So Long, Pill Mill: A Letter to My Former Patients and Their Families

36
3184

To my former patients and your families:

I may have seen you at one time in the last several years. I’ve moved around a few times and I’ve worked in a few different places. I’ve heard you tell me that you’re tired of telling your story again because I’m the sixth psychiatric provider you’ve seen in two years. That the other one didn’t listen. The one before that kept canceling on you. The one before that quit after a few months.

I’ve listened. Sometimes I try to explain that it’s because it’s just really hard, and it’s sad, but turnover is really high in these kinds of places. It shouldn’t be this way. I know.

I’ve told you that I had no intention of leaving. I meant it.

And you trusted me. We built a therapeutic relationship. I was there to celebrate when you made the honor roll. I was there to listen to figure out a plan when things felt bad. I was there to learn about you, and to see all the amazing artwork you’ve made. I was there to protect and guide you when you told me that there was abuse behind closed doors at home.

These relationships were sacred to me. I knew your cases and stories by heart. I would make a point to remember your pet’s name. Small things. Big things, too. I did not need to be reminded each appointment of the traumas you’d told me about during the first appointment… because I sat with those stories to let myself feel and try to imagine how it would affect you. Then I admired your strength for getting this far. Those stories don’t just fade away. I cannot just forget.

I have borne witness to the most incredible young human beings who have survived everything imaginable. You are so brave that you stepped into my office and asked for help.

I’ve been given the gift of you opening up to me and being vulnerable during the worst points of your life. You bared your soul to a stranger. That, too, is so incredibly brave.

I’ve been given the gift to understand at the deepest level of my heart. Because I’ve been there too. And that is something I never needed to say out loud. I think it very genuinely comes across in every interaction I’ve had with you. I’ve been told “it feels like you really care about us.” That is because I do.

And I’ve been given the gift to see you gradually improve.

I want you to know that I didn’t want to leave. It wasn’t my intention. I wanted to stay. I always wanted to stay. I had always dreamed about helping people. I wanted to be able to be the provider that would watch you grow up, cheer you on, and eventually see you move on to fulfill your dreams. To celebrate when you didn’t need medication anymore.

I’m so sorry that I won’t be there, and that you’ll have to tell your story all over again to someone else. It wouldn’t surprise me if your new provider leaves too in a year or two.

It should not be like this.

I will say it over and over again. The healthcare system is broken.

The people making decisions are not the same people who sit with you and hear your stories. They are not the same people who hurt with you when things are bad. They are not people who understand what it is to hold life in their hands and make life-or-death decisions.

Every time you come in for a visit, the people making decisions see money.

I’m not sure why I had imagined practicing as a provider would be any different, and that it wouldn’t be an assembly line of children being given pills. It is well known that clinics burn providers out by making them see so many people… they know it is not sustainable. They do not care.

But how can you get better when everyone leaves you? You really like the therapist you’ve had for two years, but now they just quit. You have to start again with a new therapist. Build trust. Then they quit. Again. Start again. Build trust. Open up. Start to make progress. They quit. You crash.

Administration does not care about consistency for those who need stability and structure.

I wanted to be your provider. And I’m so sorry I have to do this, to leave, instead.

Everyone has been asking why.

This is why: I literally aimed to be the person I wished I had when I was growing up, suffering with a lot of the same issues.

But I’ve learned that American healthcare isn’t about caring, empathy, compassion, or hope. It’s not able being culturally competent and making sure your patient has an interpreter when they cannot understand you. It’s certainly not about wellness or consistency for kids who have never known stability in their lives. It’s not even about quality care.

It’s about money. It’s about production. It’s about seeing as many people as you can see in a 10-hour day and coming back and do it again tomorrow. If you don’t want to do that, that’s okay because you are disposable and replaceable. And they will find another provider who will do that.

You only had five minutes with your patient because they showed up late? Well, you can be a jerk and send them home without medication after they had transportation issues, or you can see them and hope everything is going okay. If it’s not okay, you’ll be running behind the rest of your day.

I used to see up to four people in an hour and sometimes I would not get breaks for hours. Sometimes I had 12 patients back-to-back.

Here’s an example of a typical day I would expect to have at these clinics. Consider this:

Your first patient has depression and is crying uncontrollably. The second one just was placed back with her abusive family. The third one just told you for the first time she’s been raped. The fourth one is bubbly and happy. The fifth one is having a panic attack. The sixth one has a plan to kill her friend. The seventh one is mad at you because it took them two weeks to get in to adjust ADHD medications. The eighth one is actively hallucinating. The ninth one was just put in a group home after their dad went to jail. The tenth one has a plan to kill himself. The eleventh one is a six-year-old who has needed surgical repairs for abuse. The twelfth one is mad at you for being five minutes late.

As a human being, I want to process each of these interactions. I want to cry for the kids who just told me the worst traumas of their lives, and I want to cry for the moms who are blaming themselves for not protecting their children. I want to comfort them. I’m no doubt a highly sensitive person. The levels of empathy I am capable of have helped me to connect with families, but at the same time… it wears on me, too.

As a health care provider within these workplaces, I have no choice but to reset myself every 15 minutes to a fresh face and a fresh mind. I need to be alert to make a new medication decision. I am not allowed to process.

Even when I received news that my adolescent patient was dead. Broken down in tears, I was still expected to put away my heavy heart and see the next person waiting in the lobby.

This is why providers cannot stay at places long. This is why providers cannot be consistent. It is not sustainable.

If I say I feel this is not safe or that I do not feel comfortable, Administration tells me not to stress because they “cover my liability insurance.” They forget the fact that if something happens, that guilt will be sewn into my soul for the rest of my life. They forget when I have hard cases, I stay up at night worrying about those kids.

I love what I do, and I never want to be in a position in which I feel that my only role is pushing pills and that I shouldn’t be wasting my oh-soprecious minutes by listening to my patient tell me they got on the honor roll for the first time. I do not want to be a robot.

I will no longer accept that type of care as my norm. I want time with my patients.

I spent years working in a broken system. In late 2020, I had enough. I quit. I decided to start my own private practice, Paperflower Psychiatry. Paperflower is my effort to move away from this dysfunctional system.

I want to practice healthcare the way I dreamed it could be practiced.

I initially designed Paperflower Psychiatry to be an inclusive telehealth practice to specialize in psychiatric evaluations for children, adolescents, adults, and peripartum populations across Arizona. We provide extensive evaluations in which we have time to review options for psychiatric medications, including reviewing the actual risks, complications, and devising a plan to discontinue them. If the patient doesn’t want medication, we plan for therapy, supplements, holistic treatments, acupuncture, spirituality interventions, books that may help, and so on.

We push against the politics of professionalism in the healthcare system. I don’t want to have some form of unacknowledged “power” over you because I have a degree. I don’t want to dress up to put on a show. I want you to be the expert as I listen. For instance, if you tell me marijuana helps you, it is my job to hear you. Traditional psychiatry would love for me to tell you that you shouldn’t “self-medicate” with marijuana, and you should accept a psychotropic prescription instead.

We practice under the premises that the DSM is not the Bible. If you come to me with a diagnosis of gender dysphoria – how am I supposed to acknowledge this as “disordered”? Years ago, it was “disordered” to be attracted to someone of the same sex. How can we say that trauma is limited to a restricted set of symptoms and specific situations which exclude poverty and racism? You deserve to know that white men wrote this guide dictating labels on human beings based on some studies on white men in Western society, along with personal judgments of what they believed to be typical vs. atypical.

Paperflower Psychiatry also exists as a teaching practice. I take psychiatric nurse practitioner students into my home for their rotations to avoid an inevitable integration into a broken system. Pill-mill style clinics entice students with promises of support, money, and benefits upon completion of rotations, and typically this is after these students learn habits of providing cynical care involving overmedicating, stigmatizing, and not questioning causes of potential symptoms. My goal is to stop letting that happen. My students learn humility, empathy, and respect. We collaborate with the International Rescue Committee to provide free asylum evaluations while other providers charge upwards of thousands for these services. My students learn what human suffering looks like after surviving unimaginable trauma. More importantly in these evaluations, they learn what resilience looks like.

There are reasons humans are suffering, and you should not be conned into thinking medication alone is the solution. I’m tired of a system that forces you to believe that it is the only solution. It should not be a norm in healthcare to have a provider talk to you for 15 minutes, write you a script, and then have you come back in three months for another 15-minute appointment. It comes down to people who will trade quality care for money. I cannot accept that. You shouldn’t either.

While my decision to leave and start anew obviously has been a struggle for me, I know it is more of a struggle for you.

Invisible to them, you will have to open your heart and trust another person to start all over again.

For that, I am so sorry.

Through sharing your story and showing me your vulnerability, you have taught and given me more than I ever could have asked for. My heart hopes that you see your value, and that you’ll know when to walk away in situations where people are not allowing you to succeed.

You are the next generation. And you will someday be in these positions. You will be me. You will be the people making the decisions. You are our hope. Do better than what is being done now.

Remember that you are worth no less than anyone else.

And remember that the impact of lifting others up instead of pushing them down is absolutely endless.

With warmth and best wishes,

Your former Nurse Practitioner

***

Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

36 COMMENTS

  1. I am trying to be sympathetic but i just learned that my friends daughter just died. Although technically she died from a head injury–i suspect that undiagnosed/untreated drug induced delirium, akasthisia, or tardive psychosis was at the root of the unbearable agitation she was experiencing that led to her accident. My daughter’s friend was horribly overmedicated for years and ended up being discovered floating face down in a river. My daughter–who never got a shot at a Soteria experience during her first ‘psychosis’ declined cognitively, physically, and emotionally in direct proportion to every year of her exposure to toxic forced psychiatry.

    What I am getting at is this: you can open a private practice for the fortunate priveleged few who can afford your services who were never needle-raped, restrained, handcuffed, or institutionalized–those who have no problem establishing trust and who find comfort in the little fountain and the zen music in your lobby but as long as you are a board certified psychiatrist or prescriber and you do not organize politically to take away the power of psychiatrists to abuse vulnerable people with impunity–if you are not actively serving as as a pro bono expert witness for at least one innocent person facing involuntary commitment per week–a service for which there is a huge demand–and you are not educating NAMI parents–the majority of whom have no problem if their adult children spend all day in bed drooling–as long as they dont have to engage in difficult dialogues with their children about past traumas that would tarnish their self image of perfect parent– then you are a part of the problem and your little private practice is swatting at a fly while there is an stampede of innocent victims running towards a cliff

    • Well said, madmom!
      It appears that having any sort of angst is treated as criminal behavior, and any objection to absconding with constitutional rights amounts to waving the red flag in the face of assumed power.

      How does this happen? Psychiatry warns the public of the “danger” in leaving troubled people alone. Holy COW public safety is at risk? Fear of other people’s thoughts is at the root. Constitutionally guaranteed rights are ignored in the generated fear of anyone not like “us”. So artists and thinking people: BE very careful.

  2. It’s so nice, Maria, that some of you psychiatric nurses, who are starting to garner insight into the staggering amount of psychiatric malpractice, are starting to speak out, and trying to set up alternatives. Thank you.

    I was fortunate to have some mainstream medical nurses finally garner insight into my PCP’s, and her systemic malpractice covering up, misinformed psychiatric “professionals” misdiagnoses … which were finally noticed by her decent nurses in 2005, seen for what they were.

    Thus, those decent nurses did hand over my families’ medical records shortly thereafter. And one decent nurse even followed my family to two subsequent PCP’s, to try to protect my children and I.

    Medical records, which included the medical evidence of the sexual abuse of my four year old child, not to mention a “bad fix” on a broken bone of mine, at which that PCP’s incompetent husband had been the “attending physician.”

    In my subsequent medical research, I was shocked to learn all about, what an ethical pastor of a different religion, confessed to be “the dirty little secret of the two original educated professions.”

    It’s truly disgusting that both the psychiatric and psychological industries are largely in the business of covering up child abuse for the paternalistic religions, and easily recognized iatrogenesis for the incompetent doctors.

    So absolutely, real change is needed. Thanks, and God bless you in your efforts, of trying to bring about real life change. Especially since I have older nurse friends, who’ve freely confessed they knew nothing about the systemic psychological and psychiatric industries’ systemic scientific fraud based crimes.

    And I must agree with Madmom, that we need all decent “mental health” workers, to call for an end to the forced psychiatric treatment of all people.

  3. I think the author’s desire is noble, but, sadly no psychiatric survivor can be sure. The trauma for many can be so awful, that no one still in the psych industry and even traditional medicine can no longer be trusted. If the author of this article can completely leave the psych industry and find other ways to use her God-given talents and repent of her “sins” then we will really believe she left the “pill mill” as she calls it behind. Thank you.

  4. Hi Maria,
    Thanks for writing this.

    I recovered from “Non Existent Schizophrenia” in 1984 as a result of not taking my medication (very carefully).

    I stopped taking my Depot Injection medication on my 3rd attempt and switched to oral medication. The depot injection (which I had been taking since 1980) had been causing extrapyramidal disability.

    I cut the oral medication down to a tiny dose over a period of 6 years; and the tiny dose eventually went of it’s own accord.

    I used this type of Approach to deal with my Neuroleptic Withdrawal “High Anxiety”.

    https://youtu.be/YWvIZ9Dcyb8

    (Dr David R Hawkins)

    It Works!

  5. What is a six year old doing in your office? To talk to her?
    A six year old should never be in an office, she should be going for walks, playing, whatever she likes to do, not what the adult thinks she needs. And “observing” a child while she is playing and spinning stories about that observation is sheer privilege. To completely immerse yourself while with the child until you forget you are the “observationist” is what is healing.
    Just like yourself, I’m sure you did not like to be “observed” by other shrinks, as to how you run your business. Because they would deem it abnormal.
    Talking to kids about their traumas is not healing. It is easy and monetarily sustainable to bring the child to a building.

    If the DSM is not the bible, what is it then? How do you use it?

    What are medications and where do you use them, how do they work? If psychiatrists use drugs, they must know the mechanisms of drugs, what part of the brain the issue is, and if that drug “addresses” the found issue.

    Sorry but you cannot reform psychiatry.
    Bottom line is, empathy does not mean that the practice of psychiatry is fixed.

    • Yes, sam plover, you are absolutely correct. When I was six, I was in kindergarten; but, I played and played and played. Play is so important in the growth process to prepare a child to be an adult. Sitting in some office with some therapist and engaging in “talking therapy” as a six year old seems completely absurd and in my opinion does not bode well for the survival of the species. No wonder, we are having so much trouble in this world. This is just brainwashing children through the lies and deception of “psychotherapy.” Oh, dear God, please help us all! Thank you.

  6. My value in this article was to get a little peek into how the “healthcare system” of today operates.

    Back when I was getting therapy, it was a one-hour session every week. Insurance paid for it. Pills were totally out of the picture, as this was a psychologist, not a psychiatrist. And I got to know the person I was working with, and she got to know me.

    What cannot be addressed here, of course, is why the system is so broken. After learning what I have learned (so far) about life, I can say without hesitation that someone wanted to break this system. There are people out there who DO NOT want people to heal. And they have been able to exert sufficient political and financial pressure on the system to break it. I hear that emergency doctors still know how to patch up wounds. But iatrogenic accidents are the 3rd largest cause of death in the United States, by some estimates. And that makes zero sense, unless you factor in this avid (but hidden) desire to break the system on the part of someone who is having a fair amount of success at it.

    I just think there are better ways to die. Why go out of this world convinced that you have been betrayed by your doctors? What kind of attitude towards life will that foster? Just because life is hard doesn’t mean that we all have to suffer through it.

    This story, to me, is one of a partial escape from the system. Now we need to take it the rest of the way.

    • I’m not sure the system is “broken,” I think it just has hidden objectives that most of us find abhorrent!

      I had the same experience as you back in the 70s. I had a therapist, we met once a week, we talked about my motivations and barriers to my success, we reviewed some traumatic history, I practiced new ways of thinking and acting – no drugs were considered or needed! And I never got an official “diagnosis” from my therapist, though I’m sure she had to submit one to get reimbursed. It just wasn’t important. I wasn’t considered “ill,” I was considered one of the smart ones who realized that he could make his life better. My therapist and I both agreed that it is a lot saner to seek support than to continue pretending things are OK. It was a very supportive relationship – no “stigma” involved, and no drugs needed or wanted.

  7. Sometimes it’s hard to not lose hope. The American health system is so broken. The MBAs seem to have won. The patient is too often no longer the focus. It’s now the bottom line. I suspect a fair number of practitioners are caught in the middle. Quite likely too much focus on the patient means the loss of a job.

    I sent this article to my sister who is an emergency room nurse in southern California. She said she nearly cried when she read it. But as she said, “What can you do?” It was a rhetorical question.

    Then she told me that many of the nurses she knows are going back to school to become psychiatric nurse practitioners. What they tell her is chilling: ” I am going to work in [so and so’s] office. A patient will come in and I’ll ask, ‘How are you doing? How’s the medication working?’ Then I’ll write them a script and say, ‘Okay, I’ll see you in 2 months.’ In 5 minutes they’ll be out of my office. I’ll make so much money! I’ll never really have to see patients, just write scripts!”

    One can only hope that sooner rather than later the bottom falls out of the whole racket. I think it’s criminal. We must continue to speak up and speak out. If enough of us do so, at some point our collective voices will be heard.

    • I think I got it. First, the M.D.s of all persuasions (specialties) both legit and questionable would see you for a few minutes or so and write you a prescription for something. However, now they have found a way to not even come into the office. They have all kinds of nurses and practictioners and assistants, etc. who can write the presciptions for them and do the same thing; see the patient a few minutes and write a prescription. The authorizing doctor’s name is imprinted in his or her signature at the bottom of the script along with their authorization number. Of course, since this is all now transmitted electronically through the internet from the doctor’s office to the pharmacy; it makes it so much easier and maybe even easier to “cheat” the “system” or the patient in some way. But, who loses the most? The vulnerable, gullible patient who just wants to feel better. Thank you.

      • Oh My; I got it too. The eight hour day’s number of patients potentially can be multiplied by the number of “allied assistants” also prescribing. If the doc can see 20 patients per day, then each assistant, in theory, has that potential as well. Would insurers be able to see this multiplication factor? Are the visits covered by many different insurers so that the outlandish number is undetected?

  8. I keep coming back to this article because I want to comment. It scares me to read the “services” you offer and then you say oh I’m not one to push drugs. I had gone to a chipper young psychiatrist thinking “he’s so nice he knows what he’s doing but he didn’t”. That chipper young psychiatrist almost killed me with the polypharmacy he prescribed dismissing obvious iagtrogenic harm. Your website lists psychiatric “diagnoses” which has no basis but yet you “treat” people for them?

  9. Maria: Gosh, as I read your piece, I found myself almost melting with heartbreak–for you, for your patients, for the families and friends of so many people who are being consciously and callously destroyed by a system that simply cannot be saved (yet is likely to outlive many if not most of us, whether we like it or not). I found your own heart quite lovely and caring and sad. And I applaud your exit from the mass production line to your own organic farm, so to speak. I wish more psychiatric professionals had a soul like yours. I just want you to know I hear you and I see you and I feel for you, even though you remain in the psychiatric profession. I’m afraid, however, that you have come to a place (Mad in America) where there is, in effect, zero sympathy for psychiatry–hence, for you. It’s inevitable that most of your readers here would indict you for the sins of your profession. No matter that you entered the field with good intentions. No matter that your own lived experience does not preclude medication. No matter that your own training likely did not include a single word about the fearsome horrors of psychiatric medications, that your professional societies and associations systematically lie as much to you as they do to us. No matter that attaining your degrees and licenses and hard-earned wisdom cost you significant sums of money, that changing careers isn’t easy or even possible. You are guilty by your mere being now, I’m sorry to say. At least on this website. Nevertheless, I want to place two hands over my heart and bow to your courage and willingness to resist the system, however you can, however imperfectly, from the inside. I want you to know that, if there must be psychiatric mental health professionals, I would pray that they were all just like you. I don’t judge you, or condemn you, or imagine I can tell you what you ought to do. The mere fact that you are posting this on Mad in America gives me hope. The mere fact that you are as interested in getting people off meds as getting them on gives me hope. May you keep learning and growing and caring and do your best to save a few souls here and there, however you can. I absolve thee by the power invested in me as a father who lost his own daughter to suicide largely because of the grotesque ignorance and insensitivity of a psychiatric nurse practitioner, who had the very same letters after her name. Go in peace.

  10. One can not justify what they do to others by doing the same thing to oneself; if it creates harm, whether intentional or not. There has not been a psychiatric drug invented that does not cause harm. Why? Because, they are meant to make changes in the brain; the one organ we know least about and or meant to know least about…And, when you realize that this is because the brain is the organ that basically houses who each of us individually is; you will know that each one of us is too close to our brains to ever understand them. Aah, the mystery…Perhaps, some things are better left a mystery and that saves lives. Thank you.

  11. Ms Ingalla says she’s taking lexapro. Reports variously associate or conclude lexapro use is associated with dementia, tardive syndromes, traumatic brain injuries, weight gain, sexual dysfunction and on it goes.

    However, as one Mad in America essayist misconstrued, the incovenient truth is that some people claim high voltage impacts on the brain (for example) do feel just right. The issue is far more complicated than an essay could ever hope to impress, or confuse readers with.

    Ms Ingalla is motivated and intelligent and is running what appears to be a successful business.

    I see no indication or concern about poverty anywhere. Poverty greatly upsets anyones mental health. Much worse is the orchestrated denial that it exists along with its deliberate creation. Instead we hear a constant refrain about social justice when people are homeless and can’t pay the rent much less their mortgages.

    A thoughtful or caring mental health worker presumably understands these dynamics in the economy and it would be in the domain of their care. Realize (for example) that hedge fund managers and venture capitalists or defense contractors in Arizona aren’t apart from the poverty and desperation in the country but are direct causes of so-called mental health casualties.

    Instead Ms Ingalla has appointed her web page with diagnosis, care for sexual preferences, immigrants and refugees. Very popular and nothing objectionable. We’re all against racism, sexism, violence, and for human rights. We see the lies of omission too.

  12. Maria,

    Very interesting on many levels, thank you.

    I want to say that I generally think it’s not an ideal form to make a grandiose ‘You’ or ‘population’ of citizens as patients-clients, especially given the fluctuation and diversity. I understand it’s part of professional identity, and I feel your goodwill and struggle. The message certainly seems great to me in many ways, the attention on these issues being important.

    Part of the difficulty is not just in the ‘politics of professionalism’, but professionalism, the service-business itself, and ‘service-provider’. I admit I’m still trying to reckon with this. In a sense, there needs to be more politics FOR or ABOUT professionalism.

    I personally reject the word ‘patient’ except in rare circumstances or usually for the convenience of providers/staff in a service-business, insurance, etc. I find many people understand why, like my psychologist who has moved from the habit of ‘patient’ to ‘client’ or the county mental health services director who moved from ‘consumer’ to ‘client’, each based off my comments. Then there’s the insurance customer service, receptionist, or billing manager who asks ‘what is the patient’s name’ (I’m pretty sure I already said ‘I’ wanted ‘my’ medical records, so it is my name, not ‘the’; or ‘are you the patient’: I say, ‘yes, I am the client’, haha, but underneath I know that the client-ification and systems-language should really be transcended whenever possible, too. Not always, but whenever possible. In this way, one may relinquish some ‘power’, but another may gain it. This is what you have been doing in many ways, and I like that.

    I spoke with a Bradford agent yesterday. We didn’t know if a person I was calling about had entered their ‘system’, and she almost said ‘what is the patient’s name?’, but she hesitated. I said, ‘oh my friend? The person’s name is…..’. Apparently it didn’t even matter unless I gave her my friend’s birthdate anyways.

    I have found both positives and negatives in Dr. Humphrey’s Osmond’s book on Models of Madness, Models of Medicine about the physician’s or doctor’s Aesculapian authority and designation of the sick-role (and patient-role). Ivan Illich in Medical Nemesis has important supplementary and counter arguments to Osmond’s preferences and purposes (which have spread far beyond the classic physician). All terribly complicated.

    • This may not seem related to the conversation, but it might cut to the essence of the subject: Why are emotional issues and less than usual behaviors treated as medical issues? Or: why does a medical issue merit incarceration and punishment all without an actual trial?

      • All it ever is, is a shrinks word against yours. End of story.
        So there never is a “trial”. He literally has the last word.
        It’s the absolute power that one person has over another. They are put on this earth to ruin people’s lives, and it is all legal. The shrink will never be on any trial. His licence granted him absolute immunity.

LEAVE A REPLY