Oh Stephen,
It’s my joy and pleasure to engage in ongoing dialogs here. I’m learning a lot and getting to know great people (like you).
Writing essays is one way I work out how I think and feel about things that trouble me. Here on MIA it’s like supercharged essay writing in the comment zone. I write more off-the-cuff. I find the views expressed here both very thoughtful and thought provoking.
I do miss the personal long-term relationships I once had when I worked with people in my office. I miss the problem solving of crisis work. I miss teaching student doctors and supervising trainees. I miss collegial discussions.
No money in this. True. But I’m not alone in this world either. I’m fortunate. And we’re not a high-needs family.
So overall, I feel lucky to be here doing just what I’m doing. Until the next thing changes.;-)
Hi,
Thanks for reading and commenting. I can live with “a tad dystopian”. Perhaps I can even feel proud to have gotten this rating.;-)
Maybe I’ll be believed because of my psychiatry background. One would think. One would hope. But mostly not. I get some pretty cranky looks from some docs when I trot out my opinions. I talk to brick walls. I talk to the “yes pills are bad BUT…” folks. Every once in a while I run across a member of the choir. What a relief.
I did meet one lovely doc recently who spoke on a similar wavelength. We talked a while, shared thoughts. He’d just started to read “Anatomy of an Epidemic”. I wept afterwards. What a profound relief to be validated by another psychiatrist.
Thanks for your support of my writing. This seems to be what I’m supposed to do right now. And that’s okay with me.
This comment of yours would be funny… if it weren’t true:
“We’re all supposed to hold hands and dance in a circle and sing Kum-ba-yah and pretend that bad things don’t happen at that hospital!”
I think there is a tendency for people that work together to circle the wagons. This may be amplified in intense situations. I’ve certainly seen police and firefighters hang together even when wrong. Medical people and mental health providers, too.
The view is certainly different from one side of the stethoscope (or locked door or injection syringe) to the other.
Michelle,
I apologize. I re-read my reply to you just now. I didn’t mean to sound short in any way. An extra apology if I came across badly. I can’t always tell how things sound in writing. I’m so much better in person (I hope).
I’m so sorry about your difficult times with psychiatry. What’s going on within patient care is a shameful contortion and degradation of the practice of medicine.
We’ve left “first do no harm” far behind in our efforts to stay on the economic bus. If I could stop this out-of-control bus, I would. I tried to stop the bus (a small local one) by throwing myself under it in 2011. It kept going.
The best I’ve been able to do so far is get off the bus and speak the truth over and over. And this is the best advise I’ve been able to come up with so far:
Get off the bus and speak the truth.
I do hope that some private conversation or writing I have makes a meaningful ripple in the pond. I have private conversations with doctors whenever the opportunity arises. This has turned out to be the positive outcome of my recent job search. No jobs but a chance to talk about my thoughts to working doctors.
I’m copying and pasting this comment from above in the thread so I’ll have room to reply:
Stephen Gilbert on April 10, 2013 at 8:29 am said:
I began to wonder about it all when I got involved with Catholic schools, where they put each and every student in a uniform so that each and every one of them would look alike. They said that it was for economic reasons because uniforms were cheaper than civis and kept the kids from making fun of the less rich students. I never bought that at all.
One of the ways that you gain compliance from people is to take their individuality away from them and make them one of the masses. Often, the boys were put in uniforms that looked exactly like military kacki(sp)with military belts and military style shoes. In earlier years everyone had to say good morning to the teacher all in unison, as one voice and body. All of this started me thinking about why it was done. I didn’t like the conclusions that I came to, but of course I’m one of those people that has to question everything and accepts nothing as gospel truth until you prove it to me to suit me.
MY REPLY:
Stephen,
My older came home from his first half-day of kindergarten (in a yuppie high-end high-rated school) with this story:
His teacher had a box of cookies. She said that everybody would get a cookie if everybody clapped. Then she told them that nobody would get a cookie if even one person didn’t clap.
That was his last exposure to “education”.
I went into this believing that public school was the great gift to the masses and that anyone that home schooled was depriving their kids. Our school was the “good” one. We had the “good” teachers.
Dog treat behavioral training from day one. Of course, he saw nothing wrong with this. He thought it was great. He was very hungry. We’d been told absolutely no snacks would be served.
John,
We do a lot of “head in the sand” in this country. It’s our national pastime. I’m not so good at it any more, it seems. Or perhaps I am and I have my head in the sand about that as well. 😉
Alice
I’ve copied and pasted this post from above unchanged so I have room to reply:
John Hoggett on April 10, 2013 at 8:06 am said:
Thanks, this is hugely challenging. I googled Gatto and watched some video’s of his work. I foudn his criticism interesting but he didn’t have many answers.
There are writers like Gatto in the UK, though not many who are prominant at the moment. I think the 70′s was when I last saw an upsurge of interest in such opions.
Dorothy Rowe, the UK based Australian psychologist, wrote that there are two types of edcuation:
1 education by molding
2 education by enlightenment
According to Rowe in Russian there are seperate words for both concepts.
The word education itself, according to Rowe, comes from a latin word meaning to lead out of darkness.
The restrictive nature of school, and the move towards a factory/office atmosphere instead of one of learning and democracy was one reason why I found working there so hard.
To lead out of darkness would be the function of any good psychosocial programme for people who are mentally distressed. Would it not?
MY REPLY:
John,
I was more impressed with his early written work (“Dumbing Us Down” comes to mind. A small book to read.) than his later recorded work. I haven’t the patience to listen through the long recordings. The messages get lost for me. But I’m oriented to the written word on paper by default.
In his earlier writings he reviewed the things that he did as a NY public school teacher over a couple of decades, what worked and what didn’t, and how people responded to what he did.
If only our education system would lead people from the darkness. So often it seems to do the opposite. This makes me wonder if we’re using the wrong words for what we do in schools.
When I tell people how to evaluate the meaning of the words being used (ex. mission statements), I tell them to evaluate the outcomes. Maybe the first couple of times or rare events can be called accidents in spite of good intentions. When one continues to do the same things that cause consistent bad results, at some point you have to ignore mission statements.
Watch what’s happening to discern the truth.
The “education” we do is more what you described as a “molding”.
I would love to see a psychosocial program that enlightened the mentally distressed. As long as it also helped with the basic needs of life: Food, water, shelter, safety,relationships.
I have copied and pasted this comment unchanged so I have room to respond:
John Hoggett on April 9, 2013 at 4:41 pm said:
They’ve sold off a lot of the social care sector already. Things like home care where people get home visits. The social workers job is now to do an assessment and then put the job out to tender to varios “Care” agencies. The workers get paid badly and by the job, so they cut the time with the clients to the minimum and give very little peronal attention, especially if the client is at all, “Difficult,” as people with mental health diagnosis are likely to be (I have a gardening client who is an agroraphobic hoarder who also has physical dissabilities who has carers who do his shopping and offer help with cleaning etc and he is always having battles with them, it’s a wierd thing to witness.).
John,
In Oregon in the late 80’s county (public) mental health services were “spun off”. What this amounted to was privatization to “not for profit” corporations. “Not for Profit” corporations behave just like other corporations except they don’t have stocks and shareholders to pay dividends to.
These public mental health services have been sliced and diced and sold off and moved around year after year to the lowest bidders for 24 years.
Add layers of increasingly powerful for-profit insurance companies, medical service provider organizations and politicians beholden to campaign finance contributions.
We have a mess there. A cash sink hole called mental health services and not much in the way of care happening. Tax dollars vanish through this web into corporate pockets.
It is not possible to provide public services through private venues. No one will take care of your poor, elderly, sick and needy like you would.
Welcome to our world. You’re just a bit behind us in the process.
What is my opinion about the function of public education?
What a great question. Of course I have thoughts and opinions about this.
Although we may seem to have wandered off topic for MIA, I think this question is squarely on topic.
How have we ended up with such widespread and unquestioning obedience to the pharmaceutical companies’ (and all advertiser’s) directives?
This obedience to drugs (and other things that are bad for us and bad for the planet) is pervasive throughout all levels of society. Even mothers who know their kids are miserable being drugged seem helpless to stop it. The few that have the courage to stop the drugging often feel compelled to lie and pretend compliance.
You would think that a country which is as highly educated as we would be less easy to fool and manipulate.
In my opinion, our most holy of cows, our education system, is the cause of our obedience.
According to John Taylor Gatto, an educator and historian who looked into the roots of public education in the U.S., our Prussian model of mass education was designed and adapted here specifically to provide control of a large population over a large geographic area.
It was not designed to make good readers. The population of the colonies (outside of slaves) was already highly literate.
One of the key features of our Prussian model of mass education is to produce a majority of people who have an unquestioning obedience to leadership.
Whether that leadership comes from the front of the classroom, the front of the platoon or the front of a television doesn’t matter. We are conditioned to obedience through 13 long years of childhood classroom control.
There may be some talkers and grumblers but people go to work and do as they’re told. Even the miners who are are paid by corporate coal mining companies to blast the tops off their own mountain homes in West Virginia and poison their own groundwater still show up to work. They may feel bad and grumble about it, but they still do it.
Sorry. This is sounding like another essay. Very good question indeed. Google Gatto. Read his books.
I’ve copied and pasted this comment unchanged from the above thread to have room to respond:
John Hoggett on April 9, 2013 at 3:13 pm said:
Home schooling is getting harder in the UK too. There are financial advantages to schools to have children with diagnosis. Tehy get money to pay for teaching assistants. Whether they make any differnece has been contested. I was one for about 5 weeks. My question is are they there to enforce the school rules or to help the child get their emotional and social needs met?
John,
Thanks for your conversation. I like to hear how things are going across the pond. Personal reports are enlightening to me.
In Oregon (homeschool laws vary by the state you’re in) the school offers a free computer, internet connection and on-line curriculum. I never heard how this works out in practice.
The teaching assistants? Not sure. Not much experience with them. Behavioral control, perhaps?
John,
I hope that privatization of school works better than privatization of utilities, prisons, medical education, medical care in this country. I have developed a “cringe” reflex when I hear that word. It may not be fair to assume the result will be the same in UK as in the US. But then again, why wouldn’t it?
I’ll cross my fingers for UK’s school privatization.
Thanks for reading and for your thoughtful and gracious comments. I appreciate your support of my writing efforts. There is more than one way for a doctor to help people.
This woman I wrote could be anyone we know. I hear a variation of this story every time I have a personal conversation about psychiatry. She is a compilation of many who I’ve talked to.
You’re right. I HAD to stop work once I read RW’s book. I tried for a while to work in a new way within the old system. This went nowhere useful.
When I talk about truths that are not widely known, people do see me as being a conspiracy theorist, having a “bad attitude” or in being “too down” about things. I’ve been accused of these (and worse) by strangers, acquaintances and people who I’d once considered friends and trusted co-workers.
We must each do what we can to get the message out.
Thanks for reading, thinking and writing.
All the best.
Alice
Stephen,
Wow. I appreciate your open reporting of your “undercover” experiences. This will not appear in the mainstream media but it needs to be talked about. You’ve already done the undercover work. A lot of folks have.
People run away and slam doors when you crack through the walls of world views abruptly.
MichelleB,
Thanks for reading and commenting. I like to hear your thoughts. You ask some very good questions.
Ah yes. We have both “won”. I’m unemployed in a rental with my family with no house or job in my future. I’m not under a bridge. My kids are not being drugged.
She has a job, a house and a kid that will soon be drugged.
It is a shame that a person with my education, experience, training and smarts is unable to find a way to get paid to use any of it. I suppose I could work for free without the expensive liability insurance. Or I could retrain in tropical medicine and move to Africa. As you point out, there are endless opportunities for someone like me.
Yes. I do write other places. Check alicekeysmd.wordpress.com
Yes. The history of our education system is a real eye-opener. John Taylor Gatto (an award winning New York School Teacher) did a good job writing about this in “The Underground History of Public Education”. I think it’s available to read for free on line now.It’s a big work. Some of his shorter books about education may be more accessible like “Dumbing Us Down”.
He reviewed minutes from the meetings where our education system was designed.Chilling and enlightening reading. The militia had to be called out to march the kids to those first public schools in Boston. People did not want the system we have today. Literacy rates were much higher before public education.
This many generations into our great experiment with public education and it’s hard for anyone to question it.
Yes, I would do exactly the same if faced with the choice. Sometimes people forget that we, Americans, have a lot of tools at our disposal to fight the psychiatric oppression.
cannotsay2013,
Exactly. I think that each of us can support one another to make creative moves to take care of ourselves and our families.
Thanks for bringing up home education.I have two boys. I’ve always home schooled them. They love it. I love it.
Even though it’s been years since parent have been arrested for homeschooling their kids it still took an incredible amount of courage for me to educate my kids at home.
It kept me awake at night for years thinking I was doing it all wrong. Then I read the story of an illiterate mom who learned to read along with her homeschooling child.
Educating my kids at home has helped clear out some of my own cultural training. It’s allowed me to see that many things I “knew to be true” were simply incorrect teachings from someone else’s agenda.
Home education can be hard to pull off by single parents and in homes that require both incomes to pay the rent. There may not be anyone home to supervise the kids. They may depend on school as day care. I’ve seen people work opposite shifts to pull it off, though.
Homeschool laws very considerably from state to state. Transitioning a child who has many years of public education can take a while.
If you are a product of public education this may influence your approach to home education. I thought at first that I had to replicate the classroom experience at my kitchen table. Nothing could be further from the truth.
I’m a strong proponent of home education. There are as many variations on things that work as their are families.
Thanks again for raising this important topic. Yes. Home education is a great way to make a truly individualized education.
John,
Thanks for the UK view on education and ADHD.
I did a quick Wikipedia for rates of illiteracy. US and UK run neck and neck with 20% illiteracy and 40% “functional” illiteracy (lack literacy skills to manage every day life).
There is something basic about our education structure that’s not fulfilling its prime directive. It makes me wonder if teaching reading (and other basic skills) is the prime directive of the education system we’ve built.
John,
I’m so sorry to hear this. “For profit” means “for profit”.
Our “private” for-profit medical system is a cash cow for a few at the top of large corporations and to corporate shareholders. It puts straws into tax coffers through medicare and medicaid.
Infant mortality is increasing.The numbers with no access to health care is increasing. The price tag is increasing.
“The fear is that the private sector will undercut the NHS service to get the contract. They can do that by using profit from another enterprise. The good NHS unit then closes and all the expertise and machinery goes. The local population is then at the mercy of the private provider.”
This is exactly what’s happened with the “privatization” of prisons here. They low bid. The government infra-structure dissolves. Then the price goes through the roof and the services vanish.
It’s not possible to provide social services with a for-profit model. You can only provide profits. This is well known.
Thanks for being willing to take another look at one of the most sacred of sacred cows in our country, the mandatory “free” public education system. It is in no way “free”.
I agree that changing the way the education system works would be better than drugging kids. Amen to that.
But it’s not likely. In Oregon, the IEP (individual education plan) brings in more revenue for each individual school. They’re paid by the head. An “IEP” head brings in more money than a regular head. There is a financial conflict of interest here. More IEPs equals more revenue for a school. AN IEP the ticket to drugging.
Any masters level educator can make a psychiatric diagnosis and demand you drug your child. The kindergarten teacher or basketball coach can saddle your child with a lifelong psychiatric label and a lifetime of drugs.
I think any person incarcerated and made to sit still and be quiet inside a crowded room every day for years could develop “symptoms”. Those who become hopeless and withdrawn could be labeled with ADD. Those who rebel, jump around and act loud could be labeled with ADHD.
If one thinks of school children as young PEOPLE, my theory makes sense.
I’ve read estimates of illiteracy rates as high as 40% in this country coming out of schools (depending on how you measure and who you count) and have been steadily declining. So school isn’t there to teach people to read.
Yes. What we are doing to our children with this thing we call education needs to change. A lot.
mcoma,
Good comment. I appreciate all the work that went into it.
I like your idea of having outside observers overseeing care. This should extend into our rapidly expanding prison and jail systems where many people are being held and drugged. Human rights oversight is in order.
I’ve heard rumblings from UK about “privatization” of the NHS. Do you know anything about this? This word has been used to disguise corporate takeover of medical care (and many other things) here. It causes a precipitous decline in quality and rapidly escalating costs. It means “for profit” for shareholders. This has no place in medical care.
Thanks for your reading, thinking and writing. Keep it up.
Alice
Thanks for reading and commenting. I think you sum this issue up very well. You’re right. I haven’t often met a person who said “Hey. I’m a pill person.”
Some of the most wild west (shoot pills at anything that moves) “prescribers” I’ve known make good sounding mouth noises. They say all the right things. One has only to follow behind on their work to see the truth.
I think what you say here is very astute:
“It seems most people in the U.S. are of the opinion that psych drugs are bad, except for when they are not, which is whenever they feel assured that some case is different.”
This adds considerable clarity to what people really mean when they say they’re not a pill person. It means they know what to say.
mcoma,
Thanks for reading and especially thanks for taking the time for such a great post of your own in response.
Our cultural “brainwashing” (if I can use this word) is pervasive, contagious and starts at a very early age. I’m certain this cultural effect is a large part of the suffering that comes up in the mental health system.
The cultural effects are overlooked and all blame is laid on the brain and family of the person suffering. I’ve been asked to treat unemployment, homelessness, divorce, community deterioration, effects of public education, drug addiction, school bullying, poor nutrition (and on and on) with drugs, drugs and more drugs.
I guess if you only have a hammer everything starts to look like nails.
And, no. I’m not going undercover.;-) What a terrifying thought. We all know where this would go. They’d be too drugged to report and discredited by their “mental” history.
John, I don’t think I could handle “Brave New World” again right now. I’m just recovering from my re-read of “Grapes of Wrath”. I realize we are much more under the thumb of unfettered global capitalism than I thought.
I have no idea how our “anti-trust” laws were removed. I was taught back in school that these laws would protect us so we didn’t need to worry about huge corporations gaining too much power. Ooops. The laws are gone. I wasn’t watching and worrying because I thought we were protected by the laws and the government. Big Ooops.
Yup. I remember “endogenous”. This was supposed to mean that there wasn’t anything one could do except take drugs to feel better. It always seemed, well, wrong to me.
The incidence of kidney failure from psychotherapy must be down close to… zero?.
Thanks so much for checking in on my post. It’s always lovely to hear from you.
Phillip,
Thanks for your kind words. Marketing is no longer simply showing us the brand name and saying good things about the product. “Subtle and Pernicious” is a good set of words to describe modern marketing. It includes both obvious and hidden flattery that makes us feel clever when we reach the “right” conclusion so nicely at the same time as it’s presented to us.
Alice
Duane,
As usual, you ask a lot of very good questions.
I wondered what psychiatric drugs had to do all those nice words describing psychiatry/psychiatrists and, by default, myself.
I would like to consider myself “liberal”, “democratic” and even a product of “enlightenment”. But I got lost on the possible meaning of “consequentialism”. And, like you ask, what does any of thins have to do with psychiatric drugs?
Stephen,
I’m glad for your feedback on this. What a puzzle to “hide” in plain sight.
It’s clearly posted which company is funding each article.There are ads flickering around the edges. The “for credit” articles are directed at prescribing specific drugs in conjunction with specific diagnoses.
At the end of each article that a doc uses to collect “free” CME credits there is an optional evaluation form where you are supposed to tell them if you thought there were any visible conflicts of interest.
I’ve been puzzled why this is the case.
How accurate could this feedback be from a doc who just accepted the gift of free education credits? Is it a liability dodge for the drug company? It is simply a case of hands washing hands?
Sethf1968,
Thanks for your well-considered and well-written comment.
The only clarification is about your question of what I meant by “24/7 coverage”.
No. This did not mean I had insurance.
24/7 is the number of hours (24 hours a day seven days a week year round) I would be responsible for and available to handle all phone calls and come in to work any extra hours if needed. Whether the employer is paying for seven hours a week or twenty or forty, the expectation is that I will always be available and work however many hours are required to do the job.
This requires always being in telephone answering range and range to drive in within a set number of hours.
One job estimated about three hours a day of additional phone contact time needed. They said would “try” to keep it in three batches a day. None of these additional work hours, which includes evaluating situations and prescribing over the phone, would be paid for.
If work beyond the paid hours is needed to effectively manage the responsibilities, there is no more pay.
The hourly rate and number of hours paid may not accurately reflect the actual hours of work performed.
24/7 coverage means that for 7 hours a week pay, I belong to them day and night.
Life. liberty and the pursuit of happiness” is straight out of our American constitution. This was our government’s original mission statement when we broke away from British corporate rule.
It was not the crown we struggled against but the corporations which were controlling everything from what people could grow and make, the prices they could charge and what they could say to the next wave of settlers being sent over (nothing bad about life in the colonies and nothing good about the native population).
Ain’t history books wonderful? 😉
Thanks for your kind words about my writing. I’m certain something is brewing back there. There’s nothing like MLK speeches and Alice Walker poetry before bed to get the old creative juices flowing.
Footloose 1949,
Perhaps the money for the person’s treatment time comes from a different pocket of the budget than the money for the pills. Bureaucratic thinking like “which department budget” and “which fiscal year” is often used to move expenses around here. Medical costs happen a bit later than the onset of the psychiatric drugs. It makes the real cost harder to track
The drugs are also much more expensive here in the US than in any other country in the world. People have been buying drugs from Canada and other countries on line for years to dodge drug costs when they can.People used to drive across the border into Canada to buy them from the northern states.
And perhaps the marketing line that drugs are cheaper and faster than therapy has simply reached the level of “truth”.
“Repetition causes belief” is a well-known marketing and education strategy. Anything repeated often enough becomes fact to the human mind. This is a known feature of the human operating system and is underneath some of the cognitive therapies that help people change how they feel and view themselves. For example: thought stopping (stop the repetition of the negative belief) and replacement (repeat the new desired belief) works like a champ. This principal also underlies the danger in media exposure. Our human brains soak up the repeated images of violence, material goods and sex (plus more) as if it is the truth.
I believed that pills were faster and cheaper than psychotherapies for many years without doing the arithmetic myself. I may not be the only one. Or maybe other professionals have always seen through this falsehood and I’m simply more gullible than the average bear.
I started a new thread here so I can reply by copying David’s post:
David Ross, M.Ed., LPCC on March 13, 2013 at 6:12 pm said:
I work in a rural system and the numbers cited above are typical. I’ve never, ever heard/read of a physician being paid $70 an hour. I just can’t understand that assertion. I guess come to Ohio!
David,
Ohio. The land of opportunity. I am a buckeye by birth and still have parents and siblings farming there. What a lovely state with all four beautiful seasons.
I’ve also been informed in this thread that Oregon is the state with the highest paid doctors. I must have missed out on this for the 27 years I lived there.
I’m breaking taboo here on talking about money. Who does this taboo protect?
In 1987, fresh out of training with 100k of high interest education debt I scored a full time salaried position for about $60K a year through the VA staffing an inpatient unit, teaching medical students and doing research. A year into it I did the math for the actual hours served. It was less than minimum wage. I worked there two years. This was the last full-time regular benefited job I’ve had since leaving school.
The first month of my private practice 7/89 I had one patient visit. I didn’t get above 4 paients a week for a long time. Private practice never was a busy thing. But I also declined to do “meds-only” (med checks) because it never made any sense to me from a clinical care perspective. Pills have never equaled treatment in my book.
In my private practice I last charged $100 for a fifty-minute session and $60 for thirty minutes in 2003. I always did some pro-bono work and sliding fee. I could have filled the office all week for pro-bono work.
I worked MUCH less than half-time because that was how many patients there were who could pay. The insurance was tied up completely with managed care companies. No one could afford cash. The last two years I paid the everyone except me. That works out to zero an hour for my private practice hobby. I closed up shop 07-03.
I was hired 11/2004 to do “on-call” work in Portland for $90.97/hour. I made this same amount part-time intermittent work without benefits till I left Oregon last year. I was told this was the regular hourly pay with a special hourly bonus for being willing to be called in to work anywhere, any time.
The most I’ve ever made was $110 an hour for six months about three years ago. No benefits. 20 hours a week.
I turned down a part-time job with no benefits for $75/hour in Portland maybe three years ago. This included being available by phone all the time and me paying for downtown parking.
I passed on a verbal offer for a 7 hour a week job two months ago that required 24/7 coverage, working alone, four patients an hour. That was for seventy bucks an hour.
I did pass on a job last month (it was never offered, only suggested that I might be interested)in a jail that paid $160 an hour for 20 hours a week. The trick was, it was a 24/7 job with no benefits that had been unmanageable in a forty hour work week. So what would the real pay work out to if I did the work?
I’ve learned from hard experience to do the arithmetic.
weekly money minus overhead expenses divided by expected hours of coverage.
It has been suggested (and I suspect it’s true) that if I did a cash-n-carry prescription business with 10 minute “med checks” for $50 each and made everyone come in for refills, that I could be rolling in the cash.
John,
Thanks for your encouraging words for my writing.
It does seem that the same battles have to be fought over and over. I’m not the first to make these connections in writing. I’ve simply been reading musty old history books.
Rather like a committee with no one taking minutes, we have to learn the same lessons and fight the same fights over and over again.
Our grandchildren will have to fight these same fights unless the laws that govern corporations are changed dramatically.
Alas, corporations have been created immortal, given human rights and better passports than any mere mortal. They only have to wait for us humans to die in order to continue to grow in power. And they now have DEEP POCKETS. The prime directive written in by their (human) creators is profit. They are doing exactly what they were told to do. Very, very well.
I wonder how an immortal company who’s prime directive is to protect life, liberty and the pursuit of happiness would work. Maybe one with built in checks and balances to keep any one power hungry branch from overwhelming the whole thing. Maybe one that could modify itself over time through open discussion of ideas and free elections by the people.
Yes. Job loss is a real consequence of speaking up. Finding another job may be limited to a complete change of profession, rather like refugee doctors in a foreign country that end up working in restaurants.
I have certainly heard “purely verbal homage to the need for change” from managers in clinics only to be told that my views are “too radical” for me to be useful around the place. More than once. In more than one state.
I think of these as “mission statements”. Mission statements are fine marketing tools but may not reflect what actually happens.
I couldn’t know the feelings they may have felt about the ideals they espoused or the chains they may have felt they wore.
When evaluating expressed intentions and ideals, I monitor behavioral output. Watch for them to walk the walk. Or not.
I think the divide between stated values and behavioral output is part of a larger issue in our country today. We have all learned to say what we think the person in authority or the person we want to please would like to hear. For example, when people hear that I’m vegetarian, many say that they want to be or wish they were or almost are or will soon be vegetarian. It doesn’t slow their burger consumption one bit. Personally, I prefer the honest meat eater.
That which passes for liberal ideals today seems a thin veneer or paint job over something else to me. Perhaps there’s enough paint to settle personal unease at the rising tide of the homeless and disenfranchised poor. But it’s not enough to pay more taxes to care for the poor or enough to insist the budget throttle back on military spending to care for the poor.
Watch the walk if you want to know what a person’s highest ideals are. If it walks like a duck…
Thanks for stimulating more of my thoughts with your comment.
Keep writing.
Alice
Steve,
And I think most medical doctors know this about psychiatric drugs causing medical problems. I had a medical doc get into my face and demand to know when MY treatments would stop making HIS patients so sick. (We shared zero patients. I was the psychiatrist in shouting range.)
Pills are vastly more profitable to corporations than psychotherapies. Crank pills out in a third world country for pennies and charge dollars here.
You just can’t suck that kind of cash stream into the coffers based an hour of psychotherapy once a week. And with psychotherapy lots of folks get better and go on about their business rather than become chronic patients. This is definitely not good for the corporate bottom line.
I’m glad to see that I’m not the only one who can do basic arithmetic and see where the dollars flow.
engineer
Sorry to have missed this comment. Complex thread and all.
Thanks for your kind words. I feel supported here even in the midst of lively discussions.
You said: “I ended up in the hands of what I call a legal drug pusher”
Your assessment of the situation you found yourself in is good for everyone to keep in mind that thinks they may need help. If you see a psychiatrist today, the chance you’ll be offered at least one prescription drug is high.
I suppose if it walks like a duck and quacks like a duck, it could be a duck.;-)
John,
Yes. This is the result of my calculations as well. Counseling is cheaper than hospital stays. It has a better side-effect profile as well.
Perhaps we can advocate for the use of psychotherapy, housing support, vocational support and food in cases where the now “traditional” drugs only treatment has failed. Maybe we’d find it reduced expensive hospitalizations.
Oh wait. That’s called an ACT team. And it’s already been researched. It’s evidence-based care.
mcoma,
Thanks for spelling out the truth from the perspective of the clinic and clinician side of things. I cannot dispute anything you say here from my personal experiences in recent years in community clinics.
There is an unending stream of new clinician fodder coming out of schools green as spring twigs and shackled with debt.
Peter,
Thanks for your well-considered and well-written piece.
As a psychiatrist who has thrown myself under the proverbial bus for patient safety concerns, I have to say that the bus just keeps rolling along. No one but me looks back.
Perhaps if a whole bunch of us held hands and threw ourselves under the bus, it would stop? How many would it take since psychiatrists have been replaced by prescribing nurses, primary care docs, naturalopaths and physicians assistants and prescribing psychologists.
I’m not so sure.
I am sickened in my heart about the drugging of kids. I started to say “kids in foster care”. But the truth is drugging children makes my heart sick. Talk about being unable to give informed consent.
Take my licenses away? I pay for active licenses in three states and a federal narcotics license and what am I using them for? Even without a license, I’d always be a doctor.
Thanks. As always keep reading, thinking and writing. I’ll ad talking to this, too. Keep speaking up.
I started a new thread to have room for a response by copying his comment here:
John Hoggett on March 13, 2013 at 7:35 am said:
Indeed, Occupy was a flash in the pan, but it had a big impact. Perhaps it is best not to see it as a big battle but a skirmish in the long struggle?
Corporations are given life through government words. I say to them, “Stop being so silly,” but they don’t always listen.
Meanwhile, here is a little song and rather in your face video to hopefully chear you up (well the songs chipper the video is a bit confrontationally grim): http://www.youtube.com/watch?v=NJTcoKl0aN4
John,
Thanks for the video link. I had no idea the Occupy movement was so active in UK.
Since corporations are given life and power by government words, how can people have a say in those government words?
All the best.
Alice
“We’re all in this together. I’m pulling for you.” Red Green
Footloose 1949,
Thanks for reading and checking it here with your personal experiences. I feel supported in my writing by this. You are right. And the obesity is way beyond a self-image issue. It will cause early death after a lifetime of medical illness.
I hope you will not take offense when I disagree with this statement from your comment. I was also taught this as the excuse that insurance corporations wouldn’t pay for therapy and why I wasn’t allowed do the psychotherapy interventions that helped people have better lives:
“At the end of the day, the cost of councelling and therapies are far far more time-consuming & expensive than pills”
Pills are for a lifetime. Many don’t work in the ways we’ve been taught. Some not at all. Pills can cost hundreds to thousands of dollars a month depending upon the “cocktail” prescribed. They create expensive to treat medical conditions and take years off a life.
How’s this for slower and more expensive than counseling?
Sorry for the rant. You bumped up against one of my old pet peeves, this lie that pills are cheaper than counseling. I used to believe this story as well.
All the best. Keep reading, thinking and writing.
Alice
There are days I think I’m the only one that sees what’s been happening. People that I meet that sort of get it are in “duck and cover” mode. I suppose if I were more clever I would be as well.
We’ve made laws (international free trade agreements) that allow corporations to travel internationally with more ease than any person.
Poor India(per Ms. Shiva) is in the middle of a fight for its life against agribusiness and GMO seeds that are killing farmers. They’ve been fighting to save Himalayan forests so they can maintain water supplies and are up against the largest steel manufacturing plant in the world that’s been planned there.
Where I am, the occupy movement has been swept away. The grass grows thick and green on the government lawns where the occupiers camped.
It’s all words on paper though. Remember this. Corporations are given life by our words.
Morias,
Yes. The ones that do know and don’t care worry me the most as well. I wonder how one would pick these folks out in a crowded room. It could be a useful skill.
Thanks for these thoughts.
Alice
This a lovely piece of thought and writing. I agree. We’re all in this together.I suppose that if there were no more customers, the “industry” would dry up.
I hear from psychiatrists that people come in begging and demanding the drugs by brand name. In my experience, people came in with specific ads in mind wanting specific drugs. Name brand new ones from television, not a less expensive generic alternative.
A great start would be if everyone simply stopped watching television. Imagine how free our thoughts could become (once we detoxed) if we unplugged our end of the Madison Avenue pipeline. We’d all lose the restless wants, anger and fear generated by the marketing industry.
But then, the economy would collapse because people would only buy what they needed and it would be enough.
Stephen,
Bing, bing, bing. You win the prize for getting my message.;-)
We have to stop throwing rocks at one another long enough to work things out. This is a BIG mess. Psychiatry (and all of medicine) is only one small part.
There must be laws enacted that limit corporations.
Corporations were given immortal life and human rights by words. Words are the only way to put on the brakes.
I don’t know if this is possible or not. But since words created this mess, words are the path to freedom.
Stephen,
I have had my own primary care doc dancing in circles of frustration over my unwillingness to gobble pills. He has always declined the research papers that support my stance. I’m written up as being non-compliant with his recommendation.
I’m surprised the free clinic has the time to take. Our public clinics are overwhelmed and underfunded with four patients per hour minimum and scripts at the end. You are lucky. Hang on to this while you can.
Donna,
Lovely and well written. I appreciate your encouragement here. I love to write and will certainly continue to do so. Words must be written. I won’t stop doing this. This is work, of a sort.
I think my point is that outspoken activists for human rights may not find gainful employment within the medical system as it exists today.
You’re absolutely correct. It will have to be work outside the system.
Thanks also for your clear thoughts and writing. I think we’ve all known for a long time that the government is no longer by or for the people.
I recently heard that the woman who drafted our new Obama plan went back to work for the big insurance company for a very high salary… millions a year. I can only hope this is a foul rumor.
Jeffry,
They were both very good, very hard working and very frugal. I don’t pretend to understand the finances of others.
By your rational, very person who ever paid taxes into a system that built drones should also be prosecuted. And every shopper who buys cheap Chinese toys made by children in sweatshops. And every person who drives a car(cars are the number one cause of death from age 8-34 in America).
There is nothing in our land that is not tainted.
In the words of John Steinbeck in “The Grapes of Wrath”: “The monster isn’t men but it can make men do what it wants.”
We must find ways to work together to enact laws that limit corporate capitalism before it kills our planet.
Thanks for the opportunity to say what I feel most strongly about.
Alexa42,
Thanks for this. You have written this much more clearly than I.
There are roles for everyone to play in making things better. Some are better at speaking and writing. Some are in the clinics doing their best to improve patient care.
It sounds like you’ve become your own physician in a way, taken charge as the director of your care. Good. I’m glad you are able to do this.
I can’t speak for anyone but myself on the arithmetic. I have my own numbers well in hand.
No drug consultation fees here. I didn’t “escape the riff raff”. Private practice wasn’t lucrative even when I did cash-up-front work. I paid everyone except myself the last two years of private practice before I closed up shop in 2003. I was going to have to add money from my husband’s job to meet the overhead.
Thanks for your vibrant response. Energetic voices such as your are needed. Every voice counts.
You may be making a couple of incorrect assumptions with regard to the APA. It sounds to me as if you think all psychiatrists are members of the APA and that it operates as a voting democracy.
I have not been a member since I had to be for their sponsored professional liability insurance (that went belly up) many years ago.
A psychiatrist buys APA membership with annual fees. For this he/she receives journals filled with drug-sponsored research and ads, is placed on endless junk maillists and has the opportunity for reduced rates to attend the annual meeting (and hear about drug-sponsored research). I think there may be is a political lobbyist and a polite answering service.
If there is much more to APA for most members than this, I have no idea. I suppose some write membership it on resumes as if it means something more. There are committees and officers. I have no idea how one gets to be one of those.
Thanks for sharing your paper.
All the best.
Alice
The APA membership is not invited to vote on diagnoses.
In this essay I did not venture into whether the diagnostic system is valid or not. I try to limit myself to one issue at a time.
There are other lovely essays on this site that address validity well. Thanks for your own shot at this.
I ran out of room to reply so cut this into a new thread:
Discover and Recover on March 11, 2013 at 5:27 pm said:
A good point, Alice.
What about the professors and the doctors out there?
You’ve addressed that with the post and asked for others’ opinions.
Thanks for being on MIA.
Duane
Duane,
Thank you for thanking me. That made me smile. I feel very appreciated and welcome here. The discussion is always lively and thoughtful with a wide range of opinions. The conversation feels valuable and thought provoking. I keep learning new things.
Donna,
Good for the students for noticing and speaking up. I wonder what the impact this will have on their job choices. I wonder where Dr. Angell is now. If she was able to get another job.
The pharmaceutical influence is all through medicine. It is not just psychiatry. We all have to speak up together.
Donna,
Thanks for your support of my writing. It will take a lot of people speaking up to make things better.
Visiting any doctor is pretty dangerous. I avoid it.
What I’ve been angling for here is more understanding of how any human could end up in a position where their jobs demands they do more harm than good.
I did not say this: “then it is totally justified.”
But I can see how (for example) a computer person could find themselves working on navigation for drones used to kill starving children on the other side of the planet. An aging worker with no other job options, house payments and two kids in collage is going to do some mental gymnastics to make it okay to keep working.
I don’t justify it or think it’s right. I’ve straight out quit three jobs over patient safety. At 57 I’m unemployable. What good am I now in helping patients? They are on the inside and I’m out here.
I understand someone might choose to keep working.
Thanks for adding your voice. We need them all.
Alice
The last time you wrote about this guy I must have misunderstood you. I thought you were giving me advice on how I could go out and make a mint writing prescriptions for benzos. It’s true I could.
I love it when people ask me questions. This is a good one.
“What doctor wants to willingly give up a patient with good insurance?”
I once had a patient arrive with $1000 budgeted to see a psychiatrist. I was charging $100 an hour. I determined this was something short term therapy could help. We worked out a plan for therapy. Visit by visit we decided together if this was working for her. In nine visits we were done. She got to keep a hundred bucks. I ran into her two years later at her work. Her problem had not recurred. No pills.
What kind of doctor wants to willingly give up a patient with good insurance?
One like me who wants to see people better.
Do you suppose I’m the only one? I doubt it. I just ain’t that special.
Thanks so much for reading, thinking and writing.
It will take a lot of good people working together to make a difference.
Marian,
Thanks for checking in here and telling us about how things are in your neck of the woods.
Wow. In Denmark it’s like this, too? I’ve been asked to treat acute and chronic homelessness, acute and chronic unemployment, addictions, relationship breakups, house fires, divorces et cetera, with psychiatric drugs.
And yes. “Psycho-education” is what passes for psychotherapy. This is to “educate” the patient to the illness and the need to keep taking the meds as prescribed.
All that shines sure isn’t gold. So not to the Scandinavia for me, eh? 😉
Duane,
Another thought as to why medical students don’t question.
Our public education system were designed to train people in unquestioning obedience to authority. Think back for a moment, on the lessons you learned from school. The successful students were good at following directions, being quiet and spitting back the expected responses on tests
“Education is what’s left when you’ve forgotten everything you were taught in school.” (Someone smarter than me said this first.)
Medical students are the best of the good students and the least likely to question anything coming from a podium at the front of the room. One needn’t be a sheep to follow along, only very good in school.
Seth,
Thanks for joining this conversation. I appreciate your support of my writing.
Thanks for your well-written view point.
I wrote this article from the perspective of a well-meaning professional who is doing his best within the system as it exists today. There are many layers to everything.
I did not intend to take on the validity of the DSM in this article. I try to keep things to a circumscribed enough topic to complete my thought without writing too long. I don’t want to lose my audience by taking on too many issues at once.
It sounds like you are well-versed in the issues inherent in the DSM. Thanks for bringing this important aspect to the discussion.
Rachel,
Thanks for this alternate perspective. I’m best at speaking from my own experiences. It’s good to hear others.
There must be some people living the American dream or we’d all wake up, I suppose.
My own speculation: A lovely looking life frequently means big debt to service every month. Over the years there have been many loan brokers willing to mortgage me an enormous shiny life. If I had taken them up on it, I may not be speaking up here today.
If a person with an expensive shiny lifestyle speaks up, expensive shiny lives vanish pretty fast.
And what an elephant it is. It’s a whole herd of elephants that take up so much room there’s hardly space for any of us, clinicians or patients. And what comes along with such a crowd of elephants?
Thanks for visiting and joining this conversation. I appreciate your support of my writing.
Yes. I agree. There needs to be a lot of speaking out all the way around. My experience during private practice years was that psychologists, social workers and therapists were big proponents of drugs.
My view of this would be slanted, though, because that was why I heard from them. They wanted me to give drugs to patients.
John.
No doctors in the US have anything resembling employment protection. We are treated like interchangeable parts.
There is only the APA as a professional organization for psychiatry and a medical board that keeps track of professional violations and licensing in each state.
Perhaps the academics have some? I didn’t when I was a Federal employee on the academic track in the late 80’s.
These days psychiatrists are treated as interchangeable parts with anyone else willing to write the prescriptions. Nurse practitioners, pediatricians, primary care, doc in a box, naturopaths, physician assistants are all the same. All are referred to as “prescribers” and called “the doctor” by pharmacists. The “prescriber” work goes to the lowest bidder.
The only job offer (not in writing) I’ve had in two yuears worked out to three bucks an hour for the time they expected coverage.
Duane,
I always like it when you stop in here. Thanks for your support of my writing.
I’ll take a stab at answering what I think is your question. How do people choose to become doctors and how is psychiatry chosen as a specialty? I can only answer this for myself. I bet everyone has their own answers and that these may have changed over time.
I wanted to find a field in which I could both do good for people and have an independent business of my own. As a woman, I was astonished to find the field of medicine available to me. I planned primary care.
I was led to believe that entrance into medical school was highly competitive. “Ten applicants per seat” in a school. But once in, I discovered that every classmate had applied to 10-20 schools and that every seat was not taken in my school.
I was a good student and was accepted to both schools I applied for. The bottom line was, could I come up with the cash. Money equaled in. No money equaled not in. I was penniless. I had to borrow a LOT.
Psychiatry was the poor step-child of medicine when I was lining up professional training. It’s still low in esteem among medical professionals and at the bottom for income.
When I was looking at changing to psychiatry, I was told the field drew from the bottom of the medical class and encouraged to stay with neurology. I don’t know if this was true.
When I thought to go into psychiatry, it was a different profession than it has become. I had to overcome my own prejudices against the field to follow my heart into psychiatry. I love people. I like to get to know them. At the time, it seemed to have the most opportunities to have long term relationships with patients and help them toward better lives.
If psychiatry were then what it is now, I would not have become a psychiatrist.
I don’t know what questions students are asking today. Psychiatry is being misrepresented as a field with lots of new scientific breakthroughs. I suppose if one is willing to be a prescription mill, one can make a good living.
I wonder if the folks attracted to psychiatry now may be different than 30 years ago.
All the best. Keep reading,thinking and writing.
Alice
Marcellas,
Hang on to your job as long as you can.
It sounds like you are doing much good there. Keep speaking up however you can. People may be hearing and be on your side but not be in a position to speak up more yet.
Alexa42,
Thanks for reading and your very well considered comment. I especially like the support group your describe:
“patient support group that served as a forum where patients got together to share experiences on what to say (and not to say!) in all kinds of situations – when talking to SSDI and other benefits administrators, in ER evaluations to ensure you would (or would not) be admitted, what to say to get a doctor to discharge you from a hospital, a judge to release you during a commitment hearing, or to a college administrator to be allowed to re-enroll in classes after a medical leave.”
This sounds like a way to level the playing field (a tiny bit). I have coached people on what to say or not say as well to prevent unwanted outcomes and to increase the possibility of desired outcomes. I don’t tell them exactly what to say, just what words tend to trigger what responses.
People are not always functioning well enough to chose their words carefully during a crisis. I tell people to always bring a friend or family with them who they trust when seeing any doctor for anything. I do this myself.
Thanks again for your kind words and your support of my writing.
How would you see the legal system being involved as a national forum? Are you thinking of law suits filed by patients who’ve been harmed?
Certainly case law has given directives to the practice of psychiatry. The “duty to warn” required breach of confidentiality and involuntary commitment laws both came from legal mandates to protect.
I know there are financial conflicts of interests in mental health care. It is in the best interest of clinics to get people on disability as soon as possible.
Clinicians see this as doing the patient a good favor by making sure they get health insurance and money to live on. This also creates long-term paying customers as a side-effect.
Getting people on disability is lucrative for drug companies. Disability comes with government health insurance to buy drugs with.
Now that medicare has part “D”, this government insurance covers drugs for the disabled and retired. I am told that this was a hard fought battle won for beneficiaries.
I’m sorry for your struggles at work. Yes. Speaking up puts jobs at risk no matter how gently one speaks up.
Harper West,
Yes. The DSM is deeply flawed. It was written by committees made of people with conflicts of interest.
These deeply flawed diagnoses are used to grant or deny people access to basic health care, housing, and incomes. They are used to direct drugging through “standards of practice”.
These deeply flawed diagnoses are also deeply entrenched.
Stephen,
Good job with your answer. I added a few other comments in my reply to Licinia but you’d already covered things well. Thanks.
“Seven or eight drugs” changed rapidly. This horrifies me. Since we don’t know why or if any of the drugs work one at a time, there is no way to know what’s going on inside a human body when you have a chemical soup like this. “Prescribing” of this sort is unconscionable.
I’ve seen many people released from hospitals on soups like this. Doing this in private hospitals over a few days has become the norm, not the exception.
I’d almost have to believe drug sales people are in charge of “medical education”. Oh wait. Sorry. That’s right. They are.
If people in charge of the purse strings can’t be led to have concern about basic human safety, perhaps they could be encouraged away from allowing these terrifying drug combinations with a financial argument?
Psychologists are not medical doctors. Psychiatrists have gone to four years of college then four years of medical school to become physicians before training an additional four years as psychiatrists.
Alas, psychiatric training has devolved to “prescriber” training as drug companies have taken over funding for education. This is true in all branches of medical training.
In my own training as a psychiatrist (long ago) I learned many approaches and theories of psychotherapy, human behavior and psychology. This type of training is a thing of the past in the US.
I’ve heard that psychologists (who have no medical background or training) have been granted “prescribing privileges” in two states and in the American military so far.
Social workers have been lobbying for prescribing rights in Oregon for years.
In Oregon, any person with a “masters” level degree in any social related field (teaching, ministry) can make and give a psychiatric diagnosis. This used in schools to label children and force drugs on them. Pediatricians end up prescribing based on teacher recommendations.
The schools deny education to “non-compliant” families. Without the day-care provided by schools, this can mean loss of job and home. School teachers, in effect, are prescribing drugs to children through this multi-step process of coercion.
These policies are decided state-by-state so I can’t say how this works in the other 49 states.
Stephen,
Just me and a sack of organically grown flour.Yes. I know what you mean about the bread not spoiling. A contractor threw the bread from his sandwich outside on our wood pile for the birds to eat. We found it, unchanged even by the rain, months later. The birds and all the other creatures in our wooded yard knew better than to eat it.
The other great thing to make is vegetable soups and stews. We have “miscellaneous vegetable soup” most days. Whatever is in season. There is no better personal health and financial skill than knowing how to throw together a pot of cheap healthy fresh vegetable soup.
Oops. Perhaps I’ve wandered off topic again. But like you say, anything that supports healing and wellness will benefit those trying to remove themselves from the system and get healthy.
John.
I don’t know much about eggs and pudding or “incipient fascism”. It’s the law here and now. Our beloved Obama has also granted himself the personal privilege to order military executions of Americans abroad as well. Plus he’s using the WWI Espionage Act to prosecute and imprison Federal employee whistle blowers.
Do you suppose we’ve wandered off topic? I tend to do this. Legalization of executive and military human rights violations may have nothing to do with legalization of human rights violations in psychiatry.
To John Hoggett: (Ran out of thread to reply so continued here)
I’m delighted to hear of your exploits and of your apple pancakes. I personally bake my own bread by hand every day in protest of the awful stuff passing for bread here.;-)
Protests here are a bit difficult as well. Our occupy movement was swept away. Many were jailed. All gone now.
Our homeland security now collects and stores all internet data and communications. They started doing this while it was still illegal then back-dated amnesty for themselves.
Last year our president signed into law his right to use the military to arrest American citizens on American soil and hold them indefinitely in detainment areas without legal recourse based upon vague suspicions. Our supreme court just upheld this last month.
This puts a damper on protest movements and journalism.
I occupy my kitchen and cook my family’s food. I occupy my feet, park the car and walk. I occupy my own words.
Today, in the USA, writing and speaking of concerns has risks beyond simply being branded too radical to be employable for the rest of ones life.
Yes. Each of us does do what we can.
I rather enjoy the French and their constitutional right to public protest. It’s seen as an ordinary part of being French people. They don’t have to deal with tear gas, rubber bullets and incarceration when they speak up in public.
Well. I have to go knead up the dough for our morning baguettes.
John,
“So if the UK government is relying on corrupt, lying and dangerous drugs companies to generate wealth it is not very likely to go against them.”
Good thinking here. Always follow the cash. This also sounds like a great government marketing PR spin for arms and pharm corps.
Is it possible that a Soteria house that “uses much more medication” may simply be named Soteria?
Once upon a time I was hired by a clinical director who said her goal was to use psychiatrists for roles other than prescribing pills. Many months into this job I asked when those other parts of my work would begin. She laughed and said “Oh. That’s just a goal. We’re not really going to do it.”
Go by behaviors over words every time. (I say this to the choir.)
Oh Stephen,
It’s my joy and pleasure to engage in ongoing dialogs here. I’m learning a lot and getting to know great people (like you).
Writing essays is one way I work out how I think and feel about things that trouble me. Here on MIA it’s like supercharged essay writing in the comment zone. I write more off-the-cuff. I find the views expressed here both very thoughtful and thought provoking.
I do miss the personal long-term relationships I once had when I worked with people in my office. I miss the problem solving of crisis work. I miss teaching student doctors and supervising trainees. I miss collegial discussions.
No money in this. True. But I’m not alone in this world either. I’m fortunate. And we’re not a high-needs family.
So overall, I feel lucky to be here doing just what I’m doing. Until the next thing changes.;-)
All the best.
Alice
Report comment
Hi,
Thanks for reading and commenting. I can live with “a tad dystopian”. Perhaps I can even feel proud to have gotten this rating.;-)
Maybe I’ll be believed because of my psychiatry background. One would think. One would hope. But mostly not. I get some pretty cranky looks from some docs when I trot out my opinions. I talk to brick walls. I talk to the “yes pills are bad BUT…” folks. Every once in a while I run across a member of the choir. What a relief.
I did meet one lovely doc recently who spoke on a similar wavelength. We talked a while, shared thoughts. He’d just started to read “Anatomy of an Epidemic”. I wept afterwards. What a profound relief to be validated by another psychiatrist.
Thanks for your support of my writing. This seems to be what I’m supposed to do right now. And that’s okay with me.
Alice
Report comment
Stephen,
This comment of yours would be funny… if it weren’t true:
“We’re all supposed to hold hands and dance in a circle and sing Kum-ba-yah and pretend that bad things don’t happen at that hospital!”
I think there is a tendency for people that work together to circle the wagons. This may be amplified in intense situations. I’ve certainly seen police and firefighters hang together even when wrong. Medical people and mental health providers, too.
The view is certainly different from one side of the stethoscope (or locked door or injection syringe) to the other.
Thanks for you input.
Alice
Report comment
Michelle,
I apologize. I re-read my reply to you just now. I didn’t mean to sound short in any way. An extra apology if I came across badly. I can’t always tell how things sound in writing. I’m so much better in person (I hope).
I’m so sorry about your difficult times with psychiatry. What’s going on within patient care is a shameful contortion and degradation of the practice of medicine.
We’ve left “first do no harm” far behind in our efforts to stay on the economic bus. If I could stop this out-of-control bus, I would. I tried to stop the bus (a small local one) by throwing myself under it in 2011. It kept going.
The best I’ve been able to do so far is get off the bus and speak the truth over and over. And this is the best advise I’ve been able to come up with so far:
Get off the bus and speak the truth.
I do hope that some private conversation or writing I have makes a meaningful ripple in the pond. I have private conversations with doctors whenever the opportunity arises. This has turned out to be the positive outcome of my recent job search. No jobs but a chance to talk about my thoughts to working doctors.
All the best to you and yours.
Alice
Report comment
I’m copying and pasting this comment from above in the thread so I’ll have room to reply:
Stephen Gilbert on April 10, 2013 at 8:29 am said:
I began to wonder about it all when I got involved with Catholic schools, where they put each and every student in a uniform so that each and every one of them would look alike. They said that it was for economic reasons because uniforms were cheaper than civis and kept the kids from making fun of the less rich students. I never bought that at all.
One of the ways that you gain compliance from people is to take their individuality away from them and make them one of the masses. Often, the boys were put in uniforms that looked exactly like military kacki(sp)with military belts and military style shoes. In earlier years everyone had to say good morning to the teacher all in unison, as one voice and body. All of this started me thinking about why it was done. I didn’t like the conclusions that I came to, but of course I’m one of those people that has to question everything and accepts nothing as gospel truth until you prove it to me to suit me.
MY REPLY:
Stephen,
My older came home from his first half-day of kindergarten (in a yuppie high-end high-rated school) with this story:
His teacher had a box of cookies. She said that everybody would get a cookie if everybody clapped. Then she told them that nobody would get a cookie if even one person didn’t clap.
That was his last exposure to “education”.
I went into this believing that public school was the great gift to the masses and that anyone that home schooled was depriving their kids. Our school was the “good” one. We had the “good” teachers.
Dog treat behavioral training from day one. Of course, he saw nothing wrong with this. He thought it was great. He was very hungry. We’d been told absolutely no snacks would be served.
Sigh.
Alice
Report comment
John,
We do a lot of “head in the sand” in this country. It’s our national pastime. I’m not so good at it any more, it seems. Or perhaps I am and I have my head in the sand about that as well. 😉
Alice
Report comment
I’ve copied and pasted this post from above unchanged so I have room to reply:
John Hoggett on April 10, 2013 at 8:06 am said:
Thanks, this is hugely challenging. I googled Gatto and watched some video’s of his work. I foudn his criticism interesting but he didn’t have many answers.
There are writers like Gatto in the UK, though not many who are prominant at the moment. I think the 70′s was when I last saw an upsurge of interest in such opions.
Dorothy Rowe, the UK based Australian psychologist, wrote that there are two types of edcuation:
1 education by molding
2 education by enlightenment
According to Rowe in Russian there are seperate words for both concepts.
The word education itself, according to Rowe, comes from a latin word meaning to lead out of darkness.
The restrictive nature of school, and the move towards a factory/office atmosphere instead of one of learning and democracy was one reason why I found working there so hard.
To lead out of darkness would be the function of any good psychosocial programme for people who are mentally distressed. Would it not?
MY REPLY:
John,
I was more impressed with his early written work (“Dumbing Us Down” comes to mind. A small book to read.) than his later recorded work. I haven’t the patience to listen through the long recordings. The messages get lost for me. But I’m oriented to the written word on paper by default.
In his earlier writings he reviewed the things that he did as a NY public school teacher over a couple of decades, what worked and what didn’t, and how people responded to what he did.
If only our education system would lead people from the darkness. So often it seems to do the opposite. This makes me wonder if we’re using the wrong words for what we do in schools.
When I tell people how to evaluate the meaning of the words being used (ex. mission statements), I tell them to evaluate the outcomes. Maybe the first couple of times or rare events can be called accidents in spite of good intentions. When one continues to do the same things that cause consistent bad results, at some point you have to ignore mission statements.
Watch what’s happening to discern the truth.
The “education” we do is more what you described as a “molding”.
I would love to see a psychosocial program that enlightened the mentally distressed. As long as it also helped with the basic needs of life: Food, water, shelter, safety,relationships.
All the best.
Alice
Report comment
Alexa,
Yes. You were very fortunate to go to an alternative school.
Even before ADD/ADHD and drug marketing, children were squished together and homogenized.
We left the era of the one room school where all ages were taught together then traded it for the factory model of learning.
It’s time to get honest about education. People are not sprockets or interchangeable cogs. treating them as such is abuse.
Let’s move onward (or back) to a model that does more of what we want and less of what we don’t want.
At the very least, we can attribute harms done to the door it comes out of.
Thanks for checking in and giving me more opportunities to rant about this. 😉
Alice
Report comment
I have copied and pasted this comment unchanged so I have room to respond:
John Hoggett on April 9, 2013 at 4:41 pm said:
They’ve sold off a lot of the social care sector already. Things like home care where people get home visits. The social workers job is now to do an assessment and then put the job out to tender to varios “Care” agencies. The workers get paid badly and by the job, so they cut the time with the clients to the minimum and give very little peronal attention, especially if the client is at all, “Difficult,” as people with mental health diagnosis are likely to be (I have a gardening client who is an agroraphobic hoarder who also has physical dissabilities who has carers who do his shopping and offer help with cleaning etc and he is always having battles with them, it’s a wierd thing to witness.).
John,
In Oregon in the late 80’s county (public) mental health services were “spun off”. What this amounted to was privatization to “not for profit” corporations. “Not for Profit” corporations behave just like other corporations except they don’t have stocks and shareholders to pay dividends to.
These public mental health services have been sliced and diced and sold off and moved around year after year to the lowest bidders for 24 years.
Add layers of increasingly powerful for-profit insurance companies, medical service provider organizations and politicians beholden to campaign finance contributions.
We have a mess there. A cash sink hole called mental health services and not much in the way of care happening. Tax dollars vanish through this web into corporate pockets.
It is not possible to provide public services through private venues. No one will take care of your poor, elderly, sick and needy like you would.
Welcome to our world. You’re just a bit behind us in the process.
All the best.
Alice
Report comment
John,
What is my opinion about the function of public education?
What a great question. Of course I have thoughts and opinions about this.
Although we may seem to have wandered off topic for MIA, I think this question is squarely on topic.
How have we ended up with such widespread and unquestioning obedience to the pharmaceutical companies’ (and all advertiser’s) directives?
This obedience to drugs (and other things that are bad for us and bad for the planet) is pervasive throughout all levels of society. Even mothers who know their kids are miserable being drugged seem helpless to stop it. The few that have the courage to stop the drugging often feel compelled to lie and pretend compliance.
You would think that a country which is as highly educated as we would be less easy to fool and manipulate.
In my opinion, our most holy of cows, our education system, is the cause of our obedience.
According to John Taylor Gatto, an educator and historian who looked into the roots of public education in the U.S., our Prussian model of mass education was designed and adapted here specifically to provide control of a large population over a large geographic area.
It was not designed to make good readers. The population of the colonies (outside of slaves) was already highly literate.
One of the key features of our Prussian model of mass education is to produce a majority of people who have an unquestioning obedience to leadership.
Whether that leadership comes from the front of the classroom, the front of the platoon or the front of a television doesn’t matter. We are conditioned to obedience through 13 long years of childhood classroom control.
There may be some talkers and grumblers but people go to work and do as they’re told. Even the miners who are are paid by corporate coal mining companies to blast the tops off their own mountain homes in West Virginia and poison their own groundwater still show up to work. They may feel bad and grumble about it, but they still do it.
Sorry. This is sounding like another essay. Very good question indeed. Google Gatto. Read his books.
All the best.
Alice
Report comment
I’ve copied and pasted this comment unchanged from the above thread to have room to respond:
John Hoggett on April 9, 2013 at 3:13 pm said:
Home schooling is getting harder in the UK too. There are financial advantages to schools to have children with diagnosis. Tehy get money to pay for teaching assistants. Whether they make any differnece has been contested. I was one for about 5 weeks. My question is are they there to enforce the school rules or to help the child get their emotional and social needs met?
John,
Thanks for your conversation. I like to hear how things are going across the pond. Personal reports are enlightening to me.
In Oregon (homeschool laws vary by the state you’re in) the school offers a free computer, internet connection and on-line curriculum. I never heard how this works out in practice.
The teaching assistants? Not sure. Not much experience with them. Behavioral control, perhaps?
All the best.
Alice
Report comment
John,
I hope that privatization of school works better than privatization of utilities, prisons, medical education, medical care in this country. I have developed a “cringe” reflex when I hear that word. It may not be fair to assume the result will be the same in UK as in the US. But then again, why wouldn’t it?
I’ll cross my fingers for UK’s school privatization.
Alice
Report comment
Jeff,
Thanks for reading and for your thoughtful and gracious comments. I appreciate your support of my writing efforts. There is more than one way for a doctor to help people.
This woman I wrote could be anyone we know. I hear a variation of this story every time I have a personal conversation about psychiatry. She is a compilation of many who I’ve talked to.
You’re right. I HAD to stop work once I read RW’s book. I tried for a while to work in a new way within the old system. This went nowhere useful.
When I talk about truths that are not widely known, people do see me as being a conspiracy theorist, having a “bad attitude” or in being “too down” about things. I’ve been accused of these (and worse) by strangers, acquaintances and people who I’d once considered friends and trusted co-workers.
We must each do what we can to get the message out.
Thanks for reading, thinking and writing.
All the best.
Alice
Report comment
Stephen,
There are so many things that don’t make sense in education if you imagine it is there to teach kids.
If you can you step away from this premise and look at the outcomes of our schools the premise must change.
Alice
Report comment
Stephen,
Thanks for you’re input with regard to the education system. I’ve seen all these things happen as well.
Alice
Report comment
Stephen,
Wow. I appreciate your open reporting of your “undercover” experiences. This will not appear in the mainstream media but it needs to be talked about. You’ve already done the undercover work. A lot of folks have.
People run away and slam doors when you crack through the walls of world views abruptly.
Good to hear from you.
Alice
Report comment
MichelleB,
Thanks for reading and commenting. I like to hear your thoughts. You ask some very good questions.
Ah yes. We have both “won”. I’m unemployed in a rental with my family with no house or job in my future. I’m not under a bridge. My kids are not being drugged.
She has a job, a house and a kid that will soon be drugged.
It is a shame that a person with my education, experience, training and smarts is unable to find a way to get paid to use any of it. I suppose I could work for free without the expensive liability insurance. Or I could retrain in tropical medicine and move to Africa. As you point out, there are endless opportunities for someone like me.
Yes. I do write other places. Check alicekeysmd.wordpress.com
Thanks for asking. All the best.
Alice
Report comment
cannotsay2013,
Yes. The history of our education system is a real eye-opener. John Taylor Gatto (an award winning New York School Teacher) did a good job writing about this in “The Underground History of Public Education”. I think it’s available to read for free on line now.It’s a big work. Some of his shorter books about education may be more accessible like “Dumbing Us Down”.
He reviewed minutes from the meetings where our education system was designed.Chilling and enlightening reading. The militia had to be called out to march the kids to those first public schools in Boston. People did not want the system we have today. Literacy rates were much higher before public education.
This many generations into our great experiment with public education and it’s hard for anyone to question it.
Thanks,
Alice
Thanks,
Alice
Report comment
I copied this to have room to comment:
cannotsay2013 on April 8, 2013 at 9:12 pm said:
Yes, I would do exactly the same if faced with the choice. Sometimes people forget that we, Americans, have a lot of tools at our disposal to fight the psychiatric oppression.
cannotsay2013,
Exactly. I think that each of us can support one another to make creative moves to take care of ourselves and our families.
Thanks,
Alice
Report comment
Maxima
Good for you and good for them.
Alice
Report comment
cannotsay2013,
Thanks for bringing up home education.I have two boys. I’ve always home schooled them. They love it. I love it.
Even though it’s been years since parent have been arrested for homeschooling their kids it still took an incredible amount of courage for me to educate my kids at home.
It kept me awake at night for years thinking I was doing it all wrong. Then I read the story of an illiterate mom who learned to read along with her homeschooling child.
Educating my kids at home has helped clear out some of my own cultural training. It’s allowed me to see that many things I “knew to be true” were simply incorrect teachings from someone else’s agenda.
Home education can be hard to pull off by single parents and in homes that require both incomes to pay the rent. There may not be anyone home to supervise the kids. They may depend on school as day care. I’ve seen people work opposite shifts to pull it off, though.
Homeschool laws very considerably from state to state. Transitioning a child who has many years of public education can take a while.
If you are a product of public education this may influence your approach to home education. I thought at first that I had to replicate the classroom experience at my kitchen table. Nothing could be further from the truth.
I’m a strong proponent of home education. There are as many variations on things that work as their are families.
Thanks again for raising this important topic. Yes. Home education is a great way to make a truly individualized education.
All the best.
Alice
Report comment
John,
Thanks for the UK view on education and ADHD.
I did a quick Wikipedia for rates of illiteracy. US and UK run neck and neck with 20% illiteracy and 40% “functional” illiteracy (lack literacy skills to manage every day life).
There is something basic about our education structure that’s not fulfilling its prime directive. It makes me wonder if teaching reading (and other basic skills) is the prime directive of the education system we’ve built.
Thanks for keeping us thinking.
Alice
Report comment
John,
I’m so sorry to hear this. “For profit” means “for profit”.
Our “private” for-profit medical system is a cash cow for a few at the top of large corporations and to corporate shareholders. It puts straws into tax coffers through medicare and medicaid.
Infant mortality is increasing.The numbers with no access to health care is increasing. The price tag is increasing.
“The fear is that the private sector will undercut the NHS service to get the contract. They can do that by using profit from another enterprise. The good NHS unit then closes and all the expertise and machinery goes. The local population is then at the mercy of the private provider.”
This is exactly what’s happened with the “privatization” of prisons here. They low bid. The government infra-structure dissolves. Then the price goes through the roof and the services vanish.
It’s not possible to provide social services with a for-profit model. You can only provide profits. This is well known.
You’ve been sold down the river.
I’m so sorry.
Alice
Report comment
Alex42,
Thanks for being willing to take another look at one of the most sacred of sacred cows in our country, the mandatory “free” public education system. It is in no way “free”.
I agree that changing the way the education system works would be better than drugging kids. Amen to that.
But it’s not likely. In Oregon, the IEP (individual education plan) brings in more revenue for each individual school. They’re paid by the head. An “IEP” head brings in more money than a regular head. There is a financial conflict of interest here. More IEPs equals more revenue for a school. AN IEP the ticket to drugging.
Any masters level educator can make a psychiatric diagnosis and demand you drug your child. The kindergarten teacher or basketball coach can saddle your child with a lifelong psychiatric label and a lifetime of drugs.
I think any person incarcerated and made to sit still and be quiet inside a crowded room every day for years could develop “symptoms”. Those who become hopeless and withdrawn could be labeled with ADD. Those who rebel, jump around and act loud could be labeled with ADHD.
If one thinks of school children as young PEOPLE, my theory makes sense.
I’ve read estimates of illiteracy rates as high as 40% in this country coming out of schools (depending on how you measure and who you count) and have been steadily declining. So school isn’t there to teach people to read.
Yes. What we are doing to our children with this thing we call education needs to change. A lot.
Thanks for the space for another rant.
All the best.
Alice
Report comment
Philip,
Thanks for reading and for your support of my writing.
All the best.
Alice
Report comment
mcoma,
Good comment. I appreciate all the work that went into it.
I like your idea of having outside observers overseeing care. This should extend into our rapidly expanding prison and jail systems where many people are being held and drugged. Human rights oversight is in order.
I’ve heard rumblings from UK about “privatization” of the NHS. Do you know anything about this? This word has been used to disguise corporate takeover of medical care (and many other things) here. It causes a precipitous decline in quality and rapidly escalating costs. It means “for profit” for shareholders. This has no place in medical care.
Thanks for your reading, thinking and writing. Keep it up.
Alice
Report comment
JeffryC,
Thanks for reading and commenting. I think you sum this issue up very well. You’re right. I haven’t often met a person who said “Hey. I’m a pill person.”
Some of the most wild west (shoot pills at anything that moves) “prescribers” I’ve known make good sounding mouth noises. They say all the right things. One has only to follow behind on their work to see the truth.
I think what you say here is very astute:
“It seems most people in the U.S. are of the opinion that psych drugs are bad, except for when they are not, which is whenever they feel assured that some case is different.”
This adds considerable clarity to what people really mean when they say they’re not a pill person. It means they know what to say.
I second your “sigh”.
All the best.
Alice
Report comment
mcoma,
Thanks for reading and especially thanks for taking the time for such a great post of your own in response.
Our cultural “brainwashing” (if I can use this word) is pervasive, contagious and starts at a very early age. I’m certain this cultural effect is a large part of the suffering that comes up in the mental health system.
The cultural effects are overlooked and all blame is laid on the brain and family of the person suffering. I’ve been asked to treat unemployment, homelessness, divorce, community deterioration, effects of public education, drug addiction, school bullying, poor nutrition (and on and on) with drugs, drugs and more drugs.
I guess if you only have a hammer everything starts to look like nails.
And, no. I’m not going undercover.;-) What a terrifying thought. We all know where this would go. They’d be too drugged to report and discredited by their “mental” history.
Alice
Report comment
John, I don’t think I could handle “Brave New World” again right now. I’m just recovering from my re-read of “Grapes of Wrath”. I realize we are much more under the thumb of unfettered global capitalism than I thought.
I have no idea how our “anti-trust” laws were removed. I was taught back in school that these laws would protect us so we didn’t need to worry about huge corporations gaining too much power. Ooops. The laws are gone. I wasn’t watching and worrying because I thought we were protected by the laws and the government. Big Ooops.
Yup. I remember “endogenous”. This was supposed to mean that there wasn’t anything one could do except take drugs to feel better. It always seemed, well, wrong to me.
The incidence of kidney failure from psychotherapy must be down close to… zero?.
Thanks so much for checking in on my post. It’s always lovely to hear from you.
Alice
Report comment
Poet,
Thanks so much for reading and commenting here. I appreciate your support of my writing. I love to write.
We’ve let go of the old life and live in a temporary rental till we sort out what to do next.
I hope to find ways to have a positive impact on how things are done in medicine.
All the best.
Alice
Report comment
Phillip,
Thanks for your kind words. Marketing is no longer simply showing us the brand name and saying good things about the product. “Subtle and Pernicious” is a good set of words to describe modern marketing. It includes both obvious and hidden flattery that makes us feel clever when we reach the “right” conclusion so nicely at the same time as it’s presented to us.
Alice
Report comment
Stephen, The entire “system” we live within today is totally corrupt AND I’m getting crotchity and old.;-)
Alice
Report comment
Stephen,
I like to think that today’s heretics could be tomorrow’s saints. Reassuring to hear.;-)
Alice
Report comment
Duane, Nice to have you here. Alice 🙂
Report comment
Duane,
As usual, you ask a lot of very good questions.
I wondered what psychiatric drugs had to do all those nice words describing psychiatry/psychiatrists and, by default, myself.
I would like to consider myself “liberal”, “democratic” and even a product of “enlightenment”. But I got lost on the possible meaning of “consequentialism”. And, like you ask, what does any of thins have to do with psychiatric drugs?
All the best.
Alice
Report comment
Howdy Duane,
Thanks for stopping by. I don’t think this is “another battle brewing on religion”. I hope not.
It seemed that the up-front point of the article was in support religious tolerance.
Good to hear from you.
Alice
Report comment
Stephen,
I’m glad for your feedback on this. What a puzzle to “hide” in plain sight.
It’s clearly posted which company is funding each article.There are ads flickering around the edges. The “for credit” articles are directed at prescribing specific drugs in conjunction with specific diagnoses.
At the end of each article that a doc uses to collect “free” CME credits there is an optional evaluation form where you are supposed to tell them if you thought there were any visible conflicts of interest.
I’ve been puzzled why this is the case.
How accurate could this feedback be from a doc who just accepted the gift of free education credits? Is it a liability dodge for the drug company? It is simply a case of hands washing hands?
Thanks for checking in on this one.
Alice
Report comment
Sethf1968,
Thanks for your well-considered and well-written comment.
The only clarification is about your question of what I meant by “24/7 coverage”.
No. This did not mean I had insurance.
24/7 is the number of hours (24 hours a day seven days a week year round) I would be responsible for and available to handle all phone calls and come in to work any extra hours if needed. Whether the employer is paying for seven hours a week or twenty or forty, the expectation is that I will always be available and work however many hours are required to do the job.
This requires always being in telephone answering range and range to drive in within a set number of hours.
One job estimated about three hours a day of additional phone contact time needed. They said would “try” to keep it in three batches a day. None of these additional work hours, which includes evaluating situations and prescribing over the phone, would be paid for.
If work beyond the paid hours is needed to effectively manage the responsibilities, there is no more pay.
The hourly rate and number of hours paid may not accurately reflect the actual hours of work performed.
24/7 coverage means that for 7 hours a week pay, I belong to them day and night.
Thanks for asking.
Alice
Report comment
John,
Life. liberty and the pursuit of happiness” is straight out of our American constitution. This was our government’s original mission statement when we broke away from British corporate rule.
It was not the crown we struggled against but the corporations which were controlling everything from what people could grow and make, the prices they could charge and what they could say to the next wave of settlers being sent over (nothing bad about life in the colonies and nothing good about the native population).
Ain’t history books wonderful? 😉
Thanks for your kind words about my writing. I’m certain something is brewing back there. There’s nothing like MLK speeches and Alice Walker poetry before bed to get the old creative juices flowing.
Alice
Report comment
Footloose 1949,
Perhaps the money for the person’s treatment time comes from a different pocket of the budget than the money for the pills. Bureaucratic thinking like “which department budget” and “which fiscal year” is often used to move expenses around here. Medical costs happen a bit later than the onset of the psychiatric drugs. It makes the real cost harder to track
The drugs are also much more expensive here in the US than in any other country in the world. People have been buying drugs from Canada and other countries on line for years to dodge drug costs when they can.People used to drive across the border into Canada to buy them from the northern states.
And perhaps the marketing line that drugs are cheaper and faster than therapy has simply reached the level of “truth”.
“Repetition causes belief” is a well-known marketing and education strategy. Anything repeated often enough becomes fact to the human mind. This is a known feature of the human operating system and is underneath some of the cognitive therapies that help people change how they feel and view themselves. For example: thought stopping (stop the repetition of the negative belief) and replacement (repeat the new desired belief) works like a champ. This principal also underlies the danger in media exposure. Our human brains soak up the repeated images of violence, material goods and sex (plus more) as if it is the truth.
I believed that pills were faster and cheaper than psychotherapies for many years without doing the arithmetic myself. I may not be the only one. Or maybe other professionals have always seen through this falsehood and I’m simply more gullible than the average bear.
Thanks a lot.
Alice
Report comment
I started a new thread here so I can reply by copying David’s post:
David Ross, M.Ed., LPCC on March 13, 2013 at 6:12 pm said:
I work in a rural system and the numbers cited above are typical. I’ve never, ever heard/read of a physician being paid $70 an hour. I just can’t understand that assertion. I guess come to Ohio!
David,
Ohio. The land of opportunity. I am a buckeye by birth and still have parents and siblings farming there. What a lovely state with all four beautiful seasons.
I’ve also been informed in this thread that Oregon is the state with the highest paid doctors. I must have missed out on this for the 27 years I lived there.
I’m breaking taboo here on talking about money. Who does this taboo protect?
In 1987, fresh out of training with 100k of high interest education debt I scored a full time salaried position for about $60K a year through the VA staffing an inpatient unit, teaching medical students and doing research. A year into it I did the math for the actual hours served. It was less than minimum wage. I worked there two years. This was the last full-time regular benefited job I’ve had since leaving school.
The first month of my private practice 7/89 I had one patient visit. I didn’t get above 4 paients a week for a long time. Private practice never was a busy thing. But I also declined to do “meds-only” (med checks) because it never made any sense to me from a clinical care perspective. Pills have never equaled treatment in my book.
In my private practice I last charged $100 for a fifty-minute session and $60 for thirty minutes in 2003. I always did some pro-bono work and sliding fee. I could have filled the office all week for pro-bono work.
I worked MUCH less than half-time because that was how many patients there were who could pay. The insurance was tied up completely with managed care companies. No one could afford cash. The last two years I paid the everyone except me. That works out to zero an hour for my private practice hobby. I closed up shop 07-03.
I was hired 11/2004 to do “on-call” work in Portland for $90.97/hour. I made this same amount part-time intermittent work without benefits till I left Oregon last year. I was told this was the regular hourly pay with a special hourly bonus for being willing to be called in to work anywhere, any time.
The most I’ve ever made was $110 an hour for six months about three years ago. No benefits. 20 hours a week.
I turned down a part-time job with no benefits for $75/hour in Portland maybe three years ago. This included being available by phone all the time and me paying for downtown parking.
I passed on a verbal offer for a 7 hour a week job two months ago that required 24/7 coverage, working alone, four patients an hour. That was for seventy bucks an hour.
I did pass on a job last month (it was never offered, only suggested that I might be interested)in a jail that paid $160 an hour for 20 hours a week. The trick was, it was a 24/7 job with no benefits that had been unmanageable in a forty hour work week. So what would the real pay work out to if I did the work?
I’ve learned from hard experience to do the arithmetic.
weekly money minus overhead expenses divided by expected hours of coverage.
It has been suggested (and I suspect it’s true) that if I did a cash-n-carry prescription business with 10 minute “med checks” for $50 each and made everyone come in for refills, that I could be rolling in the cash.
All the best.
Alice
Report comment
John,
Thanks for your encouraging words for my writing.
It does seem that the same battles have to be fought over and over. I’m not the first to make these connections in writing. I’ve simply been reading musty old history books.
Rather like a committee with no one taking minutes, we have to learn the same lessons and fight the same fights over and over again.
Our grandchildren will have to fight these same fights unless the laws that govern corporations are changed dramatically.
Alas, corporations have been created immortal, given human rights and better passports than any mere mortal. They only have to wait for us humans to die in order to continue to grow in power. And they now have DEEP POCKETS. The prime directive written in by their (human) creators is profit. They are doing exactly what they were told to do. Very, very well.
I wonder how an immortal company who’s prime directive is to protect life, liberty and the pursuit of happiness would work. Maybe one with built in checks and balances to keep any one power hungry branch from overwhelming the whole thing. Maybe one that could modify itself over time through open discussion of ideas and free elections by the people.
Nah. I must be nuts.;-)
Alice
Report comment
Dear Madness of C.
Yes. Job loss is a real consequence of speaking up. Finding another job may be limited to a complete change of profession, rather like refugee doctors in a foreign country that end up working in restaurants.
I have certainly heard “purely verbal homage to the need for change” from managers in clinics only to be told that my views are “too radical” for me to be useful around the place. More than once. In more than one state.
I think of these as “mission statements”. Mission statements are fine marketing tools but may not reflect what actually happens.
I couldn’t know the feelings they may have felt about the ideals they espoused or the chains they may have felt they wore.
When evaluating expressed intentions and ideals, I monitor behavioral output. Watch for them to walk the walk. Or not.
I think the divide between stated values and behavioral output is part of a larger issue in our country today. We have all learned to say what we think the person in authority or the person we want to please would like to hear. For example, when people hear that I’m vegetarian, many say that they want to be or wish they were or almost are or will soon be vegetarian. It doesn’t slow their burger consumption one bit. Personally, I prefer the honest meat eater.
That which passes for liberal ideals today seems a thin veneer or paint job over something else to me. Perhaps there’s enough paint to settle personal unease at the rising tide of the homeless and disenfranchised poor. But it’s not enough to pay more taxes to care for the poor or enough to insist the budget throttle back on military spending to care for the poor.
Watch the walk if you want to know what a person’s highest ideals are. If it walks like a duck…
Thanks for stimulating more of my thoughts with your comment.
Keep writing.
Alice
Report comment
Steve,
And I think most medical doctors know this about psychiatric drugs causing medical problems. I had a medical doc get into my face and demand to know when MY treatments would stop making HIS patients so sick. (We shared zero patients. I was the psychiatrist in shouting range.)
Pills are vastly more profitable to corporations than psychotherapies. Crank pills out in a third world country for pennies and charge dollars here.
You just can’t suck that kind of cash stream into the coffers based an hour of psychotherapy once a week. And with psychotherapy lots of folks get better and go on about their business rather than become chronic patients. This is definitely not good for the corporate bottom line.
I’m glad to see that I’m not the only one who can do basic arithmetic and see where the dollars flow.
Thanks.
Alice
Report comment
engineer
Sorry to have missed this comment. Complex thread and all.
Thanks for your kind words. I feel supported here even in the midst of lively discussions.
You said: “I ended up in the hands of what I call a legal drug pusher”
Your assessment of the situation you found yourself in is good for everyone to keep in mind that thinks they may need help. If you see a psychiatrist today, the chance you’ll be offered at least one prescription drug is high.
I suppose if it walks like a duck and quacks like a duck, it could be a duck.;-)
All the best.
Alice
Report comment
Madness of C the B, B,
Very nicely said. You make me think.
All the best.
Alice
Report comment
John,
Yes. This is the result of my calculations as well. Counseling is cheaper than hospital stays. It has a better side-effect profile as well.
Perhaps we can advocate for the use of psychotherapy, housing support, vocational support and food in cases where the now “traditional” drugs only treatment has failed. Maybe we’d find it reduced expensive hospitalizations.
Oh wait. That’s called an ACT team. And it’s already been researched. It’s evidence-based care.
Alice
Report comment
mcoma,
I was so entranced by your words that I forgot to judeg your spelling.;-)
Keep writing.
Alice
Report comment
mcoma,
Thanks for spelling out the truth from the perspective of the clinic and clinician side of things. I cannot dispute anything you say here from my personal experiences in recent years in community clinics.
There is an unending stream of new clinician fodder coming out of schools green as spring twigs and shackled with debt.
Thanks for adding your perspective.
Alice
Report comment
Peter,
Thanks for your well-considered and well-written piece.
As a psychiatrist who has thrown myself under the proverbial bus for patient safety concerns, I have to say that the bus just keeps rolling along. No one but me looks back.
Perhaps if a whole bunch of us held hands and threw ourselves under the bus, it would stop? How many would it take since psychiatrists have been replaced by prescribing nurses, primary care docs, naturalopaths and physicians assistants and prescribing psychologists.
I’m not so sure.
I am sickened in my heart about the drugging of kids. I started to say “kids in foster care”. But the truth is drugging children makes my heart sick. Talk about being unable to give informed consent.
Take my licenses away? I pay for active licenses in three states and a federal narcotics license and what am I using them for? Even without a license, I’d always be a doctor.
Thanks. As always keep reading, thinking and writing. I’ll ad talking to this, too. Keep speaking up.
Alice
Report comment
Stephen,
I agree. This is bigger than doctors. It has been decades since doctors were stripped of the power to direct patient care.
Alice
Report comment
I started a new thread to have room for a response by copying his comment here:
John Hoggett on March 13, 2013 at 7:35 am said:
Indeed, Occupy was a flash in the pan, but it had a big impact. Perhaps it is best not to see it as a big battle but a skirmish in the long struggle?
Corporations are given life through government words. I say to them, “Stop being so silly,” but they don’t always listen.
Meanwhile, here is a little song and rather in your face video to hopefully chear you up (well the songs chipper the video is a bit confrontationally grim): http://www.youtube.com/watch?v=NJTcoKl0aN4
John,
Thanks for the video link. I had no idea the Occupy movement was so active in UK.
Since corporations are given life and power by government words, how can people have a say in those government words?
All the best.
Alice
“We’re all in this together. I’m pulling for you.” Red Green
Report comment
Footloose 1949,
Thanks for reading and checking it here with your personal experiences. I feel supported in my writing by this. You are right. And the obesity is way beyond a self-image issue. It will cause early death after a lifetime of medical illness.
I hope you will not take offense when I disagree with this statement from your comment. I was also taught this as the excuse that insurance corporations wouldn’t pay for therapy and why I wasn’t allowed do the psychotherapy interventions that helped people have better lives:
“At the end of the day, the cost of councelling and therapies are far far more time-consuming & expensive than pills”
Pills are for a lifetime. Many don’t work in the ways we’ve been taught. Some not at all. Pills can cost hundreds to thousands of dollars a month depending upon the “cocktail” prescribed. They create expensive to treat medical conditions and take years off a life.
How’s this for slower and more expensive than counseling?
Sorry for the rant. You bumped up against one of my old pet peeves, this lie that pills are cheaper than counseling. I used to believe this story as well.
All the best. Keep reading, thinking and writing.
Alice
Report comment
John,
Yes. I know.
Alice
Report comment
John,
Thanks so much for your post.
There are days I think I’m the only one that sees what’s been happening. People that I meet that sort of get it are in “duck and cover” mode. I suppose if I were more clever I would be as well.
We’ve made laws (international free trade agreements) that allow corporations to travel internationally with more ease than any person.
Poor India(per Ms. Shiva) is in the middle of a fight for its life against agribusiness and GMO seeds that are killing farmers. They’ve been fighting to save Himalayan forests so they can maintain water supplies and are up against the largest steel manufacturing plant in the world that’s been planned there.
Where I am, the occupy movement has been swept away. The grass grows thick and green on the government lawns where the occupiers camped.
It’s all words on paper though. Remember this. Corporations are given life by our words.
Alice
Report comment
Morias,
Yes. The ones that do know and don’t care worry me the most as well. I wonder how one would pick these folks out in a crowded room. It could be a useful skill.
Thanks for these thoughts.
Alice
Report comment
Stephen,
This a lovely piece of thought and writing. I agree. We’re all in this together.I suppose that if there were no more customers, the “industry” would dry up.
I hear from psychiatrists that people come in begging and demanding the drugs by brand name. In my experience, people came in with specific ads in mind wanting specific drugs. Name brand new ones from television, not a less expensive generic alternative.
A great start would be if everyone simply stopped watching television. Imagine how free our thoughts could become (once we detoxed) if we unplugged our end of the Madison Avenue pipeline. We’d all lose the restless wants, anger and fear generated by the marketing industry.
But then, the economy would collapse because people would only buy what they needed and it would be enough.
Sigh. Fantasies.
Thanks Stephen.
Alice
Report comment
Stephen,
Bing, bing, bing. You win the prize for getting my message.;-)
We have to stop throwing rocks at one another long enough to work things out. This is a BIG mess. Psychiatry (and all of medicine) is only one small part.
There must be laws enacted that limit corporations.
Corporations were given immortal life and human rights by words. Words are the only way to put on the brakes.
I don’t know if this is possible or not. But since words created this mess, words are the path to freedom.
Keep reading and thinking, writing and talking.
Alice
Report comment
Stephen,
I have had my own primary care doc dancing in circles of frustration over my unwillingness to gobble pills. He has always declined the research papers that support my stance. I’m written up as being non-compliant with his recommendation.
I’m surprised the free clinic has the time to take. Our public clinics are overwhelmed and underfunded with four patients per hour minimum and scripts at the end. You are lucky. Hang on to this while you can.
Alice
Report comment
Chuck,
Thanks for the resources. Information is good. History tells us a lot.
Alice
Report comment
Morias,
Thanks for your kind words of support. I find I sleep well at night this way. This is worth an incalculable fortune.
All the best.
Alice
Report comment
Donna,
Lovely and well written. I appreciate your encouragement here. I love to write and will certainly continue to do so. Words must be written. I won’t stop doing this. This is work, of a sort.
I think my point is that outspoken activists for human rights may not find gainful employment within the medical system as it exists today.
You’re absolutely correct. It will have to be work outside the system.
Alice
Report comment
Donna,
Thanks for checking on her. I was worried.
Thanks also for your clear thoughts and writing. I think we’ve all known for a long time that the government is no longer by or for the people.
I recently heard that the woman who drafted our new Obama plan went back to work for the big insurance company for a very high salary… millions a year. I can only hope this is a foul rumor.
Alice
Report comment
Jeffry,
They were both very good, very hard working and very frugal. I don’t pretend to understand the finances of others.
By your rational, very person who ever paid taxes into a system that built drones should also be prosecuted. And every shopper who buys cheap Chinese toys made by children in sweatshops. And every person who drives a car(cars are the number one cause of death from age 8-34 in America).
There is nothing in our land that is not tainted.
In the words of John Steinbeck in “The Grapes of Wrath”: “The monster isn’t men but it can make men do what it wants.”
We must find ways to work together to enact laws that limit corporate capitalism before it kills our planet.
Thanks for the opportunity to say what I feel most strongly about.
All the best.
Alice
Report comment
Alexa42,
Thanks for this. You have written this much more clearly than I.
There are roles for everyone to play in making things better. Some are better at speaking and writing. Some are in the clinics doing their best to improve patient care.
It sounds like you’ve become your own physician in a way, taken charge as the director of your care. Good. I’m glad you are able to do this.
Thanks for writing.
Alice
Report comment
Seth,
I can’t speak for anyone but myself on the arithmetic. I have my own numbers well in hand.
No drug consultation fees here. I didn’t “escape the riff raff”. Private practice wasn’t lucrative even when I did cash-up-front work. I paid everyone except myself the last two years of private practice before I closed up shop in 2003. I was going to have to add money from my husband’s job to meet the overhead.
Alice
Report comment
Seth,
Thanks for your vibrant response. Energetic voices such as your are needed. Every voice counts.
You may be making a couple of incorrect assumptions with regard to the APA. It sounds to me as if you think all psychiatrists are members of the APA and that it operates as a voting democracy.
I have not been a member since I had to be for their sponsored professional liability insurance (that went belly up) many years ago.
A psychiatrist buys APA membership with annual fees. For this he/she receives journals filled with drug-sponsored research and ads, is placed on endless junk maillists and has the opportunity for reduced rates to attend the annual meeting (and hear about drug-sponsored research). I think there may be is a political lobbyist and a polite answering service.
If there is much more to APA for most members than this, I have no idea. I suppose some write membership it on resumes as if it means something more. There are committees and officers. I have no idea how one gets to be one of those.
Thanks for sharing your paper.
All the best.
Alice
The APA membership is not invited to vote on diagnoses.
In this essay I did not venture into whether the diagnostic system is valid or not. I try to limit myself to one issue at a time.
There are other lovely essays on this site that address validity well. Thanks for your own shot at this.
Report comment
I ran out of room to reply so cut this into a new thread:
Discover and Recover on March 11, 2013 at 5:27 pm said:
A good point, Alice.
What about the professors and the doctors out there?
You’ve addressed that with the post and asked for others’ opinions.
Thanks for being on MIA.
Duane
Duane,
Thank you for thanking me. That made me smile. I feel very appreciated and welcome here. The discussion is always lively and thoughtful with a wide range of opinions. The conversation feels valuable and thought provoking. I keep learning new things.
I also enjoy hearing from you.
Thanks,
Alice
Report comment
Donna,
Good for the students for noticing and speaking up. I wonder what the impact this will have on their job choices. I wonder where Dr. Angell is now. If she was able to get another job.
The pharmaceutical influence is all through medicine. It is not just psychiatry. We all have to speak up together.
Thanks for pointing this one out.
Alice
Report comment
Amazing. Where did they find these docs and these jobs? No one asked me on this survey.
I found a verbal offer of a 7 hour a week job for $70 an hour that expected 24/7 coverage in my two year job search as of this week.
You find me a job paying $229K a year for a 40 hour week and I’ll go do it. (Just kidding).
All the best.
Alice
Report comment
Donna,
Thanks for your support of my writing. It will take a lot of people speaking up to make things better.
Visiting any doctor is pretty dangerous. I avoid it.
What I’ve been angling for here is more understanding of how any human could end up in a position where their jobs demands they do more harm than good.
I did not say this: “then it is totally justified.”
But I can see how (for example) a computer person could find themselves working on navigation for drones used to kill starving children on the other side of the planet. An aging worker with no other job options, house payments and two kids in collage is going to do some mental gymnastics to make it okay to keep working.
I don’t justify it or think it’s right. I’ve straight out quit three jobs over patient safety. At 57 I’m unemployable. What good am I now in helping patients? They are on the inside and I’m out here.
I understand someone might choose to keep working.
Thanks for adding your voice. We need them all.
Alice
Report comment
Hi again engineer,
The last time you wrote about this guy I must have misunderstood you. I thought you were giving me advice on how I could go out and make a mint writing prescriptions for benzos. It’s true I could.
I love it when people ask me questions. This is a good one.
“What doctor wants to willingly give up a patient with good insurance?”
I once had a patient arrive with $1000 budgeted to see a psychiatrist. I was charging $100 an hour. I determined this was something short term therapy could help. We worked out a plan for therapy. Visit by visit we decided together if this was working for her. In nine visits we were done. She got to keep a hundred bucks. I ran into her two years later at her work. Her problem had not recurred. No pills.
What kind of doctor wants to willingly give up a patient with good insurance?
One like me who wants to see people better.
Do you suppose I’m the only one? I doubt it. I just ain’t that special.
Thanks so much for reading, thinking and writing.
It will take a lot of good people working together to make a difference.
Alice
Report comment
Jeffrey,
Thanks for reading and writing here. I appreciate your support of my writing and your support of human rights. Every voice counts.
I’m surprised your horse-farm neighbor let you in on her private financials like debt to income ratio.
I also know a lovely couple who built their horse farm from her teaching piano lessons at home and him doing yard work. Their debt was astronomic.
I’ve never been clever about deciphering the finances of others.
Thanks for reading, writing and thinking.
Alice
Report comment
Susan,
Your support helps me keep talking. Every day I find more questions to ask.
Thanks.
Alice
Report comment
Marian,
Thanks for checking in here and telling us about how things are in your neck of the woods.
Wow. In Denmark it’s like this, too? I’ve been asked to treat acute and chronic homelessness, acute and chronic unemployment, addictions, relationship breakups, house fires, divorces et cetera, with psychiatric drugs.
And yes. “Psycho-education” is what passes for psychotherapy. This is to “educate” the patient to the illness and the need to keep taking the meds as prescribed.
All that shines sure isn’t gold. So not to the Scandinavia for me, eh? 😉
All the best.
Alice
Report comment
Duane,
Another thought as to why medical students don’t question.
Our public education system were designed to train people in unquestioning obedience to authority. Think back for a moment, on the lessons you learned from school. The successful students were good at following directions, being quiet and spitting back the expected responses on tests
“Education is what’s left when you’ve forgotten everything you were taught in school.” (Someone smarter than me said this first.)
Medical students are the best of the good students and the least likely to question anything coming from a podium at the front of the room. One needn’t be a sheep to follow along, only very good in school.
What do you think?
Thanks.
Alice
Report comment
Seth,
Thanks for joining this conversation. I appreciate your support of my writing.
Thanks for your well-written view point.
I wrote this article from the perspective of a well-meaning professional who is doing his best within the system as it exists today. There are many layers to everything.
I did not intend to take on the validity of the DSM in this article. I try to keep things to a circumscribed enough topic to complete my thought without writing too long. I don’t want to lose my audience by taking on too many issues at once.
It sounds like you are well-versed in the issues inherent in the DSM. Thanks for bringing this important aspect to the discussion.
Keep reading, thinking and writing.
Alice
Report comment
Rachel,
Thanks for this alternate perspective. I’m best at speaking from my own experiences. It’s good to hear others.
There must be some people living the American dream or we’d all wake up, I suppose.
My own speculation: A lovely looking life frequently means big debt to service every month. Over the years there have been many loan brokers willing to mortgage me an enormous shiny life. If I had taken them up on it, I may not be speaking up here today.
If a person with an expensive shiny lifestyle speaks up, expensive shiny lives vanish pretty fast.
Then what?
Thanks for checking in here. All the best.
Alice
Report comment
MichelleB,
Thanks for checking in on this conversation.
And what an elephant it is. It’s a whole herd of elephants that take up so much room there’s hardly space for any of us, clinicians or patients. And what comes along with such a crowd of elephants?
Thanks for reading,thinking, writing AND TALKING.
All the best.
Alice
Report comment
mcoma,
Thanks for stopping by and joining our conversation. I feel supported by your kind words about my writing.
Yes. Things have changed a lot. Too much.
Thanks for your words. Written words are powerful. Spoken words, more so. Keep speaking up.
All the best.
Alice
Report comment
Philip,
Thanks for your supportive words. I appreciate it.
Economic chains make slaves of people.
And speaking up can make a person into a retiree, ready or not.
Keep speaking up.
Alice
Report comment
Steve,
Thank you so much for speaking up against the drugging of children. I cannot thank you enough.
This is a really important point you make:
“People know what’s happening isn’t right, but we’re not supposed to talk about it.”
All it takes for evil to grow is for good people to remain silent.
Thanks for your support.
Alice
Report comment
Ron,
Thanks for visiting and joining this conversation. I appreciate your support of my writing.
Yes. I agree. There needs to be a lot of speaking out all the way around. My experience during private practice years was that psychologists, social workers and therapists were big proponents of drugs.
My view of this would be slanted, though, because that was why I heard from them. They wanted me to give drugs to patients.
Thanks for staying in touch.
Alice
Report comment
John.
No doctors in the US have anything resembling employment protection. We are treated like interchangeable parts.
There is only the APA as a professional organization for psychiatry and a medical board that keeps track of professional violations and licensing in each state.
Perhaps the academics have some? I didn’t when I was a Federal employee on the academic track in the late 80’s.
These days psychiatrists are treated as interchangeable parts with anyone else willing to write the prescriptions. Nurse practitioners, pediatricians, primary care, doc in a box, naturopaths, physician assistants are all the same. All are referred to as “prescribers” and called “the doctor” by pharmacists. The “prescriber” work goes to the lowest bidder.
The only job offer (not in writing) I’ve had in two yuears worked out to three bucks an hour for the time they expected coverage.
Alice
Report comment
Duane,
I always like it when you stop in here. Thanks for your support of my writing.
I’ll take a stab at answering what I think is your question. How do people choose to become doctors and how is psychiatry chosen as a specialty? I can only answer this for myself. I bet everyone has their own answers and that these may have changed over time.
I wanted to find a field in which I could both do good for people and have an independent business of my own. As a woman, I was astonished to find the field of medicine available to me. I planned primary care.
I was led to believe that entrance into medical school was highly competitive. “Ten applicants per seat” in a school. But once in, I discovered that every classmate had applied to 10-20 schools and that every seat was not taken in my school.
I was a good student and was accepted to both schools I applied for. The bottom line was, could I come up with the cash. Money equaled in. No money equaled not in. I was penniless. I had to borrow a LOT.
Psychiatry was the poor step-child of medicine when I was lining up professional training. It’s still low in esteem among medical professionals and at the bottom for income.
When I was looking at changing to psychiatry, I was told the field drew from the bottom of the medical class and encouraged to stay with neurology. I don’t know if this was true.
When I thought to go into psychiatry, it was a different profession than it has become. I had to overcome my own prejudices against the field to follow my heart into psychiatry. I love people. I like to get to know them. At the time, it seemed to have the most opportunities to have long term relationships with patients and help them toward better lives.
If psychiatry were then what it is now, I would not have become a psychiatrist.
I don’t know what questions students are asking today. Psychiatry is being misrepresented as a field with lots of new scientific breakthroughs. I suppose if one is willing to be a prescription mill, one can make a good living.
I wonder if the folks attracted to psychiatry now may be different than 30 years ago.
All the best. Keep reading,thinking and writing.
Alice
Report comment
Marcellas,
Hang on to your job as long as you can.
It sounds like you are doing much good there. Keep speaking up however you can. People may be hearing and be on your side but not be in a position to speak up more yet.
Thanks for your kind words of support.
Alice
Report comment
Alexa42,
Thanks for reading and your very well considered comment. I especially like the support group your describe:
“patient support group that served as a forum where patients got together to share experiences on what to say (and not to say!) in all kinds of situations – when talking to SSDI and other benefits administrators, in ER evaluations to ensure you would (or would not) be admitted, what to say to get a doctor to discharge you from a hospital, a judge to release you during a commitment hearing, or to a college administrator to be allowed to re-enroll in classes after a medical leave.”
This sounds like a way to level the playing field (a tiny bit). I have coached people on what to say or not say as well to prevent unwanted outcomes and to increase the possibility of desired outcomes. I don’t tell them exactly what to say, just what words tend to trigger what responses.
People are not always functioning well enough to chose their words carefully during a crisis. I tell people to always bring a friend or family with them who they trust when seeing any doctor for anything. I do this myself.
Thanks again for your kind words and your support of my writing.
Alice
Report comment
Marcellas,
Thanks for reading and writing.
How would you see the legal system being involved as a national forum? Are you thinking of law suits filed by patients who’ve been harmed?
Certainly case law has given directives to the practice of psychiatry. The “duty to warn” required breach of confidentiality and involuntary commitment laws both came from legal mandates to protect.
I know there are financial conflicts of interests in mental health care. It is in the best interest of clinics to get people on disability as soon as possible.
Clinicians see this as doing the patient a good favor by making sure they get health insurance and money to live on. This also creates long-term paying customers as a side-effect.
Getting people on disability is lucrative for drug companies. Disability comes with government health insurance to buy drugs with.
Now that medicare has part “D”, this government insurance covers drugs for the disabled and retired. I am told that this was a hard fought battle won for beneficiaries.
I’m sorry for your struggles at work. Yes. Speaking up puts jobs at risk no matter how gently one speaks up.
Alice
Report comment
Harper West,
Yes. The DSM is deeply flawed. It was written by committees made of people with conflicts of interest.
These deeply flawed diagnoses are used to grant or deny people access to basic health care, housing, and incomes. They are used to direct drugging through “standards of practice”.
These deeply flawed diagnoses are also deeply entrenched.
Thanks,
Alice
Report comment
The Madness of Cledwyn, the Bulb, Bulbousons,
As you point out very well in your essay, the process of not speaking up is pretty complex.
These are factors that effect everyone, not just doctors. Everyone wants to think well of themselves. Everyone spins webs.
These are features of the human operating system we all have to work with every day.
Thanks for reading, thinking and writing.
Alice
Report comment
John,
I’m glad to hear word is getting out. I’m never sure what makes it past the information gate keepers these days.
Alice
Report comment
Licinia,
Pets do get better care, even better than our children. The rates of immunizations are higher among dogs than among children.
I apologize in advance for the language I use but can’t think of a better way to say it: Medical care and psychiatric treatment is pretty crazy here.
Thanks for your sympathy with our struggle.
Alice
Report comment
Stephen,
This breaks my heart as well. Even as a psychiatrist on the “inside”, I could do nothing to stop this.
The anti-psychotics are being marketed as the “jump starters” for antidepressants. What you wrote is straight out of marketing literature.
Alice
Report comment
Stephen,
Good job with your answer. I added a few other comments in my reply to Licinia but you’d already covered things well. Thanks.
“Seven or eight drugs” changed rapidly. This horrifies me. Since we don’t know why or if any of the drugs work one at a time, there is no way to know what’s going on inside a human body when you have a chemical soup like this. “Prescribing” of this sort is unconscionable.
I’ve seen many people released from hospitals on soups like this. Doing this in private hospitals over a few days has become the norm, not the exception.
I’d almost have to believe drug sales people are in charge of “medical education”. Oh wait. Sorry. That’s right. They are.
If people in charge of the purse strings can’t be led to have concern about basic human safety, perhaps they could be encouraged away from allowing these terrifying drug combinations with a financial argument?
All the best.
Alice
Report comment
Stephen,
The world sees us in a very different way than we see ourselves. Media filters do this very well.
Alice
Report comment
Licinia,
Stephen has this right.
Psychologists are not medical doctors. Psychiatrists have gone to four years of college then four years of medical school to become physicians before training an additional four years as psychiatrists.
Alas, psychiatric training has devolved to “prescriber” training as drug companies have taken over funding for education. This is true in all branches of medical training.
In my own training as a psychiatrist (long ago) I learned many approaches and theories of psychotherapy, human behavior and psychology. This type of training is a thing of the past in the US.
I’ve heard that psychologists (who have no medical background or training) have been granted “prescribing privileges” in two states and in the American military so far.
Social workers have been lobbying for prescribing rights in Oregon for years.
In Oregon, any person with a “masters” level degree in any social related field (teaching, ministry) can make and give a psychiatric diagnosis. This used in schools to label children and force drugs on them. Pediatricians end up prescribing based on teacher recommendations.
The schools deny education to “non-compliant” families. Without the day-care provided by schools, this can mean loss of job and home. School teachers, in effect, are prescribing drugs to children through this multi-step process of coercion.
These policies are decided state-by-state so I can’t say how this works in the other 49 states.
All the best.
Alice
Report comment
Stephen,
Just me and a sack of organically grown flour.Yes. I know what you mean about the bread not spoiling. A contractor threw the bread from his sandwich outside on our wood pile for the birds to eat. We found it, unchanged even by the rain, months later. The birds and all the other creatures in our wooded yard knew better than to eat it.
The other great thing to make is vegetable soups and stews. We have “miscellaneous vegetable soup” most days. Whatever is in season. There is no better personal health and financial skill than knowing how to throw together a pot of cheap healthy fresh vegetable soup.
Oops. Perhaps I’ve wandered off topic again. But like you say, anything that supports healing and wellness will benefit those trying to remove themselves from the system and get healthy.
All the best. Be well.
Alice
Report comment
John.
I don’t know much about eggs and pudding or “incipient fascism”. It’s the law here and now. Our beloved Obama has also granted himself the personal privilege to order military executions of Americans abroad as well. Plus he’s using the WWI Espionage Act to prosecute and imprison Federal employee whistle blowers.
Do you suppose we’ve wandered off topic? I tend to do this. Legalization of executive and military human rights violations may have nothing to do with legalization of human rights violations in psychiatry.
Just call me crazy.;-)
Alice
Report comment
To John Hoggett: (Ran out of thread to reply so continued here)
I’m delighted to hear of your exploits and of your apple pancakes. I personally bake my own bread by hand every day in protest of the awful stuff passing for bread here.;-)
Protests here are a bit difficult as well. Our occupy movement was swept away. Many were jailed. All gone now.
Our homeland security now collects and stores all internet data and communications. They started doing this while it was still illegal then back-dated amnesty for themselves.
Last year our president signed into law his right to use the military to arrest American citizens on American soil and hold them indefinitely in detainment areas without legal recourse based upon vague suspicions. Our supreme court just upheld this last month.
This puts a damper on protest movements and journalism.
I occupy my kitchen and cook my family’s food. I occupy my feet, park the car and walk. I occupy my own words.
Today, in the USA, writing and speaking of concerns has risks beyond simply being branded too radical to be employable for the rest of ones life.
Yes. Each of us does do what we can.
I rather enjoy the French and their constitutional right to public protest. It’s seen as an ordinary part of being French people. They don’t have to deal with tear gas, rubber bullets and incarceration when they speak up in public.
Well. I have to go knead up the dough for our morning baguettes.
Much love and peace.
Alice
Report comment
John,
“So if the UK government is relying on corrupt, lying and dangerous drugs companies to generate wealth it is not very likely to go against them.”
Good thinking here. Always follow the cash. This also sounds like a great government marketing PR spin for arms and pharm corps.
Is it possible that a Soteria house that “uses much more medication” may simply be named Soteria?
Once upon a time I was hired by a clinical director who said her goal was to use psychiatrists for roles other than prescribing pills. Many months into this job I asked when those other parts of my work would begin. She laughed and said “Oh. That’s just a goal. We’re not really going to do it.”
Go by behaviors over words every time. (I say this to the choir.)
Thanks for reading, thinking and writing.
Alice
Report comment