I treat, or try to treat, a lot of people who are depressed. Most are depressed because their lives are rotten: they are broke, they are in bad relationships, and even those end badly, their parents are/were, mean, abusive, negligent or crazy. Stuff like that. Loss, loneliness, illness, injury, all those bad things tend to add up.
When anyone gets depressed then their outlook turns negative, often hopeless. They feel that othing matters, nothing is enjoyable, nothing will help. That's what depression is.
So, when people feel that nothing will help, they don't show up for their appointments. Then I can't help them.
If they do come, I can help them. And things go well because they want to be helped, and they believe that there is hope. So, am I helping, or just being their while they get better?
If they don't come, they they have no hope and then they won't get better. Can I help that?
Dunno.
I can think good thoughts and send them their way, but it is difficult to know how far I can project these thoughts.
I can make a phone call, but who answers a phone these days.
So I leave a message.
Sometimes they call back.
Monday, November 16, 2009
Monday, November 09, 2009
more difficult social trends
Here is another thing I am seeing going on in our ever-crumbling society. It is interesting to note, however, as I continue to complain, that things have always been getting worse, no matter whom you ask, and whenever you ask it. Yet, in truth, things remain about the same. The sad thing really, is that despite all the "progress", things remain about the same. (But, consider the source here. Me; old, cynical, on the verge of being bitter, and enjoying every moment of it.)
Anyway, what I have been noticing that for many people who have graduated from college over the last five years, things suck. If they go on for more education, to become a lawyer, scientist, doctor, or in finance, then they seem to have a chance. But getting out of school with a B.A. in any of the humanities soon leads to a $25 to $35K job that has little chance of going anywhere fast.
What this seems to have led to is that there are a lot of people who live in apartments, drive old cars, and slip into fun, but tenuous relationships. This seems to be because they feel that the money it takes to settle down and raise a family is not going to be coming in the foreseeable future.
I have had several patients who are within three years of thirty in both directions, who are in relationships that last a year or two, and then they kind of move on, sometimes just by moving to another city, or by getting bored and finding someone new. They often stay friends with the old partner because nothing bad happens. But if there is not going to be a family, and there isn't much money, then the entertainment factor is easier to find in a new relationship, with a new body to rub up against and a new mind to tell the old jokes to. These kids(?) seem to dabble in music and art, and to have a decent time, but they also have the sense that their lives are stuck and that figuring out how to get out of extended adolescence is going to be difficult.
Really, it isn't their fault. They are caught in a bad time in America, when they can't even be corporate clones, and they realize that they don't want to be. Hopefully, they will create their own communities, in which they can buy and sell to each other, support their own lifestyles in new, close to the neighborhood ways, and turn the consumer oriented values upside down.
It's much more difficult for them than it was for me. I just got yelled at by old folks because my hair was long.
Anyway, what I have been noticing that for many people who have graduated from college over the last five years, things suck. If they go on for more education, to become a lawyer, scientist, doctor, or in finance, then they seem to have a chance. But getting out of school with a B.A. in any of the humanities soon leads to a $25 to $35K job that has little chance of going anywhere fast.
What this seems to have led to is that there are a lot of people who live in apartments, drive old cars, and slip into fun, but tenuous relationships. This seems to be because they feel that the money it takes to settle down and raise a family is not going to be coming in the foreseeable future.
I have had several patients who are within three years of thirty in both directions, who are in relationships that last a year or two, and then they kind of move on, sometimes just by moving to another city, or by getting bored and finding someone new. They often stay friends with the old partner because nothing bad happens. But if there is not going to be a family, and there isn't much money, then the entertainment factor is easier to find in a new relationship, with a new body to rub up against and a new mind to tell the old jokes to. These kids(?) seem to dabble in music and art, and to have a decent time, but they also have the sense that their lives are stuck and that figuring out how to get out of extended adolescence is going to be difficult.
Really, it isn't their fault. They are caught in a bad time in America, when they can't even be corporate clones, and they realize that they don't want to be. Hopefully, they will create their own communities, in which they can buy and sell to each other, support their own lifestyles in new, close to the neighborhood ways, and turn the consumer oriented values upside down.
It's much more difficult for them than it was for me. I just got yelled at by old folks because my hair was long.
Friday, November 06, 2009
The sound and the fury
Another week blows by. All kinds of stuff. Stuff with the family: one kid bought a new house; another had an operation. We are hoping for more changes to come.
The parade of clients. Three didn't come because they said they had the flu. How many hysterical? Just as well.
Began with the woman who had left the bad relationship, gained confidence and is now leaving the bad job for a much better one. Bu† she has to leave me to take the job. Moving on. The woman on crutches with seizures. We talk of horror movies. The guy waiting for his disability hearing, still has to see three more MDs. The woman who began computer dating at 48, is IMing six guys at once. MT is sober for a year. JR for six months. TL for two weeks, but he's lying. One couple is still fighting over whose job it is to parent the other (no one wins that). Another couple has decided not to revisit the same argument they had three years ago. It's good I didn't leave town.
The week ends with SS. He holds the current spot in what somehow has come to be a long line of those who take the last, late in the evening appointment. Somehow I put them there. They are usually male, but not always. They have always been smart, accomplished, a bit overly intellectual, well read, and depressed. They usually have been raised by accomplished, emotionally distant, disapproving, often alcoholic parents. They have been married or divorced themselves, but often did not have children. Two had recently been treated with cancer.
The theme that they all have in common is that life, as they have experienced it and have come to understand it, is meaningless. What they have accomplished has not gotten them what they want. Despite houses, cars, big incomes, beautiful wives, they often have felt like phonies and failures. People have let them down, or worse. They feel distant and lost.
The other feature they have in common is that they have all love coming to therapy. Those who are a bit too vain, love to come and complain and have me take their complaints seriously for an hour. But for most of them, it is the first time they got to feel what it is like to be in a supportive relationship. That part is nice. It takes about six months for them to begin to feel it, and another three months for them to understand what it is.
Then comes the long process of getting to to believe that they can not only find someone else whom they can trust, who can be supportive to them, but that there are even more rewards in being the one who is kind, understanding and supportive. That, if you do things right, and choose right, and then become invested in a relationship, all of the craziness of the world, all of those things that they so accurately see as greed, violence, betrayal, and wickedness, seem like they are "out there" and are just part of the parade. They are no longer the feelings that live inside.
This is very gratifying.
But, then, after my last appointment, I want to go home, sit alone in the dark, and have a drink. I don't want nobody bothering me no more.
The parade of clients. Three didn't come because they said they had the flu. How many hysterical? Just as well.
Began with the woman who had left the bad relationship, gained confidence and is now leaving the bad job for a much better one. Bu† she has to leave me to take the job. Moving on. The woman on crutches with seizures. We talk of horror movies. The guy waiting for his disability hearing, still has to see three more MDs. The woman who began computer dating at 48, is IMing six guys at once. MT is sober for a year. JR for six months. TL for two weeks, but he's lying. One couple is still fighting over whose job it is to parent the other (no one wins that). Another couple has decided not to revisit the same argument they had three years ago. It's good I didn't leave town.
The week ends with SS. He holds the current spot in what somehow has come to be a long line of those who take the last, late in the evening appointment. Somehow I put them there. They are usually male, but not always. They have always been smart, accomplished, a bit overly intellectual, well read, and depressed. They usually have been raised by accomplished, emotionally distant, disapproving, often alcoholic parents. They have been married or divorced themselves, but often did not have children. Two had recently been treated with cancer.
The theme that they all have in common is that life, as they have experienced it and have come to understand it, is meaningless. What they have accomplished has not gotten them what they want. Despite houses, cars, big incomes, beautiful wives, they often have felt like phonies and failures. People have let them down, or worse. They feel distant and lost.
The other feature they have in common is that they have all love coming to therapy. Those who are a bit too vain, love to come and complain and have me take their complaints seriously for an hour. But for most of them, it is the first time they got to feel what it is like to be in a supportive relationship. That part is nice. It takes about six months for them to begin to feel it, and another three months for them to understand what it is.
Then comes the long process of getting to to believe that they can not only find someone else whom they can trust, who can be supportive to them, but that there are even more rewards in being the one who is kind, understanding and supportive. That, if you do things right, and choose right, and then become invested in a relationship, all of the craziness of the world, all of those things that they so accurately see as greed, violence, betrayal, and wickedness, seem like they are "out there" and are just part of the parade. They are no longer the feelings that live inside.
This is very gratifying.
But, then, after my last appointment, I want to go home, sit alone in the dark, and have a drink. I don't want nobody bothering me no more.
Sunday, November 01, 2009
We have a problem -- 1
We in the psychotherapy profession have a problem, and it is going to be getting worse in the near future. I am going to probably take a few of the next several entries here to spell it out for you. I know that the world has been waiting impatiently for me to do this so I will try to work on it here a few times so that I have a chance of making sense.
Part of the problem is that we are low-tech. The world has become very impressed with technology. I know I have. As soon as my eye heals and I can read the small font I am getting an iPhone. 85,000 apps! My God, there is nothing I will have to do any more -- except psychotherapy.
Look at the equipment we need -- chairs. And we don't even need them, although it is better than standing for almost an hour. Sometimes though, I have gone for a walk with a patient.
But that is only a small part of the problem, The big part is that, after a hundred years of trying somewhat scientifically to deal with psychological, emotional and behavioral problems, there is still not direct way into the mind. In fact, we really are still trying to find out what the "mind" is. Yes, we agree, it has a lot to do with the brain, but it is not the brain; it is different.
Yes, but then, what and where is the "mind?"
See, we have a problem, and already it is getting complex and confusing.
But, given all of the marvelous new technologies, people expect that there must be some way to get in there and make people better.
As I said a month or so ago, when they fixed my eye they went in, cut out the bad parts, threw them away and replaced them with good parts. My eye is healing and I expect that soon I will be able to see pretty well.
Now, even though we have marvelous fMRI machines to watch the brain, lots and lots of drugs to pour into people, and we are even learning about the genes that contribute to our talents and temperaments, we still can't get right at it. There are thousands, if not hundred of thousands of attempts, but none of them have really been that successful. We don't even really agree on what we are trying to get right at.
Now, the new US health plan (whatever it will be) is on the way. And the plan will expect that there will we empirically validated and specific treatments for whatever we do, if we are to get paid.
See, we have a problem.
Part of the problem is that we are low-tech. The world has become very impressed with technology. I know I have. As soon as my eye heals and I can read the small font I am getting an iPhone. 85,000 apps! My God, there is nothing I will have to do any more -- except psychotherapy.
Look at the equipment we need -- chairs. And we don't even need them, although it is better than standing for almost an hour. Sometimes though, I have gone for a walk with a patient.
But that is only a small part of the problem, The big part is that, after a hundred years of trying somewhat scientifically to deal with psychological, emotional and behavioral problems, there is still not direct way into the mind. In fact, we really are still trying to find out what the "mind" is. Yes, we agree, it has a lot to do with the brain, but it is not the brain; it is different.
Yes, but then, what and where is the "mind?"
See, we have a problem, and already it is getting complex and confusing.
But, given all of the marvelous new technologies, people expect that there must be some way to get in there and make people better.
As I said a month or so ago, when they fixed my eye they went in, cut out the bad parts, threw them away and replaced them with good parts. My eye is healing and I expect that soon I will be able to see pretty well.
Now, even though we have marvelous fMRI machines to watch the brain, lots and lots of drugs to pour into people, and we are even learning about the genes that contribute to our talents and temperaments, we still can't get right at it. There are thousands, if not hundred of thousands of attempts, but none of them have really been that successful. We don't even really agree on what we are trying to get right at.
Now, the new US health plan (whatever it will be) is on the way. And the plan will expect that there will we empirically validated and specific treatments for whatever we do, if we are to get paid.
See, we have a problem.
Thursday, October 29, 2009
Seaonal Affects
Boo!
Gottcha with that one.
Big surprise. Scared ya. Right, didn't I.
The sun goes down early, the dark falls fast. The shadows of the swaying branches seem to reach out for you. The wind picks up, the dry leaves blow up and and around your face. Is that a leaf or a bat? Does it bite?
Yes, but it's darker in here, isn't it?
Darker in the depths of my mind.
Oh yes, I good caring therapist. Works hard to do good and be helpful.
Ha, sure.
What about all the resentments stored up after all these years?
The slights, the times I've been over-looked or not even heard.
The fantasies of going into those trashy bars that the downest of my clients go to when they are angry and depressed and looking for trouble. How I can be clever enough to set this guy up against that guy, watch the fight break out and then walk off with their trashy women.
And what about all my counter-transference problems, now that I've become an invisible old man?
But that's nothing; that's trite. It's really about the feelings and thoughts that well up like the slime and sludge that sinks to the bottom at the sewage treatment plant. It's the vileness, corruption, and decay that builds up after decades of being battered and beaten by the demons that come howling out of the night, a world that just won't give a guy a break. The demons of stupid wars, of needless excess, of vain-glory, of unrequited vengeance over the smallest, unintended indiscretion.
The soul get nicked, then chipped then cracked. It gets covered in scar tissue that hardens as it holds the remnants together.
It comes to the worst of all conclusions:
Trick or Treat?
Who the fuck cares?
Gottcha with that one.
Big surprise. Scared ya. Right, didn't I.
The sun goes down early, the dark falls fast. The shadows of the swaying branches seem to reach out for you. The wind picks up, the dry leaves blow up and and around your face. Is that a leaf or a bat? Does it bite?
Yes, but it's darker in here, isn't it?
Darker in the depths of my mind.
Oh yes, I good caring therapist. Works hard to do good and be helpful.
Ha, sure.
What about all the resentments stored up after all these years?
The slights, the times I've been over-looked or not even heard.
The fantasies of going into those trashy bars that the downest of my clients go to when they are angry and depressed and looking for trouble. How I can be clever enough to set this guy up against that guy, watch the fight break out and then walk off with their trashy women.
And what about all my counter-transference problems, now that I've become an invisible old man?
But that's nothing; that's trite. It's really about the feelings and thoughts that well up like the slime and sludge that sinks to the bottom at the sewage treatment plant. It's the vileness, corruption, and decay that builds up after decades of being battered and beaten by the demons that come howling out of the night, a world that just won't give a guy a break. The demons of stupid wars, of needless excess, of vain-glory, of unrequited vengeance over the smallest, unintended indiscretion.
The soul get nicked, then chipped then cracked. It gets covered in scar tissue that hardens as it holds the remnants together.
It comes to the worst of all conclusions:
Trick or Treat?
Who the fuck cares?
Tuesday, October 27, 2009
Scary things
Driving home today I heard on the news that a psychiatrists was stabbed at a major Boston hospital. Also, and almost as upsetting, was the the guy who stabbed her was almost immediately shot to death by an off duty security guard.
It seems from early news reports that it was a man who stabbed a woman psychiatrist. The security guard did not work for the hospital.
Stabbing or shooting a therapist has happened s couple of times that i know of. Last year in NYC and a few years ago in a town up near whey I work.
I have really never felt frightened. There have been a few irate husbands who have blamed me for their wives leaving them. One wife told me that he was going to wait for me in the parking lot. That was about ten years ago. I still glance over my shoulder when I am the last car in the parking lot, and it is him that I have in mind.
I have been threaten in my office about three times. Two males patients got angry when I told them that their grandiose opinions of themselves were not warranted. I tried to word it more tactfully than that but apparently the message got through too clearly. Both threats were neutralized when I raised my index finger as a quiet reminder that they should sit down and reflect on what I said.
The third threat was from a woman who threatened to take her shirt off in the office. I guess I am not like the therapist on "In Treatment," who I hear has boundary issues. I think I convinced this woman that even thought I did care for her, it was not in that way, and that while the idea was tempting, it really would not be good for either of us, or what we were hoping to accomplish in therapy.
Being in private practice can be dangerous. I usually have other people who are working on the other side of a thin wall in our suite that has three offices in it. As a therapist it is important to be able to control the mood of what is going on in the session. I think that is comforting to the patient.
But if someone comes in angry and determined, and if unintended, unreal, or totally imagined slights or insults have festered in a mind that has not been working too well, bad things can happen suddenly.
I don't know if the reaction had to be immediate and fatal. That seems a bit too extreme and too American. Maybe he had to do it to save the doctor's life. I don't know, I wasn't there. Scary, all around.
It seems from early news reports that it was a man who stabbed a woman psychiatrist. The security guard did not work for the hospital.
Stabbing or shooting a therapist has happened s couple of times that i know of. Last year in NYC and a few years ago in a town up near whey I work.
I have really never felt frightened. There have been a few irate husbands who have blamed me for their wives leaving them. One wife told me that he was going to wait for me in the parking lot. That was about ten years ago. I still glance over my shoulder when I am the last car in the parking lot, and it is him that I have in mind.
I have been threaten in my office about three times. Two males patients got angry when I told them that their grandiose opinions of themselves were not warranted. I tried to word it more tactfully than that but apparently the message got through too clearly. Both threats were neutralized when I raised my index finger as a quiet reminder that they should sit down and reflect on what I said.
The third threat was from a woman who threatened to take her shirt off in the office. I guess I am not like the therapist on "In Treatment," who I hear has boundary issues. I think I convinced this woman that even thought I did care for her, it was not in that way, and that while the idea was tempting, it really would not be good for either of us, or what we were hoping to accomplish in therapy.
Being in private practice can be dangerous. I usually have other people who are working on the other side of a thin wall in our suite that has three offices in it. As a therapist it is important to be able to control the mood of what is going on in the session. I think that is comforting to the patient.
But if someone comes in angry and determined, and if unintended, unreal, or totally imagined slights or insults have festered in a mind that has not been working too well, bad things can happen suddenly.
I don't know if the reaction had to be immediate and fatal. That seems a bit too extreme and too American. Maybe he had to do it to save the doctor's life. I don't know, I wasn't there. Scary, all around.
Thursday, October 22, 2009
In my pocket
There is a patient of mine who I still see once or twice a year who often would say to me, "Can't you just put me into your pocket and take me home?" He assured me that he wouldn't be any trouble, and that he just needed a safe place to be. He wanted some protection from the life he was leading, which was really, as bad as you can imagine.
Sometimes, as a therapist, I feel like doing that. At least I do while I am sitting and talking to some of my patients. Actually, when I get out of here I am very skilled at not thinking about anyone. But I do see some really interesting and fascinating people who are insightful and articulate, but who never got a break, and who have just retreated from blows of the world.
This guy today, Frankie. He began life as a minority immigrant. His parents sent him to his uncle, who was in this country. His uncle sent him to the grandparents, who already had custody of a few of his cousins. All kinds of chaos and craziness when on in that house, which left permanent psychic scars on Frankie.
But Frankie persisted. He went out in the world full of hesitation and doubts, but he got jobs and he started relationships. Not surprisingly, they ended, sometimes softly, sometimes in disaster.
Today he told me that he just lost the job he had for the last three years. Frankie has been in human services for the last ten years. He does very well taking care of the people no one will take care of. He is caring, empathetic and he treats everyone with dignity. Because of that he got into disagreements with the people who ran the program because he took too much time, he bent some regulations, he responded to the people he was taking care of more than to the rule book. When this was pointed out to him he wold explain how what he was doing took more effort, but it really was within the rules.
So, they fired him.
Now Frankie is not naive, and he is not really trying to be a martyr, but he has standards and sensitivity, and he won't go against that. But because of this, and because of his life experience, he is depressed, and he withdraws when he gets slapped down like this. It will take a while to help him re-group, stand-up, and get out in the world again. (Of course, he will only have insurance coverage for another two weeks, but we will have to deal with that too).
It is difficult to do the "empirically supported" cognitive/behavioral therapy when the patient's belief that the world is mean, unfair, and generally sucks has been well documented by his life's experience. Sometimes you know it would be much more beneficial to take him home, wrap him in a blanket and give him some chicken soup. Which is something he never had anyone do for him, ever.
Sometimes, as a therapist, I feel like doing that. At least I do while I am sitting and talking to some of my patients. Actually, when I get out of here I am very skilled at not thinking about anyone. But I do see some really interesting and fascinating people who are insightful and articulate, but who never got a break, and who have just retreated from blows of the world.
This guy today, Frankie. He began life as a minority immigrant. His parents sent him to his uncle, who was in this country. His uncle sent him to the grandparents, who already had custody of a few of his cousins. All kinds of chaos and craziness when on in that house, which left permanent psychic scars on Frankie.
But Frankie persisted. He went out in the world full of hesitation and doubts, but he got jobs and he started relationships. Not surprisingly, they ended, sometimes softly, sometimes in disaster.
Today he told me that he just lost the job he had for the last three years. Frankie has been in human services for the last ten years. He does very well taking care of the people no one will take care of. He is caring, empathetic and he treats everyone with dignity. Because of that he got into disagreements with the people who ran the program because he took too much time, he bent some regulations, he responded to the people he was taking care of more than to the rule book. When this was pointed out to him he wold explain how what he was doing took more effort, but it really was within the rules.
So, they fired him.
Now Frankie is not naive, and he is not really trying to be a martyr, but he has standards and sensitivity, and he won't go against that. But because of this, and because of his life experience, he is depressed, and he withdraws when he gets slapped down like this. It will take a while to help him re-group, stand-up, and get out in the world again. (Of course, he will only have insurance coverage for another two weeks, but we will have to deal with that too).
It is difficult to do the "empirically supported" cognitive/behavioral therapy when the patient's belief that the world is mean, unfair, and generally sucks has been well documented by his life's experience. Sometimes you know it would be much more beneficial to take him home, wrap him in a blanket and give him some chicken soup. Which is something he never had anyone do for him, ever.
Tuesday, October 20, 2009
bipolar?
I've spent a bit of time clicking around the blogosphere and I have easily found many blogs by people who have been diagnosed with a bipolar disorder. Some of them feel they have been successfully treated, some don't, and many are kind of in the middle.
There has been a dramatic increase in the use of that diagnosis over last ten years. This has been a part of the increased view of the biological basis of mind disorders. Some of it has to do with new medications that slow down the racing thoughts and temper the manic phase, and some if it has to do with more brain research.
Many more people who come to see me bring in this label with them, and what it means seems to be very varied. It covers people who have mood changes, who get irritable, who get very depressed. It gets put on people who spend $8000 shopping when they have $400 in their bank accounts. It covers CEOs who work 20 hours a day, buying and selling other companies.
My view of all this is that there certainly are differences in how people's brains function. I think that what is called bipolar disorder today will be called five or six different things if five to ten years. People brains vary over a range, but I think what we call bipolar covers different kinds of ranges. When the thinking is adaptive, such as when people are creative and have the energy to follow through on something that wouldn't seem like a realistic undertaking to someone who was more moderate, it can work in someone's favor. But often the thinking becomes rapid, tangential, skipping logical steps and ending up in a mess or personal disaster. Then things are bad, and it takes a long time to recover and sort it all out.
A real bipolar depression seems worse than just a depression. It seems more totally devoid of energy and hope. It is more dangerous because the thinking becomes not just bleak but unreasonable. Many people, who are just depressed are often more realistic.They can see how much the world sucks, and they have more difficulty than most overlooking it. A bipolar depression just seems to be like falling into an abyss.
So, to all of you who struggle with this, I can offer the encouragement that the more you can reflect on your own thought patterns, the better chance you will have to see when you are rolling a bit off track. It is often very difficult to know when the energetic feeling you get are going to be fun and helpful, or dangerous and destructive.
I think that is where a good therapist, who you can really trust, one who wants you to be happy, and not just under control, can be helpful.
I hope so.
There has been a dramatic increase in the use of that diagnosis over last ten years. This has been a part of the increased view of the biological basis of mind disorders. Some of it has to do with new medications that slow down the racing thoughts and temper the manic phase, and some if it has to do with more brain research.
Many more people who come to see me bring in this label with them, and what it means seems to be very varied. It covers people who have mood changes, who get irritable, who get very depressed. It gets put on people who spend $8000 shopping when they have $400 in their bank accounts. It covers CEOs who work 20 hours a day, buying and selling other companies.
My view of all this is that there certainly are differences in how people's brains function. I think that what is called bipolar disorder today will be called five or six different things if five to ten years. People brains vary over a range, but I think what we call bipolar covers different kinds of ranges. When the thinking is adaptive, such as when people are creative and have the energy to follow through on something that wouldn't seem like a realistic undertaking to someone who was more moderate, it can work in someone's favor. But often the thinking becomes rapid, tangential, skipping logical steps and ending up in a mess or personal disaster. Then things are bad, and it takes a long time to recover and sort it all out.
A real bipolar depression seems worse than just a depression. It seems more totally devoid of energy and hope. It is more dangerous because the thinking becomes not just bleak but unreasonable. Many people, who are just depressed are often more realistic.They can see how much the world sucks, and they have more difficulty than most overlooking it. A bipolar depression just seems to be like falling into an abyss.
So, to all of you who struggle with this, I can offer the encouragement that the more you can reflect on your own thought patterns, the better chance you will have to see when you are rolling a bit off track. It is often very difficult to know when the energetic feeling you get are going to be fun and helpful, or dangerous and destructive.
I think that is where a good therapist, who you can really trust, one who wants you to be happy, and not just under control, can be helpful.
I hope so.
Friday, October 16, 2009
in his truck
I am back at work now, searching for minds -- where they are, what makes them, and watching how they get stuck.
My list is all backed up. I put it on the phone machine that I am not taking any new people. That just means I get calls with people giving reasons justifying why I should see them.
One such call came from a woman who I had seen about twelve years ago. She was calling for her husband, a guy who we could not get to come to see me then. She was very worried about him. She said he would come. So, when my 3 Pm appointment canceled I told him to come in.
He came in in his work clothes. He works for the city, maintaining the trucks. He has done that for at least twenty years, probably more.
This is where his mind is:
For an hour or two every day he drives his pick-up truck to a spot that over-looks the river. There he sits and smokes and listens to talk radio. Sometimes it's Rush Limbaugh, sometimes Michael Savage. He sits and listens, and gets angry.
From what i remember he has always been angry. He has always felt that the world has not been fair, and that he, for some reason he can't figure out, has gotten the short end. He resents that. For years he had been a heavy drinker. He lost his license for a year because of a DUI. He got into one fight too many in a bar, and being older, got knocked cold by some kid. That was about eight years ago. He has not had a drink since. He resents that. He works for the city and will not get a raise this year. He is angry at that. He blames it on foreigners and socialists. I'm not sure how he works that out in his head, but he resents them too.
But he came to see me because he is scared. He remembers that his father was a guy who was also always angry. He remember his father as sullen, distant and mean. But what he remembers most about his father is that when his father was about the age that he is now he stuck a double-barreled shotgun in his mouth and pulled both triggers. He doesn't want to do that, but he finds himself thinking about it, often.
We talked about depression and genetics. We talked about how he hasn't spoken to his son in three years because they are both stubborn. We talked about how he never really figured out what his wife wanted from him. She seems more relaxed since has stopped drinking.
I told him that he really didn't want to blow his head off. That depression may have some genetic link, but genetics are not fate. I told him that here is a difference between thoughts and actions. Perhaps he could try some medication (no). Maybe he could call his son. Maybe he could take his wife to a movie. Maybe he should listen to something on the radio that makes him happy instead of angry. Maybe country music, maybe Mozart.
When he left he told me that I had helped him. He liked that part about genetics the best. I told him he could come back whenever he felt like it. I doubt that he will.
To paraphrase Darrell Martini (anyone remember him) "It is a wise man who rules his genes, it is a fool who is ruled by them."
My list is all backed up. I put it on the phone machine that I am not taking any new people. That just means I get calls with people giving reasons justifying why I should see them.
One such call came from a woman who I had seen about twelve years ago. She was calling for her husband, a guy who we could not get to come to see me then. She was very worried about him. She said he would come. So, when my 3 Pm appointment canceled I told him to come in.
He came in in his work clothes. He works for the city, maintaining the trucks. He has done that for at least twenty years, probably more.
This is where his mind is:
For an hour or two every day he drives his pick-up truck to a spot that over-looks the river. There he sits and smokes and listens to talk radio. Sometimes it's Rush Limbaugh, sometimes Michael Savage. He sits and listens, and gets angry.
From what i remember he has always been angry. He has always felt that the world has not been fair, and that he, for some reason he can't figure out, has gotten the short end. He resents that. For years he had been a heavy drinker. He lost his license for a year because of a DUI. He got into one fight too many in a bar, and being older, got knocked cold by some kid. That was about eight years ago. He has not had a drink since. He resents that. He works for the city and will not get a raise this year. He is angry at that. He blames it on foreigners and socialists. I'm not sure how he works that out in his head, but he resents them too.
But he came to see me because he is scared. He remembers that his father was a guy who was also always angry. He remember his father as sullen, distant and mean. But what he remembers most about his father is that when his father was about the age that he is now he stuck a double-barreled shotgun in his mouth and pulled both triggers. He doesn't want to do that, but he finds himself thinking about it, often.
We talked about depression and genetics. We talked about how he hasn't spoken to his son in three years because they are both stubborn. We talked about how he never really figured out what his wife wanted from him. She seems more relaxed since has stopped drinking.
I told him that he really didn't want to blow his head off. That depression may have some genetic link, but genetics are not fate. I told him that here is a difference between thoughts and actions. Perhaps he could try some medication (no). Maybe he could call his son. Maybe he could take his wife to a movie. Maybe he should listen to something on the radio that makes him happy instead of angry. Maybe country music, maybe Mozart.
When he left he told me that I had helped him. He liked that part about genetics the best. I told him he could come back whenever he felt like it. I doubt that he will.
To paraphrase Darrell Martini (anyone remember him) "It is a wise man who rules his genes, it is a fool who is ruled by them."
Monday, October 12, 2009
the time it takes
I'm going back to work tomorrow. My eye, which gets tired when I read a lot, will be fine when I just sit and talk to people, even if parts of them look a little blurry.
First I go get the eye checked, and then I'm off to work. I am pleased at how well and quickly I am healing. It makes me wonder how awful it is for my patients. They come to see me and in the first hour we discuss a course of treatment, and what we hope will happen. But for most people, it will take months, if not years to make changes in their minds and lives.
I waited five months to have this surgery, and now I have to wait another three to six months before the swelling in my eye will go away, and I don't want to wait. I feel like they, those who do modern medicine, should be able to just pug in a new eye, and I should go on my way, seeing better than I ever have before. But nooooo, I have to wait until the swelling goes away.
At least my doctors operated directly on my eye. In my business we don't have direct access to the mind. We don't even know where to find it for Chissakes. Yes, it has something to do with the brain, but what? And we don't even have direct access to the brain; at least not for psychological stuff.
So how can any anyone really expect efficient treatment, given how indirect it all is?
I think we are lucky to be doing as well as we are doing.
When you find you mind, let me know where it is.
First I go get the eye checked, and then I'm off to work. I am pleased at how well and quickly I am healing. It makes me wonder how awful it is for my patients. They come to see me and in the first hour we discuss a course of treatment, and what we hope will happen. But for most people, it will take months, if not years to make changes in their minds and lives.
I waited five months to have this surgery, and now I have to wait another three to six months before the swelling in my eye will go away, and I don't want to wait. I feel like they, those who do modern medicine, should be able to just pug in a new eye, and I should go on my way, seeing better than I ever have before. But nooooo, I have to wait until the swelling goes away.
At least my doctors operated directly on my eye. In my business we don't have direct access to the mind. We don't even know where to find it for Chissakes. Yes, it has something to do with the brain, but what? And we don't even have direct access to the brain; at least not for psychological stuff.
So how can any anyone really expect efficient treatment, given how indirect it all is?
I think we are lucky to be doing as well as we are doing.
When you find you mind, let me know where it is.
Friday, October 09, 2009
newsweek trashing
The whole profession got trashed in Newsweek this week. Some columnist named Sharon Begley read about, or spoke to a couple of guys who do research and they told her that clinicians don't pay attention to their research, so she decided that means that clinicians don't pay attention to science. She seemed to say we, especially those of us with experience, are a bunch of charlatans who make it up as we go along, based on our own whims and fantasies. Just another shot in the arm for those of us who are already over-regulated and under-paid.
She read an article that says that cognitive/behavioral therapy has been proven in the laboratory, but not all psychologists do cognitive/behavioral therapy all the time with all of our patients.
A few posts ago I wrote about how I reacted when I received the Guilford catalog. It's the same thing. There are books on their list full of research that has shown how to be helpful to someone who shows certain behavioral, emotional or physical symptoms. Now, none of those symptoms are exact, nor are they all indicative of the same underlying causes. The causes can be stress in the environment, in the family, in the sub-culture, or just in the person's mind. They can also be the result of an illness, perhaps a brain condition, or even some genetic factor. The truth is, and this is THE TRUTH, it is almost always an interaction of two, three or four of these factors.
And good clinician knows this. A good clinician takes what he has read in all these books, all the research, and research from more than just psychology, and puts together the best treatment he or she can, using all of his or her own experience of what works and how to do it.
And then, do you know what? Here is the reason we get trashed in Newsweek, because despite all of this science, experience, knowledge and the art of therapy -- there are cases when it all doesn't make much difference. We can't get right into someone's mind and make it change. We are not all Dr. Phil.
Sometimes we can do a great job: be helpful, healing, transformative,
Sometimes it bounces right off, rolls down the block and falls in the sewer.
But, none of these guys in the lab, these guys with the pills, the ones with the new machines have really demonstrated that they can do any better. You can look at the data.
She read an article that says that cognitive/behavioral therapy has been proven in the laboratory, but not all psychologists do cognitive/behavioral therapy all the time with all of our patients.
A few posts ago I wrote about how I reacted when I received the Guilford catalog. It's the same thing. There are books on their list full of research that has shown how to be helpful to someone who shows certain behavioral, emotional or physical symptoms. Now, none of those symptoms are exact, nor are they all indicative of the same underlying causes. The causes can be stress in the environment, in the family, in the sub-culture, or just in the person's mind. They can also be the result of an illness, perhaps a brain condition, or even some genetic factor. The truth is, and this is THE TRUTH, it is almost always an interaction of two, three or four of these factors.
And good clinician knows this. A good clinician takes what he has read in all these books, all the research, and research from more than just psychology, and puts together the best treatment he or she can, using all of his or her own experience of what works and how to do it.
And then, do you know what? Here is the reason we get trashed in Newsweek, because despite all of this science, experience, knowledge and the art of therapy -- there are cases when it all doesn't make much difference. We can't get right into someone's mind and make it change. We are not all Dr. Phil.
Sometimes we can do a great job: be helpful, healing, transformative,
Sometimes it bounces right off, rolls down the block and falls in the sewer.
But, none of these guys in the lab, these guys with the pills, the ones with the new machines have really demonstrated that they can do any better. You can look at the data.
Thursday, October 08, 2009
survived
Hey, look at this. I can do it with two eyes now, which is kind of fun. Of course one eye is pretty blurry and I really can't make out any letters, but I can sort of see black smudges across the white screen, and that is about 40 times better than what I could see out of that eye a week ago. Now, sometime between three months and a year, the swelling in my eye and cornea will go down and I can get my vision corrected, and see even better. How much better? No one is making any promises, but this is a good start.
I was a bit nervous going into this. People had begun to quietly relate how they had a friend who went in to surgery to get his finger fixed and then died of a blood clot, or was asphyxiated by anesthesia, or were stabbed in their aorta, and such stuff. But, when I got to the hospital all I saw were people going into the door looking nervous, and people coming out with eye patches. Then, after almost four hours of just waiting, an hour of prep, a hour and a half of operating time, and a half-hour cool down, that was me, walking out with an eye path.
The coolest part (Warning -- this may gross you out) was that I was awake the whole time. I was mostly sedated with some relaxing drug. The effect of this drug was measured by the anesthesiologist who asked "Does it feel as if you had one drink or two?" Then he pumped a local into and around my eye, and I was off the surgery.
I watched as they covered m other eye, lowered a microscope and light over the bad eye, and then I could see more light when they cut the dead cornea off, and then removed the cataract, and then began stitching up the cornea. I had a team of two women surgeons working on me. They have worked together for twenty years. They gave and took directions about stitches and angles and placement. And they talked about their kids, and how they don't like electronic medical records, and how the paperwork is much worse.
The next day I went to the doctors office. She took off the patch and wiped away all the goop, and I can see. Not too clearly, but it certainly is a good start.
Psychologically, I was asked one question by the admitting nurse: How do you feel about this operation? I think it will help me see," I answered. "Optimistic" she put down. There was no follow-up question about my thoughts on waking up and being unable to move.
Doesn't matter, I'm moving now. Slowly, but that's fine.
I was a bit nervous going into this. People had begun to quietly relate how they had a friend who went in to surgery to get his finger fixed and then died of a blood clot, or was asphyxiated by anesthesia, or were stabbed in their aorta, and such stuff. But, when I got to the hospital all I saw were people going into the door looking nervous, and people coming out with eye patches. Then, after almost four hours of just waiting, an hour of prep, a hour and a half of operating time, and a half-hour cool down, that was me, walking out with an eye path.
The coolest part (Warning -- this may gross you out) was that I was awake the whole time. I was mostly sedated with some relaxing drug. The effect of this drug was measured by the anesthesiologist who asked "Does it feel as if you had one drink or two?" Then he pumped a local into and around my eye, and I was off the surgery.
I watched as they covered m other eye, lowered a microscope and light over the bad eye, and then I could see more light when they cut the dead cornea off, and then removed the cataract, and then began stitching up the cornea. I had a team of two women surgeons working on me. They have worked together for twenty years. They gave and took directions about stitches and angles and placement. And they talked about their kids, and how they don't like electronic medical records, and how the paperwork is much worse.
The next day I went to the doctors office. She took off the patch and wiped away all the goop, and I can see. Not too clearly, but it certainly is a good start.
Psychologically, I was asked one question by the admitting nurse: How do you feel about this operation? I think it will help me see," I answered. "Optimistic" she put down. There was no follow-up question about my thoughts on waking up and being unable to move.
Doesn't matter, I'm moving now. Slowly, but that's fine.
Sunday, October 04, 2009
stop by the O. R.
I don't think things were always this way, so fast, so busy, so far. We traveled a few hundred miles this weekend to be with a friend, and his friends for his birthday. One of my kids flew a few thousand miles to be with her friend for a wedding. My other kid started a new job, my son-in-law is about jump to a brand new company and take a risk. I have every hour booked for when I get back and a waiting list of about a dozen people who I have no time to see. All thin insurance companies are, again, slightly altering their rules, so I have to revise how I handle the paperwork. I am sure that the results of all this health care reform, no matter how it comes out, will be that they will pay us less. It makes me want to flee the system, except that 95% of the people I see are through the system.
And tomorrow I stop by the hospital and have two parts of my eye replaced. One will be replaced with plastic and for the other I will have somebody else's cornea stitched onto my eye.
I was getting kind of freaked out by the surgery until I read that I probably won't need too much sedation. I should be hone in a couple of hours.
I will see what I can see ....literally.
And tomorrow I stop by the hospital and have two parts of my eye replaced. One will be replaced with plastic and for the other I will have somebody else's cornea stitched onto my eye.
I was getting kind of freaked out by the surgery until I read that I probably won't need too much sedation. I should be hone in a couple of hours.
I will see what I can see ....literally.
Friday, October 02, 2009
It's never one thing at a time
The Guilford Press catalogue came to my office again. I get them quarterly. It is full of books for therapists about how to deal with what faces us. Psychotherapy has moved far away from the time when grand theories of psychology, psychotherapy or psychopathology ruled the field.
Now everything is specialized. Each book is 450 pages about a sub-specialty. ADHD in the work-place. ADHD in Jr. High. Anxiety disorders in soc ail situations. Anxiety disorders in young women with abusive histories. Depression in older males. Depression in young mothers. Depression in Jr. High boys. Alcohol dependence in women, in families, in teens, in teens with alcoholic parents.
On and on two, three, four hundred titles. All of them are well thought out approaches. Some are well researched by very capable groups at major universities. All of them seem like useful and necessary additions to our knowledge and skill base.
Except they're not. Yes, it can be useful to learn what other people are thinking and doing, but really. My nine o'clock appointment was the depressed son of an alcoholic with a depressed mother, who was having anxiety attacks at work because his company is going out of business and his anxious, formerly addicted, wife, who is grieving for her recently departed mother is pregnant.
My ten o'clock appointment is a cancer survivor who has seizures, who lost her son in a motorcycle accident, and has a father who was alcoholic and a mother who is bipolar.
So, to be able to keep up with the latest theory and research I need to read at least a dozen books before my eleven o'clock shows up.
We, those of us here working the front lines, have to deal with the whole package. That's what makes psychiatric diagnoses a joke. Bipolar disorder isn't one thing in he brain, it is probably hundred of variations. Every body's brain is different and they have all been shaped by every one's life, all of which have been very different.
This kind of stuff doesn't come out of a manual -- despite what the insurance companies want.
So, it's surgery on Monday. And my figurative model of the Sydney Harbor Bridge has been partially knocked over by the tide. I will have to begin building most of it over again after my eyes recover. Perhaps then I will look at things differently.
Now everything is specialized. Each book is 450 pages about a sub-specialty. ADHD in the work-place. ADHD in Jr. High. Anxiety disorders in soc ail situations. Anxiety disorders in young women with abusive histories. Depression in older males. Depression in young mothers. Depression in Jr. High boys. Alcohol dependence in women, in families, in teens, in teens with alcoholic parents.
On and on two, three, four hundred titles. All of them are well thought out approaches. Some are well researched by very capable groups at major universities. All of them seem like useful and necessary additions to our knowledge and skill base.
Except they're not. Yes, it can be useful to learn what other people are thinking and doing, but really. My nine o'clock appointment was the depressed son of an alcoholic with a depressed mother, who was having anxiety attacks at work because his company is going out of business and his anxious, formerly addicted, wife, who is grieving for her recently departed mother is pregnant.
My ten o'clock appointment is a cancer survivor who has seizures, who lost her son in a motorcycle accident, and has a father who was alcoholic and a mother who is bipolar.
So, to be able to keep up with the latest theory and research I need to read at least a dozen books before my eleven o'clock shows up.
We, those of us here working the front lines, have to deal with the whole package. That's what makes psychiatric diagnoses a joke. Bipolar disorder isn't one thing in he brain, it is probably hundred of variations. Every body's brain is different and they have all been shaped by every one's life, all of which have been very different.
This kind of stuff doesn't come out of a manual -- despite what the insurance companies want.
So, it's surgery on Monday. And my figurative model of the Sydney Harbor Bridge has been partially knocked over by the tide. I will have to begin building most of it over again after my eyes recover. Perhaps then I will look at things differently.
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.
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)
(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.
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.
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.
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.
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.
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.
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