Friday, September 25, 2009

bad habits

He walked in and sat down in a heap. He looked forlorn, again. This was his second session. He came last time telling me how terribly depressed he was, and he was right, he was. He had been for years.

He had started on medication about a month ago, and he said that he could feel that the medication was helping a tiny bit. He felt that some of the pressure in his chest was lighter. That was good.

But he said he was still miserable -- the foreclosure, his alcoholic father who was now dependent upon him, has wife's sometimes unstable medical condition,and worries about how long the company he worked for could last.

Then he said again, that he cannot remember a day since he was ten years old, when he had not at some moment, thought about committing suicide. Now, he's thirty-four. He was a bit fearful of how I would react. When he told this to his doctor the man had made him promise that he wouldn't kill himself until he was the psychiatrist, and the psychiatrist then sent him right on to me. He was afraid I would send him to a hospital and he didn't want to go.

But I just shrugged and told him not to worry to much ( of course, he worries all the time). Those suicidal thoughts are really just a bad habit. Your mind works like that. You run into a problem, you feel a negative emotion, or a bad thought pops up, and that feeling becomes tightly associated with other thoughts you have had in the past when you felt like that. The more this happens, the stronger the link becomes. Really, it's like taking out a cigarette when you have a cup of coffee, or thinking about sex when your girlfriend closes the bedroom door, or wanting a beer when they announce the starting line-ups. It's operant conditioning.

This guy sees a bill in the mail and then thinks about killing himself. It's a habit. It's a bad habit, but just a habit. If he hasn't done anything rash for twenty-four years I'm not too worried that he will now.

Still, I hope he shows up next week.

Sunday, September 20, 2009

heath care rant of an old psychologist

I put the follwoing rant up on a psychologist bulliten board. I thought I would put it here too.

(rant starts here)

It looks like the Senate Finance Committee has delivered its version of the Heath Care Bill, and guess what …. We, as a nation, and psychologists as a profession, are f**ked. Not a big surprise.

The Senate version does not have a public option. Max sold out to the insurance and drug lobby. The Republicans are against a public option. They say that government can’t run anything well and they don’t want to trust their medical care to the government.

They have a good point. Here in Mass, where we have health care for almost everyone, many of the subsidized people are getting moved off of the usual Medicaid program and on to a new, more bare-bones plan. The plan is low-cost, with high deductibles and high co-payments. And guess what, mental health services get paid less, much less. And guess what else, they have carved out the mental health services to a managed care company from Dallas. So, what’s new there? Nothing.

America has a great deal of trouble finding a way to provide health care to its citizens. In my small mind there are three major reasons for this:

1. Too many people are making money on health care and they don’t want to stop. In most other countries doctors makes less, hospitals are run more efficiently, and not as a business, and no one financially benefits from asking for more tests, owning stakes in MRI labs, giving out the pills of certain pharmaceutical companies, running a nursing home, or using people’s illness as a ticket to leveraged riches.
As a note to this I need someone to explain to me how private insurance is allowed to sell policies to young, mostly healthy people, and to make a nice profit on them, and then, when they are old and need much more costly medical attention, they are then put on the government’s dollar, on Medicare.. Of course Medicare runs a deficit. They have all the old and sick people. The young people send their money somewhere else.

2. Americans hate to pay taxes. They feel that every dollar they acquire, through work, dividends, inheritance, lottery, poker, cheating, stealing, or lying, is their money, and they don’t want to give much of it to the government. Of course, the government should provide the infrastructure, should keep them safe, educate their children, blow-up all possible enemies, subsidize farms, banks, unions, scientific research, mortgages; keep air and water clean; save the fishes, worms and birds, and do anything else the population may need to make money and stay healthy. But no one sees a need to pay taxes.
Look at California. They approve of many great programs, for science, education, the environment, and many more BUT they don’t approve any money to pay for it. So guess what? They are bankrupt.

3. Too many people, and too many businesses lie. They probably always did, but now with constant, total communication, it just seems to be pervasive. I don’t believe any advertisement. Whenever I see something on TV, on a web site, or if someone is selling me something, I believe the opposite of what is being said. Perhaps I am old and cynical, but doing this has saved me a great deal of money and aggravation.
I have come to believe that we now live in a culture that accepts this. We don’t expect anyone to do much of anything that is not directly in their own best interest. We don’t want to see this country as a cohesive society. And we certainly won’t give a dime to an “alien.” It was not always this way. But once some people and some businesses began to take advantage of other’s good intentions, it became clear that unless you got tough and suspicious someone would take advantage of you. So people learned.
So many psychologists are good caring people, doing as good a job as they can with the limited tools at their disposal, and guess what? Most of us, who are part of the system, have not gotten a raise in fifteen years. Now, as a reward, we will get paid less, no matter how this turns out.
I think Mr. Obama made a sincere effort to change the system. I think at times he may wonder why so many people deserted him when he thought he was doing what they elected him to do. I’m sure he can’t understand why people are more willing to pay $900 a month to a for-profit company, when they could probably get similar service by paying $400 a month in taxes. But, as I said, they won’t pay taxes.
We will inch forward. We will probably find a way to make sure that people with existing illness can get coverage, and that even if you don’t have a job you can find a way to buy health insurance, even if it is a lot of money for a not very good plan. Yet, in truth, this is progress.
Anyway, soon I will be on Medicare. I don’t want the government messing with my Medicare. And “death panels” don’t scare me. When the time comes I’m buying a Harley.

(rant ends here)

Tuesday, September 15, 2009

A month away

I guess I have not written anything her for a while. It doesn't seem like blogging is the thing any more. Most people are on Facebook and Youtube. Blogging requires too much reading, takes too long; taxes the brain having to decipher all those squiggly little symbols. Then, once your have figure out the words, you have to look for ideas and concepts. It's easier to just watch some guy slide down the mud into the water. The concept is clear.

But there I go, getting cynical again.

Maybe its because I came back from vacation and have gotten at least ten calls from new people wanting to come and tell me how their lives are falling apart. That is not what bothers me, what bothers me is that our state doesn't want to pay for it. They don't want to pay the co-payments for the people who have state insurance, and they want to put people on a new insurance plan that will cut my reimbursement rate by 25 to 40%. It all makes me feel wanted, but not valued.

So, if there is a "public option" it is pretty clear we will get screwed. Then again, if there isn't a public option, we are getting screwed already. Most insurance companies have not given us an increase in 15 to 20 years.

Otherwise I have been busy. Since it is clear that I will get old, but not rich, listening to the amazing and creative things that people will do to each other, I have begun to spend some of my limited free time seeking new ways to amuse myself. So far this has proved to be the metaphorical equivalent of building a 2% scale model of the Sydney Harbour Bridge using only plastic straws from Double Ds. My early attempts have fallen down a few times, but recently it seems that I may have a shot at getting it to stand.

It is a long process, but I will let you know.

I hope you've all been well and enjoyed the summer.

I get parts of my eye replaced in three weeks.