost two months. He is now taking an SSRI for depression and Naltraxone to help diminish his craving for alcohol. No doctor would prescribe an anti-anxiety for him because he had such strong addictive tendencies that he was a very high risk to abuse it.

Paul told me at that session that he had been running from anxiety his whole life. He had always felt that he couldn’t handle things. This was partly because his father had always put him down and he had been picked on at school. Alcohol had always driven the anxiety away. But now alcohol was only causing problems. The new medications, and psychotherapy, were supposed to help him live with and overcome anxiety and his feelings of failure. He should be able to do this. he was intelligent, caring and, when he was sober, a very reasonable person.

“Anxiety” Paul said, “is a part of life. Learning to handle it means your growing up. I am, forty-five; it’s time to grow up. There are no drugs or chemicals that can do that for you. The good thing,” he added, "is that the more you handle it, the better you feel about yourself, and the less anxious you are.”

That insight was very true, and could have come out of almost any “self-help book. The problem is that insight, fortitude, medication and psychotherapy don’t have direct access to actually changing someone’s mind. Two days later, in an impulsive moment of frustration, Paul took a whole bottle of benzos that he had kept hidden and ended up in the hospital.

That’s the way the human mind really works. So far, none of us, psychologist, psychiatrists, neurologists, geneticists, priests, probation officers, self-help gurus, nutritionists, philosophers, or third-base coaches, really know how to get in there and change it.