Wednesday, March 29, 2023

Comments by David Steingart, LCSW

Showing 11 of 11 comments.

  • I would agree completely. Kids are dis-empowered by the current system and thereby their voices are not heard. The agenda is set by the adults according to their perspective on what is important and what is not
    important or what is valid or not valid. Addressing issues such as suicide aren’t ones that are attractive to
    administrators, counselors, etc. How do we create a dialogue in the schools that involves students instead
    of dis-empowering them through our hierarchical system that does not reflect emotional needs of students? Of course, this problem is also reflected in the academic curriculum that is created and taught to kids. Who decides what is being “taught” in schools and what is deemed important or not important? Certainly not the kids!

  • Isn’t every school already telling us they ARE “attentive, caring, supportive…?” The point is not to control (and I never
    made reference to case management? It’s quite a tangential argument?) but to locate ways in which we can tune in to emotional distress.
    Words like caring are wonderful but the problem is we are NOT caring enough about emotional needs!! The truth is that the “care and support” we are currently offering is obviously not reaching those who are crying out for it. That’s because the “care” that schools offer students addresses emotional needs in terms of their relation to academic achievement, graduation rate, etc. We strive to make students similar because this is easier than recognizing their differences. Recognizing means more work.

  • I appreciate all the replies and statements. I will see say that I am not a DSM counselor if it matters. I have one on my shelf but it doesn’t go very far from there, we are not all the same. Anyway, what I am really interested in is the idea that
    my ideas would be “better received elsewhere” or do I “have any idea what this site is all about?” There is a
    difference between disagreement and condemnation and censure. Is a blog entry here “supposed to” sound a certain way! The idea that certain ideas may not “belong” is ultimately a limitation to the overall dialogue. I accept criticism (and welcome it) and some here have even clearly agreed with my main ideas but criticized specific points I made effectively. I wonder what others feel about this kind of “protective” stance on what ideas should be here and shouldn’t? (be brave!)

  • Hi Steve
    Thanks for your comments, you make some very good points about acting normally versus abnormally. I would point out that although your objection to the terms “self-medicating” is understood, recognizing the ill effects of how “street drugs” affect a person whose emotional needs are not being addressed is important. I agree that younger people are over-medicated in the psychiatric sense and I would not see that alternative as necessarily better. When you say you “hate” the term self-medicating (again because it hints at the medical model and I get that) it is really important to address the millions of lives that are derailed by addiction every day and that we need to find a better way to help teenagers in emotional distress than drug abuse of any kind.

  • I enjoyed reading the article, it was informative and I am thankful that minds such as yours are spending time discussing the realities of specific types of psychotropics. I appreciate how we as an American society came to utilize these medications as “solutions” to problems that perhaps aren’t problems in the first place!
    I do want to state that I take a Benzo type medicine at a relatively low dose for many years and it has been very helpful. For me, it has been informed psychiatrists over the years who have been forthright about information on this and other medications that included discussing side effects, alternatives, etc that has been decisive.
    I do believe, based on my experience, that while the dangers are obvious and unfortunately not being properly recognized, there is a place for psychotropic medications. Your observation in the article – “Well, I certainly don’t remember ever being trained to have that discussion with patients I was seeking to help with their struggles during my training” is very telling. Why aren’t psychiatrists trained to have “that” discussion? What if they were? What if this discussion led to client’s feeling empowered about the medications they are being offered? I believe that the answer is not to damn only the medications, but also the way in which they are “served.” Someone with a degree in psychiatry is a very persuasive person simply because they practice medicine and are thereby assumed to be “experts.’ In this field of psychiatry (that one can argue is not even a true “science” in how it operates), there needs to be a balance of power between the physician and the client, an equal and shared understanding of every aspect, including every risk of physical harm of every medication that is considered. I have been blessed to have more than once such psychiatrist (and unfortunately in the early days, others who were not of this ilk) and this has made the difference to me.

  • I am so happy that someone is talking about the APA. I don’t understand how such a “governing body” allows a “Dr.” to practice however they like without any overseeing? Think about it, if a medical doctor (non-psychiatrist) fell asleep on the job, let’s say, there would be serious mal-practice suits going on and possibly a loss of license. But if a psychologist does the same on a “patient’ let’s say for years, he or she gets off scott free! There is no oversight, there are no checks and balances. Therapists have the potential to affect a person’s life in a way that is MORE dangerous than other types of doctors. So why do we let therapists have free reign? It only stops when the therapist does some so egregious as sleeping with a “patient” or taking their money, at which point, action is taken. Think about this!!!! I had a therapist (psychiatrist) when I was young who slept, EVERY SESSION, for four years! I was too fragile to let anyone know what was happening. I assume that this human being is still working. I had another therapist who insisted on calling me constantly and generally invading my life to the point where it became a “cult-like” situation. I extricated myself with great difficulty. This man is still practicing. Yet another therapist decided to eat food every session. I was again to fragile to speak up, so she thought that was perfectly ok. What does it all mean? It means that people are getting “screwed” by therapists who have no checks and balances on them by the APA. Therapists can do whatever they want, and they do. They exercise tremendous control over a person’s mind (especially a fragile one) and they violate rules of practice, never get caught and continue making money at it. Enough is enough!

  • I will throw my two cents in: I found the article to be fascinating, it tells an interesting tale about the importance of a narrative approach versus non-narrative (medical model.) I agree with this concept totally. I also, as others have said before me, am skeptical of this philosophy because the focus seems to drift from consumer to “Dr.” The emphasis MUST be on client-centeredness, Carl Rogers believed and not psychiatrist-centeredness. Every word out of a psychiatrist’s mouth is very important because they hold power – to prescribe, to dictate diagnosis, etc. Does every person have a narrative, yes they do. I believe that LISTENING to a narrative is what is essential. I had a psychiatrist who saved my life. Somehow he knew what was happening to me but his genius was to listen and help ME figure it all out, it took time, but he knew he couldn’t give me immediate answers or else I would never have experienced real change that leads to healing. I believe that psychiatrists must beware of the power that they hold. How do you create an environment to allow for narrative, when it is a 15 minute session?
    Finally, I have to comment on intellectualism. I grew up in a family of two psychologists, had various cousins at universities, etc., etc. all with high intellectual credentials. My family’s book collection rivaled that of the local library. They could all quote any brilliant mind of any century, etc, etc. But they couldn’t relate to another human being, not at all. I am an intellectual myself, I found your references fascinating and I am not trying to insult your intellectual approach, but I always remember the lessons, I learned growing up, that analyzing something is useful, but the job of the therapist is to help the patient, to “walk the walk” so to speak.

  • Dr. Levine you make some very interesting observations and certainly back them up with profound medical evidence. I both agree with you and disagree with you and here is why: I completely agree that there is no medical “evidence” for something that we call depression. There has never been chemical evidence for a depressive state and the public is misled on this subject largely because they are misinformed about mental illnesses, as we know.
    I do however, have to point something out that counters your belief. There is a reason why people take anti-depressant medication even though there is no medical evidence for their success. They take them because they work, because they save lives. I am in recovery, and also a mental health worker, and I have seen many many individuals who were on the proverbial “edge of the cliff” whose lived were turned around with the administering of medication. Does this prove that chemically there is a legitimate scientific connection going on in these case? No, it doesn’t. Does taking these meds save lives? You bet. There are other medical instances in which “medication” is given without there being a confirmed biological basis in terms of their efficacy. When someone undergoes chemotherapy, the “medicine” is basically a poison that is injected into a cancerous body. Doesn’t make sense medically to me? But it works, sometimes.
    The theoretical biological viewpoint is a tricky one. No one wants to assume something that isn’t proven, however, it is also damning to give total weight to the environment as the sole cause of mental illness. Believe me, it is much easier to tell someone that they have a biological illness called depression than one that has no biological basis. Without the medical explanation, at least partially, the cause is on the consumer and his or her environment. If it isn’t medical, than the consumer’s environment (and hence the consumer) is to blame. There is no way around this problem as the stigma in our society dictates. The beauty of recovery is that it has a “medical ring” to its sound and people go for that, they like it, consumers and non-consumers. It combines both elements.
    Finally a comment on your list of political heroes who were depressed. I agree that society limits those with mental illnesses from entering office. But please consider this – the goal is not to venerate Lincoln for being a depressed man who became President. The goal is to conceive of a world in which Lincoln could be President as someone who has depression AND get treatment for it!! Lincoln would have been just as sensitive and probably have suffered much less if there were meds for his illness or even holistic treatments back them.
    Consider Vincent Van Gogh – we all love his art work right? Did the man have to cut off his ear (clearly psychotic) in order to paint the way that he did? Let’s not get carried away with idolizing the mentally ill heroes of our past. They were brave, but they didn’t need to suffer as they did.

  • Reflections on Connecticut – I have to say as someone in recovery now for many years that I always think very heavily on events such as the one recently in Connecticut. I remember the first such similar episode in Columbine years ago. I remember my first reaction was horror but by second reaction was a sad kind of laughter. Not laughter at the actual events but laughter at how the media was portraying the perpetrators. Over and over and over we heard “oh he was the nicest person, he never got angry, he was the last person in the world we would ever expect….etc. etc” I laughed inside because I was once one of those individuals in my own life in my own high school. Thanks be to God that I never had outward violent tendencies, but did I carry around that kind of anger inside of me, ABSOLUTELY!!!! And would I have been described as the nicest person, the ideal student, etc, yes you bet I would. My course was a different one, my life imploded by the time I reached college, my anger turned inward into fifteen years of schizophrenia and hopelessness.
    So what am I saying? I am saying that we need more school social workers, school psychologists, and more education on mental illness in general. In my high school, we were taught about sexuality and contraception but no one was given and education about basic signs of mental illness. How many kids begin to have symptoms of mental illness by their high school years? Millions and millions. Why is mental illness in the closet? Why don’t we teach parents and especially kids about it??? In my life as a social worker, I see over and over, the kind of dysfunctional families from which a mentally ill person comes from. If the family can’t provide, who will? Who will stem the anger? Who will reach out their hand when the anger gets so enormous that a kid wants to lash out? It has to be the school, it simply has to be.
    Let’s get well trained people in the schools, let’s educate our teachers, let’s educate our parents, lets especially educate our kids so that mental illness is out of the closet.
    When people react to these tragedies by blaming it on mental illness, they do so because it’s the easier thing to do than to look in the mirror and ask themselves, is there something I can do to eliminate the stigma? Is the answer to simply “blame” these killings on mental illness or is to promote PREVENTION!!! Mental illness does not happen in a vacuum, it is only scary when it goes ignored for years and years.

  • Hello. I enjoyed reading this piece, having contributed poetry of my own to other recovery minded sites.
    I am writing here not to specifically address this blog entry but to address something that is important to me, and I wonder if is important to others.
    We spend an awful lot of time here speaking of how psychiatrists and other professionals just aren’t getting it, however, each blog entry writer has the letters M.D., PhD or MSW after their name. Perhaps my suggestion sounds ludicrous but imagine a world where we did not feel compelled to type in our credentials, where the letters after my own name and others were not included in our writing. Would we interpret what the author’s words mean differently? If WE ALL dropped the b.s. titles – psychologist, social worker, what have you, and just said what we wanted to say without needing to back it up with the “sacred titles” that follow our names, I would have to think that those consumers out there would not feel the same power structure reading blog entries just as they experience when seeing their mental health workers in the “real world.”
    I made a decision after I received my graduate degree recently, that if and when I give a talk before a group of colleagues, consumers, etc, I won’t mention my “credentials” so that everyone is my equal and I am everyone elses equal with whom I am with.
    I challenge those out there blogging to follow this lead and take this seriously, if we are serious about changing the power structure than start here and let’s talk without our titles. That is my challenge.

  • I like the ideas put forth in this article. I like the bravery and I applaud your determination to confront these serious issues that are impacting, most importantly, individuals who are suffering and not receiving the kind of care they need.
    I am an LSW and also bipolar in recovery (I say the word RECOVERY) very proudly! While I totally agree with your scorn for the biomedical model, I am cautious about your polarization of a mental health “condition” (I choose not to use illness here.) The bottom line is – no one likes medications. And yes, I agree, there is not factual evidence of any scientific proof behind mental illness and this in turn makes it easy to dismiss any medication treatment as a mere outgrowth of scientific myth. But I disagree and I find myself in a strange position! I have fought very hard in my career to support the Recovery movement in mental health. Why? Because it comes from consumers! Not because it is representative of drug companies or modern psychiatry but because it works for people! I myself was healed by a gifted psychiatrist who chose not to use medication, however, his brilliant therapy with me would not have worked without simultaneous medication therapy at same time. We have all read the studies that prove that those who have both a talented therapist AND a talented person managing medication have the best chance to succeed and Recover. Remember! Not all psychiatrists are “idiots” when it comes to prescribing medications! Some are reductionists (mine is) and they understand holistic treatment as well as anybody.
    So what am I saying? I am saying listen to the consumer, don’t get caught up in terminology. Yes words are important but more important is what “works” out there for consumers. Yes as a social worker, my job is to listen and listen hard and not to bring my own ideas to the table too heavily or impose them on someone. This INCLUDES an anti-biomedical approach. I think this article proves we are taking bold steps to move in the right direction but lets be cautious about making assumptions about Recovery and its importance beyond terminology and its importance in self-determination which ultimately will divorce social workers and all therapists from the current unhealthy power structure that exists in our field.