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.)
No television (or other media) for 11 years. Learned another language and traveled outside the country to hear what they really thought and why. Read LOTS if non-fiction and history. Talked to people and listened. Paid off my debt so I could afford to open my eyes and ears.
Tolerated being called names like “conspiracy theorist” 😉 and “too radical to work here”, even when they weren’t joking.
**When things didn’t make sense, I looked where the money went.** This always leads you to the man behind the curtain.
As an old cynical behaviorist myself, I can see some sense in what you say.
One must not, however, underestimate the effects on an individual of submersion from birth in a cultural matrix put into place and maintained by the six corporations that own all information in our country.
With this in mind, one has to step back a bit further and wonder who is selling what to whom. And by what means.
All the best. Keep reading, thinking and writing.
Alice
I’m stating a new thrread so there is room to respond to this writer. I have copied his comment here:
John Hoggett on March 6, 2013 at 7:09 am said:
wow, and I thought Open Dialogue was expensive! I think the economic arguments with service commissioners are ripe for being put forward for effective psycho-social alternatives if so many people are being put on such an expensive mix of drugs
John,
As you point out, it is not the expense that gets in the way of changing direction in delivery of healthcare. There are known cheaper, safer and better approaches that are not being used just as there have been safe, fuel-efficient cars for decades in Europe that never see the light of day in the US.
Where does the power lay that keeps all this happening? Let’s see… Is it in the hands of hourly wage-slave doctors? Hmmm…
One could almost believe that giant capitalist corporations can reach across international and political boundaries with more ease and fire power than people. One could almost believe corporations have been granted immortality and basic human rights by the courts.
As John Steinbeck wrote in his book “Grapes of Wrath” “The monster isn’t men, but it can make men do what it wants.”
I had to start a new thread here. I copied this post forward so I can reply:
Discover and Recover on March 5, 2013 at 10:59 pm said:
Alice,
It seems we have the cart before the horse. *How* people get paid before *what* they get paid for.
Greed is certainly a problem – with Pharma. But also is the need to control – on the part of both the government along many in the psychiatric system.
We could do so much more, with so much less (greed and control) if we would begin to think out of the box and try something new!
Best,
Duane
Duane,
Thanks for you hopeful and helpful voice here. Thanks for your emphasis on following the big money trail. This is crucial in any understanding of the situation we face.
Richard,
I agree. You have never called me a hypocrite. Plus I have felt supported in my writing and activism efforts by your reading and commenting here.
Yes indeed. You have caught me in the act of writing in such a way that I tell people what I think they should do. What good is writing opinion if one cannot work to be persuasive as a writer?;-)
One thing I’ve learned about people is that they don’t want advise unless they ask for it. And maybe not even then. People often ask what I think as an opening to argue at me.
There is nothing I enjoy more than having people ask what I think and then listen. I think a lot about a lot of things. I have strong opinions. I’m a rather good talker.
As far as my own personal activis,m I take daily steps against a number of horrors perpetrated in the name of progress. For example, I park my car and walk most days. Cars are the number one cause of death in the US for ages 8-34 and runs a close second in other age groups.
I think each person has to choose their own fights. And I respect however they get there. After all, I drove a car every day for years.
Keep writing. All of our voices are important. All of our personal efforts count.
Licinia,
No offense taken. Lot’s of us living inside the US look at our medical system in horror as well. I’ve been unable to get safe adequate medical care for my family for the past 20 years and I’m an outspoken physician with “good” insurance. Our approach is to work hard to stay healthy and avoid medical contact.
I love to write. I can do this without burnout. My writing sometimes takes other forms but it continues unabated.
Many smiles to you and to all readers.
Alice
PS I am troubled by access to “reply” here. I haven’t given up though and work around it.
John,
What sort of rabble rousing in what sort of venues are you looking for? I sort of thought that writing here and on my personal blog and private conversations was as much voice as an unemployed psychiatrist has.
Thanks,
Alice
Duane,
It’s so nice to hear from you. I love it when people do the math. It does simplify understanding things a lot.
One really must follow the dollars. To do this you have to know where they go.
I have seen several thousand dollars (3+) a month go to one person’s drugs. Poly-pharmacy is the rule now, not the exception. During job interviews (I’ve been on a few this year) I talk about wanting to reduce and simplify drug regimens as a general approach. Providers cringe at the thought of less and fewer drugs. One woman said “I don’t want to see anyone get hit.”
There is this idea that all the drugs are keeping people safe. If you lower the drugs the patient will hurt someone. I don’t understand it. Perhaps through the media? I don’t watch TV.
All the best. I’m glad to hear you thoughts.You may have to start a new chain in the comment zone, though.
Alice
Thanks for checking in. I appreciate your support of my writing.
Good for you speaking up. It takes all styles and flavors of speaking up to be heard.
I also speak up. Check under the “rant” tab of my personal blog for other things I speak out against in my writing:
alicekeysmd.wordpress.com
I’ve learned through a variety of “speaking up” experiences over time that I can only speak up for myself and not for others. I live with the consequences of my own speaking up.
I can’t choose for another person.
So I’m probably not going to join the APA in the hopes that I could create havoc.;-)
But I will keep reading, thinking and writing. And talking to anyone who will listen to me.
John, I find have to tip toe around friends who allow their children to be drugged. They are not asking my advise. I am not their doctor. I can express concerns and direct them to reading material. A serious rant would simply drive then out of my life. It would not get them to re-think.
“A man convinced against his will is of the same opinion still.”
I find that peaking up against prevailing beliefs requires great tact.
David,
You are more of an expect on Schore’s work than I. I’ll leave explanations and analysis of his work in your capable hands.
You hit the nail on the head with “economically driven”. Money is the power driving the steamroller masquerading as medicine that flattens so many people.
Thanks for answering this question so well. This is the truth. Psychiatrists are workers with kids and payments like the rest of you.
The psychiatrist who stood up about the “no diagnosis” worried that he would lose his job over it.
Since I’ve been speaking out about the problems in psychiatry, I have been labeled as anti-psychiatrist and anti-medicine when I am neither. I have been approached with anger and suspicion by a psychiatrist I worked with for eight years and treated as if I’ve lost all competency as a professional. Although I haven’t yet been called a Scientologist;-) No one would consider employing me once they Google my name. Professionally, I’m creamed chipped beef on toast (S.O.S.) from here on out. I can blame no one who declines to speak up.
Great question.
Personality disorder diagnoses were stigmatized even before the care managers and insurance companies got into the fray and decided not to pay for treatment. This was the case when I walked into my first psychiatric training experience as a medical student in 1981.I don’t know why. A supervisor explained that this stigma was there and said she never used these diagnoses because of it. She said that once this diagnosis type was used,people stopped listening. Much later I had a teacher who always said “Don’t tell me a diagnosis, tell me about the person.” It struck me as good advise.
Alice
I’m glad to hear from you. Thanks for your support of my writing. I appreciate your offering of well-considered thoughts.
From your question below:
“Perhaps after your hiatus you may re-kindle your love for the healing professions…”
The flame of my love for the healing profession has never burned brighter. My hiatus does not reflect any loss of love for my work nor loss of love for people. If there were a venue that made sense to me, I would be there today.
Rather, my hiatus reflects a fundamental change in the healing profession. “Irreconcilable differences” have lead to my stepping away from my work. I can no longer go along with the pretense that prescribing pills, ordering tests and typing is the same thing as medical care.
With regard to your question of my thoughts about the Allan Shore excerpt you included:
I may not be the best person to respond to this. Highly theoretical complexity is lost on me. It simply slips over the surface of my brain without penetrating.
My personal stance with regard to psychotherapy and personal healing relies much on the therapeutic relationship and uses primarily a cognitive and behavioral toolkit. I like physical, interpersonal and meditative approaches. I also like understanding the cultural matrix we are all embedded in.
Steve,
Thanks for you well considered response. I, too, have labeled a lot of people with “adjustment disorder” back in the olden days before care managers in my private practice. This would unlock the private insurance sometimes without the same stigma as Major depression and without the same push for drugs.
But an adjustment disorder diagnosis gets an impoverished person nowhere but back out the front door unless they have cash in hand. Treatment for an “adjustment disorder” will not happen in the public sector. Neither will it get a bus pass or access to medicaid health insurance or disability payments.
“It’s really a beautiful scheme, if your desire is to make money without the slightest accountability.”
There’s a trouble with the “money scheme” concept you mention. This is a common misconception, that psychiatrists rake in the cash from this process. Give some thought to this arithmetic:
With these “payable” diagnosis the only ones that make the “big bucks” are the pharmaceutical companies. The drugs amount to thousands of dollars of tax-funded insurance dollars a month if prescription coverage is won with the diagnosis.
The second largest potential money winner on the diagnosis deal is the patient. They may receives a monthly disability check, free health insurance and a bus pass.
The doc will see the patient one to four times a year for maybe 15 minutes each time. This is what’s allowed by the company. In my recent job search I came up with a part-time (7 hours a week), no benefits $70 an hour job which required free 24/7 coverage. That’s $20 to $70 a year payout for one patient and worked out to less than $3 an hour for my time. Creating false psychiatric diagnoses is NOT a big money maker for a psychiatrist. It’s only a big liability and fraud risk.
Plus, if I generate more patients in the public sector, my employer double and triple books people for my same hourly rate and expects free overtime work to keep up.
I wish more doctors had the arithmetic pointed out before spending all the years and borrowing all the money for school. The money ain’t here.
Even the mental health agencies are money losers that barely keep the wheels on the bus from year to year.
Thanks for giving me the opportunity to walk through this part. It could be another rant, eh?;-)
Thanks for reading and commenting here. I appreciate your support of my writing. It’s good to hear that you and your family found some resolution to your differences. I am amazed by what different people I and my children are. Thanks for the reminder that adults must always ask and let children have their say.
Nijinsky,
I really like the story in your first paragraph of the vegetarian gypsy’s and the priest that died from “inflamed orations”, pneumonia from preaching against them. Poetic.
You post good personal and narrative tales to learn from.
Alice
Stephen,
I enjoy hearing from former teachers. I went to school to be a teacher out of a desire to help young people learn. Then I changed direction to go into medicine because I wanted to help people who were sick.
I think most teachers go into the education profession for positive reasons just like most medical professionals go into their fields because they want to help people and have a positive impact.
It’s just that it doesn’t turn out to be quite like you thought. So you can keep believing the party lines or you can stay and try to make a difference (when everyone else around you believes the party lines) or you can jump off the boat altogether.
I’m off the boat for now.
Thanks. I enjoy hearing from others who got off the boat.
Alice
Steve,
You are preaching the choir here. But keep it up. We all need encouragement that we’re on the right track.
A thorough read of Gatto’s work affirmed all my worse recollected experiences as a public school student. It also did way more than confirm my thoughts that school is not meant to teach kids to think, read and write. I had suspected for a long time that public education is there to train good factory workers. But it doesn’t seem to even do this very well. We’ve “outsourced” all those jobs.
When I read “The Underground History of American Education” and read the very clear and pointed plans for our education system, I was shocked and horrified.
People sometimes ask me if I “think” there’s a plot or conspiracy. Then they laugh as if it couldn’t possibly be true. This isn’t something I “think” or “believe”. There was a plan and is a plan. It’s been carried out effectively. We are living with the expected conclusions.
It’s no wonder to me that most of us have been taught (through school) to loath history. This keeps the facts of our past safe from “discovery” when they are in plain sight as archived government committee meeting minutes.
People also ask me how I could not have known of the dangers of psychiatric medicine. They can’t understand how I could have missed it. I also wonder how people can miss the truth of the dangers of our education system and our malignant capitalism.
We’re all too well educated. “Pass” or “fail” doesn’t matter if we’ve all spent 12 years growing up in mandatory day jail fed on standardized national “curriculum”.
“If enough people believe the dream, no one dares to wake up.” Sir Terry Pratchett
Thanks for giving me the opportunity to rant. I know I can always count on MIA for this. 😉
Thanks for reading and writing here. I appreciate this support of my writing. I always enjoy your take on things. I especially like hearing your ability to locate the unity in fragmented situations. This is one of your many gifts.
I agree that this long term “blame game” of the family is “ridiculous”. It is also not a useful concept for healing either as an individual or a society. Blaming family, either though direct behavioral condemnations or though postulating genetic sources, serves only to further degrade and fragment families. And this only serves those in power.
Stephen,
Dang. Too bad. In my “ever-hopeful” insides I had pictured a class in which ethics and problems with ethics were explored in a thoughtful manner. I have to remind myself every day that the standardized curriculum of our mandatory “education” system is there to promote and support capitalism and industrialization. Period.
“Education” is not there to teach kids to think for themselves. Ever. No industrialized country wants self-motivated creative thinkers. These would be too dangerous. One of these free thinkers might discover the “off-switch” for the corporations.
Chrys,
Your family is fortunate to have you as their matriarch. We “matriarchs” must take an active role to make our world a better place. There is nothing like our experience.
I remember the “Gray Panthers” movement as a venue for social activism among older people. Between the accrued life-lived experience and having the time to spend in thought and action, older folks are the great untapped resource for necessary social change. Younger folks are buried under jobs, debt, schools and family. They also need sound leadership to know what direction to point.
Thanks for reading and writing here.
Your experiences provide valuable lessons for us all.
Alice
Steve,
I shall have to look these Luddites up. I assume bad things happened to them. “Quelled revolution” likely.
Destruction of families and communities are a necessary, known and planned part of industrialization. Our “education” system was thoughtfully designed with this in mind. People often complain that the schools aren’t teaching reading, writing and arithmetic. There are reasons for this. This is not what they were designed to do. Schools are doing and have always done exactly what they were planned to do. Understanding this has helped me understand the hows and whys of modern psychiatry.
Check out JT Gatto’s “The Underground History of American Education” to learn more about this. He’s posted his book on line where you can read it for free. After his career as an award winning public school teacher in New York, he researched the birth of our education system. He reviewed minutes of government planning meetings that designed what we have now. I found it (at least) chilling.
Thanks for your continued support of my writing. I am encouraged by this.
All the best.
Alice
Stephen,
Thanks for your support of my writing. I clean and sort the words I write. I hope to get to the bare bones of what I need to say. Sometimes I throw away two thousand good words to get 500 right words.
I would love to hear what sorts of things this ethics class explored. It is likely off the state mandated curriculum by now.
I also posted this piece on my wordpress blog (http://alicekeysmd.wordpress.com/)at the same time. I write more broadly there; essays, poetry and fiction. I write a lot more these days but in a wider range and with a broader palette.
I find different audiences have different thoughts. A woman in Ghana expressed distress at the impact our American capitalism is having on their culture. It effects every culture it touches in the same ways: it destroys family and community. These are planned, known and necessary effects for Capitalism to take root and grow.
The psychiatric issues discussed on the MIA webzine spring from these wider, deeper sources. Even if you pull an individual weed, the soil is still thick with seeds.
Thanks for reading and commenting here. I feel less along when I find that others have similar concerns as I. I appreciate your support of my writing.
Alice
Hey Nijinsky.
Thanks for stopping by. Advertising is everywhere. Next they’ll have it printed on the inside of our eyelids. Oops. Don’t want to give any new ideas.;-)
Duane
Seriously? “Speed diagnosis?” How can this be a good thing? Yikes. Like the wild west marshal being fast on the draw? Cowboy medicine. Cowboy psychiatry. Fastest diagnosis and prescription pad in the west.
Thanks for pointing to this.
Alice
Duane,
Thanks for reading and commenting on my post.
The longer I’m away from my work as a psychiatrist, the more I see that the problems we’ve encountered in medicine and psychiatry is part of a larger matrix.
mjk,
Thanks for your support of my writing as I wander off the beaten path with my words. Thanks for the video link as well.
Poetry, and especially this type of haiku, has given me the chance to simplify and condense my thoughts about psychiatric issues.
The first one, “Baby cry too much”, sums up in 17 syllables multiple current psychiatric issues for me: the DSM 5 push to “pre-diagnose”, pushing drugs on younger and younger children. And, yes, I have heard of “treating” an infant with drugs for the “illness” of crying “too much”.
How do we judge how much crying is too much in a baby? Why would we think to drug them to make them stop? Now extrapolate to every age human and ask this question again.
Each one of these 17 syllable haiku embodies a real situation I’ve come across in psychiatry and medicine.
rcymbala,
Thanks for reading and posting here. I appreciate your support of my writing.
I’m not certain what gentleman you refer to as being intentionally cryptic. Sorry. I’ve missed soemthing. Too cryptic for me to follow.:-)
Cryptic “one-offs” that pass for relationships on social media aren’t very deep when it comes to interpersonal relating. You’re right. It’s VERY limiting. I still prefer face to face and shaking hands and knowing who people are. I like to hear a person’s voice and see who I’m talking to. But I reckeon I’m from the stone-age. 🙂 These days, I have to get by with typing little faces with computer marks so people know I’m smiling or making a joke.
I hope that feelng “more” was what worked for you. Some people need help with emotional regulation and toning feelings down. There’s so much variety in the way people are made.
I’m not so sure complete lack of suffering is possible in life. It seems that most people hope to suffer less. This makes sense to me.
Stephen,
I think you put adds in the paper and hire them like any job opening. The Second Story program in Santa Cruz was well staffed with peers. There’s a special peer training program. Some of the folks who used the respite come back as volunteers as well. What a happy place. This is a good place to look for how these can be set up. The woman who made this happen, Yana Jacobs writes here. She’s very capable. I bet she’d be a great consultant, should someone else be interested in how to make another peer respite happen.
Are there other peer support respites out there already?
Thanks for continuing this discussion.
Alice
Pete,
I know Bob Nikkel. He and I worked together in the olden days of community mental health on a multidisciplinary treatment team. Great guy. I knew that he and his wife brought Bob to speak in Oregon through their foundation. It was through Bob Nikkel pointing me at Bob Whitaker that I began writing here.
I feel much more comfortable writing here since I no longer have an employer. I don’t have to fret about losing a job if I don’t have one.
Each of us can find ways to make our unique contributions to the cause. I love to write. I get to talk to so many people this way.
Sorry to be slow responding. Your post slipped past me in the line-up.
The “R” word. Reading this makes me smile this morning.
Thanks for reading my post and for your support of my writing. I always hope to strike a chord with readers. I’m glad to hear that your personal growth is progressing. Re-framing has always been an important part of my own process of becoming as well.
Thanks for your comment. Keep reading and writing.
Alice
Ute,
Thank you for reading my essay and for your kind words. I’m happy to know that what I write and what others write is useful to you.
Welcome to MIA. Your English is lovely.
Best wishes.
Alice
Ute,
Vielen Dank für das lesen meiner Essay und für Ihre freundlichen Worte. Ich bin glücklich zu wissen, dass das, was ich schreibe und was andere schreiben, ist nützlich für Sie.
Steve,
Sorry to be slow in getting back about your comment here.
Thanks for your lovely post and your supportive words with regard to my home education choice.
Home education has been one of the best decisions of my life, both for myself and for the rest of my family (if I may speak for them). I’ve been astonished by the things I’ve had to learn to keep up with them (not that I always have). Home education has been a personally transforming and liberating experience. It’s given me many opportunities to re-frame my world views.
If leaving our children with strangers at five can have such an impact, I wonder about the impact of our modern habits of dropping them off at six weeks. I can see how doing this would seem bizarre to you. It seems likely to me as well that the modern education “contributes to our community burden of mental/emotional/spiritual distress”.
Thanks for having the courage to educate your children at home. It’s not always an easy path.
So when do we start? I’m not an administrator or a grant writer. But I’m a psychiatrist. Me or not, it seems we’d need one of those.
This would be a good time to promote treatment approaches that save money. Government third-party payers are stretched thin. When I watched about the new Soteria House start-up (MIA video), it sounded like there was a market for more humane treatments that could save money.
Just thoughts. But everything human that is or ever will be started with thoughts.
Pete,
I’ve heard of this program in Northern Finland. I’d forgotten it was called “open dialog”. When I read what you wrote earlier, I had a flash of optimism that there was something akin to this in the U.S. I had a spontaneous hopeful vision that there was one here. Rather like the two Soteria-style programs and the Second story peer support respite in Santa Cruz. I guess not then.
In my private practice I found that people with episodes of psychosis do quite well on low dose and no medicine. This required a strong supportive treatment relationship, an individualized approach and flexibility of how we worked together over time. This meant keeping in touch very frequently at times. Sometimes it meant a house call. One universal goal was to avoid the hospital. We made plans on what that would take.
I would like nothing better than to see an “open dialog” style approach here. When I brought the idea of this treatment approach up for discussion at work, I was told I had to be realistic, that these kinds of treatments only work when people have more resources (money and social supports). I was told the best we can do is stick with the medicines since this is what we have available.
The people I’ve known that work in mental health are good people who are there because they want to help. There’s not a lot of room for movement to change things inside any company. A company has a life of its own. Bean counters have to sharp to keep a company alive. That knife cuts out a lot of choices.
Any idea of the cost to run this? I know this treatment is effective. But people always want to know the cost, how much bang for your buck you’ll get and where the “resources” will come from.
The bean-counter way of program development here is very short sighted. It thinks in quarters and fiscal calenders, terms in office and annual block grants. It doesn’t calculate the cost of human suffering, early death and long term financial costs of secondary medical illnesses from the drugs.
I think 80% working, in school and looking for work sounds like a lot fewer people trapped in lifetime of disability and expensive drugs.
David,
Thanks for adding your point of view on “recovery” and pointing out how it ties in with materialism.
In America, most things are defined in commercial terms, how much money you have or appear to have. This drives the debt monster that’s enslaves so many people. Everyone is caught up buying their image and polishing it.
When I meet people they want to know what I “do”. By this, they always mean “who do I work for” and how much income do I have. When I talk to people about writing I’m asked if I’ve sold anything. As a landscape painter (in a past life), people only wanted to know if I’d sold anything. Folks look at my twenty year old car and make value judgements about my worth as a human. One person took took me aside and laughed at my old car. He suggested I buy a “doctor car”.
Thanks for sharing your personal experiences with recovery and with the system. The psychiatric system is definitely part of the larger culture. I’ve written a couple of recent pieces that explore materialism and industrial culture in my newly-up WordPress blog.
“… when it comes to specific cases, they almost always decide drugs are needed.”
This is true. People that work in psychiatric clinics are “afraid” not to prescribe drugs and more drugs. One cause is something the APA puts out, standards of practice or practice guidelines. I’ve forgotten what it’s called. There are also “community standards of practice” that require a kind of consensus prescribing habit. There are also clinic “standards of care” written by medical directors. There’s not much latitude for thoughtful work. Anyone who doesn’t toe these lines will be left out alone on the legal chopping block if anything goes wrong.
They are afraid to reduce drugs, even complicated pharmacologic soups that no one could possibly know the effects of. There is a pervasive fear that people will become dangerous with drugs are reduced. I recently suggested at a job interview that I would be inclined to reduce and simplify med combinations if I worked there. “You can do what you want,” I was told. “But we don’t want anyone getting hit.”
Open dialog:
You’re right. Psychiatrists have not been allowed to even see patients before the decision has already been made that there is a “need for medication”. Open dialog sounds like a great process. Where is this happening?
Stephen,
Thanks for weighing in on this important topic. The word “recovery” is in frequent use in the places I’ve worked in recent years. Yes. By recovery they mean being cooperative with taking drugs as prescribed, keeping appointments and behaving agreeably.
I doubt it’s possible to return to a prior self however much one may wish to do this. People grow and change. This is a natural process. Life is a “river rather than a stagnant pond”, as you said.
I like the sense of a “journey of recover”y to become who we are “called to be”. This feels like each of us has an important purpose we may not yet be aware of. This is very forward looking and process oriented.
Peter,
Thank you for your support of my writing. I’m happy to hear that you enjoyed reading my essay.
Your reply is eloquent. I see that “recovery” may not be useful to you personally as a concept. You sound like someone who is internally directed in your living. Perhaps recovery could be seen as a process in which a person becomes more internally directed, if they want. I suppose that a person choosing to relinquish internal control could be making an internally directed choice as well.
In the olden days, when I was still able to do “talk therapy” with people as a psychiatrist, exploration of personal internal choices was an important part of this work. Even not making choices for oneself are kinds of choices. Being aware of how we give away our personal power and choices to others every day is a starting place. Examples: Saying “You make me mad” hands over control of your feelings to the object of your anger. Borrowing money gives away your power to choose how you spend your time and money in the future.
Perhaps the focus of “helping” could begin with asking whether a person wants help and what sort of help they’d like. Even the most confused appearing adult is still an adult. The next step would be to listen well. I have asked many people presenting to psychiatric emergency care what they want. I hear things like safe housing, a job, to stay out of jail, food, to feel better, medical care, help sorting out a troubling issue. There are a lot of requests for pills but there are a lot of requests for help with basic needs.
I agree that “mental health” and “mental illness” are cultural constructs. Today these constructs focus on behaviors that are unacceptable to the surrounding community, like sleeping in doorways and talking aloud to one-self in public. I suppose there may be other ways to manage these socially unacceptable behaviors than our culture’s current two-pronged management approach: drugs and/or incarceration.
Having said that, I should add that I think there is a place for psychiatric drugs still. I have seen people, through the use of psychiatric drugs, regain their ability to be internally self-directed that they had lost while experiencing extreme states.
Thanks for entering the discussion with me. I think of more to say when I meet others here.
All the best.
Alice
Kathleen,
Thanks for reading and commenting. I appreciate your kind and encouraging words about my writing. I love to write. And welcome to MIA. I enjoy the variety of perspectives and expertise in both the regular contributors and the commentary.
I see your point about not liking the use of the term “recovery” in medical areas like chronic pain and HIV/AIDS. Recovery implies a return to some prior self. Even injuries we think of as being healed and recovered like broken bones may still cause pain from time to time later and need to have some additional care. I suppose there may be similar issues with the word “heal”. How does one “heal” from chronic pain? By definition you have it for long term.
I’m sorry if a life-long process of recovery sounds “exhausting and overwhelming” to you. I can see how you would feel this way. I think you’re not alone in this response. But to me, having a lifetime of opportunities to change and grow gives me chances to continue to make myself over. From time-to-time I re-evaluate and re-frame old experiences and perceptions and find more peaceful ways to live with (or around) them. Thinking I have to be “done” or “not done”, healed or not healed, recovered or not recovered makes me feel like I’m waiting to be graded. And I always hated that.
I’m familiar with the process of “being in recovery” of friends of mine that go to 12-step meetings. (Please. Any expert in the 12-step recovery process can speak up here and correct me.) Being “in recovery” sounds like a life-long process. One friend has over 25 years “in the program” and still considers herself to be “in recovery”. It doesn’t sound like she has to work at the same level of intensity on the same things now that she did once. “In recovery” seems an evolutionary process. I’ve never heard her talk about “being recovered” in a ‘done with it’ sort of way. I also hear her talk with great enthusiasm and hope about her process.
Specific outcome measures are currently required in every mental health agency that accepts state funding. A lot of time is spent making an individual treatment plan or contract with each person. Every interaction that is paid for must be linked back to agreed upon, measurable and countable improvements. At this time, every agency is held financially accountable to the paper trail that documents that this is happening. I have seen agencies have to pay back a lot of money because of deficits in the documentation trail. This is why they type so much.
Dear Poet,
Thanks for taking the time to read and respond to my essay here. I am delighted to have the opportunity to think about what you write. Every interaction gives me a chance to explore ideas further.
You say this so much this better than I:
“What is most important is having a meaningful life and having a meaningful life is also the most important part of recovery.”
I agree with you completely.
I also agree that mental health agencies are very good at “re-badgeing” (re-branding?) whatever they do as being in line with whatever the current word is. Examples: if “case-management” is what’s paid for then “case-management” is what we do. Exactly what is done when one does “case-management” changes over time.”Med-management” now means a brief ‘howdy’, lots of typing and prescription refills. What is being “managed” here?
What kind of “recovery” is being facilitated when the primary “treatment” is a prescription? In my experience “recovery” inside financially strapped “mental health providers” currently means “stable on meds” which means “may be transferred to the primary care doc care for ongoing refills”.
When I think about humans and recovery, I don’t think about recovery in terms of having “leverage” over what mental health providers do. I think about each person being in charge of moving their life forward in a way that makes sense to them.
I suppose this all means that I’m not the best person to help formulate a “clear and powerful definition” of the “goal” of “recovery”.
Thanks again for letting me have a chance to write more here.
David,
Thanks for this lovely and entertaining piece. I shall have to try making 100 word summaries. “Grapes of Wrath” distilled to a 100 word essence, for example. There is a likeness to free verse poetry about the process that appeals to me. Word count limits help one filter and choose.
I’m glad to hear your insider’s view of editorial oversight in a professional journal, the supposed outlet for “evidence based” research we physicians use to fill our post-graduate education needs.
I do care deeply about how my kids view my life and behaviors. I even gave up swearing and sold my gun when they came along. I held on to the motorcycle and leathers for a while longer, though. ;-))
How I live is one of the greatest gift I can give them. Thanks for noticing this. “Walking the walk” and living my life in line with my values means tolerating a certain amount of uncertainty and exercising generous amounts of impulse control each day.
I learned long ago that if I have the choice to believe someone’s word or their behavior, I’d sure better go with what they actually do.
A favorite quote from a hero of mine (Dr. George Saslow) is “Don’t apologize, change your behavior.” My mother said “Actions speak louder than words.” My friend Robert would say “Talk’s cheap.”
Thanks for reading and commenting here.
All the best.
Alice
Nijinsky,
I like the planned and remembered escape for a few minutes each hour. What a lovely break from what normally passes as reality.
All the best.
Alice
Thanks for doing the research to locate the source of messages of hopelessness. A hopeless person is a powerless person. I think personal power is an essential tool in recovery. We need more hope, more power and more recovery.
I agree that it is essential to get the word out about hope. We have to get it out to treatment providers and family members as well as people both inside and outside the current treatment systems.
ocdtalk,
Thanks for reading and commenting here. Your support means a lot to me.
You’re right. All the best we do is still not enough to shield us and our kids from every illness and misfortune. Staying together as a family has been very important for us. Staying together as a family provides us with more strength to cope when things do go wrong.
I’m glad to hear that your son is doing better now. Staying together as a family is more important than ever.
I’m glad that the world gained a new advocte for OCD awareness in you. Thanks for the good work you do. If each of us do the things we can, we’ll build a better world. My mother used to say that ‘many hands make happy work’. I’m happy for your hands’ work in the world.
I had the opportunity to visit and tour Second Story a couple of weeks ago in Santa Cruz, not long after the MIA interview.
The atmosphere is pleasant and relaxed. The staff are friendly. All in all this is a very homey and supportive place. I liked it that people staying there are free to come and go and eat as they wish. This is so unlike the standard hospital “treatment” model.
Kudos to all involved in obtaining the grant and designing and running the house.
Stephen,
Your kind words give me a bright happy feeling this morning. I like it when I find out that something I write effects another person. I feel supported and appreciated by your words.
Thank you also for the time and effort you put in to help raise your brothers and sister. I have a friend who raised her younger brother and sister after their parents passed away. She was hardly more than a kid herself back then. I know your hard work made a difference.
This “all one” is an important concept to me. When I hurt another, I hurt myself as well as everyone else. When I help or give comfort to another, this is done for all. I like knowing that a person like yourself, a kind-hearted being with lived experience, is there working in the state hospital. This is courageous. You bring the seeds of kindness and understanding in your pocket with you to work. This is impressive and important to me. Thanks for your work there.
Ah yes. The rest of the story. Even in the best of best there is no one purely good. But also in the worst of worst there is no pure evil. Knowing this gives me hope that things can be better. Knowing this also gives me caution. I am encouraged by this knowledge to study the contents of my own purse regularly.
Nijnsky,
Wow. I learn something new each time you post here. Did Babyloniuns have fewer fingers? ;-))
I stopped using alarms to get up years ago (Unless I’m freaked out about catching a plane. Then my head wake me up before the clock anyway.). The alarms jolt too much. My head naturally wakes up in the morning. I suppose I’m just lucky that way.
Chrys,
Thanks for taking the time to be a support to your children when they were small. I’m sure this is important. Many parents today in America no longer have the luxury of spending this kind of time being acively involved in their children’s upbringing. It takes multiple jobs to keep the roof and food. Parent are forced to be away from their kids in order to provide for them. When babies cry “too much” and children are anxious and depressed, we call the babies mentally ill and drug them.
Like you say,”it’s a crazy world and getting crazier all the time.”
I agree, there will always be mentally distressed people in the world. Even the Buddha noticed there was a lot of suffering in human existence way before psychiatry was invented.
I, too, would like there to be better ways to support our family members and neighbors through times of mental distress. To me, we are all connected. When we treat people in distress badly, we treat all of us badly.
I’m grateful to you for your efforts as a psychiatric survivor advocate, a writer and a campaigner. I hope you will be here working for a lot longer.
Nijinsky,
Thanks for reading my post and supporting my writing efforts. I always enjoy hearing from you. You have an elegant way with words. I appreciate you reassurances about the illusion nature of illusions.
I find that kids are great sources of wisdom when they’re allowed to be.
I like your thoughts about the universal light source with each of us as light bulbs. You made me laugh with your light bulb analogy, the part about it being a hopefully green flourescent bulb that will save electricity.
I also don’t percieve of time as being linear. Dr. Who (British sci-fi time travelor) calls it “wibbly wobbly timey wimey”. We humans fractured time into bits and began counting the bits like beans not that long ago. Breaking and counting time in equal-units was part of the mechanistic industrial revolution. The modern concepts of time clicking away, wasting time, saving time (as if seconds are pennies to be piled up and used later) is transmitted through our education system so we can keep to a work schedule. We have to remember that modern education and beliefs about how time works came as part of industrialization. Public education and clocks came hand-in-hand with the change from agrarian/community life to factory/city life. To me, there have been some losses incured by humanity in this transition.
Thanks again for writing. You get my thoughts jump-started.
All the best.
Alice
Thanks for reading and supporting my writing adventures. I’m the lucky one to have support from folks like you and to have my family to guide me when the path is uncertain.
I wasn’t sure exactly where this essay belonged so I’ve also posted this one on my personal blog: alicekeysmd.wordpress.com
Ted,
Thanks for taking the time to read this morning. As a writer, I always feel better knowing that I’m being read. Knowing that what I wrote is meaningful is even better.
Thanks,
Alice
Alix,
Thanks for taking the time to read my post today. I appreciate your interest and support of my writing.
Home education is not for everyone. In fact, the vast majority of folks turns out just fine with their school educations. It sounds like you’re making the asumption that school is equivalent to the “real world” and that it provides tools to kids to resist temptations. This could be a good area of research.
Staying friends with your children is mission critical in my book. Good job to be able and available to do this for them. Our children face a challenging world.
I agree. There’s nothing wrong with going out and earning a living as long as the parameters involved can be managed in an honest way. This can be the trick since an employee may only have something less than half of the say in the matter.
I don’t yet know the impact that DSM 5 will have on providing or preventing access to care and special education. I suspect there will a continued push for more drugs and away from other kinds of services. This is the direction we’ve been going for a long time here: more drugs and less supportive avenues toward better lives. With or without DSM 5, this is the road we’re on.
markps2,
Thanks for reading my blog and commenting here.
That cargo ship’s another big polluter. Buy less imports that are shipped here? I stay away from imported food. I skip the apples when they’re shipped from New Zealand and wait till the local ones are in.
Walking is good for your health as well as the health of the planet. Except when you get crushed in a crosswalk and killed (Woman in Portland OR last Tuesday. There are bound to be lots more examples).
Cars are the deadliest killing machine on the planet just for out and out direct daily kills. We kill 89 Americans a day every day year round (2010 CDC statistics). There are lots of inury statistics as well with this.
I suppose since your comment is addressed to another person, I should stay out of it. But since it is posted in the comments to my blog, I suppose I could say something with regard to the part that effects me and everyone who has been the target of bigotry of any kind.
“Typical Psychiatrist” is the same kind of comment as “typical black” or typical woman” or “typical mental patient”.
Thanks for reading my blog and your support of my writing here. I feel so powerless to make a direct and significant impact the larger political, economic and environmental issues myself. I have to find small things that I CAN do. I park my car and walk to save lives. I think and read and write and encourage others to do so. I hold my own family close. I cook dinner. I focus on my own internal locus of control and support others in finding their own power. I can do these things every day.
I believe that combining the little things I CAN do with the small things that others CAN do will add up to the big changes we need.
I believe that each of us must be the change we can be in the world. I have felt so overwhelmed at times by the enormity of the situations that need reparation that I’ve wanted to give up. I finally had to get busy doing things that I know I can do and hoping that everyone else pitches in.
Ivana,
I just got back to MIA this morning on the west coast. It looks like I missed some conversations here. I shall have to go back and read the post where this discussion began.
Thanks for the suport you’ve given my writing here on MIA.
Ivana,
The nathuropathic physicians in the state of Oregon recently aquired full “prescribing priveleges” for allopathic drugs. Naturopathic physicians have been (in the past) the doctor one went to to avoid pills. They were the specialist for “natural” healing processes like lifestyle and nutrition. Now they are yet another avenue for faster and cheaper prescription refills.
The Osteopathic physicians (“O.D”, whose medical theories depend upon manipulations of bones) are interchangeable with M.D. here. We all train in the same specialist residencies after attending different medical schools. An O.D. Psychiatrist is the same as an M.D. psychiatrist now.
I haven’t looked into what prescribing priveleges the homeopathic physicians have. Homeopathic remedies are sold at food stores here.
In three states in the US, so far, psychologists (not medical at all) have aquired “prescribing priveleges” for psychiatric drugs. Social workers advocate for the ability to prescribe psychiatric drugs as well. So far the social worker initiatives have failed. Most states have authorized nurses and nurse midwives to prescribe drugs as well, with additional training.
Child psychiatry has lost “family first”. In Oregon, masters level educators (school teachers. non-medical) can legally give pychiatric diagnoses to children. They then pressure family members to go to the pediatrician (non-psychiatrist) for fast prescriptions of psychiatric drugs. They may refuse to allow the child to return to school unless the parent puts their child on drugs.
Many parents rely on school as the place for their child to go so they can work. No school means no work. Loss of work here can mean loss of housing. Loss of housing can mean loss of your kids. The kids will certainly get drugged in foster care. The family is not coming first in this situation.
Thanks for giving me the opportunity to think and write more. This is a good discussion. Perhaps we can have a conversation in person some day.
I also think family connections and leadership of elders is important. Family and community conections have been shown to lower the incidence of psychosis and improve outcomes in other places. Also the Buddhist philosophy must help.
It would be nice to know what’s working for this population. Perhaps there are way we can reduce the incidence of psychosis and manage it better here.
Ivana,
Thanks for the link. I hope that others will also look into these to use.
Every small thing we do to move in the right direction helps. It’s easy to think that only BIG efforts can make things better when we are up against such big problems. There are a lot of us. Each of us doing some small thing can make a big difference.
I’m sorry for your loss and struggles. A thousand years from now, you will be your son’s mother still.
Thanks for your clear exposition on the differences between legality and ethics.
In the US, it’s not always easy to get people to see past legality and liability to actual patient dangers; to get from “I might get sued” to “A person could die.”
As a nation, we in the US have a very attorney-heavy population. These are busy professionals. So, we are very “legality” conscious to the point of maintaining some losses in the ethics department.
The legal system (corrections) is a strong presence in this country. Our nation has both the highest numbers of prisoners incarcerated and the highest rates of imprisonment of any country in the world. This pushes us to be more focused on legalities as well.
I have found that people who would ordinarily be kind and ethical away from work become much more focused on legal liability within their corporate employment. I have had trainings to ensure this and been given suggested scripts to work from.
This is not meant as an excuse and may not be the case in this corporation’s tactics but with you. It is only my opinion. (Legal disclaimer).
Ivana,
Thank you for staying in touch. I enjoy hearing your point of view on things and appreciate your encouragement.
What a lovely idea these leaflets are. Do you have a link to locate them on line? It would be good if every patient were given information like this BEFORE drugs are considered. If people know what to expect and what the wide range of normal human experience is, they will cope better and use fewer drugs.
There were times people came to me to be told their experiences were NOT crazy. Leaflets could help.
I do not have an office now or treat patients. If I had an office still I would certainly put something like this out in the waiting room. The “informational” and “educational” leaflets available from organizations here have a strong medication bias. When I had a private office, I made up some of my own leaflets and left them out. One was on Sleep Hygiene, how one could improve and regulate sleep without drugs.
One could not leave out leaflets in a “doctor as employee” office situation. This is how most doctors work here in the US. In my experience, informational leaflets here are carefully controled by management. They come from NAMI or drug companies. The leaflets carried the drug bias of those who paid for them.
Thanks for sharing your ideas. All great things start with ideas.
Alice
PS I did get back and reply to your comment of december 8 on “Just the way things are”.
I think that the differing structure of our medical system does explain a lot of the differences in health care between the US and France. Our system is made of a changing web of profit making organizations all battling for market share. Units of health care are sold to those that have money. No money, no health care.
Also poorer people have less access to healthy food here. There are areas of towns and cities that have no access to food unless it comes from fast food chains. Our small corner groceries sell snack food and beer, not produce or good bread.
It is interesting to me that the Buddhist immegrants have a lower incidence of psychosis. Do you suppose social support and family support is stronger?
Karina,
I, too, think that re-building communities that can sustain us is very important. I wish I knew how to go about doing this in these modern times.
I think that many of our modern human (and planetary) ills are the result of the ongoing industrialization process and an unrestrained capitalistic economy. These processes have slashed and burned families, farms, forests and communities the world over.
I know how to “network” with people today (emails, drive to meetings, texts, phones, co-workers and classmates) but I have no idea how to re-build actual communities. I grew up in a small agricultural community. When I think of community, I think of sitting on the front porch to see what’s happening in town, walking across the field to dig potatoes, sharing the extra tomatoes with grandma and sitting outside in the evening with neighbors talking as the night falls. You helped your neighbor, not simply because it’s the “right” thing to do but because next time you’ll need help. You weld my plow and I’ll can your pickles, kind of thing. We lived near the same people for a long time to get there. You didn’t always get along with everyone, but you knew what to expect from them.
That’s what I think of when I think of community.Can we get there?
The American way of life is very busy and filled with stuff and noise. We have no time to be with people, even our own families. Babies go to day care at six weeks of age. However nice the workers may be, they are not the parents. No amount of “quality time” can make up for this. I feel pity for little children today as well.
I read today (in drug company sponsored education material) about three year olds diagnosed with anxiety disorders, depression and elective mutism. Perhaps a three year old in day care for ten hours a day since the age of 6 weeks is right to feel anxious, depressed and not want to talk.
Thanks for your work and clear writing about the important practice of hope. I especially appreciate your comment that “hope can be messy and spacious”.
Personally, I like to zoom right past “reasonable hope” and into hope beyond reason. This is the hope I like in my daily practice.
Back to my premise that professionals should all be very thoughtful, careful and considerate of the records they make. Medical records, psychiatric records, credit records, work performance reviews, police records, school records all (especially in the electronic age) can follow us.
I wonder if it would be possible to go back and have the record ammended now? I’ve amended charts for people in publicly-funded mental health clinics. For medical-legal reasons, even I (as the doctor) can’t erase or cross out anything I’ve written so as to make it illegible. I was told that files can’t be altered because there is a concern that if the records go to a court of law, it will look like an intentional alteration of the record to cover something up. But it’s possible to enter additional information and corrections as an addendum, even in electronic medical records. The old record stays legibel with a line through and the time and date the change was made is next to it.
It is also possible that your records have been destroyed already, depending on how long ago it was. Medical records don’t have to kept forever. Depending on the state and the year, there is a finite numer of years after a patient is last seen that records have to be maintained.
In my private office, I aged out and destroyed medical records in line with the state laws of Oregon at the time. I have had individuals look me up to find out if their old records were discoverable years after the fact. Nope. Without a record I can only reply that I have no record of you.
You could always check with the medical records department and find out their policies and procedures. Medical records staff are generally helpful.
Thanks for reading and writing. Every time I log on to MIA and look through the comments, I am amazed all over again at the depth of wisdom I read.
I smiled a lot when I read this. You sound so much like the inside of my own head and how I think about things that I feel like I know you from somewhere. I can only say that I wish I’d written what you just wrote here. You spell things out so clearly and concisely. Very nice.
Your experiences with what healing takes is exactly what mine were during the ancient days of yore when I still was allowed to practice psychotherapy as part of my professional work. Even before I knew of the serious medical side effects of psychiatric drugs, I was still reluctant to hand them out. Once I gave a person that first prescription, they stopped working for change and growth. They went into “waiting for the meds to kick in” mode. If they felt better on drugs, then there’s no need to grow or change. Then when “the meds pooped out” we’d have to “try” other drugs.
There is something very dis-empowering about handing over the locus of control for your happiness to a bottle of pills. If not this one, then perhaps the next, or the next, or the next.
Oh Stephen. Thank you for asking after my happiness. Every day I am surprised by the ability to touch one another using words alone. Words are powerful, aren’t they?
I take great personal joy in my writing. This is the thing (beyond caring for my family) that gives me pleasure and personal meaning. I get up before dawn while it’s quiet every day and write. This process clarifies my thoughts and directs growth and change in my life. I have done this for many years.
Having gained a small readership here gives me joy as well. I love that people read what I write and then write back to me about it. I can imagine few greater pleasures.
I’m sorry if so many things I write here are so sad and desolate. I am, by nature, a hopeful, energetic and happy person. I shall attempt at some point to write about the immeasurable joy of life on this planet.
Alex,
To have the patient and doctor work together to populate the information of the file is a great idea. Once upon a time, when I had a private practice and still had my own little boat to steer, I did this.
The first time I came in contact with the medical profession and medical records was when I was in college and accessing the “free” medical-student-run clnic as a poor patient. An unlabeled student doc I’d never met and didn’t expect clumped in, plunked down and, without so much as a howdy or introduction, began grilling me on intensely personal aspects of my life. I was not happy or pleasant with the young woman. The supervising doctor (himself a trainee) came in and caught me reading what the other young ass had written about me in my own record. None of it was pretty. This supervisor snatched my medical record out of my hand and verbally chastised me for reading it and for treating the medical student in a less than polite manner. I lectured him on polite behaviors to supervise his trainee in.
I can see how easy one may get the medical record reputation of having authority conflicts.
Nathan,
Thanks for hanging in with our discussion in the comment section.
I found this part of your comment particularly well stated and in line with my experience as a physician in relationship with the “insurance industry” and “health care industry” over the past twenty-five years.
“This is complicated by the resiliency of industrial complexes, as they respond to challenges and challenge by trying to maintain itself, often seamlessly reconfiguring and disciplining the components of the system to stay functioning. There is not all that much agency for individuals or individual parts, because the parts of the system become themselves only as part of the system.”
It has been my experience that, as an indiviual physician, I have been relegated to the position of being an interchangeable cog in a larger machine. There is one role, writing prescriptions, allowed me. The mass of the industry is such that, even when experiencing and expressing concerns about real dangers, I could have no impact on the larger system. No one, including the top managers, CEOs and governemnt funding gatekeepers could shift things either. When I did get someone to talk to me, the answer was “It can’t be changed”.
Yes. The bottom of the “dupe” pyramid is the patient. But duping travels pretty high in the pyramid and doesn’t seem to thin out until close to the top of the upper management levels. Even those that invest their retirement stocks in nice medical investements are duped. But earnings on your investment makes it easier to turn a blind eye.
Prisoners are the stock in trade of the prison industrial complex. Those bad people half a planet away and our young soldiers are the “cannon fodder” for the military-industrial complex.
All the best.
Alice
My choices were always only two: play along quietly or go away and be replaced by the newest cog. Guess which ultimately happened?
Alex,
Yes. If more people requested their own files (It is your right to have them.), folks would be more cautious of the things they said in them and how they said them. These files are passed between providers whenever you sign a “release of information”. They are accessed by any third party payor for care. If you don’t sign a release, they won’t pay.
Peter,
Thanks for taking the time to read and especially the time to write here.
My “random thought” from reading yours:
The entire medical system is a for-profit “industry”. I cringe when I hear the word “industry” these days. “Prison industry” comes to mind at once to me. Then I have to think about the millions of prisoners we keep locked up as part of a for-profit “industry”.
Once upon a time, “industry” mean you produced or manufactured a product. What is the “product” in the “insurance industry”, the “health care industry”, the “military-industrial complex”, the “defense industry” and the “prison industry”?
“Pants”. I like it. “gobsmackingly unbelievable that anyone should take this idea seriously” What a way with words you have. I may have to steal this phrase with regard to having a diagnosis if your grief runs beyond two weeks.
The human relationship is the most powerful healing tool I know. I’d like to think it was the time you put in with him as well. It supports my belief.
Thanks for your support of my writing here. I enjoy your commentary and your point of view from the other side of the big pond.
Louise,
Thanks for your support. “Ex-patients” would be all there is for me right now. I and the American “prescription-pad style” practice of medicine have parted ways for now.
I, also, would have a hard time making a diagnosis of schizophrenia in the absense of symtoms for 12 years. This is rather like the habit of continuing to say a person is diabetic when they’v lost weight, changed their lifestyle and have normal blood sugars with no medical intervention. But this is done. Or continuing to be labeled as hypertensive with normal blood pressure off medicines. Once you get a diagnosis, it’s yours forever.
There are no “cures” in Amreican medicine. Everything in maintenance and requires pills.
Sigh.
Thanks for reading and writing. Encourage others to do so as well.
Alex,
Thanks for reading here and taking the time to respond. It means a lot to me to know that people are reading and thinking about what I write. Thank you for this gift.
I can tell a lot of thoughtful consideration has gone into your remarks. I appreciate the time you took to review your life experiences and get clearer about what worked for you and what didn’t. I’m glad you’ve been able to find your way beyond fear and despair by using your “energy and vibration theory of health and well-being”.
Thanks for telling about your experiences in the mental health systems. These make a strong contrast with how you transformed your life by looking at your experiences in very different ways and trying new approaches.
I like “miracle” stories. The world can always use more hope.
If the ways you’re looking at things and doing things isn’t working for you, try different ways.
Thanks for reading, thinking and writing.
All the best.
Alice
I’m sorry for your losses. I have known people who grieved their whole life from losses as deep as yours. How is this psychopathology? You’re right. Grief is a highly personal process. The DSM 5 allows two weeks for grief? The idea that grief is mandated a problem to be medicated after two weeks is beyond insanity.
MJK,
I’m so sorry for your losses. And you’ve had a lot of them. You’re not the only person I’ve met whose children were held hostage in exchange for medication “compliance”.
Alice
I apologize in case you took my question about the diagnositic criteria for insane in a way I did not intend. I did not mean to make light of any of your “diagnoses”. I was not aware that “insanity” was in the DSM anything, that’s all.
I’m sorry for your suffering and hope for any tranformation that can bring you more happiness in your life.
Stephen,
Thanks for validating my perception that psychotherapy has been lost to psychiatric hospitals.
You’re right. Sometimes psychotherapay is long and difficult work. But not always. It depends on the person and the situation and the therapist. Research on outcomes of psychotherapy show that the most important aspect that effects outcome is the realtionship formed.
So we’ve traded treatments that work well and give lasting benefits (a variety of therapies including “talk” therapy) for pill treatment that is medically dangerous, expensive and don’t work so well. I wish a bean counter in charge of treatment dollars would calulate all the costs. They would come up with very different sums.
Hospitals are now used for short term “stabilization” ie fast behavior control. This is not therapy or treatment. Therapies take a bit longer but have more lasting results (and less medical side-effects).
I’ll see if I can recall her name. She worked with me in the Portland VA A and D residential treatment program in about 1987. I will email you her name.
I recall she talked about other nursing research about locus of control at the time.
Locus of control has been a useful concept in my work with folks.
I’m glad to hear your friend is doing well. Nine diagnoses and five drugs for seven years with no improvement. That’s an indictment of the treatment he recieved.
Sorry. I don’t follow that last line.
“Psychiatry – my diagnosis – Pants, possibly, Big Pants.”
Perhaps a British turn of phrase or I’m completely out of the reality loop (possible).
WW,
Thanks for reading and posting here. You’re right. The names of the diagnoses are problmatic as well.
Changing the names to new names doesn’t always help a great deal either. Thirty-five years ago there was a push to change the diagnosis from Schizophrenia to Bipolar disorder for many patients. The more common diagnosis was schizophrenia. Bipolar disorder was fairly uncommon then. I was told that bipolar disorder was a “more hopeful” diagnosis and we should always start with this one, rather than say “Schizophrenia” when a person first presented.
Over the years the “popularity” (if I may use this word) of the bipolar diagnosis has skyrocketed with each new drug approved for its treament. This is a case of the diagnosis being sold to sell a drug.
I have even heard of people being given a psychiatric diagnosis because they took a drug and felt better while taking it. For example: You are have trouble sleeping. You are given a drug that has been marketed for bipolar disorder. While on the drug you sleep better. This means you have bipoar disorder. This is very bad reasoning. One can’t reason backwards from what a drug is marketed for to make a diagnosis. If the drug was originally sold for siezures (drugs marketed for bipolar disorder frequently are), does this mean you have a siezure disorder?
Psychiatry (and all of medicine) is plagued with this kind of bad reasoning. If an antidepressant makes you feel good, you have depression. If an antianxiety drug makes you feel good, then you have an anxiety disorder. If amphetamines make you feels more focused, then you have A.D.D. Come on. Most anyone feels more focused on a stimulant.
In my private office, I knew that saying “adjustment disorder with depressed mood” had fewer negative effects to a person’s insurance status. This implies you’re adjusting to a stress that could cause depressive symptoms in anyone. Once you say “Major depression, single episode” you’re on the lookout for recurrance and chronicity. You have a permanent risk mark on you from an insurance perspective.
There are clinics that cannot get paid for treating anyone with a “lesser” diagnosis. You have to have one of the big Axis I diagnoses for the govermental agency to approve payment. How do you think this effects the diagnosis made at the time of evaluation and intake?
Thanks for reading my post and writing back. I appreciate your willingness to share so openly here.
Wow. What a collection. How is it possible that these are all accurate medical diagnoses based on careful examinations?
I’m sorry you’ve been hurt by this pack of words. To throw this many labels at a single individual demonstrates my point. The words that are being tossed around by psychiatry today as if they are medical diagnoses are not useful for communicating an individual’s situation or useful in planning a course of action. They are being used in other ways.
For me, psychiatric dianosis has gotten in the way of my work with people. It was something I worked around and tolerated and kept to a minimum. In order that a person can access their insurance benefits, a diagnosis is required. In my private practice, I worked together with individuals to determine what we both thought would be an accurate (by the official lists) and the least damaging label to use to bill insurance. There were times that these discussions lead people to skip the diagnosis and skip the insurance payments.
The way these words are used hurts people. I think we agree here.
I suppose your final question is meant to be rhetorical and aimed from you to the “you” of the larger psychiatric community you’ve had contact with. I won’t address it personally.
Thanks for writing this piece. I especially like your premise “We are the ones we have been waiting for.”
In addition to illustrating how people with lived experience can provide transformational support to one another, it also reminds me of the concept of “locus of control” in wellness.
For me, your premise cuts right to the heart of the matter of “locus of control”. So much of routine medical and psychiatric care removes the percieved center of control from inside the individual and hands it over to “care providers”. Waiting on “meds to kick in” is placing power well outside the individual. To say the least, this is dis-empowering.
I worked with a nurse many years ago who did reserach on patient’s perceived locus of control and their recovery from medical illnesses. People who saw themselves as being in charge of the process had better outcomes than those who believed the “locus of control” was outside of themselves.
Thanks for the well-written portrayal of medical training. It gave me flash backs.
There were not so many drugs being marketed when I was in training. Equating “doctor” with “prescriber” is a transformation that has occured gradually over the past 25 years. Especially in the field of psychiatry, this has meant the loss of many skill sets and the devaluing of the therapeutic relationship.
I would really like to hear about small individual steps anyone has made as well.
My own efforts have been focused on myself and my own family. I have stepped away from the prescription pad for now to give myself time to think. I have simplified my life in many ways.
Your NP must be allowed more time with you. You are fortunate to have found a place you can afford medical care that works for you.
Thank you very much for offering a French perspective. I am honored that you would take the time to read what I write here. Thank you.
I meet doctors in this country (besides myself) who have also decided to stop the practice of medicine. I suspect that more would stop if they were economically able. The numbers of women practicing medicine here has been on the increase as well. The highest numbers of women work in the lowest paid specialties (pediatrics, primary care, psychiatry).
We have also been licensing nurses in the USA to practice medicine here for many years. The “nurse practitioner” profession is a field dominated by females as it is a a graduate nursing degree. They work as independent practitioners and are used as a low-pay doctor equivalent for the same work.
I have heard that private insurance companies are making inroads in France, as in England. I have heard of a push to “privatize” medical care in France. I would like to hear your thoughts about the impact this will have.
What are the costs for a routine medical check up there? My Primary care doctor’s fees for an annual check up (about 45 minutes) runs around $500. This does not include any lab tests, xrays or medicines. An uninsured person could not afford this.
Thanks so much. I would like to hear more from your perspective when you have the time.
“Yet is cause and effect thinking to shallow, and far to mechanical to capture the nature of being?”
I am personally unable to capture the “nature of being” with thoughts. I find words get in the way for me. Of course there are different paths for different folks.
David,
Thanks for your support of my writing here on MIA.
I can tell you put a lot of time and thought into your writing here.
I wonder if “cause and effect thinking”, as you put it, is a natural and built in feature of the human cognitive operating system. For example, if you stub your toe your toe hurts and if you eat rotten food you get sick. “Cause and effect thinking” sounds like a good thing for everyday life.
I certainly hope we are entering a time of more unity of spirit and understanding.
Thanks for your support of my work here. Thanks for your comments.
The conversations in the comment section give me an opportunity to explore the issues we will all have to work with if things are to get better.
I learned long ago, in biology 101, that a “radical” is the central core root without which the plant is unlikely to thrive or survive. The meaning of the word “radical” has changed so far that it now means its opposite: an extreme view that can be pruned away to relieve distress of the core group.
Those I talk to about my “radical” views (neighbors, friends, doctors, nurses, social workers, administrators, patients, the insured and the uninsured), agree that things have gone very wrong with medical care. The current “medical system” is not meeting needs on many levels. I guess this means that I and my radical views are closer to the core of things and more in line with the old biology 101 definition.
Yup. Our medical system is pretty broken, indeed.
I have always taken seriously the doctor’s’s mandate toward education of patients, co-workers, the public and the medical community. I was taught in medical school that one aspect of the word “doctor” is “teacher”. I took this lesson to heart that day and still do. As a doctor today, I am left with this role: doctor as teacher.
I’m glad to meet you in the “movement”. My hope is that the energy invested in “barricades” can be instead used find ways to better meet the needs of everyone.
Stephen,
Thanks for taking the time, enegy and thought that have obviously gone into your post here. Wow. It’s a blog in itself.
So I’ll follow it with what should probably be yet another blog.
The fifteen minute (or less!) appointments are a contruct of the insurance/medical corporations and have nothing to do with providing care. Personally, there is nothing I can get done in fifteen minutes outside of hello, goodbye, typing a progress note and data entering prescriptions. This is not care. It’s a payment pump.
Even patients have come to believe in the fifteen minute appointment as a stadard of care. For the last two years of my private practice (2002-2004), I kept my rates down so low that I could only pay the overhead of a low overhead private practice. I had 30 and 50 minute appointments for the price of the usual “med checks” at the medical school clinic. I was still trying to practice medicine in a way that made sense to me.
9 of 10 calls that came to me were from people only wanted a fraction of an hour every six months or a year so they could obtain prescriptions with endless refills. They looked for the cheapest, easiest access to the brand and type of drugs they wanted. Period.
Physicians did not invent the “managed care” companies. Physicians do not run medical corporations. Physicians do not make policies for these corporations. At times, to add an air of legitimacy or as a liability foil, physicians are hired as figurehead “medical directors” or “advisory panels”. These docs still have to pump “billable units of care” as fast as they can to keep their jobs. Lower paid providers (nurses or social workers) are put in the position of directly “managing” care (limiting access and expenditures). But they must follow the corporate rules. It gives an air of validity to be turned down by a licensed professional even if they are following a corporate script.
Doctors are employees of corporations these days. Nothing more. They’re not allowed unions. The days of a “private practice” of medicine in this country has been dead and gone for over a decade.
“Medical system” means “for-profit medical services corporation”. Don’t be fooled by a “non-profit” label. This is a tax designation. They are not working for free. They still pay their top management very well. These medical services corporations have every bit of the medical field tied up tight. They will not simply roll over and play dead. There’s way too much money involved.
The largest third-party (insurance) payor in our country is the US government. Money is paid from tax coffers through medicare and medicaid entitlements. This is a big pool of dollars. This is the reason for the big push in the past twenty years to get everyone possible on disability. Each disabled person is another cash cow.
Medicare prescription coverage was a great win for the pharmaceutical companies. This additional “benefit” for the disabled and retired make each one into another lucrative place to stick a straw.
If I (or any other physician) decides not to play ball by corporate rules, we are out of a job, out of the game. Period. For me, there was no union, no benefits, no unemployment, no retirement. I’ve spent my life training and paying off loans for training and working as a doctor.
What was my backup plan to earn a living? I don’t have a back up plan. Neither does your doctor.
I think you are right when you say we are all to blame for this mess. We all must work together. It is, indeed, very complicated.
Richard,
Thanks for your support of my writing and processes. As a writer, I enjoy being read.
Although I do feel professionally alienated by the current system of profit driven, mass-marketed and drug-based “health care”, I’m not the “overthrowing” and “dismantling” kind. That takes an outwardly aggressive edge I was not born with.
And I honestly cannot say that I’m “anti-” psychiatry or even “anti-” biologic psychiatry on the whole.
I am a physician. I am a psychiatrist. I have prescribed drugs to people and found that there were times that the drugs were useful to specific people.
Before going much further, please notice the quotation marks around the word fragment “anti”. This is the pivot point of my thoughts on the matter.
In my experience, any time I’ve focused on what I “didn’t” want, that very thing came into my life. When I spend a lot of time thinking about anything, it becomes more apparent in my life. When I proudly proclaimed that I’d “never” do something, I invariably came to the point of doing just that. I learned not to say “never”. Focusing on “fat loss”, for example, has ones eyes glued to “fat” and “loss” rather than health and vigor. “Mad” in America, draws anger like a lightening rod. “Pain” management draws the focus to what hurts.
How I use words directs how I think and feel and how I live.
I certainly encourage every physician I talk to to re-evaluate their notions about medicines, their relationships with their patients and their relationships with their employers, the medical corporations.
I’m very much in support of finding and developing more humane ways to take care of one another.
Good job on writing the historical review of the system of classifications.
I’m reminded of what my mentor of long ago, Dr. George Saslow always said when I came to him for supervision:
“Don’t tell me a diagnosis. Tell me about the patient.”
It was clear to me that he believed sticking psychiatric labels over people kept you from understanding what was going on and how to help.
I would like to hear what you think about the financial conflicts of interest that have gone into the making of the DSM. Is there any treatment purpose in sticking labels on a person?
MJK,
What a lovely response you’ve written today. Very thoughtful.
I have additional thoughts about liberty. Buying anything on credit makes a person less free. Any time you’re obligated to make payments, it influences your decision-making. No one is immune to this.
Every doctor I know leaves school with a lot of debt. There is no other way for a person of less than independent means to become a physician. Medical schools accept a lot of fundng from pharmaceautical companies. This doesn’t prevent the schools from demanding enormous sums from the trainees as well. Banks are out there, ready to loan money to earnest young people who want to help. These loans can no longer be discharged through bancruptcy.
Back to my recent re-read of “Grapes of Wrath”. People lost their family farms after accepting bank loans against them that they couldn’t pay. Steinbeck mentions that the people who worked for the banks didn’t want to do what they did (ie take away the homes and farms) but that they had no choice in the matter. Disobeying would mean job loss to those workers and loss of livelihood.
Everything’s connected.
Thanks for reading, writing and thinking.
Alice
John,
You sum it up so much more clearly than I can. From what I’ve been able to gather with regard to the 2008 banking crisis, much of the banking crisis came from unregulated financial institutions, the “shadow banking” industry. This “shadow banking” industry vanished very quickly, as did the money invested in it.
We all still ride out the waves of economic consequence from this.
My inspiration for this piece came from a recent re-read of John Steinbeck’s “Grapes of Wrath”. Not much has changed in the tactics of Corporations since the 193o’s when the small farms of our country were turned into massive agri-business.
Stephen,
Thanks for reading and sharing your thoughts here. I appreciate you’re validation of my observations of the history and changes in health care.
I’m skeptical of the Affordable Health Care Act and will wait and see how it pans out. So far it’s boosted the premiums of my $4000 deductable insurance to “add” a few scraps of “well women’s health coverage” we already had. I count myself lucky to have insurance at all and do everything in my power to neither use it nor lose it.
I have talked to people who are trapped in unhappy work, unhappy realtionships, unhappy locations because they are held hostage by health insurance. They can’t leave without losing access thay may never be able to re-gain. I know people who are impoverished by insurance premiums. These are the lucky “haves”.
Then there’s everyone else, the uninsured without access to medical care.
“Affordable Health Care” can only work when the for-profit insurance corporations are removed from the picture and all care is delivered through one equal single payer system with everyone in one risk bucket. Insurance works by averaging risks among high and low risk people. If you “cherry pick” the healthy young ones and put them in a separate low-risk category and keep out anyone with a “pre-exsisting” condition you apear to lower costs (and you REALLY increase profits), But you kill the whole principal of shared risk in the process. This is one reason why early “managed care” plans seemed to work so well. They sold these plans to companies with young healthy worker populations.
Thanks for your input.
Please, everyone, keep reading, thinking and writing.
John,
Thank you so much for reading and connecting the dots.
I have watched management corporations chew through health care systems in Oregon for two decades now. The timing is different in different locations. The poorest people have least voice so they go first. It’s taken a while for the chomping jaws to make it around to the better-off layers of communities.
Where I am right now has had a lot of budget and program cuts but, I am told, hasn’t been stripped down to the bare bones of medication as the treatment for everything yet. These look like temporary budget cuts in a bad economy. There’s a lot of denial.
I doubt that “Preventative” medical care will be excericise programs, talk therapy or life changes. It will be pills.
Hey Ruby,
I’m glad to see you’re still around the MIA to greet me on my first return blog. You have a good way with words and raise some good points.
I agee. Multigeneraltional poverty is a problem. I don’t like to see poverty or unemployment being used as an excuse for poor health care. Good health care should be available equally to all without regard to their employment or finanacial status.
Yes. We each have to be the change we wish to see in the world.
Emily,
Thanks for reading and replying. Sorry if I’ve missed the mark for you. You ask some great questions.
“Multigenerational poverty” and lack of money was/is used as an excuse to market “meds only” treatment in every part of medicine. I was taught that when medical care failed, it was not because medical care was lacking in any fundamental way, but because the patients were lacking somehow: being “non-compliant” and taking bad care of themselves.
In essence, I was taught to blame the victim when they only came in for care when things had reached emergency critical proportions.
The latest marketing of all drugs, including psychiatric drugs, is that we physicians need to “treat” people that do not yet have an illness with pills to “prevent” the possible onset of illness i.e. cholesterol lowering drugs to “prevent” coronary artery disease because the patient cannot be counted on to make pro-active life changes toward health. Cholesterol lowering medicine have never been shown to prevent anything in an otherwise healthy person.
Thanks for your kind words about my efforts here. I want to get people reading, thinking and writing so we can find new ways to do things.There have to be better ways.
I hope I have not come across as trivializing damage done to anyone by any means.
The “head in the bucket” is something avery human has. It ois part of the human condition. I did nto mean to imply that only psychiatrists wear these.
I know what you mean about leaving a system. I skipped out of the AMA in the late 1980’s, dumped the APA about ten years ago, closed the office in 2003 and haven’t worked as a psychiatrist since last August. But the system chugs on just fine without me.
Kermit is an editor here. He occasionally edit posts. My understanding is that they watch for things that may be considered personal attacks that would make people not feel safe to post here. I’m certain you can email him at this site directly. All my dealings with Kermit have been good.
I also have the capacity to remove or edit any posts on my own essays but have only removed two by specific requests of the people that put them up. I’m not real celar how this works for sure.
Funding this place? I have no idea if there is any. I write for free here for the fun of it. Robert Whitaker invited me after he read something I wrote. I hope to have an impact on making things better through the use of my writing. I’ve written eleven (I think) essays here about my own personal experiences, thoughts and opinions with regard to the field of psychiatry.
My understanding of the agenda is to promote conversations that will lead to re-thinking psychiatry and making the future of care for people that have been labeled as mentally ill better. I’m certain you could email Robert Whitaker care of this site and have his own ideas. It’s his webzine. Other agendas may also be here. For example, he is a writer and speaker on these topics. Some of the bloggers may have their own books or businesses related to this field.
I hope this covers your questions. I’m pretty new around the word of on-line conversation and this webzine. A couple months, I think.
fun (fn)
n.
1. A source of enjoyment, amusement, or pleasure.
2. Enjoyment; amusement: have fun at the beach.
3. Playful, often noisy, activity.
I meant fun in the “enjoyment” sense. Not like a day at the beach.
The guys on that first VA ward taught me how to shoot pool after lunch. They smiled and laughed and talked about thier lives. I enjoy listening to people and learning about them. This is fun to me. Maybe it wouldn’t be to everyone.
Those guys seemed to have fun (ie enjoyment) as well. The job I referred to specifically was my very first time working in psychiatry as a required part of my neurology training.
Remember, psychiatry was not so much about drugs in those days. We had “mileau therapy”, “occupational therapy”, group therapy, family therapy, individual therapy. We had “therapeutic relationships”.
Today’s psychiatric units and hospitals do not sound like “fun” to me. I do not work in those. I’ve spent decades doing everything I can to keep people from going to psychiatric hospitals.
I appreciate your contributions here. Every time you reply I get to think more. I enjoy this. It’s fun.
I would never suggest that money should be an acceptable motive to drug a child. However, a psychiatric diagnosis is sometimes required to access special educational services, health insurance and income. A psychiatric diagnosis often comes with a prescription.
Disability payments do not come from simply being unable to perform life functions, they require diagnoses. These days a diagnosis frequently requires a prescription. If the prescription goes away the disability may go away.
Sometimes stopping medicines means a person will lose their income. This doesn’t make sense. And loss of disability also comes with loss of medical coverage.
How is it that we’ve tied prescriptions to diagnosis to disability to health insurance and income?
I was taught (long ago in the history of my own medical training) that one can never reason backwards from medication effect to diagnosis. For example, if one focuses better on psychostimulants this does not mean you have ADD.
Somehow, we’ve gotten into the habit of saying that taking an antidepressant means he’s depressed and taking an antipsychotic means she’s psychotic.
This ‘stinking thinking’ happens in internal medicine as well. For example, if a histamine blocker makes your stomach pain better then you must have had overactive histamine in your stomach. If a medicine for reflux makes your stomach pain better then you must have reflux.
I have treated stage fright with blood pressure medicine (in addition to cognitive and behavioral interventions) This doesn’t mean the person has high blood pressure.
Dr D L,
Were there really tennis courts for prison guards? You hav a real interest in history, then. I had no idea.
Actually, my motivation for stopping my practice of psychiatry did have a lot to do with a lack of fun. Fun has been gradually drained from the whole medical world over the decades since I went to school. The practice of psychiatry has come to focus more and more on medicating people and less and less in helping people grow lives that work better for them. Being a psychiatrist has turned into writing prescriptions as an interchangeable cog on a too-fast conveyor belt. This doesn’t help people. It’s also not fun at all.
I think a lot. Writing helps me think. Writing conversations with people helps me think even more. I am very grateful for the opportunity to converse with all kinds of people from all over the world here on MIA. What a miracle. I enjoy everyone I meet here for as many different reasons as there are different people.
I’m downsizing here as well for several years. Downsizing is a philosphical stance as well.
I’m still a doctor and a psychiatrist, though. A person doesn’t stop being these even if no longer praticing medicine or psychiatry. I had a friend that was a psychiatrist till he died at 99 even though he hadn’t worked in a long time. He was a reader, thinker, philosopher. Many things.
I hope that more people can see that being a psychiatrist is not just one thing.
Dr D L,
Nope. I didn’t answer your question directly. You asked one of those questions that it doesn’t pay to attempt to answer directly. It’s very much like the classic “Are you still beating your wife?” question that implies guilt and is aimed to “trick” a person into admissions of guilt.
You are not the first here in MIA comment land to take on this approach with me. Probably not the last.
The best I can do is tell you what I lived and experienced there. If you or someone you loved was there at the time, I’d be happy to compare notes.
I like this: I have an “infamous need to have fun.” I suppose if one has to be infamous for something…
I agree that being stuck in the ““Pain – Anger – Rage – Revenge,” stage” keeps us from moving forward into the future. The anger/retribution stance interferes with thoughts and both emotional and physical well-being. It blocks cooperation. (Even worse, it blocks fun).
My ever-so-small suspicious streak would have me thinking that the great American “us vs them” attitude is indeed the result of divide and conquer propaganda. It works so well in so many ways to keep grassroots campaigns from going anywhere. We have the perfect channels in place to promote these attitudes.
Thanks for reading, thinking and writing.
Best,
Alice
DR DL,
You sound serious about amnesty hearings. I got that.
Are they really making foodstamps only for “healthy food” and taking away bus passes to make people walk and be healthy? That’s what I was referring to when I said careful or they’ll pick it up as a cost savings measure. Perhaps these have already been done?
Stephen,
I like the give and take. I think more when I have intelligent, thinking people to communicate with. This all helps me get clearer about things.
Have there been zings? Nothing but sweetness and light on MIA. ;-))
Seriously. People here know me by the words I write. I try to be clear. Some make assumptions about who I am and how I’ve lead my life based on me being a doctor and psychiatrist. Sometimes they’re right. Sometimes they’re wrong.I try to sort it out as it comes but I can’t always do this.
Dr D,
I am certain that others will disagree with my answer on the grounds that I was a psychiatry resident and worked there. I also worked there as a neurology resident and as a medicine resident in addition to a psychiatry resident. The years were around 1981-84.
Charity was a difficult setting for all patients. Dusty wind blew in the halls. People were assualted in the stairwells. Patients were cared for in open wards with curtains betweeen the beds. All the patients we cared for had no alternatives for care. People remained in lines to be seen in the “emergency department” for days at times. I worked long hours and through the night to provide the best care I could given the resources available at the time. Everyone I knew there did the same. There were months at a time that we lacked basic equipment to work with (ex. 10cc syringes). Nursing coverage was so short I had to stay up at night to change IV bags so the lines wouldn’t clot off and to pass vital medicines to the critically ill.
It was a rough time. It was the only care available to those with none. Because of this, people were very,very ill by the time they came in.
Is there a reason for your interest in the history of Charity Hospital? Have your had personal experiences there as well?
mjk,
Wow. Thanks. You got it. This is what I meant. Your personal comments say it so much better than I could.
Thanks for the vivid and vital re-stating from your experiences.
Turning off the TV won’t make the wars end but it will reduce the impact of the terrorist media on our own emotional selves. Terrorizing ourselves by watching will not make the wars end, either.
Yes. These symptoms we label as “mental illness” could be caused by the real life experiences. Of course. But our minds really can’t sort the deaths and explosions we get from vivid second hand sources like TV out from things that happened to people close to us. I have had Viet Nam “PTSD” nightmares from running therapy groups with combat veterans. I have had nightmares from media exposure.
I can understand about having to wear other people’s clothes. I grew up in a materially poor “hand-me-down” family. I reacted for a time in adulthood by wanting a lot of stuff. Thankfully, I am back to living with few things and haunting thrift shops to clothe me and my family. Yes. I do know the difference between making a voluntary choice to live with less and having no choice.
Stephen,
You’re right. This one didn’t “grab me” as much either. This is not the first one to make a softer landing here. Perhaps the muses have days off, too.
I will work to give people more to argue about (smiles).
anonymous,
You are absolutely right. It is what came out of the hands that morning.
I think there are “on-topic” things woven in. This more accurately reflects how I feel psychiatry is embedded in the bigger picture of living life in our country.
Paula,
You’re right. It’s bound to be more complicated than this. Everything is.
From my own personal experiences as a psychiatrist (and this may be too limited a view) I don’t recall wanting more mental health workers. I do remember hoping that the phone would ring and there would be a person I could work and help using psychotherapy who didn’t want pills. I hoped it would be a person that could afford to pay something to offset the rent and liability insurance. This was a money motive for me. I couldn’t be in business without income. Any doctor’s office is a business. I obviously wasn’t so good at “creating patients” as I ended up working without paying myself the last two years. (smiles) I did enjoy (happy) working with patients a lot or I would have closed my office years sooner.
I used the (“science”?) of human relationships and cognitive/behavioral therapy to help people get on a path of a happier life that worked better for them.
Perhaps you’re looking at things from a more global perspective here?
Thanks for reading, thinking and writing.
Best.
Alice
David,
I’m glad to hear that South East Asia has retained community and extended family relationships. The loss of both of these in our post-industrialization cultural has been devastating for us mammals that live here. We all need a web of others in order to be healthy. This concept, that we humans need close relationships, may be part of the underpinnings of why the Soteria model works.
I was taught that the “full blown euphoric psychosis” you describe is self-limiting and was the experience that made the “diagnosis of Bipolar disorder” for a person. I was taught (before the advent of the many marketed products) that with time (weeks), this would pass and go completely away. I was taught that many would only have one “episode” and that those with recurring “episodes” would “return to their baseline of functioning between episodes”. I was taught that the “diagnosis of bipolar disorder” was “a hopeful diagnosis”, that people with these experiences were, between episodes, the same as anyone else ie would have jobs and families and “lead normal lives”. Who are the ones now labeled as having “bipolar disorder” and why are they in need of lifelong polypharmacy?
I think we do have to look at real life experieinces for our evidence now. With marketed products driving diagnostic labeling, “research” and education, there is an unmistakable bias in the literature.
Another of your great questions:
“How we use the intellect to dissociate from our own visceral nature? We might think with our brain, yet do we still react with gut instinct?”
I don’t believe it possible to dissect out the visceral from the thinking part. The theoritical chemistry of all of this is the same. “Stimultions” like anger, fear, excitement seem ot run on similar chemicals. All of these change the wy we think about things and our opinions.
Keep reading, thinking and writing.
Your thoughts help me think more.
Alice
mjk,
I skip the sunscreeen and go out in the morning and evening.
I keep the internet down to a dull roar…email mostly. This is the first time I’ve done the interactive online thing. I use wikipedia when I don’t know what something is. I don’t have much luck with accuracy when I look for a business on line. I still get calls from the internet on a practice I closed in 2003.
Certainly. I am on a quest.
I’ll let you know when I figure out what it’s for. 😉
David,
Thanks for reading my essay, giving it thought and writing your comments here. I like your additional questions. All of us have to formulate our own questions.
To me, the questions that arise in the field of psychiatry and psychopharmacology are mixed in with questions about everything else. I suspect the “epidemic of mental illness” in our country is not so much an actual epidemic as a wider and wider casting of the net for new drug customers. It’s more a case of diagnosis expansion. For example, I do not believe that autism prevelence is increasing as it seems to be. Only the diagnosis is. It’s one of the steps to getting special services in school systems. Getting an evaluation and diagnosis from a psychiatrist then leads to increased drug prescribing. When all you have is a hammer, everything begins to look like nails.
“80 million deadly bombs left over form the Vietnam era” “farm children get limbs blown off”
It’s like we are still at war with today’s children there all these years later. I suppose if we, as a country, are not taking responsibility for this that we will take responsibility for other things. BTW, there is some lovely radar mapping technology for finding buried landmines that could be used for cleanup of old minefields.
“Can you invest your previous experience as a psychiatrist in this much needed paradigm shift in human awareness?”
Here I am. I’m a writer. I write. I can do words.
“Has psychosis always been an aspect of human experience for a reason?”
Can you ask yourself “if madness is not what psychiatry says it is, then what is it?” _M. Cornwall
I believe that psychosis is culturally defined. The definition of a “delusion” (a sub-type of psychosis) is “a fixed false belief in spite of evidence to the contrary”. I can find these in almost anyone, not simply those defined as psychotic. If you belong to a culture that values direct messages from God, these would be fine. If not, then they may be labeled “psychosis”.
Poorer countries cannot afford the drug products that drive the “epidemic”. So maybe it’s not the trauma behind the “metal illness” boom?
mjk,
Some of these questions I already have a good feel for myself. This was one of those mornings when every question seemed to raise five more. I decided to write the questions down.
I’m not so sure I understand all the questions. Some seemed to be for me. Some seemed to not be for me.
I haven’t seen either movie. But I’m out of the broadcast media zone as much as I can be. The media seems to be unrelenting in the agendas it promotes. Money is the motive force. I’ve had to “vote” with the “off” button for myself and my family. Ten years now away from broadcast media. I’m a bit out of the cultural loop but folks generally tell me when an earthquake happens or a tropical storm hits.
Broadcast media (if you turn it on) gives people you don’t know direct access to the inside of your head. It is a common misperception that we can sort and filter this and not be effected. If it were true, that the mute button protects you or that you can be too clever to be effected, there would be no money in advertising. Nothing would get through. But it does get through. A lot.
If there’s too much money in drug advertising to ever get it banned (likely), then that leaves us no other choice than to turn off the media at the user end, one at a time. This would be true grassroots rebellion.
Once I “detoxed” from TV, radio, newspapers and magazines I found I was more relaxed and less materialistic. These are both good.
Thanks for reading, thinking and writing.
Best,
Alice
I’m pretty good at being happy. I’m also pretty good at loving people. I even love folks that have less than glowing feelings about me. These have always been two of my specialities. I suppose one could do both of these (be happy and love people) just about anywhere and in any situation.
I also don’t believe that being “loved back” figured into my motives back then. I was there because I believed I could help people. That’s why I went into medicine. That’s why I became a psychiatrist. That’s why I worked in the field of psychiatry for years.
I love it when folks are “stunned” by my profile. There has been a bit of that going round. There may be other surprises in store for you. All psychiatrist are not cut from the same cookie cutter. There is a range of individuality in psychiatry that you could find in any field.
All of us have to seek meaning in our lives. It’s a good lifelong practice. Spiritual guidance has always been a big part of that search for me. I hope spiritual guidance part for you as well on your own personal search for meaning.
Thanks for taking the time to go back and read my other posts. It’s an ongoing story.
Thanks for reading, thinking and writing.
Best,
Alice
Alix,
This was one of those questioning days for me.
You’re right: “each of us has to find answers for ourselves and life is all about balance”.
Everyone has to find which of the questions are the most compelling to pursue. I like asking the same questions over time and seeing how the answers change.
Thanks for reading, thinking and writing.
Best,
Alice
Dr D Lightfull,
Thanks for adding your own questions to the list. I could have gone on. It ws one of those mornings when every question I could think of to write about presented more questions. I try to keep things to a thousand words.
I wasn’t sure…are your questions for me personally?
marcellas,
Great idea. These discussions are great. I know people that read them closely that don’t post. There are many silent readers. There are many more “hits” than “comments”.
I’m happy to take my writing to a broader readership should this become available. In the meantime I spread the word and send links to people I know each time I post.
I don’t know if we can take the commentary elsewhere. People may not want what they’ve written put somewhere else. How could you get permission from them all? This is an administrative question to look at should a bigger venue become available.
“I was particularly disturbed by the recent comment that “the biggest problem facing psychiatry today is untreated illness”. I believe it was the current APA president who stated this.”
This statement bothers me as well. I see way bigger problems than this.
Marianne,
Wow. I hadn’t thought of multiple bracelets in different colors. One each “diagnosis” or each hospital stay or drug you’ve taken? How could severity be depicted? Maybe brighter colors?
Yes. Writing can come out of nowhere. Sometimes it works that way for me as well.
“Drugs…are a convenient way for many people to ignore that there’s a big problem. Sort of like taking the battery out of the fire alarm and being happy; and then when the house burns down…”
I like this part you wrote. I ran a mostly psychotherapy private practive. I discovered that when I gave people the pills they wanted, they often quit working on change. Later the “meds quit working”. Pills can block uncomfortable but natural feelings about a life that’s not working. No bad feelings, no motivation to change life. They keep doing what doesn’t work for them.
I hadn’t heard of this aboriginal vanishing. Interesting.
You have enough ideas to explore for a book. I especially like the following:
“we have a spirit that’s beyond time and space”
“letting go of fear”
“If you decide to use it for love, you are part of forever and everything there is real.”
“having an enemy to fight against as a group doesn’t create a community or a society”
Yes. Our culture has a lot of “fixed false beliefs in spite of evidence to the contrary”. You’ve pointed out several. This part in quotes is what I learned in psychiatry training as the definition of “delusion” which is a subcategory of “psychosis”.
I resist the urge here to launch into my own list of cultural “delusions”.
You are right to wonder who is crazy and who is sane. Who gets to decide?
A Howells,
I have seen children be very concerned about the feelings of others and also completely self-absorbed. I’ve seen the same range from other-concern to self-absorption in every age group.
You’re right. None of this warrents abusing them.
Best,
Alice
A Howells,
First, thanks for taking the time to read my post, think about it and respond. Most people that read here don’t take the time as you have to put their thoughts into writing.
There are a couple of things in your post I’d like to touch base about. The first is the following phrase:
“Psychiatry’s current agenda is, inter alia, crypto-eugenicist”
Sorry. Your use of metaphor ran straight past my head on this one. I have no idea what you mean by “inter alia, crypto-eugenicist”. I generally have to translate the big words into plain talk. Is this a phrase you’ve created or one from somewhere else?
Next, I’m getting the idea that you’ve had some experiences with “mental health treatment providers” and pills.You write as if from personal experiences.
I’ve clipped out these three statements and put them together below. To me, they seem to be linked by feeling tone. I apologize for taking them out of context like this. I didn’t want the feelings you are expressing here to be lost among the words.
It sounds like speaking up, letting people know what you want and expressing your feelings hasn’t been well recieved.
“all this criticism only serves to augment whatever disregard they have for our feelings.”
“the all too human desire to mercilessly crush your enemies, and we are their enemies.”
“discrepant interests and mutual contempt”
I’m sorry this has happened. Thanks for bringing your concerns here.
A Howells,
I personally resonate with the use of metaphor. At times metaphor is the only way to get a message across for me. Poetry uses metaphor to take communication from the concrete and literal into the depths of the soul. Metaphor can bring understanding not otherwise reached with ordinary words.
There are times, however, that the use of metphor deteriorates to infammatory name-calling and personal attacks. At this point it no longer is a tool for comunication and becomes a weapon.
I know, I know. My mom told me that “sticks and stones can break my bones but words can never hurt me.” Except words are way more powerful than we are taught. Words can and do hurt.
The use of inflammatory name-calling and metaphor as a weapon backfires onto the one who raises this in a conversation. The use of inflammatory language that slides over that line into the war zone brings the level of the entire dialog down a notch. This loses readers and participants.
The vast majority of readers never sign in on the comment page. Every word I write here, I am aware of this silent audience. There are a lot of folks to get these messages out to. I am reluctant to turn any of them away.
Thanks so much for bringing this topic up today. It’s good for all of us to remind one another of the consequences of our use of words here.
Marianne,
I have to admit that I’ve chased a lot of disability paperwork and free medicine paperwork and samples for patients.
Disability payments can mean the difference between a roof and homelessness but it comes with a diagnosis and medical insurance that buys drugs. This is all so mcuh more complicated than I ever thought. When I thought I was helping by assisting someone with disability paperwork I was putting them right into the paying customer category for drug companies.
mjk,
I like using this webzine as a focal point. This is a place where people read, think and write together. I have learned so many things in such a short time right here.
Thanks,
Alice
EAC,
They would not be a group of 45 year olds. There may not be “equal numbers” in opposite age ranges. Countries with high infant mortality rates score low life expectancies because the infant deaths are averaged in.
The average life expectancy of Americans is 78-80. Women tend to live longer then men. Some live to be 105. Some die in infancy.
Jeane,
I think “genocide” is a great word when it’s used for an ethnic or national group that’s been singled out for extermination. I certainly know there has been a history of murder of the mentall ill. Genocide happens around the world with wars today.
The use of psychiatric drugs is so widespread now that they no longer encompass a defined group of people with a “mental illness”. Everyone everywhere in this country and many other countries (any country with finanacial resources) is now in the target market population.
With the new DSMV push to “pre-diagnosis” this is a clear step toward marketing to people who someone thinks might someday become mentally ill. Even now the target market population is so big and vague as to be non-specific.
The edges of a “genocide” boundary for meantl illness are gone. Everyone is at risk in any country with money to purchase the products. People die. But I have a hard time labeling what’s happening right now as “genocide” or “nazi”
What would be the word for selling products with disregard to health and safety to anyone with money to buy them? There must be a more accurate word than “genocide” or “nazi”.
My concern is that when we use these less accurate and inflammatory words, we will drive away the people who need most to hear the messages.
There are a lot of people who may not know they are at risk. The message must get out to them. This is important.
Anniken,
I’m sorry for your loss. This is waht I mean by a “face” on the statistics. People are interested in people more than numbers. This is why the faces sell drugs better than numbers and text.
Stephen,
You’re right. I suppose if he knew up front about the intensity that occurs here sometimes that he would be prepared for it. He sounds like he has a lot of useful experience and ideas. I like a person with ideas and experience over what can pass for education.
It sounds like you do good work from the heart. I hope they know that where you work.
You’re right. It’s the person that’s important, not some arbitrary category they’ve been placed in.
Duh?,
Your creative thoughts are refreshing. This sounds like the basis for a screenplay.
Maybe we could use bright colored plastic bracelets for this. More durable, The color could show the diagnosis or drug from a block away and wouldn’t be mistaken for anythign else. Brave new world material.
markps2,
I think that Robert Whitacker’s information is more current than this study. Could this report be based on a study done in the last nineties? The difference between life expectancies of the “mentally ill” Americans and the American population has been getting bigger over time. It was 10-15 years in the early nineties.
This difference is big. It’s even more frightening that the gap is increasing even with of our ever increasing diagnostic nets.
Lowry,
Thanks for putting eugenics on a timeline perspective into history with regard to psychiatry. I’m pretty sure that money is the big driving force behnd the rapidly expanding market for pills today.
Alice
Stephen,
Stubbornness can be a grand thing indeed. You are here. I have seen it be the deciding factor in recovery.
I just listened to his talk while making dinner. He’s great. I wonder if he, in his retirement could be convinced to do an occasional piece? Do you think people here would be open to something like that?
re diagnoses: I have always found it more useful to learn about the person, not the diagnois. The diagnosis is not a useful treatment decision tool or predicter of outcome to me. It was meant to be a way to have diagnostic uniformity for research. It’s been used (sadly) for SO MUCH MORE.
Barbara,
I took this straight out of Robert Whitaker’s talk in the video side bar. I was so impressed with the number that I didn’t stop to look it up for myself.
Sorry.
Alice
Barbara,
The same folks own everything and have for a long time.
Pervasive.
I watched some old videos with my kids last week. Even without commercials I could see them promoting soda brands a chips. The characters always had the drink can labels pointed at the camera and their backs to the vending machine.
Ads are embedded in the programming. The mute button doesn’t stop it. It’s like the old movies stars all smoking.
Stephen,
I will always be grateful to the people that came to Charity Hospital for their care. They taught me to be a doctor more than any teacher could. Many of these individuals are printed on my mind. After medical school at Tulane/Charity. I stayed for two years of residency.
State funding of Charity hospital and the Charity clinics kept things a bit “cleaner” from a drug money point of view. We could do research on things like the causes of Schizophrenia (I helped with a blood viscosity protocol) and undiagnosed medical conditions among psychiatric inpatients. Since the state put money into patient care and medical training, there was room for non-drug research there.
Barbara,
I bet the number of drugs (in all categories) is much higher now in geriatric nursing home patients. These are very sensitive people biologicaly (as are young children). These are some of our most vulnerable family members and neighbors.
Polypharmacy has always frightened me. I have no idea how one can tell what is going on inside a person with so many drugs on board.
Stephen,
I hope that by pointing out the enormous percentage of those effected, that people will come to understand that this is not about those mental patients down the street but is about themselves and their family. I got a message recently from woman concerned about the school mandated drugging of a friend’s grandhild. Word’s getting around and people are concerned about folks that they never thought about before.
There are times I have more hope that the word is getting out.
Ruby,
The number one cause of death in adult “psychiatric patients” is the same as the general population only much earlier; cardiovascular disease. This fits with the information you gave the links to.
I’m puzzeled at the impulse of the prescribers I talk to about these issues to attribute the increasingly early deaths to “lifestyle choices” such as smoking, overeating and inactivity rather than the drugs. Certainly in adult patients the drugs cause over eating and inactivity.
Smoking? I was taught (by an academic researcher funded by a drug company) that the mental illness itself caused people to smoke more, something in the dopamine system. But the drugs muck about in the dopamine system. Could they cause increased smoking and make it harder stop?
There is a new epidemic of cardiovasculr disease and metabolic syndrome in children, including what used to be called “adult onset diabetes”. With over 21% of kids under the age of 17 taking psychiatric drugs, has anyone looked at concordance between the psychiatric drugs and the increasing rates of CV disease and metabolic syndrome in kids? Perhaps its not all “lifestyle choices” like fast food and inactivity. Perhaps the drugs cause over eating (as they are known to do) and low energy (as they are known to do). Could doctors be looking at side-effects of the drugs (obesity and inactivity) and mistaking these for the causes of the metabolic issues?
I think 80% alternate prescribers sounds right, but I haven’t seen numbers. Since the drug companies can and sometimes do track every prescription I personally write for their products (for sample distribution), I know the data is out there. I’m sure insurance companies know. We lack tha unified data base of a national health system.
I think that most people that get psychiatric drugs don’t see a psychiatrist at all.
Some may see a psychiatrist once but then get “refered” to a GP (primary care) by the insurance plan. A lot of insurance doesn’t pay for “specialists” without a referal from the primary care “gatekeeper”. Some of the reimbursement plans take money away from the primary care every time they refer out. It keeps the gate locked.
Back to my contention that the drugs are about money and corporate profits (rather than intentional and planned harm directed at specific groups). Probably I repeat myself too much on this.
Twice, when you ran out of insurance, you had to go off “cold turkey”.
No cash, no pills.
I’m glad you were able to stop the medicine without symptoms. Easy for some. Not so easy for others. I’ve seen both and a lot in between.
I will watch the video. What sorts of questions would you like to hear his viewpoint on?
Alternative radio perhaps? KBOO in Porland Oregon just interviewed Robert Whitaker last week. There is a national alternative radio (not to be confused with “public radio”). They have a genuinely liberal alternative viewpoint (at least in Portland). does your town have one?
We all have to get past the “fighting with one another” thing. It eats too much band width.
Thanks for your participation in these discussions.
Alice
markps2,
Also, I suspect that government bean counters have been convinced that the pills are cheaper than providing healthcare.
They may have also been convinced that the poor physical health is secondary to causes other than medicines.
When the states finally got it that tobacco and alcohol was costing them a lot of medical expenses, they shut down advertising and added taxes to cover their increased medical expenses. In Oregon, gambling profits are required to pay for gambling treatments.
Marianne,
The “help” programs are very short term and meant to start a patient on a drug while that patient gets signed up for state and federal funding to continue them. They are also useful PR campaigns that promote the idea that the for-profit corporation “cares” and “helps”. “Free samples” are only given for the newest and most expensive drugs. There are no “free samples” of generics.
In my experiences working with the “free help” medication program, they are VERY “prescriber” time intensive, paperwork intensive and short lived. The “hoops” vary with the drug. These things make them hard to access. Drug conmpanies do not intend to give away quantities of drugs to those that can never be “funded”. They are bridges between “free samples” and government funding sources to buy them for the patients.
Even the “free samples” come with “prescriber education” obligations. No talking, no pills. Now, the number of samples are directly linked to the numbers of PAID prescriptions for that product coming from my specific pen. If I don’t write paying prescriptions, my unfunded patients cannot have access to “free samples”.
Both of these “free help for the poor” programs (samples and patient assistance programs) are in place specifically to increase PAID ongoing prescriptions, get the company direct access to “educate” staff and physicians and to provide friendly PR for the company.
You probably already knew all this but maybe some folks missed the details.
Medicines are available for the funded. There are lots of poor people in Oregon that are not funded and will not be unless someone will declare them to be “disabled”. Follow the money trails.
Stephen,
I grew up in Ohio on a farm (potatoes and vegetables), lived in Georgia for 7 years where I worked construction then went to college (sunshine and grits) and spent 6 years in New Orleans in medical training(beans and rice and Mardi Gras) before moving to Oregon 26 years go (the land under the Great Gray Cloud). I’m in Santa Cruz right now writing (sunshine, sand and surfers).
Bingelybingelybing. You’ve got it. “it’s one, huge, convoluted mess”
The rest of my message is this: You may be able to find helpful people from any of the groups involved. You, for example, work at a state hospital. If we threw away every state hospital worker as if you were the cause of the problem, we’d lose you. Then there’s me, and maybe other psychiatrists, that we would lose to the effort if we vilify all psychaitrists. Who knows, there could even be (dare I say this?) a former drug rep that could play a an important and useful part in making things better.
When over 69,000,000 Americans out of 311 million are taking psychiatric drugs, YOU COUNT.
What other group has this kind of “count”? This is a lot of votes. This is a lot of black arm bands. This is a lot of occupy. This is a lot of human and financial resources.
markps2,
I suspect that the “whole point” of selling pills is to make money. The “weaken the patient” is an unfortunate “side-effect” you have to “educate” your way around.
Steve,
Long ago. I was trained that it’s my role of a psychiatrist to see past the “symptoms” and provide a thorough medical evaluation of the underlying medical conditions. The woman that complained of a dog in her stomach had ulcers.
The expectation of me as a “prescriber”, now, is that I’ll precribe, fast. I’m actively discouraged from doing medical evaluations both from a “no money for it” and “no professional liability to cover it” perspectives. The assumption has become that if it looks “psychiatric”, it is this and only this.
Tha practice of psychiatry, for me, has changed a lot.
We did research on undiagnosed and untreated medical conditions among our hospitalized psychiatric patients at Tulane/Charity Hospital. There were a lot. A resident doctor was hospitalized in the unit. It turned out to be a hyperthroid condition. All the medical screening missed this because it “looked” psychiatric. We also diagnosed a man’s brain tumor that had him on the psychaitric unit. He could only rock and hold his head and moan. Had to be mental, right?
I thought that psychiatrists were the ones that were better at diagnosing medical conditions because we knew to and could see past the “symptoms” to the underlying medical conditions. We had complex screening protocols required for every new diagnosis looking underlying medical conditions. Whatever happened to medical the “workup” in psychiatry?
Philroy,
There are bound to be other contributing factors. I’ve seen it laid at the door of tobacco. Tobbaco use takes off about 12-14 years of a life. With “mental illness” we’re talking about the difference between 45 and 80 years.
What precentage of people with mental illness diagnoses smoke? The American population is 23%. I read that with “addictions OR mental illness” “75%”. No separation of the two groups was made. The arithmatic doesn’t add up for me.
The gap is widening at a frightening (to me) rate.
As each new addition of “prescribing priveleges” has come along in the Oregon, I was told it was to cure a “shortage” of psychiatrists in “undereserved” areas. Any questions I raised were shut down with accustions that I didn’t want any competition for my cash cow or “trough”.
I did not “ask” it to happen or requests this. Check who paid for the potilical campaigns. Not me. Follow the cash trail. The “blame” is easy to place on psychiatrists in retrospect (A lot of this happens). But I was there. I am here.
I have finally learned to shrug (rather than spend my time defending myself against accusation of greed) and say “Go ahead. Get “prescribing priveleges” for your profession (most recently for naturapaths, psychologists and social workers). I told anyone that would listen that they would NOT like what happened when all their professional skills were reduced to this one final common “prescriber” pathway.
Becoming “prescribers” guts out and destroys all other professional skills.
Psychiatry was gutted of all other skills when we were taught (and bought) that “prescribing” was the thing that made us “special” and meant we could “charge more” than other mental health providers. These are the same “baits” being offered to other professions to take on this “presriber” role.
It was once rare for primary care doctors (GP, family practice) doctors to prescribe psychiatric drugs in the USA as well. This “prescriber of psychiatric drugs” role by GPs has been pushed by drug marketing and by the medical service provider corporations as “cost saving” and providing “accessible care” (back to the old “shortage” story).
I feel sad at the situation we are trapped in. Wait a moment. Isn’t there a pill for this? 😉
Thanks so much for the perspective from Australia.
Alice
Emma,
Thanks for reading, thinking and commenting here.
I also have a hard time believing that either the “mental illness” itself or individual “lifestyle choices” can account for the increasingly large gap in life expectancy between those with diagnosed mental illnesses and the rest of the population.
Alexa,
It sounds like you’ve found a health care team you’re satisfied with. You’re lucky. You’re also educating yourself and doing waht you can to moderate the health risks. The metabolic issues you mention are one of the known health risk side-effects of atypical antipsychotics.
Mary,
Great ideas. I’m a psychiatrist and I’m writing.
Rememeber the public direct marketing. I had a steady stream of patients to my private practice requesting (and demanding) drugs. I had a CB therpay based practice and turned away nine out of ten potential patients because they wanted drugs and nothing more. This was from 1989 through 2003. I closed when there were not enough therapy patients to pay my overhead. Things are not better since.
Thanks,
Alice
My rant:
Ban the ads. Ban the ads. BAn the ads. Ban the ads.
Marianne,
I’m not sure of anything. 20% sounds way too low to me too. Interent research. Not science.
Does NAMI recieve donations from any corportions? I’ve seen patient educational literature imprinted with both NAMI and drug company names in years past.
33,
From a quick scan of internet today: (Yes, I know this doesn’t constitute “real” medical research.)
In the early nineties the life expectancy of people with “mental illnesses” was listed as “10-15 years shorter” than the national average.
In 2007 it was said to be 25 years shorter than the national average.
Today? Robert Whitaker reported a recent study that showed the “mentally ill” now live an average of 45 years? The average American lives 78-81 years. Now “the mentally ill” live 35 years shorter on average?
Things are changing. They’re going in a very wrong direction.
Barbara,
Thanks for your support and encouragement.
I appreciate your ability to see things from other perspectives. Seeing things from wider perspectives is not the same as making excuses. I think of it as gaining useful understanding.
The increasingly stretchy criteria for bipolar disorder have troubled me as well.
Steve,
I’d love to see a comparison study of average age of death in one of the “poor” countries without so many psychiatric drugs. It might be easier to get a less/non drug effected current comparison group. Compare those with the psychiatric diagnoses with and without drugs to the general population. This might help sort out the drug impact. Maybe the data is already out there? Anyone know?
Thanks,
Alice
Steve,
I don’t know how to sort out the specific causes and effects. They weren’t listed.
With the expansion and changes in diagnostic categories, the expansion and changes in medicines and the tendency toward polypharmacy how could we even be compare old data with new? Were these “earlier deaths” you learned about assoiated with psychiatric diagnoses studied before the time of medicines? How much earlier were they? Were they attributed to any particular causes? Were these numbers before “de-insitutionalization”? How many years earlier were you told?
I was taught this once as well (I don’t recall where, when or by whom), that people with psychiatric diagnoses die younger than the average population. I was taught it was for unknown reasons. I don’t remember the average age at death being 45. This number got my attention (obviously).
I was also taught that risk factors and associated findings are not the same as direct causes.
Just the same, if I found myself in a category associated with such significantly earlier deaths, I think I’d find a way to mosey out the back door while folks talked it out.
Altostrata,
Today, I write essays on MIA to encourage all of us to re-think what we do. I’m a writer. I write.
I’m glad to see you are here re-thinking as well.
“What would you do to have a a more immediate effect?” is a question each of us must ask ourselves. If I ask you this question, how would you answer it? If you ask it of yourself, how would your answer change?
Perhaps you’re right. If we wait quietly, the drug companies will gradually stop marketing on their own as drugs go off patent. I’ll be over here waiting with the flying pigs. (humor intended here)
Sorry to pop in here. You say things that make me think. This is good. I hope others read and think as well.
Could people be taught to care about 69,000,000 real people who are at increased risk of early death by their exposure to psychiatric drugs? Over 20% of American children and over 20% of American adults are prescribed them.
These 69,000,0000 people include teachers, mechanics, hair dressers, software engineers, mothers, florists, firefighters, grandparents, police officers, unemployed,social workers, construction workers, doctors, xray technicians, meter readers, TV repairmen, ministers, soldiers, plumbers, electricians, nurses, environmentalists, bill collecters, car salemen, retirees, fathers, postal workers, CEOs, realtors, shop keepers, students, psychiatrists, farmers, insurance salesmen, airline stewards, tour guides, bus drivers, drug reps…add everyone you know to this list.
No one is immune. The marketing is pervasive. We are way past “us and them”.
Other causes have used “poster children” because suffering kids draw sympathy. Perhaps we need postors of all 69,000,000 people? That’s a lot of posters.
Marian,
I was speaking of Americans here. Over twenty percent of all Americans are prescribed psychiatric drugs. This is 69,000,000 Americans at risk for early death.
Talking about eugenics with regard to drug prescribing today implies there are special categories of people based on genetics or ethnic characteristics that are being targeted for death. If this were true, the customer base in some targeted group would be declining behind these efforts.
This would not make financial sense. Drug companies want an increasing funded customer base, not fewer cutomers.
Where’s the target in America TODAY? The wallet. The third party payments. Government insurance comes with the disability payments.
Today’s drugs are about money. Nothing personal. No ethnic cleansing. Simply cash profits.
Perhaps I should write an essay about the financial motives of capitalist corportions to clarify how this works.
Thanks for your thoughts.
Best,
Alice
Today’s rant:
Ban the ads. Ban the ads. Ban the ads. Ban the ads.
Altostrata,
You would think this true. If only it were. In the face of overwhelming marketing, no doctor can convince another doctor or patient of anything. I’ve tried. Perhaps I’ll write an essay about these failed efforts.
Thanks,
Alice
My rant of the day:
Ban the ads. Ban the ads. Ban the ads. Ban the ads.
anonymous,
Thanks for your support and reading today.
I wish we had real numbers or, better yet, real names. With over 20% of the American population now being prescribed psychiatric drugs, arithmetic can give us the number of Americans that could be at increased risk of early death.
.20 X 311 million = over 62,000,000 Americans are at risk.
You may believe that psychiatrists, and the many other health car providers prescribing these pills, are “safe” from the effects of psychiatric drugs. You would be wrong. I know an awful lot of physicians, psychiatrists, nurse practitioners and mental health professionals that are on mental health drugs as well. This would be a good percentage number to discover. It may be a lot higher than the general population.
Please understand that people that prescribe these drugs believe in them, take them and give them to family members as well.
Thanks again.
Whenever I hear from you, I think new thoughts.
Keep readin, writing and thinking.
Alice
Genocide is a strong word indeed. In this situation it is inaccurate as well. “Genocide”, by definiation, requires the group being killed to be of one genetic or ethnic group. For example, killing people of Jewish descent or middle eastern descent or Albanian desent is genocide if the aim is to destoy the entire group.
Putting over 20 percent of the adult and child population of the USA at risk for early death is big, important and scarey, but it’s not genocide. Currently, these people are not being sorted by genetic or ethnic similarity (unless you believe there is a genetic predisposition for “mental illness”)but rather by access to third party payment for drugs. You don’t have money, you don’t get the drugs.
I include the following 1944 defintion of genocide from wikipedia:
By ‘genocide’ we mean the destruction of an ethnic group . . . . Generally speaking, genocide does not necessarily mean the immediate destruction of a nation, except when accomplished by mass killings of all members of a nation. It is intended rather to signify a coordinated plan of different actions aiming at the destruction of essential foundations of the life of national groups, with the aim of annihilating the groups themselves.
How we use words is important.
Thanks for your input. It gave me a chance to look it up today.
Alice
Ted,
Ban the ads. Ban the ads. Ban the ads. Ban the ads.
“Criminal prosecution” is only possible if there are laws broken. One must first have the laws. I am not an attorney (perhaps one could respond) but I believe that one would have to pursue other legal measures besides “criminal prosecution” it the behaviors engaged in have not been legally made “crimes”.
Another important point is that “us is them”. Twenty percent of the American population is “us” now according to a Fox News report from 2011. I think this is a low estimate. Psychiatric drugs are handed out to everyone by every health care provider.
By your thoughts, do we have to send every physician to prison that has prescribed a drug that had a bad outcome? We already have 25% of the world’s prisoners from 2% of the world popualtion. Perhaps other solutions could make an impact?
My rant:
Ban the ads. Ban the ads. Ban the ads. Ban the ads.
Rob,
A friend forwarded me a couple of chapters from an ACT made Easy book that covered the basic principles in an understandable manner. Thees sound quite a lot like my own variety of CB therapy I used in my private practice. I wasn’t so clear as to organize the material into six pillars of teachable material for others to use.
What I read sounds like it’s based on Beck’s “Cognitive Therapy” and Seligman’s “What you can change and what you can’t” with a spiritual buddhist seasoning.
Am I in your ballpark yet?
BTW. The other (F)ACT model works well, too. There’s nothing like getting food, shelter and assistance with the legal system to get one’s feet on the ground.
Donna,
Thanks for sharing your personal experiences here. I’m glad things have gotten better.
Thanks also for pointing out the variability of the effects of pot. I have know many people told me their use for many years had no effects other than “getting high”.
I have also met individuals who told me a little bit of pot caused serious problems for them.
Best,
Alice
There’s a lot of variability and all is not known in the world.
AA,
Some people came to my private office and paid cash out of pocket rather than leave a paper trail of their treatment in insurance land. As long as they never admitted to anyone and never signed a release of information I could never say a word to anyone.
I also was careful to keep personal details out of the medical records text. Only the minimum necessary. Insurance companies have access to your records if they are paying. Sometimes the employer is also the insurance company.
Privacy tactics are necessary in general medicine as well. I met a slim healthy young man (not a patient of mine) who was having trouble sleeping. His primary care doc sent him for a sleep study. He has “sleep apnea” only if sleeps in one specific position. This requires no treatment. He was given the “sleep apnea” diagnosis. Now, as a consequence, he cannot purchase private health insurance.
Any time your medical information is written down anywhere it will be used.
Here’s a related tangent:
Having huge medical service delivery and insurance corporations owning the doctors, hospitals, clinics, labs, test equipment pharmacies, pharmacists, nurses and “members” is filled with enormous potential financial and information conflicts on interest. The insurance company in charge of approving government payments for treatment also owns the treatment providers. Do anti-trust laws come into play here?
EAC,
I see your point with the antipsychotics. I wonder if this holds true with all the psychoactive drugs. It seems the benzodiazepines and stimulants (diet pills and “Bennies”) were very popular among GP prescribing long ago (60’s-70’s) without much encouragement from psychiatry. Valium and tranxene. Antidepressants? They may have had a good go with the GPs and with no psychiatric help as well.
marcellas,
I, too, am grateful for these discussions. I’m learning all sorts of things. Thanks for your lovely post. I was stuck on how this “anosognosia” word got to be used in psychiatry. I hadn’t run into it. But then, I’ve never been great with big words and doctor-speak. I have to translate them into plain-speak (as you’ve done a good job of doing with this) before I can understand things.
I’ve always been a big believer in believing. It is core to making a life.
anonymous,
If this is as prevalent a psychiatric usage as you say, it’s a miracle that I have not heard of this innaccurate use of the neurologic term. Perhaps I do not travel in the right circles or search out the right propaganda channels?
I learned of this first, here, on the comment section on MIA in the past few days. I had to google the term to be sure I was right with the neurologic definition from my long ago neurology training.
All the best,
Alice
Rob,
Thanks for the correction. The ACT acronym sounded the same. You may certainly send me any information you think useful through this website.
Alice
Altostrata,
I hear what you’re saying:
“Concerned psychiatrists need to turn their attention away from the crumbling of their hegemony and towards truly taking care of patients. If this had been the focus of the profession all along, it wouldn’t be in the pickle it’s in now.”
I agree all doctors need to turn toward truly taking care of their patients. How that would look or transpire for each individual doctor would be beyond me to dictate.
The second half is much too narrow a view of the causes of the pickle. It hands doctors more power than they ever had.
Best,
Alice
Even if psychiatry had never exsisted (no cheering out there) drugs would have been invented and marketed. If you’ve seen no parallels among the Primary care drugs of over-prescribing and later discovery of bad side-effects (ex: cholesterol lowering, antibiotics, bone hardening, hormone replacing, allergy relief, anti-inflammatory,weight loss, blood pressure lowering, GERD drugs) then you haven’t done your research yet.
And the for-profit medical service provider organizations would have sucked up the practice of medicine just as they have today.
Altostata,
Honestly. Reseach goes where the money is. There is no money for long term research. Turning out drugs for short term profits is what the for-profit corporations do. That and enormous ad campaigns.
I presented a research proposal in my short-lived attempt in academics. Since it was for a prospective study concerning the efficacy of group therapy in A and D treatment, there was no money.
No federal grant money. No drug company money. No research. No academic position. No job.
Yes. There should be long term research. There is no money in this country for it.
David,
I thought (maybe I’m wrong) that the word “anosognosia” was a neurologist’s word for a brain injury that did not allow the patient to know they had a brain injury, a phenomenon discribed in stroke patients and others with injured brains.
Rob,
I am familiar with ACT model. I worked half-time for six months a couple of years back with a start-up FACT (forensic community action team). This evidence-based treatment model seems very much like the old multi-disciplinary treatment team appproach I remember that offered way more than pills. I wasn’t looking for work at the time but when they described the level of support available and the resources we could offer people, it made sense for me to do it. We were able to help people with housing, food, clothes, support to manage the legal system, access to medical care, personal and A and D counseling, vocational support, financial support in addition to medicines. We could go pick them up and give them a ride to an appointment if that was what was needed. This is waht I remember the “old days” of community mental health to be. Much less about pills and more about the whole person and situation. That specific team is no longer around.
Thanks. There are excellant ACT trainers in Portland. I have met some of them and done trainings.
Jeremy,
If we could get non-medication open-dialogue treatment that helps people here without medicines I am all for this. I could learn to do this kind of treatment or I could go drive a cab and cheer things on from the sidelines. Good patient care and patient choice comes first.
Why would a psychiatrist be precluded from providing this kind of treatment? I have years of experience and much training in non-pill therapies, individual and group. Sadly, there has been no request for these other treatments. I asked and suggested to administators for years if I may run therapy groups or provide counseling. I finally stopped asking.
I love providing other types of care. Sign me up for open-dialog training.
I can’t imagine being “threatened” by good care that works.
EAC,
I presume you are in the US (I can’t always tell).
I haven’t watched TV since 2002. I understand there are some pretty high end commercials out there for prescription drugs. I’ve heard of a bouncing blue face that really sold an anitdepressant. I’ve seen a couple drug ads by accident when there’s a TV in a waiting area. Do you think the marketing campaigns have had any influence on the popularity and widespread use of these drugs?
Thanks,
Alice
Stephen,
Thanks for the thoughtful and understanding post. I do know that people here only know me by what I write, my name and the initials after my name. I choose my words as carefully as I can. When people come to inaccurate conclusions about me I first I look at what I’ve written. Sometimes I’m not as clear as I thought. I take into account the experiences people have had. I always learn something from them.
There is a huge problem here. I may not get all the details but I get it that there is a huge one. It’s way bigger than me or anything I can do about it alone.
Altostrata,
You would have to give me the specific patient and the specific missed side effect that I, specifically missed for me to answer your question about MY thoughts at that time. It is not possible for me to answer such a general “if” question. Perhaps you could take a swing at it yourself?
Steve,
It’s what I did for 14 years 1989-2003). It quit working financially in about 2001.I could pay everyone except me those last two years before I closed up shop. I also (by virtue of enormous federal debt) had to pick up hourly clinic “prescriber” work to pay the loans every month.
I doubt you’ll find what you’re looking for in a “job”. You’ll have to invent something on your own. An employer will not pay you to “think and cultivate relationships with your patients”. Yes, this is what works. It’s the right thing to do.
David,
Right now I’m a writer and a mom and a wife. I haven’t worked as a doctor in nine months and my dance card is pretty full. I’m not looking for another career path. Will one find me? Will I want it?
Maybe I’ll pack up the kids and head off to Africa where doctors can still be doctors. I could brush up on tropical infectious diseases, baby birthing, bone setting and sanitation. I was a pretty good wound stitcher in my time (This is mostly a joke.)
Hey Duane,
I’m not so personally concerned about whether psychiatry survives either. I was asked what I thought and answered as best I could.
I am here writing because I’d like to imagine that I could have an impact on making things better. That’s all. Maybe I will. Maybe not.
I had hoped that looking at the “bigger picture” would help us all understand the forces we’re up against and where best to point our energies.
I do believe that the loss of the therapeutic alliance has taken the heart and soul out of psychiatry in the process of the transformation into a pill model of care. There were not “third party payments” to me in my “good old days”. If my patient got good value from my work, he/she paid me. This seemed fair.
Ruby,
Sorry to misinterpret what you wrote as being a suggestion that I (or another psychiatrist like me) pursue medicine tapering as a line of work. Folks misintepret what I write as well. It is one of those foibles of using only the printed word to communicate without the other non-verbal and vocalizations. Perhaps there are other psychiatrists reading here who could work this into their practice.
For sure. Money colors decisions for every person. Money is a fact of modern living. Of course, greed exsists. I’d be a real polyanna if I said it didn’t. No one group has the market cornered on greed. I remember the doctor “across the river” who kept his schedule full of cash-and-carry ten minute prescription appointments till the state pulled his license.
I have no idea what kinds of people would be presenting to me today if I made myself available to do tapers. I can only report my personal experiences as a psychaitrist who did make myself available to do this in years past. I can’t assume to speak for the experiences of anyone else but myself or for any time but then.
There were people that called me asking to be “tapered off” (believe it or not) that took higher than the doses prescribed to them, that got medicine and sold it to other people, that had been “tapered off” by their usual prescriber without actually stopping, that “collected” a stable of “prescibers”.
I’m glad you found a doctor to work with you on your slow taper. You are fortunate.
It sounds like you are good at collecting resource lists. Others here are as well.
Diana,
I’m glad you found someone willing and able to help with your medicine taper.
There’s a lot of interest in gathering such resources here.
Best,
Alice
You’re right. Psychiatrists have not always been psychopharmacologists (“pill pushers”). I was trained by psychoanalysts, hypnotherapists, a great gestalt therapist, gorup therapists, A and D treatment therapists and CB therapists, all psychiatrists. I was also trained by teachers from every related field. But my best teachers have always been my patients.
How can we begin teaching a broader range of skills to psychiatrists? How can we put the time back in the day to use them?
I was taught by an excellant old-school neurologist that there are times when the only thing you can do is be there and hold your patient’s hand. This is good for all of us to remember. We doctors want to do something, give something. It’s good to remember that this is something that can be given.
Ruby,
It’s easy to make assumptions about rationales for the professional decisions of others. It’s also easy to get things wrong.
When I did handle “tapering” as a professional direction (I did that already years ago), what I found was that most patients who said they wanted to taper were actually shopping for another supplier. It put me in the situation of continuing prescriptions for people I would never had started on the drugs in the first place. I stopped doing this for drugs started by other doctors because it did not go well.
Perhaps things would be different today. I couldn’t presume to say.
Alice
Thanks for pointing out that focusing on psychiatrists will have limited postive results. It will have results. They may not be be those hoped for.
I’ll bet the patients and other psychiatrists that have had good results with judicious prescribing wouldn’t dream of poking their heads up here. There are times when being a psychiatrist writing here is rather like painting a target on myself and walking into a firing squad. I have also seen people who have had good experiences within mental health treatment systems take it pretty rough when they spoke up.
Don’t get me wrong. There are lovely, supportive and thoughtful replies. There are just a considerable amount of the others.
Ruby,
Funny you should mention this. A few years backI left my dog with a house sitter. She wasn’t so good at getting her outside to the bathroom. When I discovered this, she told me the dog was depressed and the vet wanted to put her on prozac.
If I wanted to make money on this, I’d be out there doing it. This is, indeed, the land of opportunity. They can also prescribe ANY psychiatric drug. All of them.
EAC,
Family doctors and counselors do this “brain disease” convincement every day in this country. The biggest pressure I used to have in my private practice (behind the direct cold-call demands from patients) to prescribe psychiatric drugs came from counselors, therapists and family doctors. They have also been convinced of the “brain disease” model and spread it around. All psychiatrists could vanish tonight and this would live on.
I don’t know what percentage of “research” of psychiatric drugs is done by “academic psychiatrists”. Certainly academics must “publish or perish” in every branch of medicine,in every branch of academics. During my brief attempt in academics I was unable to get funding for a study of group therapy in A and D treatment from the feds. I didn’t know, then, of their funding sources or priorities. Pif. That was it for me and academics. I was a stupe (I discovered 25 years later).
There are private clinics that do a lot of these “studies” for money. Look around for the ads for patients/subjects. I know of one in Portland. There is a psychiatrist (to validate the “research”) and many other clinicians to process the research subjects. There will always be those willing to perform if the money is there. This is not limited to psychiatry or medicine. Every field has them.
Thanks for reading and asking questions. It keeps me thinking and writing.
Best,
Alice
John,
Do you think we sould start an anti-GP movement then? (Sorry. Bad joke. Not a joking matter at all.)
I’m sure the GP’s have been just as persuaded by the marketing hype as all the various “prescribers” in the US. I had heard rumor from UK that GP’s are required to refer to other treatments before starting antidepressants (ex. exercise, counseling). Any truth in this?
Stephen,
Wow. I wish I’d written this piece. You write very clearly with plenty of personal experience to back it up.
1. “the ones who are willing to walk with people on their journeys of the dark night of the soul, the ones who aren’t afraid of huge emotions, the ones who care enough to actually listen to the people in their care, the ones who realize that the “expert” in a person’s life is only that person, the ones who let people drive their own cars and care, the ones who minister to people out of their own humanity and who are transparent enough to admit that they don’t know everything, the ones who are humble and know that even they can learn some valuable things from their patients.”
You are right. There is no place for psychiatrists like this in the current systems. Neither is there room for any “service provider” like this.
2. “Be careful what you pray for because you just might get it!”
I was thinking this when I was writing about all those that have lobbied for “prescribing priveleges” and thought they would be winning a prize. “Prescribing priveleges” is the fastest path I know for social workers, psychologists and naturopaths to lose everything else they now do. They can do this. But they may not like when they end up.
I don’t know where to break this cycle. It has already eaten psychiatry.
I hope that those who habitually scapegoat and vilify psychiatrists as the root cause of all this can step away from their anger and target practice long enough to find answers, if not for systems, then for themsleves.
Mark,
Thanks for your thoughtful approach to this issue.
You would have us step back further than I did and take an even wider view. Beyond our corporate approach to medicine and psychiatry, there is this culture of ours it is all embedded in. The systems and corporations and organizations have sprouted from the soil of our own country.
Nine out of ten calls in my private practice came in search of pills and nothing else.
You say we can only have two out of three of the following:
quick fix
low cost
high quality
Fast, good, cheap. Pick two.
I’ve got it. But sometimes we get only zero or one.
Thanks for putting your spin on this. More thinking together is good.
Best,
Alice
John,
I had a conversation with a friend this weekend about a child that must take stimulants to be allowed in school. This is routinely done in this country both in private and public schools. When a family depends on school to provide day care for a child so they can go to work, they are in a real bind. Staying home means job loss. What can the parent(s) do?
Since many of the children’s drugs come through pediatrician’s offices on the recommendation of educators, where can this be stopped?
anonymous,
I compare the marketing of drugs to the marketing of drugs. Both categories of drugs have serious side-effects and are used for things never approved. I review the programmable cognitive filters we all have and how drug marketing works with this.
I am certain our (you and I) programmed cognitive filters do not match perfectly. It would be unlikely that any two humans would ever be identical.
I don’t believe I’ve written yet to address “force” and “involutary psychiatry”. I believe others write widely about these issues here.
I’m sorry my posts don’t work for you. I hope others here on MIA do.
Stephen,
Perhaps my reply was misdirected. I get things in order of time they are posted, not by the comment thread.My machine refuses to process the scroll view. Perhaps you are not the person who said he was a “chaplain” in a nursing home. That is the only one I recall saying anything like “man of the cloth” to.
Perhaps my answers are going awry when I answer from the “dashboard” mode.
Heidi,
I get these posts in order of time stamps so the threads are jumbled for me. Apologies if I repeat myself. You are not the only person who misunderstood my point. I shall truely have to work more at clarity in my writing. I suppose there will always be some I cannot reach. It is as it is.
All of us, every single struggling, searching, thinking, researching human has a programmable cognitive filter in place. Me. You. All of us.
Having very real “obligations” to patients does not change the limitations of this operating system every human organism has. Me. You. All of us.
I, also, wish I had been bequeathed with special and different powers, for example: to see the future, see what’s hidden, to be immune from marketing.
Some people THINK they are different and immune. This frightens me.
Others imagine I am. This frighens me as well.
This is the point of my “bucket metaphor” stripped of the bucket. This is as clear as I can be.
I hear your wish for an apology. If I have done something to harm you personally, here with my words, be sure it was not intended. For that I am willing to say I’m sorry.
Anom,
What were you hoping that I (or another) would say or do? Is there a specific set of words you await?
I’m curious to understand exactly what you are looking for and the changes you hope these things would make.
Altostrata,
People driving deadly cars every day is an illustration of the programmable cognitive filter all of us wear. It allows all of us to miss important information. Sorry you missed the point. You are not the only one. I will work toward more clarity in future posts. I’m new at this.
All the best,
Alice
The part about how I ran my professional practice. Wrong. You weren’t there. You’ll have to take my word for it. Or not.
The other part about us “not being in this together”. There’s some truth in that. I’m here “in it” because I thought there may be a “snowball’s chance” of me helping make things better with words. You can stand a little further way, if you like, while I try. Me and you being together to work on making things better? You get to choose.
Nijinsky,
These are not meant to be direct correlates of psychiatry but rather examples to demonstrate my idea of a programmable cognitive filter on all of us. You are not the only one to miss this so I shall have to get better at tossing them.
Best,
Alice
Jen,
In the view that I use here, I see comments by time posted so can’t always track the complex web. If I used the initials “APA” in a post, I would have meant Psychiatric. I have associations with neither organization.
Alice
Certainly not you. But I am learning what topics are “hot buttons” here and introduce them with caution.
How is one to immediately know that a dangerous situation is the result of drugs and alcohol? When the knife is swinging or the fists punching and dangerousness is occuring one cannot always know the immediate cause. One is morally and legally obligated to make things as safe as one can as gently as one can.
As you say “we have laws in the regular legislation that allow, even demand, everybody to intervene at a dangerous situation, if necessary using physical force, to prevent the danger.” We are also bound, in this country, by both morality and laws, to use the least force necessary.
I met this specific gentleman when I came to work in a psychiatric emergency area. He was already in restraints. The PCP in his blood was discovered only after the police brought him in.
PCP has a tricky way of repeating on a person based in its metabolism. A person can seem well out of the grips of its fury and then “relapse” hours or days later. There can be a return of the drug effect and more assaultive behavior. This is unpredictable. This did happen when he was up around around later a few hours later. I’m certain that the necessary action taken to make the small, crowded area was hard on everyone there. Still. What were the choices?
Long ago, when I worked in this emergency hospital area as a part of my training there was not separate place for A and D related assaultive behavior or separate legal codes for responding to dangerousness. And yes, the dangerous behavior had to be immediate and witnessed to bring you there.
This is not meant to be coming down on the “side” of forced drugging and restraints or “against” it.
My point is that everything on this planet has more than two sides. Sometimes there are as many “sides” as there are people.
Thanks for reading and commenting,
Alice
PS: The phrase “talk somebody down” was used in quotes as I was responding to another commenter who used this phrase. Of course there are other ways to say this. I also like your phrase “meet people where they are at”. I feel a better sense of communication when I use the other guy’s words and meet him where he is.
This article is not only about the “head buckets” (programmable cognitive filtering systems) of psychiatrists. Our deadly habits of driving cars is meant to be an example of how any human, including psychiatrists, could “not know” something even IF the information is right in front of them. It is meant to be an illustration, in the ordinary human words that work best for me, of how all of us are vulnerable to this built-in operating system.
Sorry the metahor didn’t work for you. Back to the drawing board… I mean lap top.
Maree,
Of course, there are other ways to enforce without a court order. Parents are forced to drug their children to access both public and private schools.
True statement you make “… you either take what they give or you go without.”
As you say, “(medication) is very largely the only thing on offer what choice do they have.” Drugs are the only thing many clinic have left to offer. Funding for every other service has been methodically cut from above, even before the recent economic down turn.
Altostrata,
The huge mess of modern society IS the point and not a digression at all. Herein are the aswers you seek.
Thanks for reading, thinking and writing.
Alice
Alix,
Forward him links to my posts if he will only listen to a psychiatrist. Foreward the link to MIA if he’s more open to the points of views of others.
I was taught by a very wise mentor that I have to adjust my use of language to meet the person I’m talking to. For example, if someone tells me he feels like his motor’s not running right, I’d better talk to him about his motor and not his heart and lungs.It’s part of human communication.
Yes, it’s his job to be open and listen. As an outspoken doctor, I’ve had no better luck getting my own doctors to listen to me over the years.
“What is getting between all doctors and hearing what their patients are saying?” This is a book’s worth.
Marianne,
You are exactly on topic. Our pill culture is big. Psychiatric pills are a part of a much bigger problem.
If all psychiatrists vanished today (Okay. No applause ;-)) the problem of overprescribing on all fronts would go one unchecked. People still would be clamoring for pills (supplements are in this category to me). All the other “prescribers” would go on filling the artificially created “need” for pills.
Thanks for stepping back and looking at a bigger picture.
Alice
Greg,
Isn’t it nice that we don’t have to agree on everything here. Each of us has our own viewpoint.
Sorry you “sting a bit”.
When people who were not there in my skin and shoes make presumptions about what I knew, didn’t know, could have done or should have known, they are engaging in Monday morning quarterbacking. It happens all the time.
Another way I see this is looking through the “retrospectroscope”. Perhaps there are more palatable metphors for the human habit of imagining that one could have done things differently had one been there. This goes on in the aftermath of lots of really bad happenings from ten-car pileups to genocide. We all would like to imagine we would have known better and that it could never happen to us.
We still kill more Americans “by accident” with cars each year than in our intentional wars. We’d like to think these won’t happen to us because we’re smarter, safer drivers.
Pliny the middle-aged,
Yes there are. I have seen many ICU pateints in restraints, many geriatric medical patients in “posey belts” (restraints) to keep them from falling out of bedor wandering. I have had to “restrain” confused or intoxicated medical patients in ED to perform necessary life-saving care.
I have seen chidren and adults have treatment for acute medical illnesses forced upon them against their will. This depends on the state. Some states will remove a kid from parents’ for withholding care for religious reasons.
Verbal coercion is used every day in the offices of primary care doctors. I have experienced this first hand in protecting myself and my spouse from toxic cholesterol lowering drugs. Even the insurance company and corporate employer got in on the act. They charge an extra $600 a year in premiums for our making the choice of not taking the unproven and toxic drugs.
Coercion, forced medication and restraints are not just a psychiatric issue. No legal committemnt or review document is required for any of this in the medical environment or nursing home.
Thanks for stepping back and broadening the view. This is important.
Alice
Yes. This is all much, much bigger than psychiatry.
Yes, there are experience, exsistential and cultural things (to list only three) that play a huge part in pain and suffering. Imagining that we (or our mothers) are “responsible” for all life’s suffering is narrow. I think that exploring these is an important part of cognitive and behavioral therapies. I’ve successfully “prescribed” (in my version of CB therapy) a wide range of life changes including relocating to a sunnier climate. I’ve successfully “precribed” to a young person trapped “in the box” of public education a change to another education venue. I’ve prescribed pets, plants, walking, smiling, food changes,playing, laughing, meditation, tai chi…the list is long and always growing.
While addressing how we run our thoughts and feelings is an important part of CB therapy, the ways to make a life that works better for an individual are as different as there are numbers of people.
It’s also important to know what you can change and what you can’t.
Thanks for the lovely post.
Best,
Alice
PS We are still killing more Americans with cars in the USA every year “accidently” that our intentionally fought wars (by my internet sources of statistics). This is not counting the emmissions poisoning the planet or any deaths from manufacturing, fuel aquisition or auto maintenance. We need more work on safety standards or less driving.
David,
Thanks for a lovely post and taking the time to explore my use of metaphor. I like metaphor (and poetics) because they cast a wider net of understanding for a visual thinker like me. I move a past words in understanding with metaphor. The ones I choose work for me at the time. They may not ring true for all or even anyone else but me.
I have no need for metaphor for this thing:
Psychotrophic drugs for two year olds as way past “the height of insanity” in my book. I have not personally “gotten” precribing psychotrophics for children. We’ll have to get a hild psychiatris on board to discuss this. I’d have to stay out of it.
I would also not “categorize” an “overwhelming sense of oneness” as psychosis. This has been the goal of mystics for as long as there have been mystics.
Nijinsky,
Thanks for the link. I have seen lovely, skilled clinicians in the crisis area I’ve worked in talk people down. This is always the best way.
I also know one lovely skilled worker who was slashed badly with a knife by a customer in the front office of a clinic because he walked into the room. No talk time in that moment.
I remember long ago (I risk buckshot on this one) a gentleman who had injested considerable PCP (veternary tranqilizer/anesthetic) and was on a crowded street fighting wildly with a knife to cut his own parts off and anyone who was near. There was no talking that would get through the drug confusion and agitation. This was decades ago. I don’t remember more about what was going on except that PCP (angel dust) was big in New Orleans then.
For most things, I can see more sides than two. Maybe this is my “flaw” as a doctor
Different things work in different situations and with different people on different days.
Nijinsky,
You are indeed a creative thinker. Thanks.
Perhaps others with more legal savvy would like to take this on.
Even when a hospital nearly killed my oldest child through the use of another child’s chart, missed xray diagnosis and the wrong medicines, I did not sue. I did speak up. But I’m not a law suit pursuing kind of person. From what I’ve seen with law suits (limited experience) the only winners are the attorneys even when the suit is “won”. (This is not meant to be bashing of attorneys. They work for a living and have to be paid for their time and services like anyone.)
Marian,
I’m a library user so I read them but they’re not on my shelf.
The bucket is a big deal. It is our belief system. This is part of the human condition. I work on making more of mine on my own by exposing my head to what I want in my belief system and avoiding the media. We all got one. I kind of have fun tipping mine up and looking around.
Best,
Alice
Margarat,
I’m sorry you’re not well today. I’m sorry you’re not able to get the medical care you need. If Stephen Boren is directly involved in your care, you may wish to contact him through other channels. If he is not, then your “vitriol” is mis-directed.
In any case your post has crossed the line from dialog for solutions to personal attacks on an individual’s character. I, myself, was called to task today for this and took a few minutes to tone my post down.
We hope to invite as many different kinds of help as possible to the table here. I, at least, don’t want to run anyone off.
Marian,
My apologies for any words that could have been construed as aspersions to your character. You will notice I have edited the above post to remove things objected to by another commenter.
If there is further moderation that I can perform, please let me know. You can contact me [email protected] or through this commentary conversation.
Greg,
Lack of finding does not imply lack of looking.
There was not “an abundance of information” for “half a century” in any place that I could find in public libraries, medical school libraries, professional books or journals. Sorry. The information, in those pre-internet days, was not findable even by a well-meaning, well-read professional like me. Even now, the internet is a wasteland of mis-information. It may be even harder to sort anything out.
When I figured out (by attending classes, reading and pondering) that there were some holes in the theories (as early as the early ninties) I did begin informing my patients of this and talking to people around me. I changed how I practiced. I think that’s as good as one can do. I expect there are many who did likewise.
Monday morning is a great time to re-play the game for the quarterback and find him lacking. It looks much easier after the fact.
For me to say that I didn’t look, ask, search and read to the best of my ability at the time, would be a lie. This is why I don’t say it. It’s not “hard to say”. It comes across in the commentary section here like people want me to make a forced confession of wrong doing. What goal would be furthered by this?
If me taking personal blame and being scapegoated for many things that were clearly beyond my control(ex. hidden information, marketing disguised as education) or taking the blame for not knowing things that only became widely known at a much later date would help us move forward on the re-make of our system, I could do this. Perhaps
Except it won’t move us forward. It will only serve to further the anti-psychiatry bigotry that is no prettier than anti-patient bigotry. It will become the required hazing process for anyone that presents wanting to help.
We can’t afford to chase away mental health workers who may be able and willing to help witt the remaking of mental health. Some of them may have good ideas.
Best,
Alice
PS My student loans didn’t force me not to find information. It only enforced work choices. You will be there any day now. (My loans acrued compound interest while I was in school at 18-22 percent. Doctor loans for those rich doctor-types.) You loans will force your work choices for decades. This is a long time. Sorry.
Nijinsky,
You’re right. My interpretation of the tone of her report as “gleeful” certainly overstepped my usual boundaries of decorum. You will see I have intentionally edited this out of my post because of your point here. This is a public apology for using the word “gleeful” in my response. Only she can know the truth of her personal feelings with regard to her own post. Thanks for pointing out when I step over the edge.
Is this the extent of your concern or is there more?
Nijinsky,
Thanks for another lovely sensitive post. I like cognitive and behavioral approaches to helping people feel better and suffer less. Thanks for remembering I said this.
This is where I spun off from what you wrote today:
Any repetitive thoughts or behaviors (including feelings, words, physical movements, marketing, visualizations etc) will re-wire your brain at any age. This is the miracle of our neurology. This is big to me. You can put in new wiring in your head with music practice, repeated affirmations and repeatedly summoning up emotional states (just to give three random examples).
Any time. It’s never too late.
Replacing fear habits and anger habits with other more positive feelings will “re-wire” (electrochemical and structural) your brain.
Chronic fear and anger wears us out (bancrupts us) from physical, spiritual, cognitive and emotional respects. Did I miss one?
Our culture in America is largely fear and anger based. Fear turns to anger. The media hammers it home and then we hammer it home on ourselves and those around us.
Scared and angry people are easier to control than calm thoughtful ones. There are 311 million of us to control here in America.
When we let ourselves be habitually angry, we are handing the keys to our freedom over to someone else that may not have our best interests at heart.
Marian,
My reading is not limited to “science” at all. How dull that would be.
I read fiction (Terry Pratchett is an all time favorite), poetry (Rumi translated by Coleman Barks and Walt Whitman. Jimmy Carter is a fine poet), how-too, self-help, history, anthropology, biography (Lillian Carter was a wonder), education (Must read: Gatto), arts and crafts , cooking (“Wild Fermentation” is great), health and fitness, nutrition, philosophy (Dalai Lama’s good). Heck, I even read investigative journalism (check out Robert Whitaker’s books). Oh yes. I do read science. I love natural sciences like ornithology and botany. Physics is fun where it bumps up against philosophy.
Thanks for taking an interest. How else can we get to know each other here unless we can step past assumptions?
From your description (I wasn’t there) it sounds like the poor woman was terrified of a big, loud threatening male up close. That would work to generate fear in most folks. Probably on me or you as well. Well, maybe not you. 😉
You’re missing a (or some) steps in your logic. Scaring a woman does not equal psychiatry being “fear based”. Psychiatry may be fear based. Scaring a woman with direct threats to her physical safety doesn’t prove this.
Me angry? Heavens no. I’m not a human or anything. I’m one of those mythologic psychiatrist creatures.I just do “existential angst” 😉 But thanks for asking. It’s good to hear concern for my wellbeing here. I just got back from a run. It does wonders to help manage those pesky human emotions.
Thanks for asking. I hope you’re doing well, too.
Best,
Alice
Marellas,
Cool. I get to be right about something. Thanks. I still like the “bucket” metaphor. I’m a visual thinker. I can “see” it better as a bucket.
Best,
Alice
Stephany,
I’m sorry these things happen. Thanks for bearing witness here.
All of us together will be necessary to change the system.
Thanks for your comments.
Best,
Alice
Lowry,
“people jump from “I don’t understand” to “I am afraid” to “You are a danger to me” without any logic necessary.”
“When I can locate the problem in YOU, I do not have to look at ME”
Very nicely written. I think you may be able to add “I’m rightfully angry” in after the “I am afraid” in many human situations. Scared shifts to mad pretty fast for most folks.
I’m curious what state you live in that has a law that allows committment based upon noisy, odd and eccentric behavior alone. I’m familiar with “dangerous to self and others” having to be witnessed attempts or actual harm.
I live in a financially resource poor state. This may help protect the rights of some. Psychiatric committments are paid for by tax dollars. Although Oregon does have involutary committment laws, money is channeled into keeping folks out of this situation. The financial bottom line ends up as a protector of human rights.
Ruby,
I, too, get angry at the condition of our medical system. I, too, have “fired” doctors for not listening to what I said (six of them over the years to be exact). One would have let me bleed to death from a miscarriage at home rather than take my call.
I once had to remove my child AMA from a pediatric hosptial to save his life from the wrong treatment when he was small. I had to pull his IV out of his arm myself at one in the morning and carry him through the front door on my back to save his life. Turned out later they had the wrong kid’s chart, missed the collapsed lung on his x-ray and held him down to give him the wrong medicine.
This is not all about psychiatry. The medical system is no different for an outspoken, reading, thinking doctor with blue cross insurance than for anyone else. Things have been way broken for a long time.
Internal medicine and primary care has been just as swept away in this pill culture as psychiatry.
All of us have very good reasons for anger. I’m convinced that the only ones our anger serves are those running the profit-driven corporations that have a death-grip on so much of our country. I will not give my thought capacity away to them by falling into rageful bickering, finger-pointing and name calling. There is way too much work to do. The only tools I have are my words.
When I feel too angry to moderate my communications, I go for another brisk walk. Some days are three walk days.
After writing this one, I’ll go for a run and see if I can come back to write later.
Marian,
You’ve obviously put a lot of time and effort into your comment here. Thanks for that.
You make assumptions that I have not questioned, not asked, not read. You also assume that psychiatrists don’t question, ask or read. These are poor assumptions to make. You throw away many kind people who could help.
I’m impressed by the level of anger expressed in your post. Not your own, perhaps, but certainly through the descriptions of the behaviors of others.
As a human rights activist, I’m surprised that you would vividly describe and then justify your large male friend’s loud threatening behavior toward a woman. Of course, she would be frightened. I’m not sure what one can infer from this except that she was afraid. Of course.
When one justifies aggression in words and behaviors, one sides with aggression everywhere.
Skyblue,
Thanks for sharing your personal experiences.
No, I don’t suppose this to be a “fair and just” society. I don’t think this is restricted to psychiatry. We are embedded 24/7 in marketing. True.
While I would never suggest than anyone succumb to the pressures and let go of the dream of making things better, I would make two suggestions.The first is about living a life built of anger. The second is about doing things that will result in being sucked up by the system as it currently exsits.
First. Anger is unhealthy and unhappy, especially when there is so much of it. When I feel angry, I feel bad. I want to feel better even while we work together on this. The hormones released when angry trash the body and unplug the thinking brain. Angry displays drive away others that could help. Is it possible that your anger could play into the other guy’s plan? Likely.
Second. The laws are unfair and the sytem wrong. But it is there now. Bashing yourself against the laws will result in you becoming yet another unsung martyr. What good can you do from there?
If you like the Nazi metaphor (and I’m getting it that some people here do) think of the French resistance fighters. They did not go out and throw rocks at German soldiers in the street. That would have meant one less to work for the cause of French freedom. They went underground and worked quietly.
We need all the clear thinking help we can get to turn things around.
My apologies to those that have been troubled by the Nazi rhetoric on this web site. Please hang around.
I hope we can all find ways to remember to work politely together. I hope not to take shots at anyone, even if they do support a “pharmaceautical model”. Being on the attack creates more hostilites and a closes the doors of communication. I believe a peacful, understanding and cooperative approach is necessary if we hope to have a real impact on changing things.
Ruby,
I’m glad you’ve found good help for your efforts of tapering off medicine. All the best.
The “bucket” I referred to in the article is not the exclusive domain of doctors or psychiatrists. We all have our unique belief systems we each call ” the truth”. Fascinating.
My hope is for cooperative healing relationships here that allow people from all disciplines to come together to make mental health into a better and more humane process for all. Everyone wants to feel better and suffer less.
There are times when (understandable) anger makes the conversation less open to anyone from the mental health field. If excluding mental health workers in the point, we should be clear up front. No one comes here to be blasted. I don’t. We should post a warning sign or something.
More wag. Less bark. (bumper sticker I saw recently)
I appreciate you posting here. Welcome.
Best,
Alice
Altostrata,
Others may be interested in doing what you do from your website, giving advice to people about getting off their medicines. Have you run into any legal stumbling blocks with this that others should avoid? You’ve told me you can’t get any doctors to help you do this. It sounds like the market is wide open to provide this type of online service.
Alice
Kermit,
Thanks for your support. What a heart warmer to read.
It is a bit for me to juggle so many conversations. There is one me and (Woo Hoo!) a whole bunch of you. This is great. Unexpected. I’m so happy that so many folks are taking the time to speak up and be counted toward finding solutions.
Probably you’re going to get tired of hearing this:
We’re all in this together.
Best,
Alice
Anonymous,
You do have to knwo what to say nd not say. The laws state real clearly the things a “designated” mental health professional, ED doctor, police officer must do if someone makes threats to self or others in front of them. They are bound by law. A person has to know not to say those things or behave in a threatening way. You are absolutely right.
Alice
Marianne,
Thanks. I appreciate your support and trust here. My heart feels better reading this.
On a website like this we are all driving blind. I never see get to you and you never get to see me. I’m out here with my real picture and real name. That’s as good as it gets.
To be honest, there are times I forget everyone here is driving blind. I wonder, how could they think this about me? How could they say something like that?
I have to remind myself that no one here actually knows anything about me except the words I type. It’s likely people have a lot of hurt and anger from bad things that have happened somewhere else and some other time. I want them to feel better and suffer less.
I’m here writing because I wanted to see if one voice could make a difference. I’ve read all this philosophical stuff about a butterfly wing on this side of the world resulting in a typhoon on the other side of the globe. I’m a believer in peaceful cooperative approaches to change.
Stephany,
Being a psychiatrist, I risk another volley of cannon fire but here is the truth from 8 years of experience from 2004-2011. This is not a stance for or against “forced drugging”. It is simply a report from recent experience at work. I hope it’s useful information.
I have worked in a crisis clinic for the uninsured that handles (among many other things) temporary medicine continuation post-hospital discharge. These people were not “mandatory” or “forced” to take drugs even if they had been on an involuntary committment at the hospital. There were “no court ordered medication compliance” in their discharge plans. These people came on their own and asked for the medicines. The people I occasionally met with court mandated drugs were involved in the criminal justice system, not the medical system. The medicines were part of a release from incarceration ordered by a judge. They also walked in.
I contend that, at least in my city, forced drugging is NOT “status quo for hospital discharge” at you say.
Alice
Stephany,
I’m sorry that such things happened to your child.
If others back legislation that remove freedom of choice, then back legislation that promotes freedom of choice.
This is Mad In America, where people who have been harmed can have a voice. Absolutely.
It is also (maybe I’ve gotten this wrong) where people who have been harmed and know people that have been harmed find cooperative ways to change things for the better.
You are very right. There is no paying work for a psychiatrist who will not prescribe drugs. This is not a “pay cut”. This is zero. Most of this is happening through other channels now anyway, cheaper ones like PAs, NPs, primary care, obgyn, psychologists. Even the social worker lobby want in on the act.
And, ah, the student loans that have everyone in a lifetime of financial disaster today. There is no bancruptcy discharge for these.
The trap snaps and we blame those caught in the cages.
Thanks for posting.
Keep talking and writing, reading and thinking.
Alice
John,
Good one. Clear and to the point.
“It is about drug company marketing and PR influencing practitioners and the public by using huge, multi-million dollar budgets.”
“profit driven madness”. It’s good to know which way to point the eyes and arrows.
Thanks,
Alice
Altostrata,
Thanks for being out there and thinking. It will take us all to get things turned around.
You have suggested to me in the past that you think my energies would be best spent working in an office to taper people off medicines. Thanks for your thoughts on how I can best live. Advice and opinions are great, but we each have to find our own paths.
Perhaps if the rhetoric were toned down just a hair it would help others who could help hear the messages and respond. I doubt that many are willing to walk into the blasts of accusations and name calling. At times, I have doubts concerning my own skin being thick enough for this.
If your approach is working to achieve your goals, good. If not, maybe it’s time to try something a little different. Perhaps not.
Altostata,
Thanks for another enlightening post. I’m glad you figured all this out through self-education. The real task today is finding ways the message can get out. I fear that your “big stick” approach may run off the folks that need to hear.
Best,
Alice
Greg,
“Caught up in the mental health system” certainly describes my experience from the time I set foot outside the halls of my training programs. I don’t recall being in charge of anything beyond my small psychotherapy (no cash flow) private practice and the prescription pad I was allowed at the hourly pay/no benefits jobs. I had a LOT of high interest medical school loans to pay.
Thanks for your post.
Best,
Alice
Vanessa,
You make assumptions about how I grew up and my personal experiences that may be incorrect. The “trust” I have has been intentionally cultivated later in life. My own starting point was pretty suspicious, angry and accusing.
We live in a cultural bucket of deeply-embedded mistrust, fear and anger. True stories. I had to rent an electric piano in another country. My language is poor. They had little English. My credit card wouldn’t work because they use an imbedded ID chip we don’t have. They handed over a new-in-the-box piano for 70 euros cash rental and my word I’d bring it back. They didn’t know me and only had a hotel address in another town. When? Last October. Another time, I was on a crowded city street, same other country. A four year old girl raced between our legs with a money in her hand. I was freaked. No one else noticed her. She ran into the news shop up the block and came back with a paper in one hand and her change in the other. She vanished into the crowd behind me. Both these are normal and everyday in other countries.
We are different here in America. Very, very different. Sometimes one must get “outside the bucket” to see things
More trust is good.
Isn’t it nice we don’t have to agree on everything?
Altostrata,
I’m a marketing dupe. We’re all marketing dupes. This is the point of “Bucket”article. Thanks for getting it.
Are you German? I’m not. My extraction is Portugese, Italian, Irish, Dutch etc. Excuse me. Maybe I mistake your “good German” comment. Are we back to the Nazi rhetoric again? There is no place for bigotry and target practice of any kind in an open, solution-focused discussion.
Maybe I’m wrong about the goals here on MIA.
Best,
Alice
Marianne,
I’d not heard that specific one. I’m heard similar kinds of things about psychiatrists, attorneys, internists, priests, ministers, software engineers,jews, hispanics, Italians, Poles, gays and lesbians.
Alice
Altostrata,
Sorry. I knew that. That was my attempt at light-hearted banter with a keyboard. Your comment that you’d “answer to Buddha when you saw him” made me smile. I admire the independent thinking you show in your comments here.
Marianne,
Thanks for your support. I’m sorry you have suffered so much.
“Most medical doctors” don’t do research.They work in the clinical office with patients. Research is left in the hands of the medical schools and academics or the “research for hire” clinics that do just this all day.
Most medical doctors are not trained or exeprienced in research. It is very expensive and time consuming and would not allow time for patient care. We generally choose one path or the other. Research findinbg must be found and generally is.
Thanks,
Alice
NIjinsky,
Thanks for telling me more about your friend. Perhaps “Sorry for your loss” isn’t quite right considering your experiences of her death. Still. I’m sorry this happened. I am sorry for your loss.
You are not the first I have heard this types of experince from. All is not known in this world.
Christian,
Thanks for your well-thought, well-written description of your work and professional background. This helps give balance to the discussions here.
Welcome,
Alice
Nathan,
Yes, yes. Cars are safe. It’s worth the trade-off in deaths. We’ll have to get into that another time. I have something more important to say. Time’s short.
I am away from work and writing here to see if one psychiatrist (me) can make any meaningful change in the “mental health industry”. I really don’t see how I could. But I try.
I hate hearing any helping profession referred to like a cash factory, don’t you? Oil industry. Automobile industry. Medical industry. Mental health industry.
Open dialog is critical. The “anti-psychiatry movement” has gotten so locked on a “target” painted on “all psychiatrists” that I’m not so sure it can move beyond this anger to solutions. If you killed all psychiatrists (“hung by the neck till dead” has been hinted at with the nazi rhetoric used on this website) you would still be left with a pharmaceutical industry marketing to the public and scads of “prescribers”; NPs, PAs, primary care docs, ob-gyn, psychologists. All this gratified self-righteous retribution and nothing would change.
I’m not wanting to “take the heat off the mental health industry”. I’d like folks to step away from the target, unlock their eyes and take a wider look. What if, for example, (this is just supposition) the pharm companies could throw psychiatrists to the wolves as scapegoats and continue to make their profits just fine? We are there now.
The media would have us believe that those interested in reform are a bunch of dangerous “scientologists”. If I believed this still I wouldn’t be writing. I did once. I risk sharing this brand with you all when I speak up here.
How has the entire responsibility for all that has gone wrong as we’ve been swept away by a culture of pills been placed at the feet of psychiatrists? Is anyone looking closely?
Stephen,
Most patients I see come in search of pills and nothing more. Much of our culture has been “educated” through the media to the pill culture as well.
How would one “defrock” a culture? Or would one “defrock” the advertising campaigns?
Another metaphor coming here (a true story from a friend long ago and how she ran her personal life):
I know I’m on the attack with you but you’re a blond man. After all I was hurt more than once by a blond man. Many people I knew were hurt by blond men once. Those blond men were in positions of power and trust; arrogant, not listening. Some of us were hurt by blond men they didn’t even know very well. Why should any of us trust any blond man anywhere any time? I have every right to call you names because you’re a blond man. Any of us that were hurt or ever heard of anyone being hurt by blond men has the right to stay angry forever at every blond man. Nothing personal. You’re a blond man. You should know better than to be here. Even if I really whack you hard and hurt you, I have the right to. How else will I know if I can trust you?
How can I trust you? You’ve been taking some mighty broad punches for a man of the cloth. Are you “worth trusting”? Why and why not?
“If you need somebody you can trust, trust yourself.” Bob Dylan
Stephen,
Back to nazi rhetoric here in comment land?
Will this further peaceful discussion?
Will this lead us to solutions or simply through fuel on anger and kill thought?
What’s your goal for participating in the discussion here?
Chaplain? Man of God and peace?
Oops. Too many questions.
Much love,
Alice
Michelle,
I don’t prescribe simulants for anyone at any age despite the big demand (generated by marketing to the public) for them at all age groups.
I have been told repeatedly that “stimulants unmask early onset bipolar” by drug sales people (that the employer allows in) that corner me, by the clinical staff that have been to the drug lecture lunch, by required continuing medical “education”, by the PDR (before I realized it was a paid ad catelog). I never bought this. It’s speed, for goodness sake.
I have also been told by a drug rep over and over about a type of depression (that doesn’t exsist even in the DSM) that should be treated with her antipsychotics. I have had to be less than polite on more than one occasion to make her go away. High energy emotions power the drill. I remember the days, the person and the lies. I didn’t buy those either.
Try “generated by the pharmaceutical company marketing campaigns” in place of “by the psychiatric community”.
Thanks for the reminder to set the record straight.
Alice
If he just published the 20 year study this spring (2012?)this would have been too late for me to read in 1983, or 1993 or 2003. How would I, or anyone out there, have heard of this? I still hadn’t till the past couple of weeks.
You certainly are on to something important here:
“the journals etc. are controlled by Big Pharma and it decides which articles are going to be published so it’s very difficult (read impossible. The information legally belongs to the one that paid for the research) for people with information such as this to get their information out to the public. And the media won’t cover things properly, and even the NIMH didn’t mention Harrow’s studies.”
I learned back in training (believe it or not) that 1/3 get better, 1/3 stay the same and 1/3 get worse or people with the diagnosis of schizophrenia in a big long term study. This is old information. I heard thatbck then. You don’t even hear this older information in the ever increasing flurry of drug funded marketing “education”.
Stephen,
You rock. Thanks for choosing more safety for yourself, those around you and the planet.
I am in the process of re-making our life where all can be done without a car. It took a step outside the box (to another country) to see back inside the box (move the bucket around) and discover the truth of our car dependency in this country.
I was convinced there was no way to change, that an American life couldn’t be lived without a car. I think there are many places where this is true. I had gotten the clue it was wrong to drive so much but felt trapped and hopeless to do anything about it.
I’m down to 1-2 trips a week total for a family of four from two commuters and several trips a day running kids and getting groceries.
Like most American homes, the old place is in a car dependant area. We bought it 22 years ago while working under the influence of another bucket drill pattern; privacy, space, investing in an asset, the American dream of home owership, mortgage interest deductions, pressure from ever-increasing rents.
It’s possible to make decisions while under the influence of bucket drill patterns (cultural, marketing, educational) that don’t play out very well later.
Steve,
What a good project. Perhaps a student teaching device for trainees?
I liked to talk about how the “mechanism of action is unknown” and that the neurotransmittor theory is just that, a theory. Not a fact.
The people I have treated have come requesting drugs for the most part. I have been able to “unsell” the drugs to a few customer by saying these truths.
Keep thinking. Keep reading. Keep writing.
Thanks,
Alice
Nijnisky,
It’s good to hear you loggin in on this one.
Spending a life being angry at or hating anything can become a life defining “hole in the bucket”. My theory is that, with practice, you could make a “love” hole instead. It seems a more a pleasant one from inside, maybe from the outside. I’ll let you know how it goes.
I’ve been thinking more about the “bucket metaphor”. I notice a big “cultural” bucket sometimes. It seems there’s a lot of anger in our country. Maybe I’m wrong here.
Okay. No electrical or carpenter metaphors. Where did it come from anyway? Sorry.
Arta,
In a similar area: As a new medical student on my first clinical rotation, one of my first medical patients was a doctor/teacher from the medical school. He had terminal metastatic liver cancer. This really got my attention about mortality and banished any young illusions I may have had about fighting death and winning.
There’s nothing like experience. I have know several psychiatrists that were hospitalized for psychiatric reasons over the years. I can’t speak for the impact this must have had on their practice. I’ve also worked a lot in A and D treatment. The thought from those working in the A and D field is that I can’t “get it” till I develop an addiction and go through the recovery process. However, I have known very good counselors who were not in recovery themselves.
Thanks for your contribution to this discussion.
Best,
Alice
Anonymous,
I don’t belong to the APA. I gave up “psych journals” years ago because of the dense marketing. I have spent no time defending coercion. I am a psychiatrist.
I know you don’t mean me personally. You’ve told me this before (If this is the same Anonymous).
One role I’ve taken on here is helping folks remember that all psychiatrists are not cut from the same cookie cutter any more than all memebers of any other group.
Micheal,
Thanks for all your active participation in what is turning out to be a great conversation. I always appreciate hearing your point of view.
Alice
Doctor,
I read the “Deference” piece. Commented. Will get around to reading the other after done here in comment land.
So you were never a paid a member of a multidiscipinary treatment team? You spent all your career getting everyone off the evil drugs? You never saw any person’s life on medicine work better than without? Never wrote a diagnosis on a piece of paper for anyone, not even so they could get on disability?
I don’t quarrel with the battles you say you’ve fought and won. Good for you.
Tossing the phrase “drinking koolaid” around with regard to my professional life sounds like you may be referring to the old LSD experimentation days of psychology. Those days were gone by the time I came along
Vanessa,
My comment that it may take a few psychiatrists to help turn things around is not intended as snide. I intended to convey the idea that I believe the system is very broken and requires repair. I mean to imply with this statement that it behooves a movement looking to fix such large and broken things to get together all the help they can. Help could come from unexpected places. It could come from the ranks of those being vilified. I’m sorry that some people have been hurt through the actions of some psychiatrists. Some does not equal all.
I’m certain I didn’t call myself a “victim of a broken system”. Thanks. I’m pretty good at using my own words. Or perhaps I did and I forgot.
Blind eye? If there is no “alternate point of view” being presented then there is no blind eye. There is an assumption being made that information was available and in plain sight. “Koolaid” implies I was too drugged up something, acid?, to see something that was there to see. I suppose if you had been there with me in my training program, in my private practice, in the clinics where I worked you may be able to say this. Until then… I suppose you can say it all you want. It’s a “free country”*.
*(This is intended to be snide)
My biggest personal liability is my habit of trusting what people tell me, presuming good intentions and seeing the basic goodness of human spirit in everyone I contact.
Sometimes it lets me down. But not so often that I shall stop.
Here’s to the basic goodness of human spirit.
Alice
Emma,
Of course. I have always explained the risks and benefits to the best of my knowlege and the information available at the time.
Would you fault your carpenter for building a house that got eaten by termites because termite resistant materials came on the market later? Old electrical code is not safe by today’s standards. Old cars lack modern safety features. New information comes up in every field.
Dr. Cornwall,
I only assume you have a cognitive filter like the rest of us and maybe don’t see your own holes any better than the average bear. But I don’t know you so I could be wrong. It wouldn’t be the first time I was.
Tell us more about the job you worked at for thirty years where you knew psychiatrists. Did you have a separate solo private practice or were you a member of their treatment team? This could give me a bit more understanding of where you’re coming from and how you could have spent all those years not drinking koolaid.
I wonder if there were ever a psychiatrist who ever did an act of kindness and caring for a patient. Yes. There is evil afoot. But every psychiatrist is not always evil. All or none, black or white.
By the way, my mom used to put koolaid in my bottle as a baby. I liked the green.
All the best always. Me and you. We’re not so far apart as it may seem.
Vanessa,
Every step of the way I studied the research that was available to me. I was motivated by a desire to help others. I believed what I was taught because I had no reason to question. I had respectful relationships with the patients I treated. I offered choice and the information that I had to share. When I had questions about things, I shared them. When I came across Robert Whitaker’s book at the library, I read it. I went back to work and shared what I learned. I changed how I worked. Then I left. Now I write here to have a bigger impact.
When the information was available I read it and changed.
I think the part where I feel like I was given no choice is the part where the research was hidden, surpressed and lied about and I believed it. If I had the information back then that I have now, I would have made other choices. But I didn’t so I didn’t. Isn’t the “retrospectroscope” great?
I’m actually fine with the choices I’ve made over the years. Each one was made based on the best information I could get at the time. Who could do better? A psychic?
I’m advocating for a more tolerant and understanding attitude toward the psychiatric profession. I understand that a lot of folks have had bad experiences with psychiatrists. But I imagine there may be others that have been well-meaning and done the best anyone could do with the information available at the time. We need these people here in the discussion. When people shoot at every psychiatrist because they were hurt by one once, it can be counterproductive to the goal of making things better.
We are all in this together.
Thanks for reading and thinking and writing. We need you as well.
Alice
Steve,
Thanks for responding here. Good luck finding a job.
Unfortunatly I have seen no employer in decades that want more than a fast note and a quick prescription. Many of those jobs are going to lower priced NPs, PAs and (in 2 states and the military) psychologists. Interchangeable prescribing cogs is the deal in most medical systems. I have done my best to sneak in a bit of therapy between the closely counted “prescriber” minutes. I had a therapy based private practice for many years. You may have to make your own way if you want the practice of psychiatry to allow you to be more than a “prescriber”. There are also hourly contract jobs doing disability evaluations out there.
If you’ve been immune to the forces of marketing, you’re lucky. They must not allow drug reps and samples into the training program you’ve been at. Some do not. And those teachers must not have passed on what they “know”. And I imagine the APA no longer takes money from pharmceutical companies to fund presentations. I’m glad your bucket has remained unscathed. My has not.
Thanks for reading and commenting here. I’m glad to know that you’re reading outside the box. Welcome to MIA.
Arta,
Once upon a time back in the olden days these were taught in school. Interviewing classes with clinicians demonstrating with real volunteer patients. Observed and critiqued interviews and examinations of real live patients.Perhaps they still are. I haven’t been there in a long time.
Any younger docs out there to respond? I graduated in 1983. This was a big part of clinical training.
Alice
Nathan,
I don’t think that most psychiatrists have the new information. Some may read it. All don’t believe it. We are up against a wall of expensive “education” (marketing).
“Should people seeking support for distress trust psychiatrists/medicine?” I would not. And, yes, I am a doctor.
Thanks for asking hard questions. Sorry I don’t have answers to them all. What it will take for trust? Don’t know.
Cars. Number one cause of death in children in the US. They cannot be “safe drivers”. We’ve built a car dependent culture because of marketing that began with Henry Ford. Park your car one day in protest. Reduce your risk in a “dose dependant” way. No driver is “safe”.
Mark,
Thanks for taking the time to compose such a thoughtful and complex commentary. This is a good summry of the complex web of pressures and information we are all expected to navigate, especially those of us in medicine. Most doctors I know do want to help.
I have explained over and over to patients next to me in the office that, indeed, we are doing an experiment of “1”. Everything is not known. Much of what is believed could be disproven. These are theories, not facts. Most have been relieved. Some have been aghast.
This is not the sole territory of psychiatry, the unknown. All is not known.
There are also different standards of marketing pharmaceutical products in Europe as well as differnt standards for drug approval.
Lovely post.
Thanks for reading and writing.
Alice
Anon,
You assume that psychiatrists are a special and separate breed of humans that are not trapped with the same cognitive system as others.
Oh how I wish it were true that I had special powers to see past marketing and see information that’s been hidden form view. But it’s not.
What you were taught about depression and medicines is what I was taught is what everyone with a television was taught.
We are in the same boat here.
Being given the “right to take away liberty” can be addressed through the courts and elected officials. These laws are made our elected representatives. Remedy for these comes through those channels. The psychitrists, ED doctors, police, mental health professionals are legally bound to comply with the committemtn laws of the state. Laws can be changed.
Thanks for reading and commenting. Good discussion.
Alice
Diana,
The bucket is big and thick, isn’t it? I find it’s always easier to see when someone else’s is on crooked or has the holes in the wrong place than to see my own.
It will take all kinds of people working together to make substantial changes in the way we handle mental health in this country.
Yes. Some psychiatrists have done bad things.But perhaps you have not yet met every psychiatrist. Perhaps there are some who could make useful contributions here. It would be a shame to run them all off by assuming all are “dangerous”. Perhaps the one that spoke in BC? She changed her practice and teaches others. Could she join in here and help? How would she be recieved?
We are all more alike than different.
Thanks for reading. I’m glad to have your commentary here.
Alice
Vanessa,
Recruiting “sympathy” here is not a goal of mine.
Recruiting a more tolerant and open-minded approach to one another is. It will take all kinds of people, maybe even the occasional psychiatrist, to get this boat turned around.
If the goal is to re-make mental health care into something that works better, then more understanding of one another is in order.
“I have worked hard in life, personally and professionally, to listen to people, to connect with them, to investigate truth, to be honest about what I know and what I don’t. I work hard to look beyond the simple answer…”
This sounds like it could be a quote from how I’ve run my professional life. Perhaps we are more alike than you imagine. Turn the bucket and tilt it just a bit. You may see me, yet.;-)
Emma,
I did “know” the tools of my trade as well as anyone else practicing in the field did at the time. The great “retrospectroscope” has vision that no one, not even us God-like shrinks 😉 have. All of us humans, including psychiatrists, are limited to the information available at the time. All of us are “victims” of the same cognitive operating system being manipulated by media/marketing.
Subsuming the question IS my point. We are all more alike than different. Holding psychiatrists to standards of human cognition (like knowing information not available at the time and being immune to market-driven education) only gives us self-rightcheous reasons to shoot at them.
I don’t think it wise to drive every psychiatrist away from the discussion table. Occasionally one of us may want to help.
We’re all in this together. It will take all of us to make things better. Maybe even the occasional psychiatrist.
Jonathan,
Weeping eyes here. You heard the whole message. Thanks for reading.
Yes. Definite yes to society-sized bucket. Yikes. Don’t get me started on this one or I won’t get to the others who have been kind enough to read and respond.
None us us can take of the bucket completely. It is the operating system sorting for us. The best that can be done is to take the drills away from the pharmaceutical companies. Get the adds out of magazines, television and internet. Get the sweet drug reps and their “helpful information”, “patient training” and “free samples” out of all doctor offices. Unplug the drug cash.
No fast answers here. There is not way to change our heads till we change the messages.
Thanks from “still inside my bucket just with new vent holes”
Alice
Keith,
So many questions and so little time. Thanks for “getting” the metaphor.
How about we take the drill out of the hands of the drug companies for starters. Even New Zealand finally did. Outlaw marketing of drugs to the public. Get the “free” samples and drug reps out of every doctor training location. Big financial conflict of interest disclaimers on the DSM and PDR. “Diagnostic criteria brought to youby the makers of… )
I had worked for decades before I relaized the PDR is a paid drug marketing catalog. Doctos BUY this thing for the “i” things now.
Stephen,
Psychiatry training is DSM and drugs. Yup. That’s right. Education is funded by pharmaceautical company dollars. We’ve long ago voted out state funding of teaching hospitals. Does anyone else even remember when medical education was state funded and the trainees took care of the poor in exchange?
He that pays the piper gets to call the tune.
How can we expect that doctors in training, enslaved with education loans and exhausted by long hours, to know better and save us all? It’s a lot to expect of another person.
Perhaps they do try. Maybe they get swamped. I did.
Alice
John,
I am so happy that you got what I meant to say. Marketing is BIG and marquerades as education all the way down to infancy in our country. This is about MARKETING, not science.
One of the reasons I am writing here becasue I finally got it that there’s nothing I can do as an isolated doctor drowning in the trenches. The laptop is mightier…
This will take a lot of efforts by a lot of people from all walks of life to make better. We may even need to let some of the (I’ll whisper this) psychiatrists in on whats happening. We’re all in this together.
Stephen,
Somewhere in this particular doctor’s training and life experience he got the belief that he can do this. I wonder who drilled this hole in his belief system. Most docs behave better most of the time (I think).
I have also seen non-doctor yell, swear and throw things. Poor behavior comes from all kind of people.
Stanley,
I was taught that “all antidepressants work 80 percent of the time to relieve the symptoms of depression”. “Each medicine works on a different group of patients. So if the first doesn’t help, the second has a good chance of helping.”
I was taught that antidepressants had few and mild side-effects and no withdrawel.
Each new “indication” for them was presented as a gift to help suffering patients. ex.”SSRIs releive anxiety”
The information you refer to was not “out there” at the time. The above information I quote chapter and verse was repeated a thousand times in every professional conference and magazine and continuing education I attended. This drilled my bucket holes.
I’m not a math wizard. Never have been. But 80% is a lot of help isn’t it?
Thanks for reading and commenting.
Alice
Dr. Cornwall,
How often are these “clear warnings” a part of medical education? How often are they a part of psychiatry training. HOw often are they a part of every day life?
I have had to stumble upon each of these one by one over the years through wide personl reading.
Everyone of us is unknowingly programmed by those things we have the most exposure to, what’s right hammering the air in front of us. Repetition. For warnings to be warnings they have to be visible and audible.
Every single one us us has our own invisible “head-bucket” filter. All of us.
Alix,
Things are quite a lot the same here. Patients in hospital may be started on a lot of drugs all at once then discharged after a short stay. Someone else, frequently a primary care doc, has to deal with the consequences of sorting out if any of it is necessary or useful or safe. Hospital stays are short. There’s no feedback loop. Every year the list of “brand new to the patient” discharge medicines is larger; bigger dosages, more complex regimens. I have no idea where this “treatment approach” comes from. (Well, yes I do. Post graduate medical education is drug funded.)
The trouble with being really smart and educated is that it gives one a false sense of security in ones ability to see the good information from the hype. It doesn’t. It also leads your patients to believe you may be above it. You’re not.
Doctors are people too and live with the same cognitive processing system as everyone else. It’s just as easy to program by marketing. Maybe more so. How often does a lovely young drug rep drop in on you at work with chocolate, flattery and drug samples to “help” the poor? I guess it depends on where you work.
No one is immune.
Marcellas,
Thanks for your kind words. There will always be a place for therpaists who can teach folks how to manage their own thoughts, feelings and behaviors. Keep talking and teaching. You’re gentle teaching approach is right. Confrontation shuts people off to hearing. But you’re a CB therapist. You already know this.
I find ways to make contributions. Today, I write.
Best,
Alice
Stephen,
I agree. It’s easier to feel “they are me and I am them” when the “other” embodies good qualities or is the injured party.
There is a ho’o ponopono (Hawaiian) meditation that goes like this:
“I love you. I’m sorry. Please forgive me. Thank you.”
I read once of a psychologist that used this meditation/prayer in his mental health work in a state hospital. Any time he heard or read of bad things that happened, he took the responsibility on himself as the cause of the harm and did private meditations with this while holding the person in his mind and heart. He took the embodyment of “all one” all the way.
Thanks for reading, thinking and sharing here.
Alice
Demo,
In the highly unlikely event that I “ran the show” I would have everyone lay their anger to one side so that we can work together to make things better. Anger clouds thinking when we need clear thought. Anger divides us from ourselves and others when we require unity.
If I “ran the show”, respectful and loving conversation would be how all people everywhere communicated. It would be natural because everyone knew it to be right.
If I “ran the show” everyone would be invited to the table on equal footing and every voice would be heard and valued.
If I “ran the show” everyone would already know in a deep personal way that we are all one; hurting you is the same thing as hurting me. Loving you and loving me is the same thing.
Thanks for asking a great question. You could ask yourself this question as well and see what you’d come up with. I suspect we are surprisingly close together on this.
Laura,
Thanks for reminding us that every individual in “category” is not identical.
Thanks for supporting my writing here. I hope there’s room at the table for all kinds of thought and input. It’s going to take every resource we can come up with to find new and better ways.
There has to be room for psychiatrists (and everyone) to change how they think. Peaceful nd respectful conversation are essential ingredients for successful change.
Psychiatrists may even bring a good idea of their own from time to time. It may be that one or more of those less than welcoming psychiatrists you saw at the APA could become strong advocates of change. These things happen.
Kermit,
I’ve had to come back and read your post several times throughout the day. You’re saying so many things and saying them so well. Every paragraph or so I take a deep breath and say “Yeah. That’s right. I wish I’d said that.” You have an eloquent way with words.
Our reality is one big thing we all share but we don’t always see things in just the same way.
Psychiatrists (and anyone) who behaves in an autocratic or dismissive way pisses me off, too. If I am vulnerable to their power, this is especially touchy.
We have to keep talking. Ongoing communication can get through a lot. Letting anger run unchecked blocks clear thought and conversation.
“Reading “Mad” and “Anatomy” affirmed things I had suspected or felt to be true.” This could have come out of my own mouth.
We’re all in this together. It will take us all.
“It’s not over yet.” (Yeah. That’ right. I wish I’d said that.”)
Laura,
Thanks for your courage to stand and speak your truths in such a public (and unwelcoming) venue. I regret that there is not yet an open forum inside APA meetings for the voices of “patients” and former “patients”.
There is much that needs to be learned by doctors. Open minded listening by psychiatrists would be a good place to start. We psychiatrists are supposed to be specially trained with this skill. We are also supposed to be advocates for those we work with.
You’re right that the field of psychiatry has gotten extreme about labeling and pathologizing many aspects of the human condition and exsistence. So much of the labeling begins early in life, inside the education system, as your story so clearly reveals.
Your writing is eloquent, your story poignant and your energy powerful.
Keep up the good work. Keep writing and speaking. All ears are not deaf. I’m listening.
Kermit,
I, too, want this to be a safe forum for discussion. Everyone brings a unique and valuable point of view to the meeting table. An open and inclusive conversation is most likely to get us where we need to go to improve mental health (and medical) care.
Thanks again.
Alice
I’m sitting here re-reading your post to see what else I could add. There is nothing else. This is a lovely, poetic, understanding and compassionate post.
It’s clear to me that your work in mental health is rooted in an understanding of both the human condition and human communication
Best always,
Alice
Gail,
I know that you’re right. Psychiatric drugs can “deaden” emotions. I have heard this directly from people taking them. Many have stopped taking them because of this. Some have kept taking them because of this.
I also know that the “side-effects” can be miserable. I have heard this directly as well. Some “side-effects” do make a person want to stay in bed. Some “symptoms” do as well. This has always been tricky to sort out for me. I have to depend on the person I’m working help with for this.
I have also heard directly from patients that they were having “symptoms” that were intolerable that were better or gone with medicines. For some, the “side-effects” are easier to tolerate than the “symptoms” and they choose to take medicine.
I am certain that the focus of mental health care has gotten too narrow and “pill” focused. There are other known helpful approaches not in widespread use.
Thanks for reading and posting here. You make a valuable contribution to this discussion.
Alice
Note: I use quotation marks around the words “symptoms” and “side-effects” herein because there is disagreement about the definition of each. I use them here as a well-meaning doctor (me) who is willing to hear how the individual before me is defining them. These definitions vary with the person and over time.
Patti,
Thanks for this post. This warms my heart to hear. Having fun is, indeed, essential to life and living.
Thanks for reading and responding here.
Warm regards,
Alice
Joe,
Thanks for bringing your decades of experience to the table. I agree with what you’re saying here.
Arrogant people are everywhere. I’ve bumped into arrogance in every technical and professional field. Maybe there’s a higher percentage in medicine than in other fields. Maybe it’s more obvious and “in ones face” in medicine/mental health because it’s so personal and vulnerable to ask for medical and mental health help.
“One needs to respectfully enter into a dialogue with the “client”, “patient” and together explore what is wrong and what might help.” I like this a lot. Can I quote you some day when they let me teach student doctors? This is the basic tenant of approaching all patients in every field of medicine, likely for every healing/helping professional.
Thanks for putting in your point of view here.
Alice
Donna,
Hang in there. Your contributions here are essential to the mix. I wish I had some magic way to help things feel better all the way around.
Sorry.
All my best,
Alice
Kermit,
Thanks. I just got back from the woods a few minutes ago myself.I am also not on line every moment. I am happy to participate in whatever way possible to help the discussions be useful.
Thanks,
Alice
Jennifer,
I am truly blessed by all the vivid commentary and conversation here. What a great gift Robert Whitaker has given to us with this vehicle for communication and change.
Alix,
I agree with your statement that “no one should have this power over their fellow human beings”. I wish we lived in a culture where saying “sorry” wasn’t an automatic lawsuit liability. I have been advised by auto insurance folks (years before “no-fault” insurance) to never say “I’m sorry” at the scene of an accident, that this implies it was all my fault and I’m taking full legal and financial responsibility.
Here, I hope I can say “I’m sorry” without fear of legal retribution. When this is how I feel, I should be able to say it.
I’m very sorry you and your son have had such bad experiences in your search for help. I’m sorry that those involved can’t say “sorry” as well. I’m glad to hear things are better now for you both.
David,
You make good points. Perhaps I would amend the “words create the world” statement to “words create our waking world”. My unconcious, nonverbal and dream-self are the bubbling well from which my words arise.
I’m not meaning to be dismissive of reality. When I say “Words create the world” I hope I am suggesting we all use extreme caution and care when we select our words. Especially in this word-based communication on-line environment.
Nijinsky,
I’m not surprised to hear the effect of music on healing the brain. It has been known for a long time that music study makes for more complex brain development in kids. With the new-ish thought that brain developement and re-wiring goes on our whole life, it only follows that music will help this.
So you know what I mean about Rumi’s poetry, here is one translated by Coleman Barks. Rumi was a Sufi poet from the 1300’s.
Alice
One Song
“Move beyond any attachment to names
Every war and every conflict between human beings has occured because of some disagreement about names.
It’s such an unecessary foolishness because just beyond the arguing is a long table of companionship set and waiting for us to sit down.
What is praised is one, so the praise is one too, many jugs being poured into a huge basin.
All religions, all this singing one song.
The differences are just illusion and vanity.
Sunlight looks a little different on this wall than it does on that wall and a lot different on this other one, but it is still one light.
We have borrowed these clothes, these time-and-space personalities, from a light, and when we praise, we are pouring them back in.”
Donna,
I hit he “trash” button on the one from you to “Mary” (Marianne) from 7:36 pm today 5/5. I hope this is the one you meant. There’s an undo key but I don’t know how long it will work. Let me know If I got the wrong one. I’m not real sure how this works.
Best,
Alice
Donna,
I was warning people off way before that news came out. Nothing is absolutely “safe” for use during pregnancy. We just don’t know everything.
Alice
Marianne,
Thanks for talking about how psychiatrists could be “caught” in the system. They are. The risks for a psychiatrist certainly include the loss of livelihood for themselves and their family.
The hardest part for me has been the loss of my trust in myself and my own personal judgement. If I could be duped about safety and efficacy pharmaceautical products, what else could I be wrong about in my personal andprofessional life? This strikes at the base of personal identity and integrity.
What if all those years I believed I was doing good for my patients (excuse my archaic terminology) and I wasn’t? What if I had unwittingly being “doing harm?” This is a much bigger pain to face than not having a job. This is the complete loss of the foundations of my professional identity and internal sense of integrity.
This was a lot to have crash on my head at home alone one afternoon.
I know I will certainly take flack for saying that I understand and have sympathy for those doctors that don’t “getit” I even have sympathy for those that “get it” and then completely pack it all away under lock and key again deep inside. I have seen people in therapy with me do something quite like this to defend against the excruciating pain of awakening to painful truths of how they’ve been living. If they’ve been living that wrong then they’ve “wasted all those years”. Sometimes it’s easier to shut it all away and keep doing the same old pain you’re used than to face the big sudden pain of knowing.
I’m not saying this is “right” or condoning continued injury to their patients after they see what’s happening. I’m only suggesting that I can see things from their side.
Marianne,
Thanks for telling your personal story about your experiences with ECT and at the state hospital. I’m sorry you were put through these. Nineteen is so young. (Not that anyone should have to go through what you went through at any age). I look around and see 19 year olds. They are all so young and growing still and fragile.
Best,
Alice
Becky,
Thanks for telling us all how you feel. I’m sorry you’ve felt disrespected, disapproved and invalidated when you posted here before.
I know that anger is a natural consequence of being hurt. No one wants to be hurt again. Disrespect is hurtful. People who’s been hurt can still be pretty angry whether it was long ago or last week that they were hurt. Sometimes hurt, angry people hurt others.
This is a public forum. I’m new to this kind of posting as of April 19. There’s no way to guarentee that hurtful things will never be said. My understanding is that Bob Whitaker wants this to be as open as possible so that people can talk about what’s important and of concern to them (somebody correct me here).
I hope you can feel okay about joining the discussions. I would understand if you don’t. But please keep reading. You can still be in on the discussion even if you don’t wish to post.
I hope for peaceful discussions. I don’t want to run anyone off.
Last winter on a car trip with a 71 year old lady friend of mine in New Mexico we were stopped and questioned (not in a nice way) by armed uniformed men with dogs over an hour’s drive north of the border. There were banks of cameras on every highway there for “facial recognition” purposes and “border patrol” vehicles everywhere I looked.
We’re killing people on multiple fronts in the middle east with hightech computerized machines. Families with children are homeless. Bank owned houses are boarded up and empty. Food banks are doing a brisk business. People spend so much time indoors that, even in the deep south, there are epidemics of “pathologic” fractures due to lack of sun. The grocery stores are filled with “food products” that are an amalgam of high-fructose corn sweeteners, partially-hydrogenated seed oils and unpronounceable additives. I struggle to find safe food for my family. The polar ice caps melt and we each drive, one to a car.
Donna. There is so much so wrong with how we all live here in the “land of the free and the home of the brave”, that I fear this whole psychiatry thing, however big and important it is to all of us here, is the tip of another iceberg.
Sorry. I wish you were a “conspiracy nut”. This would make the situation very different.
I pray and meditate alot. Now I write. Words are important. Words can re-make the world.
Best,
Alice
Donna,
I warned people that these drugs are not studied in pregnancy and cannot be considered “safe” even when there are no birth defects known (yet).
Alice
Donna,
“Bwa ha ha”. My kid use this as a joking “evil laugh” in both talking and writing. Maybe it came from a Terry Pratchett book? I was tired after many hours of trying to keep up with the lovely flood of commentary. There is only one of me. It sort of slipped out and I left it.
Scott,
Sorry. There have been times in this discussion that I have felt endowed with powers that I lack.
“Cog” is how I’ve felt working in modern psychiatry outside my private office. And “care managers” of insurance corporations made it more and more so over time.
So much of American living is based on the premises of industrialization and the education process that goes with this. I think the roots of much that’s off-kilter about our culture dates back to the changes brought about by industrialization.
Scott,
I’ve noticed things you list in your post: bank fraud, wars, drugging of more and more people including infants now. The part I’m missing is how psychiatry is at the helm of all this.
Marianne,
There are a lot of smart, compassionate humans who believe in the genetic, biological and neurochemistry theories. I know and like many of these people. I’m sure there are other kind, smart, compassionate people who also believe in other theories that I don’t.
Personal tangent:
I’m comfortable not knowing for now. Since no one really knows, I guess I’d better be comfortable with it. I’m better and better with uncertainty in my life all the way around. Not needing to know feels liberating to me. I’m pretty clear on what and who I am right now. This feels liberating as well. I’m not waiting around for anyone else to define me or un-define me.
Marianne,
Thanks for the understanding and support. Thanks also for encouraging both my writing and sense of humor.
Your mention of my being educated under the neurotransmitter myth: I remember having so much trouble keeping them all straight. I went up to the medical school to a special grand rounds (many years ago) determined to learn them at last. I listened and took many notes from the several speakers. At the end I realized that if the first guy’s theories were right then the last guy’s had to be wrong. There were mutually exclusive parts in the theories. I wish I had those notes today.
I think that was the day I got clearer about the difference between theories and facts. I decided henceforth to tell people who wanted to talk neurochemistry with me that these are theories. There’s a line in the PDR with all the antidepressants I read to people alot: “the mechanism of action is unknown”.
Yes. I continued to prescribe these drugs. But I knew it was a theory and explained it as such. It was the best I could do at the time with the information I had. Back then I still was working from the literature that said anitdepressants worked and didn’t have withdrawel symptoms. It never occured to me to think these were also “theories”.
My mentor used to call this looking through “the retrospectroscope”. It makes things look different.
Best,
Donna,
Thanks for the positive and encouraging post.
Right now I’m writing as an alternative path to being a helping person on the planet. Perhaps down the road I will find a satisfying a place in direct patient care or consulting. Today, this is good enough for me.
Mariane,
Yikes. Thanks for sharing your personal experience in the “eugenics” area. Sorry. Especially since there is no known “gene” for schizoprenia. I have suggested people not get pregnant while taking medicines with known birth defect problems. I suppose my “wait till these drugs are not in your body” and “don’t get pregnant while you’re taking this” could be interpreted as “eugenics”.
Thanks for clarifying this to me. I understand things better when given clear, specific, current examples.
I’m sorry these things happened to you. I’m glad you’ve found your way into the clear.
Best,
Alice
Altostrata,
I bailed on the APA years ago. I joined and paid membership dues to the national and state groups because it was the only way to access affordable professional liability insurance. I quit when this quit. Perhaps I am unable to speak to the thoughts of “mainstream psychiatry” and the “APA”. Could we get some APA members to comment?
Alice
Nijinski,
Thanks for the reminder that we are “all one” ( “None of us are separate from each other.”).
Thanks also for the reminder that anger turns off perceptions. (“Sometimes, when you get riled up you can’t see the not so little “little” things that are there for you.”) Fear does this too.
I like this. “… experience what is designed (by nature) to help them let go of fears, find a true community and see there’s something there beyond it that does heal…”
Really great messages can drown and be lost among angry words.
While anger is an understandable reaction to wrong doings, correcting wrongs requires calm thoughts and careful actions, together.(see “all one” above.)
Words are important. How I handle my feelings is important.
The more I study the things you all say, the more I see how we are all alike.
And yes. Thank you Nijinsky. It is a “such beautiful day”, right at this moment.
anonymous, (lower case “a”)
I stand corrected.
You have more experience with committments that I do.
We all depend on each other’s experiences and knowledge to gain a more accurate world views.
Thanks,
Alice
David,
Thanks for reading and contributing here. Brainstorming is one of my favorite things to do. I enjoy generating options with other people. A very old book by Napoleon Hill he called this a “mastermind alliance”. You get together people with a variety of different skills and viewpoints and work together in a coopertive manner to come up with options and solutions. This is way better than any of one of us can do alone. I don’t agree with every single thing in his book and his language use is out of date but I like his phrase. The idea is powerful.
Alice
Alix,
Change has to come from within psychiatry.
And within the practice of medicine,
And within third party payment corporations,
And within the government (ie stopping drug ads),
And within drug companies,
And from MIA.
Best,
Alice
We are all in this together.
Josephene,
YAY? 🙂
This was unexpected to me.
Busy times to sort through the posts. There is but one of me.
I am having fun and learning. Both are good things in my book.
Alice
“yep irrational sounding beliefs such as these drugs will heal you, negative self-talk such as these drugs will heal you, reactions to trauma such as these drugs will heal you… just fill in the blank
attention deficit such as “these drugs will heal you.”
Bingo. You’ve got it. These “beliefs and thoughts” are irrational and negative and block healing. Thes have been my arguments for years when I’ve been saying “no” to the drugs 9 out of ten patients that talk to me want.
Anonymous,
It is the judge who makes this final decision in Oregon, not a psychiatrist. The “holds” (brief) are written by two police officers OR two mental health professionals OR (I think) by two physicians in a hospital(ED docs). I do not have the legal power to wrote a “hold” in Oregon. A judge makes the final decision.
Involutary committment laws vary from state to state and are crafted by politicians. They change over time. Read up on what they are where you live.
Donna,
Thanks for catching us up on the political end of things. I have not kept up with them. We all need to know things from every angle to get clear about what’s been happening here to us all.
Forgive me for repeating a post to David here. I think your question bumps up against these same thoughts. As you will see, nurses and naturopaths (and everyone else) already presecribe psychiatric drugs in Oregon. Also, psychiatrists are not neurologists.
Of course psychiatry is obsolete. It has been (at least) since we allowed our profession to be diminished into “prescriber” roles. Read the following.
Thanks for your post.
Alice
David,
I’m not so sure it’s salvagable either. I thought about this while I was cooking dinner for my family tonight. I had one of those “a ha” moments. Probably I’d better write an article about it so the word gets to more people. Others can think about this idea of mine, too. This is a tangent off your topic but I hope worth reading.
More and more psychiatric prescribing isn’t done by psychiatrists at all. (What percentage of psychiatric prescriptions are written by psychiatrists?) Along with the ramped up market demand (through direct public marketing) there has been a long term marketing of the idea of a “psychiatrist shortage”.
I’ve been hearing about this “psychiatrist shortage” as part of the “doctor shortage” since the 1980′s. This was the rationale for licensing nurses to be “prescribers” in Oregon. One post yesterday (Huffman) mentioned that they use PAs and NPs because they cost half as much as psychiatrists and that is all they want us all for, “prescribing”. I knew that. Most “prescribing” in Portland community mental health is done by NPs and PAs.
In Oregon, under funding pressures, we have methodically shifted mental health “prescribing” to primary care docs and pediatricians, NPs. PAs and now, last year, Naturopaths were approved and licensed by the state of Oregon. Social workers also lobbied for “prescribing” in Oregon a couple of years ago.
Psychologists in two states and the military now can pescribe psychiatric drugs. It could be a good piece of research to find out how much of the funding for these initiatives were drug company based. I heard at the time that those helpful pharmaceutical companies helped us out with our psychiatrist “shortage” by lobbying for several other professional classes to be able to “prescribe”. Just to help us overworked psychiatists, you know.
At this point it’s absolutely fine if psychistrists are scapegoated for all the hidden information about drugs, the manipulation of the diagnostic criteria, the artificial “consumer” market for the products.
At this point, from a pharmaceutical market perspective, psychiatrists are completely disposable. While we sit here on MIA and shoot at psychiatrists, the pharmaceautical companies can laugh all the way to the bank. They have new conveyances for their products.
Yikes. I think I’ve frightened myself with this one.
Donna,
You’ve bumped up against an interesting point. “Mainstream” psychiatry” is not run by psychiatrists. The “research” to generate the DSM (also the PDR of ALL medicines) is funded by pharmaceautical money to promote their products.
The laws, made by judges and politicians, decide who is in jail or prison. Not “mainstream” psychiatry. However much there have been times that I would have liked to “put away” an abuser, society has never given me this power.
Rest assured, however, that those incarcerated and on release from prisons and jails recieve their (I hate to use this phrase) “fair share” of psychiatric drugs. This is enforced by judges and police and funded by our tax dollars.
I think you may be granting ordinary psychiatrists more power than we have. Certainly this is more power than I have ever had as a pychiatrist.
I’m finding, here, that I have more power as a writer.
Thanks be to Bob Whitaker for bringing us all together here.
Markps2,
You are right about pharmaceutical corporations making efforts to expand their markets. This is the prime directive of immortal capitalistic corporations. In this country we have given them the same rights as live humans. I find this whole idea frightening. These same corporations will be around to “make profits” from my great grandchildren, no matter what we do today.
You have begun to see through the veils of deception a bit.
I would ask you to step back and broaden your perspective with regard to ALL pharmaceutical products. You may see that there are more people in our boat than you ever imagined.
Think about cholesterol lowering drugs for a moment. These are widely prescibed drugs making recent inroads into off label pediatric markets. They have enormous marketing campaigns that lead us to believe elevated blood cholesterol is a medical disease.
Where is the “endpoint” or the “true disease”? These drugs(All but one with other problems) lower cholesterol levels by poisoning every mitochondria in the body and brain. We depend on mitochondrial function for health. In short term studies (the ones we’ve seen) these drugs reduced the incidence of repeat heart attacks in a few men during a three month trial. The side effects include destruction of muscle tissue that can cause siezures and death, constant aching exhaustion and trouble thinking. There has been no evidence that these should ever been given to women, men or kids that have no history of heart attack.
So. I have another blog here to get the word out to folks not caught up in this conversation. Right?
This is a big boat we are in. Way bigger than psychiatry. Lets all work together.
Alice
Donna,
These are great ideas. This is quite a lot like my focus in my old private office practice. I was alternative before alternative was cool ;-). I did a lot of therapy work. I’ve been active in learning about health and nutrition and “prescribed” nutrition, exercise, socialization, education, life-changes etc. I used my prescription pads for “do this week” lists.
I did cash business as much as I could, kept my rates low and gave 20% of my gross back in sliding fee treatment. Dare I use the “F” word again in public with regard to psychiatric work? I had fun. (humor)
The economics of a part-time practice like this didn’t pan out for me. Doctor liability insurance rates were skyrocketing ($10,000 a year with plans to double). Rent and utilities. Accountant. Taxes. The math just didn’t work out. I worked without paying me for a long time then closed up shop. Too bad.
I love to write. I’m doing a lot of it. It’s fun. Words are really really important. They create the world.
I’m not taking the angry posts “personally”. I’m pretty solid in knowing who and what I’m about so I know it’s not me folks are mad at. I know bad things have happened. I know bad things still happen. I’m sorry about all of that.
I’m also hopeful people can move past anger and fighting so we can work things out and make the world a better place. Maybe one small corner over here where we are is a place we could start with.
David,
My concern is that by excluding all psychiatrists from a discussion of remaking mental health care you may be losing some good thinkers, some good insights, some good “insider” information that could be useful, some good-hearted and dedicated souls. This would be a loss.
I’m not certain yet where I fit in the big picture of the mental health world of the future, if at all. I have stepped off the train to think.
David,
I’m not so sure it’s salvagable either. I thought about this while I was cooking dinner for my family tonight. I had one of those “a ha” moments. Probably I’d better write an article about it so the word gets to more people. Others can think about this idea of mine, too. This is a tangent off your topic but I hope worth reading.
More and more psychiatric prescribing isn’t done by psychiatrists at all. (What percentage of psychiatric prescriptions are written by psychiatrists?) Along with the ramped up market demand (through direct public marketing) there has been a long term marketing of the idea of a “psychiatrist shortage”.
I’ve been hearing about this “psychiatrist shortage” as part of the “doctor shortage” since the 1980’s. This was the rationale for licensing nurses to be “prescribers” in Oregon. One post yesterday (Huffman) mentioned that they use PAs and NPs because they cost half as much as psychiatrists and that is all they want us all for, “prescribing”. I knew that. Most “prescribing” in Portland community mental health is done by NPs and PAs.
In Oregon, under funding pressures, we have methodically shifted mental health “prescribing” to primary care docs and pediatricians, NPs. PAs and now, last year, Naturopaths were approved and licensed by the state of Oregon. Social workers also lobbied for “prescribing” in Oregon a couple of years ago.
Psychologists in two states and the military now can pescribe psychiatric drugs. It could be a good piece of research to find out how much of the funding for these initiatives were drug company based. I heard at the time that those helpful pharmaceutical companies helped us out with our psychiatrist “shortage” by lobbying for several other professional classes to be able to “prescribe”. Just to help us overworked psychiatists, you know.
At this point it’s absolutely fine if psychistrists are scapegoated for all the hidden information about drugs, the manipulation of the diagnostic criteria, the artificial “consumer” market for the products.
At this point, from a pharmaceutical market perspective, psychiatrists are completely disposable. While we sit here on MIA and shoot at psychiatrists, the pharmaceautical companies can laugh all the way to the bank. They have new conveyances for their products.
Yikes. I think I’ve frightened myself with this one.
David,
Thanks for your post. I, too, may have missed a few here. I am certainly behind the curve a couple of hours.
I went to medical school, licensed to be a doctor, started in neurology, completed the “GP” (general practice) training then trained as psychiarist. I was a doctor before I became a psychiatrist and am still one now. If I completed psychoanalytic training I would be a psychoanalist (sp?) and but still would be a doctor.
Alice
Did you know that as a writer here I have “edit” and “delete” buttons (plus other buttons of mass destruction) here on my dashboard and could do that to anyone’s post I choose? I feel like writing “bwa ha ha” here but I fear no one would understand the joke. I’m a bit worn out by the mayhem (lively discussions) of the last day but am still having fun here with you all. Together having fun, I hope.
I mean really. I’m the “fox” and you guys are the “hens”? Guys. “flying feathers and more dead poultry”? I love your use of metaphor. Visually evocative. There are a lot of psychiatrists Mr. Whitaker could have invited in. But he asked me. I suppose he could also “un” ask me.
I have only deleted one response of another person (My husband’s several days ago, he asked me to.). I suppose I have the power to moniter and enforce the discussion if I wanted till someone took away my buttons.
I like the free flow of ideas. I like it when I see folks sticking up for themselves and one another. I even like it when somebody sticks up for me. I like finding agreement. I like the energy. This energy pointed in a useful positive directions? Who knows where it could go? We could fix things, come up with better ideas and see them happen.
As I see it, we’re all in this boat together. We may as well take down part of the fence. Okay. We can leave up your part for a while longer. (Again. I’m risking humor here.) Humor is hard on the internet. It works better with voice and facial gestures.
Stephen,
Thanks for reminding us all that this information was hidden from all of us. I had no idea at the time either. It has been assumed by a some that I (we psychiatrists) must to have known what was going on. Nope. Known “at least by the drug companies” is the key phrase.
This is why I agreed to write for MIA when I was asked.
Nijinsky,
This is a longer and more complicated answer than fits in this moment. But consider that much of the answer will be viewed through my “retrospectroscope” which changes how things look. All decisions are time dependent.
Best,
Alice
I had (past tense) a friend long ago who used to tell me “I don’t like doctor-types” and “I don’t like psychiatrist-types and then explain that present company (me) was excluded. He also made derogatory generalizations about “women” (not me, I was “different”). He also said things about a racial minority group and “excluded” another friend of mine . It all felt the same to me.
Alice
Nijinsky,
I agree with your statement that “putting them on psychiatric drugs because of their behavior will (not) help them understand themselves”.
I have always had concerns that addicting drugs are addicting drugs, however nicely they’re packaged.
In my primarily psychotherapy based private practice for 13 years, I said “no” giving to a lot of medicines because I knew they would block the work of self understanding.
Be careful. We may have to agree.;-)
I can’t keep up with you on the historic CIA and things. It sounds like you’ve studied it all a great deal more than I.
Perhaps I was unclear about “fun” I had and could have been more specific. It didn’t occur to me that anyone would assume I was “having fun” at the expense of others. “Fun”, to me, in a group environment includes the others in the group. On that unit in 1983 we had a pool table. I would shoot pool with the people (back then they were still “patients” on an “inpatient” unit) and talk with them at lunch.It was a delight to get to know them this way. Relaxed. I certainly remember we all seemed to be havng fun. Perhaps I am a bit dense.
But I am a doctor of medicine. I did the required training as a GP (general practitioner) back then, treated peoples’ diabetes and high blood pressure and stitched folks up in the ED. Why would I pretend not to be what I am beacuse I later recieved additional training as a psychiatrist? Again. I may be a bit dense here. I can’t stop being a doctor. It’s what I am. Kind of like a nurse is still a nurse even after retirement and a teacher is still a teacher and an accountant is an accountant. I know a retired primary care doctor. He’s still a doctor.
I get it that the “pill” model of all medical care is flawed and misleading. I include the “pill” model in internal medicine as well. Since I am a doctor, I do not limit my thought to mental health. I’m thinking of a much bigger picture here.
Scott,
Psychiatric drugs are very prevalent in the USA today. It seems that everyone (across every socio-economic and racial boundary) is taking mood stabilizers, mood elevators and anti-anxiety pills. Some of these drugs have sexaul side effects. If this is a eugenics plot, it’s doing a lousy job. (insert irony here).
The prescribing of antihypertensives (Blood pressure medicines) is very prevalent. Some of them cause sexual side-effects. Perhaps the primary care docs are in on it, too? (insert more irony here).
If we want to make better options to reduce suffering and have people live happier healthier lives, we need all of us together: you, me, families, neighbors. We may even need psychiatrists. Well maybe I shouldn’t go that far (insert third bit of irony here).
Mary,
The state laws vary considerably with regard to committments and forcing people to take medicines against their will. The place I have seen mandated long term outpatient psychiatric medications has been in the PSRB (psychiatric security review board) situation where a person committed crimes for which they were convicted. In this case, medicine is part of the their sentencing.
The majority of inpatient and outpatient medications are taken on a voluntary basis.
Yes. All medicines, including psychiatric ones, are released after short research protocols. No one knows the long term effects when they are released. I explain this to people that come in wanting the new drug they saw on television. I recommend, if they must take medicine, to use one that’s been around for years so we have a better idea what to expect from it.
Donna,
Perhaps you could give specific examples of how “eugenics” is practiced by every day psychiatrists (like me) today. We would be the ones doing it, if it were happening. I’m still confused. Perhaps a clear definition of what you mean by eugenics would help clarify the discussion.
When blanket statements are made concerning any population or group, they mean every member in it. I’m a psychiatrist. It’s personal. If I began making blanket statements about a group of(for example) “teachers” or “therapist” or “baseball players” or “mothers” or “Italians” or “patients” it could rapidly become very personal if you were a member of that group.
One cannot say “psychiatrists” without including me. I am a real person with a face and a name. I am also a psychiatrist.
This is an important issue. Thanks for pursuing it with such vigor.
Alice
Marian,
Of course, I’m all of those things inside of different relationships with different people at different times. All of us are. When friends and family eat my bread they are appreciating my individual skills as a baker. They also know I’m a doctor. Being a doctor doesn’t make my bread any better or worse. But I am still a doctor.
I have no answer ot your question of why people would believe that a medical degree qualifies someone to help with emotional distress. This is a great question for which I have no answer. You may wish to pose this question to those people holding this belief. There are certainly many others better qualified and trained to help with emotional distress. That said, any individual doctor could have exceptional skills to help with emotional distress.
Rossa, You’re right that biologic psychiatry doesn’t teach better coping skills.
In additon to “failure of the family” you mention, I would broaden the roots of distress and suffering to include cultural ones. The nuclear family bears a pretty heavy burden in psychological theories of mental health. Although our fragmented nuclear are the closest personal relationships we have, our society is increasingly isolated and lacking in long term community relationships. This puts the squeeze on what’s left of family to cope with a lot lone. I’m not surprised they fail.
Thanks for posting your personal story out here. This takes courage.
Alice
Marian,
I agree that no one needs a medical degree to help someone make sense of their experience. I couldn’t have said this better myself.
Of course my medical degree is not the only thing that has given me the skills I have used to help people. Much reading, experince, introspection, mentoring and being mentored has gone into my particular skill set. Other things as well. Medical school and residency training have only been parts of that.
I assert that all physicians and all psychiatrists are not interchangeable parts any more than all social workers or all poets are the same. Although I am a physician, I am (personally) good at things besides writing presciptions.
But I am a physician. It’s what I am.
Thanks,
Alice
Nijinsky,
Thanks for you kind and supportive post to Philroy. These are good suggestions to look at. You’re right. Everything doesn’t help everyone. It’s good to have a lot of thins that help.
Alice
Nijinsky,
I don’t know much about “eugenics” except what I read on wikipedia last night. It referred to making changes in the genetic content of a population of people by selective breeding and culling. (This is not a quote but only my understanding by a quick read)
The thought of eugenics horrifies me. This is emotionally evocative language but I’m not sure it’s an accurate use of the term in this situation. I don’t see how your earlier post, repeated here, supports the accusations of “eugenics” toward psychiatry.
Greeney,
Thanks for you kind reply to Philroy.
I agree that we have left behind treatment and healing modalities that work well in the rush for more pills.
You make good suggestions.
Alice
Nijinsky,
You may not want to hear this, but I agree with much that you say in this one.
Labeling “abnormal behavior” (outside of the cultural “norm”) “abnormal biology” is far fetched. We also call unwanted behavior “abnormal” even when it is perfectly normal and understandable in the situation. Here are a couple of examples: little kids running around a lot when they’re forced to stay indoors all day every day in school, babies crying (see MIA article on the pathologizing of infancy) or reactions to traumas. We are quick, in this country AND when you can find a source of funding, to drug these behaviors rather than sort them out. Without the funding source, no drugs.
It’s easier for me to hear and understand your messages when the you use language that is less “strong” (This may not be the right word exactly for what I mean). Of course, how you speak is up to you. I understand you have strong feelings.
I kind of like it when we agree a little bit once in a while. It’s fun.;-)
Best,
Alice
Philroy,
Yes. The Soteria model does focus on intervention in psychosis. It does a good job, too. Traditionally (this means,I was taught this long ago) the symptoms of psychosis have not been thought to respond to psychotherapy. Soteria is one model that disproves this theory to me.
I think the Soteria model could be used more widely for a broader range of distress.I think the lines between what we psychiatrists refer to as “psychosis” and things such as irrational-sounding beliefs, negative self-talk and reactions to trauma is a lot wider and less clear than we sometimes suppose. Soteria’s community and relationship aproach reminds me of ho’oh ponopono, a traditional community healing process I have read about in Hawaii. I don’t know if it is used any more there.
Duane,
Thanks for being so quick to offer Philroy support. You are a kind fellow. Your warmth is great to have here. You are also good with the resources.
Best,
Alice
Nijinsky,
Sorry my article didn’t work for you. I suppose I could have written a great deal longer article and clipped quotes from the replies to posts and other blogs to substantiate my observations. Perhaps this would have worked better. But it seems that way would have been more personally intrusive and considerably longer.
Since I have heard talk of nazis and eugenics have been tossed around in reference to psychiatrists, I wanted to bring it up for a more open discussion. Since psychiatrists in general are a customary target here (and I am one), this also seemed a good discussion to open up.
The two points I had hoped to make were:
I think it was okay to have fun at work even if I’m a psychiatrist.
and
The labels you give people matter.
The first point, I will probably not convince you of.
The second point, I suspect you already knew. No one misses being “mis-labeled” in this life.
This is okay with me. We don’t have to agree about everything. Concentration camp metaphors for psychiatric care don’t work for me. Maybe I missed the boat on the iceberg metaphor with you.
Words matter.
Thanks for bringing your words here,
Alice
Philroy,
Thanks for your deeply personal post. It takes great courage to reveal your personal story here. You could get some flack for this. I know you know that’s possible.
I know you are not the only one who struggles. This story coming from you is a powerful way to add balance to our discussion here.
I would like there to be other refuge options as well. We’ll all have to put our heads together and design some. Dr. Mosher’s Soteria ideas are good.
If we’re going to make a difference in the direction that psychiatry takes in the future, it will take all of us together. Posts like your help.
Donna,
I certainly know you are not attacking me personally. I have also been distressed when some people that have done harmful things to others are released from the criminal justice system or the courts.
Thanks for your post,
Alice
Donna,
Please. I’m slow. Can you (or someone) explain the “eugenics” accusations being targeted at the psychiatric profession to me? I’m a psychiatrist. I’m not sure what it is I’m supposed to have done that could be considered the genetic manipulation of the human population to improve the race (I looked it up on wikipedia just now).
Are there ways in which you personally have been “specifically targeted” by a psychiatrist or are you referring to someone else you know?
Thanks for your participation in this lively discussion.
Warm regards,
Alice
Stanley,
You sound like you are familiar with the laws concerning involuntary committement. They vary from state to state a bit. In Oregon you have to be dangerous to yourself or others and have a mental illness. Dangerous last week or yesterday or might be dangerous next week won’t do it. This has to be an active and current threat.
Dangerous behavior alone may route you to the jail system.
It’s rather difficult to gain access to a hospital bed in Portland, Oregon if you want to go (Yes, some do). They have reevaluate holds quickly to determine if the criteria are still met ie if no longer dangerous, the person is released.
In Louisiana (long ago, may be out of date) there was a third criteria called “gravely disabled” as well. This isn’t used in Oregon.
Hey robertr,
Sorry to be slow to get back with you here. “Unexpected” level of responses and I was out all day.
You sound like a guy with lots of experience and knowledge about the laws and how things work. Thanks for offering your expertise here.
Best,
Alice
Where do you work, how did you take up with such a bunch and stay for all these years? Not fun.
I have not been “deferred to” because I was a doctor at work since 1983 when the first task of my licensed medical career (on a medical ward) of “declaring” a poor soul, “dead”. The nurse asked me “Is he dead, Doctor?” and waited. She knew this to be the case as well as me. State law mandated that I was the one legally bound to “declare” this to be the truth. By law, he was not dead till I said so and the hurse wrote the time on the chart.
Or maybe I’m so trained by the “meritocracy” that it is invisible to me. One cannot be an accurate anthropologist inside one’s own culture.
I have had to make the “final call” on some treatment decisions (usually medicines) in a treatment team setting. Most treatment decisions are not mine at all. Half the patients that come there never meet me. Most treatment decisions are agreed upon among the patient and staff.
Heck, there’s only one guy there that will bring me a cup of coffee (thanks for the coffee, if you’re reading this) and, even then, I have to say please (humor).
Michael,
I came home this afternoon to 67 replies from this morning’s post. “Unexpected” again. A bit much to sort through in one go but I’m having fun.
I am also mostly on first names with people after those first polite introductions. I haven’t spent much time working in years where I see the same person twice. We are always on the polite first meeting terms. I introduce myself as “Dr. Keys” and invite them to call me “Alice” if they prefer.
I’m old school. They are legally my patients and I have legal and moral responsibilities to them because of this from the moment I agree to treat them. Perhaps I should have gone to law school. 🙂
I am dedicated to working to turn this boat around. Glad you’re on board. We can only do this together.
Relationships and communication are important. The most important healing tool, relationship, in psychiatry (and all of medicine) has been diminished by the growing focus on pills and by the takeover of the “doctor-patient realtionship” by insurance “care managers”.
Thanks for your thoughtful and caring response,
Alice
Anonymous,
I’m not certain what an “outpatient committment” is? Committment laws vary from state to state. I do not sign committments. One of the crisis clinic’s goal where I have worked is to prevent hospitlizations.
Marian,
I am mom, a writer, a teacher, a baker, a walker, a gardener, a friend, a wife. But people consult me at work because I’m a doctor. It’s what I am.
I also (when I had an office pracice) did much work with cognitive and behavior therapy, relationship therapy, gestalt therapy, hypnotherapy, family therapy. I have always personally preferred the non-pill treatment approaches. But I’m still a physician. Even if I never write another prescription in my life, even if I let my license lapse, even if I never treat another patient I am still a doctor.
Nijinsky,
The “happy” time I referred that made me turn the corner into psychiatry was 6 months in 1983. The majority of the people there were voluntary at the time.I was also happy for the two years (87-89) I worked on another locked unit. Again, most were voluntary back. Things have changed. I’ve spent my outpatient and crisis work helping people avoid hospitals.
I did not refer to reactions as “unjust”, simply as unexpected to me. I thought it could mean there were more strong feelings that I wasn’t hearing expressed, the “under water” part of an iceberg metaphor. I am, you see, a member of the group of humans called psychiatrists. When the entire group is blasted, it hits me too.
Dr. Cornwall,
Do you have your favorite replacement word then? Mostly in the office I say “Mrs. Jones” or “Mike”, depending on our agreement. I have yet to say “mental patient Mike”. I think of them as “my patient” not “my mental patient”.
Alice
Alix,
Thanks for getting what I said. I just got home to look at the posts. I had not idea there would beso much commentary. I guess I’m old fashioned, too.
Alice
Sandy,
I have tapered people of medicines and lowered medicine for many years in private practice and in community mental health. Polypharmacy and high doses has always frightened me.
Thanks,
Alice
Mary,
It seems a shame to me that human suffering and findinf ways to alleviate human suffering are not in the equation when public policies are debated. It does seem to always boil down to money.
Marian,
This question ventures into the realm of philosophy for me. All human condition is “life circumstance”. If there is such a thing (I have not seen it proven) as spontaneously, random “imbalanced brain chemistry”, then it, too, is a “life circumstance”. Therefore, as Buddha once put it so nicely, “Life is suffering.”
If you’re asking if I, personally, am of the opinion that there are “chemical imbalances in the brain” that just sort of happen and that can only be corrected by taking more chemicals, I would say “no”.
Since there is no one “dependent” upon me as their physician at this time, may I assume I am not responsible for “driving people mad” (as you put it) today.
I love these discussions. They keep me thinking.
Alice
Duane,
Bob Nikkel and Gina Nikkel (both blog here) have a non-profit to create a find a new mainstream for mental health care. Are you any good at grant writing?
Alice
Altostrata,
Yup. We’re talking past each other. I suggest talking to the doctor who is prescribing the medicines as a FIRST move. If you have a relationship with a doctor, even if she doesn’t end up doing what you want, she needs to know what you’re doing.
My advise as a FIRST step stands. Always START with the person you have a treatment relationship with. Then, if you have to cast a wider net to do what you need to do, keep her in the loop. Or change doctors.
Altostrata,
You are exactly right. I know there aren’t many. There aren’t many psychiatrists available in Portland to do anything, medicines or not. I still get calls and my private practice has been closed for years. Read my reply to Katie today. I think I addressed how the situation panned out for me with an office practice.
When someone says they’re taking medicines, I assume that someone is prescribing them. This is the first stop when looking for a taper off. Bring friend and family to the discussion. Have questions written out.
I tip toe a bit here in the reply area. I don’t want to accidently be seen as a doctor who is providing individual medical treatment advice to someone I’ve never met. There are so many ways that could go really wrong.
Yes. You’re right. The wrong assumption is sometimes made when “discontinuation” or “withdrawel” symptoms occur that this means you “need” to keep taking the pills or that “your illness” is back. It’s good to have a clear list of symptoms before starting a taper. This requires self knowledge and awareness.
There are not enough resources yet to do the jobs that need to be done.
Duane,
Thanks for writing more about Soteria and Dr. Mosher.
In our culture, we are starved for human contact and communication. Mother Teresa said it righter than I ever could.
Check out Bob Nikkel’s post from yesterday. He gave me a better understanding of how community mental health was cornered into the medical model (at least in Oregon) through the changing funding streams. It has always pinched me to be cast in the role of just a “prescriber” when I have other skills and gifts.
Thanks again. It’s always a pleasure to hear from you.
Alice
I am grateful that you’ve made your years of experience and expertise available to readers on MIA.
I had no idea that the Federal financial pressures were driving the “medicalization” of mental health. I experience this as the pressure to be a “prescriber” and nothing more in community mental health. Folks act as if I have nothing else to offer; a prescription and a signature on state and federal paperwork.
It’s easy to make a “medically necessary” case for getting paid for your work when precription medicines are involved. Every person recieving a doctor’s prescription would therefore be eligible for funding to provide for that care.
What I see as the devolution of the practice of psychiatry to a presciption and signature machine has real economic forces behind it.
This approach to funding mental health services has brought us to the point where not much is funded except prescription writing. So not much else happens. The spread-sheet economics mentality of medical care dictates that if it’s not reimbursed, it can’t happen.
Thanks for a real “A HA” moment for me this morning.Keep writing.
Good morning Alix,
Thanks for your reminders. Help and support are a critical ingredients in the process of moving toward a life with less or no psychiatric medicines. This can be a longer process than anyone would like. The repercussions of both having taken medicines and also of stopping them cannnot be forseen for an individual. They must be watched for. Make a clear plan. Take notes as you go. Moving too fast can backfire. Everyone’s process will be different.
Having made this cautionary statement, I have also known people who lowered and stopped medicines and felt better than they had in years. I met one young woman who was taking six different psychiatic medicines. We weaned down to just one pill a day over a year. She had not been on them long. She had an incredibly good support system. Years later, I heard back from her that she had even stopped the last one. She had made good structural changes in her life that made this possible and maintained her fine support network.
Duane,
I would like to see Soteria and peer-run options everywhere so folks can stay home or close to home and still get help.The internet is good but there’s nothing like looking in another human face.
Duane,
You seem passionate and helpful. I appreciate all your support and energy. I am definitely the “new kid” around here on MIA. Others, like yourself, have been collecting resources and spreading the word for a while now.
I think I know what you mean about being from “hill country”. I grew up on a small family farm in Ohio. “You can take the girl out of the farm, but not the farm out of the girl”.
I’m over here visualizing for a new future, too. There are days I can think bigger and days I have to keep my focus small so as not to overwhelm myself.
We’re planting trees here in addition to the one season crops. Some will bear fruit sooner than others.
Duane,
Absolutely. Building support networks will work for a lot. So much of our culture is without these. We are left living life as “individuals”.There is no precedent in the history of the world for the level of social isolation and lack of extended family realtionships before about 150 years ago with the advent of the industrial revolution. Social isolation is now the every day “norm” but not “normal”. A life of isolation is neither biologically or psychologically sound for humans. Of course, there are introverts (up to half the population) who function better with contemplative time alone. I don’t suggest everyone has to be “out there” all the time. But people do need relationships to thrive.
One of the reasons that community mental health centers work less and less well has been the draining away of support networks they once provided; art groups, socializations centers, classes, etc. There are people now who’s only contact with community mental health center is occasional 15 minute “meds only” contact with a “prescriber”. It’s difficult to imagine how this can benefit. This is expecting prescription to do an awful lot. Relationships heal and support.
I like the Soteria House model of Dr. L Mosher as one approach to helping people in crisis situations. I’m sure there are experts in this area that can speak more fully to this topic.
Emily,
You are in the driver’s seat of your life. You are the only expert on you. Get as much advise and information as you can from every source you can and then decide how you want to do things. Watch the life timing. I’m sorry I can’t give you specific advice for your personal situation.
If you(or anyone) wants to taper down or off medicines, it would be best to do this in the context of a relationship with someone who knows you well that you trust. It’s good to have a support system in place. You and this treatment provider would need to make a clear list of symptoms and management interventions for them and then play it slowly. Write things down in a journal because memory is notorious for forgetting. Being in a hurry can trip things up. There are medicines that give a person “symptoms” when stopped that they never would have had otherwise. Don’t confuse these with “symptoms” of your illness if they are new and different.
If you decide to stay on medicines, this is a personal choice as well. Get information and advice. Work with people you trust that know you well. Don’t let someone else’s agenda decide for you.
Neither path is risk-free. Everything is not known.
I am reminded that no one will ever take care of my best interests the way I will. I have fired doctors, dentists and an accountant in the process of discovering this basic truth in my life.
However much advice and directions I ask and get from others, this is my life and I’m driving it. Our advisers are only that. They will not be with me and see and feel what I do. I am the expert on my own experiences. When things happen in my life, I am the one there, the one that has to take action.
I hope that no one really imagines that “wearing a white coat and taking the Hippocratic Oath gave them some kind of expertise” as you say. If that were true we could all be “experts” by chanting a few words and dressing for a costume party. It would be like the Wizard of Oz handing out heart, brains and courage.
Thanks for your reminder that there is nothing like personal experience and self-education. I believe all true education to be self-education. Anyone willing to read and dig and study with access to information can become an expert.
One treatment approach to explore is that of Dr. Loren Mosher and the “Sorteria House”.The original Sorteria House in San Jose is closed, but there are other outposts of psychosocial community care and “open dialog” treatment such as in Alaska and Lapland (Finland). Little to no antipsychotic drugs, no restraints, no hospital stay, good outcomes, reduced financial costs, reduced disability, reduced relapse of psychosis.
This takes more forethought and planning than a pre-loaded syringe but the outcomes are so much nicer.
I don’t remember “mainstream psychiatry” gathering around Dr. Mosher’s bandwagon when he was alive. I’m not sure how to get “mainstream psychiatry” to get serious about making alternatives a reality.
That said, I was somewhere in the “mainstream of psychiatry” till a couple of years ago. I have met others as well who are shifting their perspectives. Perhaps we can enlist “mainstream” psychiatry to leave the familiar old channel and help design alternatives as well. There must be others out there.
Keith,
Thanks for identifying that song. That one song from elementary school has influenced how I view the concept of “free”.
Do you have a link for the “landmark forum”? It sounds like another venue for thoughtful folks to grow ideas.
Are you asking for my personal ideals, wishes and dreams for providing care if I could carve out a hidden niche and work the way I would like as a psychiatrist? Are you asking where I can imagine having the most impact on changing the whole huge snarled healthcare delivery system as it is today toward something that will work? Either of these two are huge topics. Are you asking something else?
Thanks for reading and posing such thought stimulating questions. Another writer for MIA, Bob Nikkel, is a former commisioner of mental health and addictions from Oregon. He and his wife recently started a non-profit whose focus is the design of a “new mainstream” in mental health. He and Gina both write here and would be good to have in this kind of discussion. I’m certain there are others. I’m the new kid on the block.
Thanks again for reading and posting. Welcome to a discussion that impacts all 311 million of us in this country.
Altostrata,
I like idea of looking at public health costs and disability payments numbers. These have skyrocketed with the “epidemic”. These are line item dollar amounts on a politician’s budget. I agree with you that human costs with regard to issues like safety, efficacy and suffering are immeasurably more important than dollars. However, political policy makers look at the dollar costs of a specific line item on their budget spread sheets. For the most policy change effects, talk to their spreadsheets. I bet that one of the pressures that forced legislation to get tobacco and liquor ads off television were the health care costs from the consequences of tobacco and liquor use. Once an individual’s financial resources are gone, medical and nursing home care falls to the Federal government’s budget. This is bad for the Feds but good for big pharm.
These are the kind of conversations that can lead to effective strategies.
Thanks,
Alice
Good morning Altostrata,
Thanks for your concern about my well-being. Rest assured I am well. Thanks for the links. I feel very supported here.
Really, I thought this morning’s post was about hope and working together for common goals. About avoiding fighting when other approaches can work more effectively. About the hope that can be found even when you do have a big mess of trouble. I must have missed my mark. Ah well. Another day, another post. I do hope you enjoyed the read, nonetheless.
Doctoro,
I listed these two cateories, life circumstance and medical conditions, as examples. They are not intended to be an exclusive list. Sorry for the misunderstanding. If you want the entire list, read the DSM.
I see stopping public ads for pharmaceutical products as a way soften “consumer” demands for all prescription drugs. A move toward use of “cheaper drugs” is a rationale to nudge policy makers to move along in direction of outlawing advertising to the public. Budget cost savings is one thing policy makers will listen to.
Thanks for the review of the financial budget end of pharmaceautical products. There is nothing like budget bottom lines to get the attention of policy makers. This could be a great selling point for legislation to ban advertising of all drugs to the public.
If we soften the market for the enormously expensive brand new drug at the patients’ end, it will save the government a lot of money.
The Federal government is the largest third party payer of health care costs in the USA through the medicare and medicaid programs, Veteran’s administration and the military medical services. Simply making the choice of a $4/month drug (that’s been around a long time) over a new and less tested $2000/ month drug easier for all physicians would add up to costs savings at the Federal budget level.
$4 drugs are not marketed. At all. To anyone. The overall demands for drugs would eventually fall off with more longer term costs savings.
Patient ardent demands for their entitled “right” to have the newest and hotest (most marketed, most expensive, least tested) drugs can be hard to dodge for a doctor. This is actually easier when the patient is uninsured. Especially if the doctor’s office refuses to carry “free” samples (hooks to get patients on the spendy drugs. No one “samples” the $4 meds). You simply point out the price tag and a $4 drug becomes worth a try.
Sad but true. Economic arguments speak loudest and are the most convincing at the level of policy makers and at the level of individuals.
Thanks for the encouragement. I am spreading the word every day. Likely I am designated as spam in some former colleagues’s email filters. I tell them to read the book and give them links to MIA. I talk to people on the street. Anyone that will stand still and who shows the slightest interest gets to hear about it from me.
Maria,
I am so sorry for your losses. As a mother, I can imagine none greater. Thank you for telling your story here.
Thanks also for clearing up my illusions about health care, mental health care and attitudes toward children and families being “better” and more humane in New Zealand. The long web of multi-national corporations reach around the globe.
Thanks for saying what you say so eloquently.
The schools in my home state of Oregon recieve more money for each and every child that has an “IEP”, paperwork that asserts the child has “special” educational needs as determined by the teachers. Masters level educators can legally give a child a DSM psychiatric diagnosis.
Much of the diagnosis made in a child psychiatrist’s office rests on information from the teachers. Teachers can and do demand that the parent drug their kids before they may return to class. Parents home with their children risk job loss and all that comes with that.
I am made so heart-sick by the drugging of children and now babies,that I’ve run out of words.
Marian,
Thanks for your thoughtful post and the energy you bring to this discussion. We have to hear about all the issues in our current medical system to find our way home together. We have a lot of work to do.
Jennifer,
What a lovely, strong and pure voice you bring to the task at hand. I agree with your thoughts concerning the similarities between the recovery process of an individual and the recovery process of the medical profession.
Indeed, it is a spark of hope that recovery is possible which brings me here to write. The process of sharing our various truths and experinces with one another to awaken the sleepers among us and to open the path to unity of spirit is essential to recovery of such an enormous patient. 311 million Americans is a lot of people.
John,
Yes. Of course. There are so many things that need to happen here, many tasks for many hands. And I only feel I have a “one in a million chance” of making a difference for the better. But, as Sir Terry Pratchett said,”One in a million chance things happen all the time.”
Best,
Alice
John,
I like to hear from you. It really gets me going with new ideas. Diagnosis “creep” is a misnomer. It seems to me more of a diagnosis “flood” here.
Stay with us. Plus write the radio stations. Plus read books. Plus eat well and exercise and have fun with friends. These are all necessary to your “human potential”. Human potential is so much bigger than the “task at hand”. It’s all important.
Altostrata,
I think doctors are very, very busy. It takes time, at least a few minutes to say “no” and explain why in a polite manner.
I spoke to a neighbor yesterday who’s wife is a primary care doc. She just saw 27 patients in one 8 hour day, 5 of them brand new to her. I have only seen her outside once in six months. She spends all of her mornings and evenings at home typing reports on patients so that she can spend those few minutes allowed with each person making eye contact, talking, listening and examining them. This is her usual work life. Many of her patients are “psychiatric”. She is head down, bailing the ocean with a teaspoon. To me she’s a hero. What could I teach her?
Another primary care doc I met last spring at an educational conference (not drug funded) told me she sees four patients an hour, all day, every day. This time includes typing, chart reviews, interviewing, examining patients, lunch, bathroom breaks. Four patients an hour. Nonstop.
I think doctors don’t have time to pee, much less provide polite explanations and and make thoughtful prescribing decisions. It’s not that they don’t understand side-effects or are unable to say “no”. It’s that they run all day every day on a too-fast treadmill in the factory-style doctoring institutions that have taken over.
Sorry. I wish I were more hopeful about all this.
Thanks for your thoughtful contributions to this discussion.
Scott,
I don’t know the right words for the system we are lost in right now in our country; whether it’s capitalist or corporate or fascist. I’ll leave the labels to those who know. I do know that things have gone seriously wrong. I’ve been watching the threshold for “mental illness” and for drugging people go down and down and the net grow wider and wider my entire professional career.
I read recently of public elementary schools where 40% of the children are being “treated” with drugs for ADD. When exactly did a relatively uncommon “disorder”, well-treated with social and behaioral interventions become drugging of so many kids? When did everyone who has moods that change during the course of a day (everyone human) and people who get angry (everyone human) become candidates for drugs?
I am regularly horrified by the lists of medicines that patients come out of hospitals on after a three to seven day stay. I have been told that the hospital docs are under pressure to get people out fast so the next ones waiting in the ED can come in, a bed shortage issue. This makes no sense to me.
Psychiatry is not “heading” there. We have arrived. Oppositional defiant behavior in adults translates into bipolar disorder.
Thanks for the clear headed talk. We need a lot more of that.
Alice
Doctoro,
With the same respect you offer me as a “particular” doctor and psychiatrist, I disagree. Making conclusions about an entire group based upon one quality held in common (in this case, completing psychiatric residency) is plain old, garden-variety stereotyping.
I had a friend long ago who used to say to me “I don’t like doctor-types” and “I don’t like psychiatry-types” and assert unpleasant qualities they all shared. He would then carefully make noises to exclude “present company”. I have also heard similar remarks made with regard to members of racial groups, ethnic groups, socio-economic classes, psychiatric patients, pretty much every group one could put together and call a group.
What seems obvious from one position may be less so if you stand somewhere else.
Thanks for bringing your energy to this discussion. Making things better for everyone will take all the energy we can get together. Isn’t it nice to know we don’t all have to agree on everything here?
Altostrata,
Psychiatrists can and do decline to make psychiatric diagnoses and decline to prescribe drugs. I did this a lot. There is chart “coding” to be done in medical records. This coding must be completed for medical-legal and insurance reasons. There is a code for “no psychiatric diagnosis” and codes for life circumstances and medical conditions that cause symptoms that look psychiatric. There are a lot of “non-psychiatric” “diagnoses” codes to choose from to fill in the little boxes.
Nine (or more) of ten people that I see these days that walk in the door saying they have “bipolar disorder” do not. The drugs sold to treat this are heavily marketed and the symptoms are vividly displayed by actors on television all day long. “I’m like just that lady on TV” they tell me. “I know I have bipolar. I know that’s the medicine for me.” They are in effect “coached” with the symptoms to display for me by the television marketing. The prevalance of this disorder has sky-rocketed in the past ten years. As ENORMOUSLY expensive new drugs are brought out for sale, the criteria are bent and bent by the marketing reps. Other psychiatric symptoms are dragged into the treatment pile for the new medicine till everyone qualifies for it. There are drugs that cost over a thousand dollars a month being marketed for bipolar disorder today IF the person is only on “monotherapy” (one drug).
Remember, the cheap drugs are not on TV. Frequently they are not in the “PDR” (Physicians Desk Reference), an enormous drug marketing catalog that only lists prescribing information if the company pays for it. Most folks think this is a reference book. It’s a marketing device.
I have developed what I hope to be polite and diplomatic ways of saying “no” to these requests for psychiatric diagnoses and the drugs that go with them when they are not warrented.
Good morning Anonymous,
I agree. I can’t imagine a “good experince” that involves “forced drugging and forced electroshock” or “forced” anything for that matter.
Best always,
Alice
I’m glad to hear you also have “fun” at work as I do. It sounds like the things that make you smile are what make me smile. I also enjoy upbeat co-workers.
I DO introduce myself as “Dr. Keys”. In crisis work, where I rarely have the opportunity to see the same person twice, it’s important to let people know who I am and what my role is. They see so many providers at one visit. It can be confusing. Especially as a woman doctor with a big smile, they are uncertain if they’ve gotten to the “real doctor” yet.
I suggest they may call me Alice, if they prefer. I ask them what they would prefer to be called.
But I am an “old school” physician trained by old school physicians. The doctor/patient relationship is one of mutual respect and trust. I feel okay about that.
Everyone doesn’t have to agree on everything here.
Duane,
Ah,smart kid. The old advertising premise is that even bad advertising is good advertising. If it catches your attention you remember it. Hence annoying ads are good ads. Ads that blither of about side-effects catch your attention. It all sells. We imagine our concious screening process does a better job of protecting us than it does.
Drugging kids worries me as well. Drugging old people worries me. Drugging pregnant ladies worries me. Drugging everyone else worries me. Drugs are a worrisome treatment modality.
Here’s worrisome. In the state of Oregon the Naturopaths recently fought and won the privelege of prescibing all medical and psychiatric drugs (except one). How much “integrative” work do you think they will be doing now? To me it seemed a movement in the wrong direction for them, away from their professional specialty and into mainstream prescription expectations.
Anonymous,
Thanks for listening to my explanation with regard my comment on the old happy times (“fun”) that lead me to my professional career choice. I believe that work and career choice is best lead by good feelings. It stinks to have to take jobs that are not happy places to be. I’ve done it. People do it every day.
I don’t believe in ALL my profession’s belief systems either. You’re in good company that way. Most of the folks writing and reading here also do not believe in them ALL. Welcome.
I’m glad to hear that you have found your “third choice” path. The “two paths” I referred concerned some less fortunate people I have known who perhaps have less resiliance and self-reliance abilities than yourself. All humans are not equally capable all the time.
Everyone is at their own place on their own path. Everyone.
There are those who would like help and support managing life for a time. Some people I have spoken with would like there to be a safe haven for them away from the streets, even for a while. I think safe housing should be available to everyone regardless of any “psychiatric diagnosis”. It is irresponsible as a society to leave people living on the streets who don’t want to be there.
As a physician, I have referred to people as “my patient” and shall continue to do so. I am honored by “my patients” when they likewise refer to me as “my doctor” or “my psychiatrist”. I’m a doctor. I have patients. It’s the deal I make with people and they make with me.
I’m sorry you’ve had such bad experiences. I’m glad to hear you of your recovery. The story of your recovery is one that can give hope to others coming along.
When I was early in training in an analytic based program I studied dream analysis. I had Jungia dreams when we studied Jung, Freudian dreams with Freud and Viet Nam PTSD dreams when we studied those. I’m too suggestable. Thanks for the Jungian view. It is good seasoning to the mix.
Alice
John,
Wow. Good job with this. There is nothing I can add here.
Frightening. Where does one shove a stick in the spokes to stop the wheels from turning? Or do we have to wait for the wheels to come off the bus naturally?
Thanks for the interesting and thoughtful conversation.
Alice
Steve,
Thanks for your response. I am actively reaching out to people I know and inviting them to read Robert Whitaker’s book and join the discussions here. I welcome everyone who wishes to talk to the discussion table. There is so much to learn from all sides of this matter.
I don’t mean to dwell on the past with historical material so much as help understand how well meaning people could have gotten where we are today. I’ve lived through and watched changes unfold around me without knowing what it would mean for us all.
Anonymous,
Please read my post with regard to your earlier commentary. I hope this will clear up some of your questions. One additonal thing: At that time, residents in training had no choices about where they went for training. You signed up and awaited a “match”. Once you got the “match”, the program you were assigned to put you where they wanted yo to work. I had a little leeway as per timing but no choice as to the venue. I was not looking forward to the psychiatric rotation at the time as I was a neurology trainee. I saw it as “something to get over with” so I could get on with my career path as a neurologist. The happiness I felt working there was unexpected. I genuinely enjoyed spending time with my patients there. I still enjoy working with mental health patients.
Thanks again for writing. I have no idea how the things I write strike people unless I hear back. I hope this clears it up for you. If not, ask more.
Best always,
Alice
Anonymous,
Thanks for adding your post to the discussion. The only way we can hear all sides of the story is if people like you speak up.
Yes. The hospital I did my psychiatric training in during the early 80’s sounds a vastly different place than your current experiences. We did zero ECT. No forced drugging. There were a lot less drugs in play then. People stayed long enough to benefit from the alternative the therapies provided: OT, PT, art therapy, group therapy, individual and fammily therapy. Respectful treatment. A calm atmosphere. Although the doors were locked, most of the guys were voluntary, most of the time. There were times we had to keep a close eye to keep someone safe. It was the Veteran’s Hospital in New Orleans. I think that most of the time, the guys (mostly men) that stayed there were okay about being there. What I found “fun” was developing warm relationships and seeing people go back home in better condition, better able to cope, than they came in. It was a pleasant and hopeful environment to be a part of.
I’m sorry that things have devolved to the point that “under the bridge” beats care. You are not the first I’ve heard this from. I’ve heard stories from the over crowded and understaffed state hospitals. They are not easy places for anyone. I have worked hard to keep people out of hospitals for years. I’ve also worked in downtown shelters and seen people come in having been assaulted while living outside. Women and young people with disordered thoughts are very vulnerable to being preyed upon by the more “capable” folks that live outdoors. It’s a rough life. I’m sorry these are the choices available. I hope we can do something to change it.
I’m sorry if my use of the word “fun” sounded flip or heartless. That happy feeling was genuinely what caused me to make the shift, that feeling and the hopefulness of the times, the great guys in the wards where I worked and the staff.
John,
In my opinion, unrestrained capitalism has been a big factor in getting us where we are. But I am not a political scientist. I seemed to have missed much of high school civics class where we were supposed to have learned the whys and wherefors of our fine and free government system. Capitalism does what it’s supposed to do very well: it makes a few big piles of money (capital) from small piles of money. The more unrestrained and deregulated things are, the better it is at this. I have wondered for a long time if a system which has as it’s bottom line the goal of collecting a few big piles of money is the best route to building health care, education and human services sytems. Probably Capitalism is good for something, right? Oh yeah. Making a few big piles of money out of little piles of money.
My recollection of the history of what is being passed around as “the medical model” of psychiatry today is that this “medical model” came about after the advent of pharmaceuticals. I started training in a program that was based in psychoanalytic psychotherapy. At that time, the foundations of the program were under attack by the purveyors of “rapid tranquilization” drugs for acute psychosis; big, fast, injected doses. The pharmceautical company was paying a young staff psychiatrist to do the “research” there at Charity Hospital.It was a time of validating psychiatry as a “real” branch of medicine. We had our drug treatments.
What we call the “medical model” in psychiatry today is actually the “pill model”, a marketing strategy initially rolled out for doctors and which now saturates our entire culture. The “chemical imbalances” are marketing inventions. Antibiotics and vaccines were designed to treat and prevent medical disorders with known pathogens and causes. The “chemical imbalance” theories are all made up.
This “medical model” (pill model) has its hands around the throat of all of medicine today. We no longer describe a medical condition and explore its pathology and cause. We now reason backwards from pill effecst and infer the cause from this. I recall being taught in school that one can never, ever do this. Faulty ad hoc reasoning. NOT medical, scientific thought at all. For example. Your car is running too hot. You open the hood and hit it hard with a big rock. It stops running and cools down. Therefore, the overheating problem was due to a rock definciency.
Thanks for your participation in these discussions,
Alice
Mark,
Thanks for your dedication to the field of nursing and for your move into the role of educator. Every professional nursing student you touch will carry a bit of you out into their professional career.I hope you talk about your doubts, experiences and concerns with them every day.
I write here today, in part, because of the guidance of a mentor of mine from many years ago. We will never know how far the ripples we make will spread.
John,
Thanks for your show of support. Yes, there is much to do beyond this.
Some medical schools have thrown out the drug reps, drug samples, drug lunch “lectures”. It is an individual institutional moral stance. Oregon Health Sciences University is one who has a “no drug samples” policy. I know they still do a lot of drug funded research there. Drug company funded research is a well-known path to academic tenured teaching positions.
Stephen,
Here we are today, beginning our own marketing through this webzine. Move the information outward like ripples in a pond.
Our government is us. Perhaps government representatives could be convinced by a “cost savings approach”, less tax dollars going for expensive drugs through medicare and medicaid. Money talks.
Not only psychiatric drugs but all medical drug ads need to go. The whole of medicine is in the same boat. Patients show up demanding specific pills, the newer, the most expensive, the most advertised.
The psychiatric field does not have the market cornered on toxic drugs and deceptive marketing. For example, most cholesterol lowering drugs work by poisoning mitochondrial function throughout the body and brain. We require healthy mitochondrial fuction for life. How can we hope health to be conferred by this process? A friend’s husband nearly died from the muscle breakdown side-effect of cholesterol lowering drugs last year.
Blocking drug ads to the public needs to be for all drugs, not a pick and choose category. It’s too easy to side-slip categories.
Altostrata,
Perhaps speaking will come about naturaly for me as a process of writing here.I’m really much better at writing than talking, though. And I do talk to people I know, one by one. I have also been emailing links to these posts to the local community mental health leaders that I know. It only seems fair to give them a chance to help. Others here may want to invite mental health professionals, physicians, friends and family to join the conversation. Every person’s voice counts and matters. E pluribus unum. Many together,one. Look at the back of a penny when you feel isolated. We are all out here.
David,
Thank you very much for encouraging words. I believe in the power of words. Just think of the influence of the media and advertisements and “medical education” process that keeps us so stuck. Words are powerful.Let’s all use them to remake our medical system. Other countries have done this. We can too.
We may have to start with outlawing advertisements of prescription drugs to the general public as the rest of the world has done. Cigarette ads were banned on TV. Marketing prescription drugs like they are breakfast cereal and box juice is a travesty. We have to break the thrall of the general public somewhere at the beginning I think.
Trying to break free of the “pill culture” without taking away the customer base is like trying to fight the war on methamphetamines while prescribing stimulants to our children. How well it that going so far?
I’m having a lot of fun with this. I’m so happy that you and others are finding value in these conversations.
Back in the olden days when I was still allowed the time and space to be a group therapist (Imagine. A psychiatrist running a therapy group. Is there a billing code for this today? ;-)). Anyhow, back in those days, I tried to remember not to enter the group with expectations or agendas. This way I could let the process lead the way.
Writing here, I’m reminding myself of this. I have no way of knowing where these writings will lead or what precise good things will come of it all. I write with an open heart and look for what arises.
All the best. Enjoy your grandkids. Family of very important.
Thanks for your personal story. I hope your son continues to do well.
I have been able to help people manage with less drugs by having a clear individual written action plan we make up together. They keep it where they can see it. There are specific interventions for specific symptoms. One of these interventions could be short term doses of medicines. This is certainly not the only intervention.
A long and winding road from contruction laborer and a series of chance meetings brought me to psychiatry. This was not a long term or lifetime plan. We didn’t have psychiatrists down on the farm growing up. We barely had doctors at all. That final jog in the road from Neurology into psychiatry was made because it was fun and I came home from the hospital smiling.
I’m happy to see you posting here. The state of medical care in America today is not just a mental health situation. Not at all.
You are absolutely right. Patients’ situations (like all of ours) are complicated and very individual. There’s a lot to take into account before you make your best judgement.
Alix,
I believe I’ve helped some people with pills. I’ve seen myself as a well-meaning psychiatrist. I’m also know there have been unintended bad consequences to my prescribing. It’s very complicated and not about to get simpler.
You’re right about guidleines and rules. There is also something called “the community standard of practice” that all physicians are held to. It frequently includes prescribing drugs in “off-label” ways. There are a lot of people in my consulting room besides just me and my patient. Enough for a whole rant blog.
Thank you for bringing your personal story to the forum. I understand your preference to hear it from another doctor but I hope you will except my heartfelt sympathy for the suffering you and your son must have gone through. For that, I am truly sorry. Maybe you can consider me the “next, next lot”, even though we only meet through words, here. I wish you and your son genuine healing.
The motives and life circumstances that bring helping professionals to their work varies considerably. During my training years, psychiatrists were required to undergo therapy themselves as part of the training process, rather like analysts undergoing analysis during their training. I don’t know how common this is today. It seems a good idea for all those training in the helping professions. I think psychotherapy could be of benefit to anyone who would like to sort out their motives.
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
Duane,
I love words. “Crony” sound so friendly.
Stealing money is called theft.
Misrepresenting for gain is called fraud.
Knowingly causing deaths is called murder.
Conscious misrepresentation is called lying.
The central care tap root that a plant depends upon to live is called a radical.
Alice
Report comment
Duane,
But if the Capitalists own the government, then who is for the people?
Alice
Report comment
Stephen,
No television (or other media) for 11 years. Learned another language and traveled outside the country to hear what they really thought and why. Read LOTS if non-fiction and history. Talked to people and listened. Paid off my debt so I could afford to open my eyes and ears.
Tolerated being called names like “conspiracy theorist” 😉 and “too radical to work here”, even when they weren’t joking.
**When things didn’t make sense, I looked where the money went.** This always leads you to the man behind the curtain.
Thanks for asking. Really.
Alice
Report comment
Marcella,
As an old cynical behaviorist myself, I can see some sense in what you say.
One must not, however, underestimate the effects on an individual of submersion from birth in a cultural matrix put into place and maintained by the six corporations that own all information in our country.
With this in mind, one has to step back a bit further and wonder who is selling what to whom. And by what means.
All the best. Keep reading, thinking and writing.
Alice
Report comment
I am starting a new thread here by copying this post:
Discover and Recover on March 6, 2013 at 9:27 pm said:
John,
I have to wonder if the federal government is concerned with spending.
They can either borrow or print.
For the states, it’s a different matter. Which IMO, is *why* the feds want to take on health care. It’s not about saving money, it’s about power.
Duane
Duane,
If it doesn’t seem like government is interested in saving money, they’re probably not.
Government is bought and owned by corps. Bottom line is more cash funneled into big pockets, not “savings” or “health care”.
Alice
Report comment
Engineer,
What you describe sounds like a money maker on the one hand and easy access to pills for folks who want them on the other.
“Med check” may be a misnomer used for insurance billing purposes, however.
What sort of things could possibly be “med checked” in ten minutes while typing the legally required documentation and writing prescriptions?
Takes two to tango, I suppose. Where there’s a customer, there will be a salesman.
Alice
Report comment
I’m stating a new thrread so there is room to respond to this writer. I have copied his comment here:
John Hoggett on March 6, 2013 at 7:09 am said:
wow, and I thought Open Dialogue was expensive! I think the economic arguments with service commissioners are ripe for being put forward for effective psycho-social alternatives if so many people are being put on such an expensive mix of drugs
John,
As you point out, it is not the expense that gets in the way of changing direction in delivery of healthcare. There are known cheaper, safer and better approaches that are not being used just as there have been safe, fuel-efficient cars for decades in Europe that never see the light of day in the US.
Where does the power lay that keeps all this happening? Let’s see… Is it in the hands of hourly wage-slave doctors? Hmmm…
One could almost believe that giant capitalist corporations can reach across international and political boundaries with more ease and fire power than people. One could almost believe corporations have been granted immortality and basic human rights by the courts.
As John Steinbeck wrote in his book “Grapes of Wrath” “The monster isn’t men, but it can make men do what it wants.”
But where to go with this…
Alice
Report comment
I had to start a new thread here. I copied this post forward so I can reply:
Discover and Recover on March 5, 2013 at 10:59 pm said:
Alice,
It seems we have the cart before the horse. *How* people get paid before *what* they get paid for.
Greed is certainly a problem – with Pharma. But also is the need to control – on the part of both the government along many in the psychiatric system.
We could do so much more, with so much less (greed and control) if we would begin to think out of the box and try something new!
Best,
Duane
Duane,
Thanks for you hopeful and helpful voice here. Thanks for your emphasis on following the big money trail. This is crucial in any understanding of the situation we face.
Alice
Report comment
AA
Thanks for your support of my writing. This means a lot to me.
I don’t know when we got to this point where a patient can leave an acute hospital after a few days on seven new drugs. But here we are.
This frightens me.
And the outpatient doctors may be afraid to make reductions. Any problem, whether from reducing the drugs or not, is pinned on the drug reduction.
I didn’t hear “hypocrite” so much as I hear someone who hopes that I can do more than I have been. I understand this desire. There’s a lot to do.
Alice
Report comment
Richard,
I agree. You have never called me a hypocrite. Plus I have felt supported in my writing and activism efforts by your reading and commenting here.
Yes indeed. You have caught me in the act of writing in such a way that I tell people what I think they should do. What good is writing opinion if one cannot work to be persuasive as a writer?;-)
One thing I’ve learned about people is that they don’t want advise unless they ask for it. And maybe not even then. People often ask what I think as an opening to argue at me.
There is nothing I enjoy more than having people ask what I think and then listen. I think a lot about a lot of things. I have strong opinions. I’m a rather good talker.
As far as my own personal activis,m I take daily steps against a number of horrors perpetrated in the name of progress. For example, I park my car and walk most days. Cars are the number one cause of death in the US for ages 8-34 and runs a close second in other age groups.
I think each person has to choose their own fights. And I respect however they get there. After all, I drove a car every day for years.
Keep writing. All of our voices are important. All of our personal efforts count.
Alice
Report comment
Licinia,
No offense taken. Lot’s of us living inside the US look at our medical system in horror as well. I’ve been unable to get safe adequate medical care for my family for the past 20 years and I’m an outspoken physician with “good” insurance. Our approach is to work hard to stay healthy and avoid medical contact.
I love to write. I can do this without burnout. My writing sometimes takes other forms but it continues unabated.
Many smiles to you and to all readers.
Alice
PS I am troubled by access to “reply” here. I haven’t given up though and work around it.
Report comment
John,
What sort of rabble rousing in what sort of venues are you looking for? I sort of thought that writing here and on my personal blog and private conversations was as much voice as an unemployed psychiatrist has.
Thanks,
Alice
Report comment
Richard,
I appreciate your personal outspokenness and your contributions.
At the same time I am unclear where these barricades lie that I am to go to and what the expected behavior would look or sound like.
Forgive my brief response. I lack my usual access to an internal “reply” button. I am limited by this.
Alice
Report comment
Licinia,
Thanks for bringing this tragedy to light. I depend on people like you to keep the information channels open.
Yes. We all speak and write as much as possible and to the best of our personal abilities. I certainly do.
And I’m not certain where these “barricades” I’ve heard about lay or what the exact behavior I’m supposed to be demonstrating there may be.
All the best.
Alice
Report comment
Duane,
It’s so nice to hear from you. I love it when people do the math. It does simplify understanding things a lot.
One really must follow the dollars. To do this you have to know where they go.
I have seen several thousand dollars (3+) a month go to one person’s drugs. Poly-pharmacy is the rule now, not the exception. During job interviews (I’ve been on a few this year) I talk about wanting to reduce and simplify drug regimens as a general approach. Providers cringe at the thought of less and fewer drugs. One woman said “I don’t want to see anyone get hit.”
There is this idea that all the drugs are keeping people safe. If you lower the drugs the patient will hurt someone. I don’t understand it. Perhaps through the media? I don’t watch TV.
All the best. I’m glad to hear you thoughts.You may have to start a new chain in the comment zone, though.
Alice
Report comment
Richard,
Thanks for checking in. I appreciate your support of my writing.
Good for you speaking up. It takes all styles and flavors of speaking up to be heard.
I also speak up. Check under the “rant” tab of my personal blog for other things I speak out against in my writing:
alicekeysmd.wordpress.com
I’ve learned through a variety of “speaking up” experiences over time that I can only speak up for myself and not for others. I live with the consequences of my own speaking up.
I can’t choose for another person.
So I’m probably not going to join the APA in the hopes that I could create havoc.;-)
But I will keep reading, thinking and writing. And talking to anyone who will listen to me.
All the best.
Alice
Report comment
Thank you. What a lovely thought. I will look into this. Relocating a medical license to another country is not so easy.
Report comment
John, I find have to tip toe around friends who allow their children to be drugged. They are not asking my advise. I am not their doctor. I can express concerns and direct them to reading material. A serious rant would simply drive then out of my life. It would not get them to re-think.
“A man convinced against his will is of the same opinion still.”
I find that peaking up against prevailing beliefs requires great tact.
Alice
Report comment
John, Thanks for doing a good job of clarifying the situation. There are similar issues here with regard to clinician attitudes. Alice
Report comment
David,
You are more of an expect on Schore’s work than I. I’ll leave explanations and analysis of his work in your capable hands.
You hit the nail on the head with “economically driven”. Money is the power driving the steamroller masquerading as medicine that flattens so many people.
All the best,
Alice
Report comment
Jeffrey,
If I had know back in 1979 what I know now, I would not have borrowed the big piles of money to go to medical school.
So here we are today,you and I, having made choices we each made in our unchangeable pasts.
There is only forward to go from here for each of us.
Thanks for reading and commenting. I appreciate your support of my writing.
Alice
Report comment
Steve,
Thanks for answering this question so well. This is the truth. Psychiatrists are workers with kids and payments like the rest of you.
The psychiatrist who stood up about the “no diagnosis” worried that he would lose his job over it.
Since I’ve been speaking out about the problems in psychiatry, I have been labeled as anti-psychiatrist and anti-medicine when I am neither. I have been approached with anger and suspicion by a psychiatrist I worked with for eight years and treated as if I’ve lost all competency as a professional. Although I haven’t yet been called a Scientologist;-) No one would consider employing me once they Google my name. Professionally, I’m creamed chipped beef on toast (S.O.S.) from here on out. I can blame no one who declines to speak up.
Alice Keys MD
Report comment
Licinia,
I resonate with your sadness. Yes. Something is very rotten in America.
Alice
Report comment
Licinia,
Great question.
Personality disorder diagnoses were stigmatized even before the care managers and insurance companies got into the fray and decided not to pay for treatment. This was the case when I walked into my first psychiatric training experience as a medical student in 1981.I don’t know why. A supervisor explained that this stigma was there and said she never used these diagnoses because of it. She said that once this diagnosis type was used,people stopped listening. Much later I had a teacher who always said “Don’t tell me a diagnosis, tell me about the person.” It struck me as good advise.
Alice
Report comment
Hey David,
I’m glad to hear from you. Thanks for your support of my writing. I appreciate your offering of well-considered thoughts.
From your question below:
“Perhaps after your hiatus you may re-kindle your love for the healing professions…”
The flame of my love for the healing profession has never burned brighter. My hiatus does not reflect any loss of love for my work nor loss of love for people. If there were a venue that made sense to me, I would be there today.
Rather, my hiatus reflects a fundamental change in the healing profession. “Irreconcilable differences” have lead to my stepping away from my work. I can no longer go along with the pretense that prescribing pills, ordering tests and typing is the same thing as medical care.
With regard to your question of my thoughts about the Allan Shore excerpt you included:
I may not be the best person to respond to this. Highly theoretical complexity is lost on me. It simply slips over the surface of my brain without penetrating.
My personal stance with regard to psychotherapy and personal healing relies much on the therapeutic relationship and uses primarily a cognitive and behavioral toolkit. I like physical, interpersonal and meditative approaches. I also like understanding the cultural matrix we are all embedded in.
Perhaps this is in the ballpark of your question.
Thanks again. All the best.
Alice
Report comment
Steve,
Greed is the driving force. And yes. The insurance companies are the other big winners along with the drug companies.
Follow the cash. It tells the story.
And disability can be a trap.
Thanks for your perspective.
Alice
Report comment
Steve,
Thanks for you well considered response. I, too, have labeled a lot of people with “adjustment disorder” back in the olden days before care managers in my private practice. This would unlock the private insurance sometimes without the same stigma as Major depression and without the same push for drugs.
But an adjustment disorder diagnosis gets an impoverished person nowhere but back out the front door unless they have cash in hand. Treatment for an “adjustment disorder” will not happen in the public sector. Neither will it get a bus pass or access to medicaid health insurance or disability payments.
“It’s really a beautiful scheme, if your desire is to make money without the slightest accountability.”
There’s a trouble with the “money scheme” concept you mention. This is a common misconception, that psychiatrists rake in the cash from this process. Give some thought to this arithmetic:
With these “payable” diagnosis the only ones that make the “big bucks” are the pharmaceutical companies. The drugs amount to thousands of dollars of tax-funded insurance dollars a month if prescription coverage is won with the diagnosis.
The second largest potential money winner on the diagnosis deal is the patient. They may receives a monthly disability check, free health insurance and a bus pass.
The doc will see the patient one to four times a year for maybe 15 minutes each time. This is what’s allowed by the company. In my recent job search I came up with a part-time (7 hours a week), no benefits $70 an hour job which required free 24/7 coverage. That’s $20 to $70 a year payout for one patient and worked out to less than $3 an hour for my time. Creating false psychiatric diagnoses is NOT a big money maker for a psychiatrist. It’s only a big liability and fraud risk.
Plus, if I generate more patients in the public sector, my employer double and triple books people for my same hourly rate and expects free overtime work to keep up.
I wish more doctors had the arithmetic pointed out before spending all the years and borrowing all the money for school. The money ain’t here.
Even the mental health agencies are money losers that barely keep the wheels on the bus from year to year.
Thanks for giving me the opportunity to walk through this part. It could be another rant, eh?;-)
Alice
Report comment
Nathan,
Thanks for reading and commenting.
Yes. Personality disorder diagnoses are very stigmatizing.
In this situation I believe the correct diagnosis was “no psychiatric diagnosis”.
Is it possible that a person can be troubled and struggling but NOT have an axis I or axis I diagnosis?
Could a person like this still benefit from access to counseling, health insurance and financial assistance?
I think the answer to both of these questions is “yes”.
All the best.
Alice
Report comment
Thanks for reading and commenting here. I appreciate your support of my writing. It’s good to hear that you and your family found some resolution to your differences. I am amazed by what different people I and my children are. Thanks for the reminder that adults must always ask and let children have their say.
All the best.
Alice
Report comment
Nijinsky,
I really like the story in your first paragraph of the vegetarian gypsy’s and the priest that died from “inflamed orations”, pneumonia from preaching against them. Poetic.
You post good personal and narrative tales to learn from.
Alice
Report comment
Stephen,
I enjoy hearing from former teachers. I went to school to be a teacher out of a desire to help young people learn. Then I changed direction to go into medicine because I wanted to help people who were sick.
I think most teachers go into the education profession for positive reasons just like most medical professionals go into their fields because they want to help people and have a positive impact.
It’s just that it doesn’t turn out to be quite like you thought. So you can keep believing the party lines or you can stay and try to make a difference (when everyone else around you believes the party lines) or you can jump off the boat altogether.
I’m off the boat for now.
Thanks. I enjoy hearing from others who got off the boat.
Alice
Report comment
Steve,
You are preaching the choir here. But keep it up. We all need encouragement that we’re on the right track.
A thorough read of Gatto’s work affirmed all my worse recollected experiences as a public school student. It also did way more than confirm my thoughts that school is not meant to teach kids to think, read and write. I had suspected for a long time that public education is there to train good factory workers. But it doesn’t seem to even do this very well. We’ve “outsourced” all those jobs.
When I read “The Underground History of American Education” and read the very clear and pointed plans for our education system, I was shocked and horrified.
People sometimes ask me if I “think” there’s a plot or conspiracy. Then they laugh as if it couldn’t possibly be true. This isn’t something I “think” or “believe”. There was a plan and is a plan. It’s been carried out effectively. We are living with the expected conclusions.
It’s no wonder to me that most of us have been taught (through school) to loath history. This keeps the facts of our past safe from “discovery” when they are in plain sight as archived government committee meeting minutes.
People also ask me how I could not have known of the dangers of psychiatric medicine. They can’t understand how I could have missed it. I also wonder how people can miss the truth of the dangers of our education system and our malignant capitalism.
We’re all too well educated. “Pass” or “fail” doesn’t matter if we’ve all spent 12 years growing up in mandatory day jail fed on standardized national “curriculum”.
“If enough people believe the dream, no one dares to wake up.” Sir Terry Pratchett
Thanks for giving me the opportunity to rant. I know I can always count on MIA for this. 😉
All the best.
Alice
Report comment
Nijinsky,
Thanks for reading and writing here. I appreciate this support of my writing. I always enjoy your take on things. I especially like hearing your ability to locate the unity in fragmented situations. This is one of your many gifts.
I agree that this long term “blame game” of the family is “ridiculous”. It is also not a useful concept for healing either as an individual or a society. Blaming family, either though direct behavioral condemnations or though postulating genetic sources, serves only to further degrade and fragment families. And this only serves those in power.
Keep in touch.
All the best.
Alice
Report comment
Stephen,
Dang. Too bad. In my “ever-hopeful” insides I had pictured a class in which ethics and problems with ethics were explored in a thoughtful manner. I have to remind myself every day that the standardized curriculum of our mandatory “education” system is there to promote and support capitalism and industrialization. Period.
“Education” is not there to teach kids to think for themselves. Ever. No industrialized country wants self-motivated creative thinkers. These would be too dangerous. One of these free thinkers might discover the “off-switch” for the corporations.
Thanks for getting back with me about this.
Alice
Report comment
Chrys,
Your family is fortunate to have you as their matriarch. We “matriarchs” must take an active role to make our world a better place. There is nothing like our experience.
I remember the “Gray Panthers” movement as a venue for social activism among older people. Between the accrued life-lived experience and having the time to spend in thought and action, older folks are the great untapped resource for necessary social change. Younger folks are buried under jobs, debt, schools and family. They also need sound leadership to know what direction to point.
Thanks for reading and writing here.
Your experiences provide valuable lessons for us all.
Alice
Report comment
MJK,
Thanks for reading and commenting here.
I am deeply touched by the honesty of your post.
My only hope when I hear the depth of your suffering is that there will be some way for some seed of good to sprout from this.
Perhaps. Perhaps not.
I’m sorry for the suffering you and your family has had in your lives.
All the best.
Alice
Report comment
Steve,
I shall have to look these Luddites up. I assume bad things happened to them. “Quelled revolution” likely.
Destruction of families and communities are a necessary, known and planned part of industrialization. Our “education” system was thoughtfully designed with this in mind. People often complain that the schools aren’t teaching reading, writing and arithmetic. There are reasons for this. This is not what they were designed to do. Schools are doing and have always done exactly what they were planned to do. Understanding this has helped me understand the hows and whys of modern psychiatry.
Check out JT Gatto’s “The Underground History of American Education” to learn more about this. He’s posted his book on line where you can read it for free. After his career as an award winning public school teacher in New York, he researched the birth of our education system. He reviewed minutes of government planning meetings that designed what we have now. I found it (at least) chilling.
Thanks for your continued support of my writing. I am encouraged by this.
All the best.
Alice
Report comment
Stephen,
Thanks for your support of my writing. I clean and sort the words I write. I hope to get to the bare bones of what I need to say. Sometimes I throw away two thousand good words to get 500 right words.
I would love to hear what sorts of things this ethics class explored. It is likely off the state mandated curriculum by now.
I also posted this piece on my wordpress blog (http://alicekeysmd.wordpress.com/)at the same time. I write more broadly there; essays, poetry and fiction. I write a lot more these days but in a wider range and with a broader palette.
I find different audiences have different thoughts. A woman in Ghana expressed distress at the impact our American capitalism is having on their culture. It effects every culture it touches in the same ways: it destroys family and community. These are planned, known and necessary effects for Capitalism to take root and grow.
The psychiatric issues discussed on the MIA webzine spring from these wider, deeper sources. Even if you pull an individual weed, the soil is still thick with seeds.
It’s very good to hear from you again.
Keep in touch.
Alice
Report comment
Nijinsky,
All I see is bright red when I stare at the sun with my eyes closed. I think we’re in the clear there so far.;-)
Alice
PS Thanks for your support of my writing.
Report comment
Thanks for reading and commenting here. I feel less along when I find that others have similar concerns as I. I appreciate your support of my writing.
Alice
Report comment
Hey Nijinsky.
Thanks for stopping by. Advertising is everywhere. Next they’ll have it printed on the inside of our eyelids. Oops. Don’t want to give any new ideas.;-)
Report comment
You’re a funny guy..er…cowboy.;-)
Report comment
I’m afraid you’ve got it pegged. Sigh.
Report comment
Glad to see you here.
Alice
Report comment
Duane
Seriously? “Speed diagnosis?” How can this be a good thing? Yikes. Like the wild west marshal being fast on the draw? Cowboy medicine. Cowboy psychiatry. Fastest diagnosis and prescription pad in the west.
Thanks for pointing to this.
Alice
Report comment
Duane,
Thanks for reading and commenting on my post.
The longer I’m away from my work as a psychiatrist, the more I see that the problems we’ve encountered in medicine and psychiatry is part of a larger matrix.
Money is the source of power these days.
All the best.
Alice
Report comment
mjk,
Thanks for your support of my writing as I wander off the beaten path with my words. Thanks for the video link as well.
Poetry, and especially this type of haiku, has given me the chance to simplify and condense my thoughts about psychiatric issues.
The first one, “Baby cry too much”, sums up in 17 syllables multiple current psychiatric issues for me: the DSM 5 push to “pre-diagnose”, pushing drugs on younger and younger children. And, yes, I have heard of “treating” an infant with drugs for the “illness” of crying “too much”.
How do we judge how much crying is too much in a baby? Why would we think to drug them to make them stop? Now extrapolate to every age human and ask this question again.
Each one of these 17 syllable haiku embodies a real situation I’ve come across in psychiatry and medicine.
Thanks.
Alice
Report comment
rcymbala,
Thanks for reading and posting here. I appreciate your support of my writing.
I’m not certain what gentleman you refer to as being intentionally cryptic. Sorry. I’ve missed soemthing. Too cryptic for me to follow.:-)
Cryptic “one-offs” that pass for relationships on social media aren’t very deep when it comes to interpersonal relating. You’re right. It’s VERY limiting. I still prefer face to face and shaking hands and knowing who people are. I like to hear a person’s voice and see who I’m talking to. But I reckeon I’m from the stone-age. 🙂 These days, I have to get by with typing little faces with computer marks so people know I’m smiling or making a joke.
I hope that feelng “more” was what worked for you. Some people need help with emotional regulation and toning feelings down. There’s so much variety in the way people are made.
I’m not so sure complete lack of suffering is possible in life. It seems that most people hope to suffer less. This makes sense to me.
All the best,
Alice
Report comment
Ute,
I’m sure you’re right.
Alice
Report comment
Stephen,
I think you put adds in the paper and hire them like any job opening. The Second Story program in Santa Cruz was well staffed with peers. There’s a special peer training program. Some of the folks who used the respite come back as volunteers as well. What a happy place. This is a good place to look for how these can be set up. The woman who made this happen, Yana Jacobs writes here. She’s very capable. I bet she’d be a great consultant, should someone else be interested in how to make another peer respite happen.
Are there other peer support respites out there already?
Thanks for continuing this discussion.
Alice
Report comment
Pete,
I know Bob Nikkel. He and I worked together in the olden days of community mental health on a multidisciplinary treatment team. Great guy. I knew that he and his wife brought Bob to speak in Oregon through their foundation. It was through Bob Nikkel pointing me at Bob Whitaker that I began writing here.
I feel much more comfortable writing here since I no longer have an employer. I don’t have to fret about losing a job if I don’t have one.
Each of us can find ways to make our unique contributions to the cause. I love to write. I get to talk to so many people this way.
Thanks for the leads.
Alice
Report comment
epower,
Sorry to be slow responding. Your post slipped past me in the line-up.
The “R” word. Reading this makes me smile this morning.
Thanks for reading my post and for your support of my writing. I always hope to strike a chord with readers. I’m glad to hear that your personal growth is progressing. Re-framing has always been an important part of my own process of becoming as well.
Thanks for your comment. Keep reading and writing.
Alice
Report comment
Ute,
Thank you for reading my essay and for your kind words. I’m happy to know that what I write and what others write is useful to you.
Welcome to MIA. Your English is lovely.
Best wishes.
Alice
Ute,
Vielen Dank für das lesen meiner Essay und für Ihre freundlichen Worte. Ich bin glücklich zu wissen, dass das, was ich schreibe und was andere schreiben, ist nützlich für Sie.
Willkommen bei MIA. Ihr Englisch ist sehr schön.
Die besten Wünsche.
Alice
Report comment
Steve,
Sorry to be slow in getting back about your comment here.
Thanks for your lovely post and your supportive words with regard to my home education choice.
Home education has been one of the best decisions of my life, both for myself and for the rest of my family (if I may speak for them). I’ve been astonished by the things I’ve had to learn to keep up with them (not that I always have). Home education has been a personally transforming and liberating experience. It’s given me many opportunities to re-frame my world views.
If leaving our children with strangers at five can have such an impact, I wonder about the impact of our modern habits of dropping them off at six weeks. I can see how doing this would seem bizarre to you. It seems likely to me as well that the modern education “contributes to our community burden of mental/emotional/spiritual distress”.
Thanks for having the courage to educate your children at home. It’s not always an easy path.
Thanks for reading, thinking and writing.
Alice
Report comment
David,
Where do I sign up for classes at the Cyrenaic school of hedonism? ;-))
You made me smile. Thanks.
Alice
Report comment
Peter,
So when do we start? I’m not an administrator or a grant writer. But I’m a psychiatrist. Me or not, it seems we’d need one of those.
This would be a good time to promote treatment approaches that save money. Government third-party payers are stretched thin. When I watched about the new Soteria House start-up (MIA video), it sounded like there was a market for more humane treatments that could save money.
Just thoughts. But everything human that is or ever will be started with thoughts.
Keep thinking.
All the best.
Alice
Report comment
Pete,
I’ve heard of this program in Northern Finland. I’d forgotten it was called “open dialog”. When I read what you wrote earlier, I had a flash of optimism that there was something akin to this in the U.S. I had a spontaneous hopeful vision that there was one here. Rather like the two Soteria-style programs and the Second story peer support respite in Santa Cruz. I guess not then.
In my private practice I found that people with episodes of psychosis do quite well on low dose and no medicine. This required a strong supportive treatment relationship, an individualized approach and flexibility of how we worked together over time. This meant keeping in touch very frequently at times. Sometimes it meant a house call. One universal goal was to avoid the hospital. We made plans on what that would take.
I would like nothing better than to see an “open dialog” style approach here. When I brought the idea of this treatment approach up for discussion at work, I was told I had to be realistic, that these kinds of treatments only work when people have more resources (money and social supports). I was told the best we can do is stick with the medicines since this is what we have available.
The people I’ve known that work in mental health are good people who are there because they want to help. There’s not a lot of room for movement to change things inside any company. A company has a life of its own. Bean counters have to sharp to keep a company alive. That knife cuts out a lot of choices.
Any idea of the cost to run this? I know this treatment is effective. But people always want to know the cost, how much bang for your buck you’ll get and where the “resources” will come from.
The bean-counter way of program development here is very short sighted. It thinks in quarters and fiscal calenders, terms in office and annual block grants. It doesn’t calculate the cost of human suffering, early death and long term financial costs of secondary medical illnesses from the drugs.
I think 80% working, in school and looking for work sounds like a lot fewer people trapped in lifetime of disability and expensive drugs.
Thanks a lot for clarifying this for me.
Alice
But what do I know.
Report comment
David,
Thanks for adding your point of view on “recovery” and pointing out how it ties in with materialism.
In America, most things are defined in commercial terms, how much money you have or appear to have. This drives the debt monster that’s enslaves so many people. Everyone is caught up buying their image and polishing it.
When I meet people they want to know what I “do”. By this, they always mean “who do I work for” and how much income do I have. When I talk to people about writing I’m asked if I’ve sold anything. As a landscape painter (in a past life), people only wanted to know if I’d sold anything. Folks look at my twenty year old car and make value judgements about my worth as a human. One person took took me aside and laughed at my old car. He suggested I buy a “doctor car”.
Thanks for sharing your personal experiences with recovery and with the system. The psychiatric system is definitely part of the larger culture. I’ve written a couple of recent pieces that explore materialism and industrial culture in my newly-up WordPress blog.
http://alicekeysmd.wordpress.com/2012/12/24/the-biggest-gift-is-a-small-christmas/
http://alicekeysmd.wordpress.com/2013/01/01/grapes-of-wrath-oped-submission/
Thanks for your support of my writing.
Alice
Report comment
Pete,
It’s nice to hear back from you.
My thoughts on this that you wrote:
“… when it comes to specific cases, they almost always decide drugs are needed.”
This is true. People that work in psychiatric clinics are “afraid” not to prescribe drugs and more drugs. One cause is something the APA puts out, standards of practice or practice guidelines. I’ve forgotten what it’s called. There are also “community standards of practice” that require a kind of consensus prescribing habit. There are also clinic “standards of care” written by medical directors. There’s not much latitude for thoughtful work. Anyone who doesn’t toe these lines will be left out alone on the legal chopping block if anything goes wrong.
They are afraid to reduce drugs, even complicated pharmacologic soups that no one could possibly know the effects of. There is a pervasive fear that people will become dangerous with drugs are reduced. I recently suggested at a job interview that I would be inclined to reduce and simplify med combinations if I worked there. “You can do what you want,” I was told. “But we don’t want anyone getting hit.”
Open dialog:
You’re right. Psychiatrists have not been allowed to even see patients before the decision has already been made that there is a “need for medication”. Open dialog sounds like a great process. Where is this happening?
Thanks for your thoughtful input here.
Alice
Report comment
Stephen,
Thanks for weighing in on this important topic. The word “recovery” is in frequent use in the places I’ve worked in recent years. Yes. By recovery they mean being cooperative with taking drugs as prescribed, keeping appointments and behaving agreeably.
I doubt it’s possible to return to a prior self however much one may wish to do this. People grow and change. This is a natural process. Life is a “river rather than a stagnant pond”, as you said.
I like the sense of a “journey of recover”y to become who we are “called to be”. This feels like each of us has an important purpose we may not yet be aware of. This is very forward looking and process oriented.
Well-thought and well-written.
Thanks.
Alice
Report comment
madincanada,
Thanks for reading.
I’m so glad your son is better and well on his path.
I like your words “let him find his own recovery”. This says it all to me.
Thanks for having the courage to walk away from what was not working and find a new way that does.
All the best.
Alice
Report comment
Peter,
Thank you for your support of my writing. I’m happy to hear that you enjoyed reading my essay.
Your reply is eloquent. I see that “recovery” may not be useful to you personally as a concept. You sound like someone who is internally directed in your living. Perhaps recovery could be seen as a process in which a person becomes more internally directed, if they want. I suppose that a person choosing to relinquish internal control could be making an internally directed choice as well.
In the olden days, when I was still able to do “talk therapy” with people as a psychiatrist, exploration of personal internal choices was an important part of this work. Even not making choices for oneself are kinds of choices. Being aware of how we give away our personal power and choices to others every day is a starting place. Examples: Saying “You make me mad” hands over control of your feelings to the object of your anger. Borrowing money gives away your power to choose how you spend your time and money in the future.
Perhaps the focus of “helping” could begin with asking whether a person wants help and what sort of help they’d like. Even the most confused appearing adult is still an adult. The next step would be to listen well. I have asked many people presenting to psychiatric emergency care what they want. I hear things like safe housing, a job, to stay out of jail, food, to feel better, medical care, help sorting out a troubling issue. There are a lot of requests for pills but there are a lot of requests for help with basic needs.
I agree that “mental health” and “mental illness” are cultural constructs. Today these constructs focus on behaviors that are unacceptable to the surrounding community, like sleeping in doorways and talking aloud to one-self in public. I suppose there may be other ways to manage these socially unacceptable behaviors than our culture’s current two-pronged management approach: drugs and/or incarceration.
Having said that, I should add that I think there is a place for psychiatric drugs still. I have seen people, through the use of psychiatric drugs, regain their ability to be internally self-directed that they had lost while experiencing extreme states.
Thanks for entering the discussion with me. I think of more to say when I meet others here.
All the best.
Alice
Report comment
Kathleen,
Thanks for reading and commenting. I appreciate your kind and encouraging words about my writing. I love to write. And welcome to MIA. I enjoy the variety of perspectives and expertise in both the regular contributors and the commentary.
I see your point about not liking the use of the term “recovery” in medical areas like chronic pain and HIV/AIDS. Recovery implies a return to some prior self. Even injuries we think of as being healed and recovered like broken bones may still cause pain from time to time later and need to have some additional care. I suppose there may be similar issues with the word “heal”. How does one “heal” from chronic pain? By definition you have it for long term.
I’m sorry if a life-long process of recovery sounds “exhausting and overwhelming” to you. I can see how you would feel this way. I think you’re not alone in this response. But to me, having a lifetime of opportunities to change and grow gives me chances to continue to make myself over. From time-to-time I re-evaluate and re-frame old experiences and perceptions and find more peaceful ways to live with (or around) them. Thinking I have to be “done” or “not done”, healed or not healed, recovered or not recovered makes me feel like I’m waiting to be graded. And I always hated that.
I’m familiar with the process of “being in recovery” of friends of mine that go to 12-step meetings. (Please. Any expert in the 12-step recovery process can speak up here and correct me.) Being “in recovery” sounds like a life-long process. One friend has over 25 years “in the program” and still considers herself to be “in recovery”. It doesn’t sound like she has to work at the same level of intensity on the same things now that she did once. “In recovery” seems an evolutionary process. I’ve never heard her talk about “being recovered” in a ‘done with it’ sort of way. I also hear her talk with great enthusiasm and hope about her process.
Specific outcome measures are currently required in every mental health agency that accepts state funding. A lot of time is spent making an individual treatment plan or contract with each person. Every interaction that is paid for must be linked back to agreed upon, measurable and countable improvements. At this time, every agency is held financially accountable to the paper trail that documents that this is happening. I have seen agencies have to pay back a lot of money because of deficits in the documentation trail. This is why they type so much.
Thanks for reading, thinking and writing.
Alice
Report comment
Dear Poet,
Thanks for taking the time to read and respond to my essay here. I am delighted to have the opportunity to think about what you write. Every interaction gives me a chance to explore ideas further.
You say this so much this better than I:
“What is most important is having a meaningful life and having a meaningful life is also the most important part of recovery.”
I agree with you completely.
I also agree that mental health agencies are very good at “re-badgeing” (re-branding?) whatever they do as being in line with whatever the current word is. Examples: if “case-management” is what’s paid for then “case-management” is what we do. Exactly what is done when one does “case-management” changes over time.”Med-management” now means a brief ‘howdy’, lots of typing and prescription refills. What is being “managed” here?
What kind of “recovery” is being facilitated when the primary “treatment” is a prescription? In my experience “recovery” inside financially strapped “mental health providers” currently means “stable on meds” which means “may be transferred to the primary care doc care for ongoing refills”.
When I think about humans and recovery, I don’t think about recovery in terms of having “leverage” over what mental health providers do. I think about each person being in charge of moving their life forward in a way that makes sense to them.
I suppose this all means that I’m not the best person to help formulate a “clear and powerful definition” of the “goal” of “recovery”.
Thanks again for letting me have a chance to write more here.
All the best.
Alice
Report comment
David,
Thanks for this lovely and entertaining piece. I shall have to try making 100 word summaries. “Grapes of Wrath” distilled to a 100 word essence, for example. There is a likeness to free verse poetry about the process that appeals to me. Word count limits help one filter and choose.
I’m glad to hear your insider’s view of editorial oversight in a professional journal, the supposed outlet for “evidence based” research we physicians use to fill our post-graduate education needs.
Alice
Report comment
sehuffman,
Thank you for your kind words.
I do care deeply about how my kids view my life and behaviors. I even gave up swearing and sold my gun when they came along. I held on to the motorcycle and leathers for a while longer, though. ;-))
How I live is one of the greatest gift I can give them. Thanks for noticing this. “Walking the walk” and living my life in line with my values means tolerating a certain amount of uncertainty and exercising generous amounts of impulse control each day.
I learned long ago that if I have the choice to believe someone’s word or their behavior, I’d sure better go with what they actually do.
A favorite quote from a hero of mine (Dr. George Saslow) is “Don’t apologize, change your behavior.” My mother said “Actions speak louder than words.” My friend Robert would say “Talk’s cheap.”
Thanks for reading and commenting here.
All the best.
Alice
Report comment
Nijinsky,
I like the planned and remembered escape for a few minutes each hour. What a lovely break from what normally passes as reality.
All the best.
Alice
Report comment
Sophie,
Thanks for doing the research to locate the source of messages of hopelessness. A hopeless person is a powerless person. I think personal power is an essential tool in recovery. We need more hope, more power and more recovery.
I agree that it is essential to get the word out about hope. We have to get it out to treatment providers and family members as well as people both inside and outside the current treatment systems.
All the best.
Alice Keys MD
Report comment
Nijinsky,
You just went right over my head. Music theory. I was never so good at that part of piano.;-))
All the best.
Alice
Report comment
ocdtalk,
Thanks for reading and commenting here. Your support means a lot to me.
You’re right. All the best we do is still not enough to shield us and our kids from every illness and misfortune. Staying together as a family has been very important for us. Staying together as a family provides us with more strength to cope when things do go wrong.
I’m glad to hear that your son is doing better now. Staying together as a family is more important than ever.
I’m glad that the world gained a new advocte for OCD awareness in you. Thanks for the good work you do. If each of us do the things we can, we’ll build a better world. My mother used to say that ‘many hands make happy work’. I’m happy for your hands’ work in the world.
Stay in touch.
All the best.
Alice
Report comment
I had the opportunity to visit and tour Second Story a couple of weeks ago in Santa Cruz, not long after the MIA interview.
The atmosphere is pleasant and relaxed. The staff are friendly. All in all this is a very homey and supportive place. I liked it that people staying there are free to come and go and eat as they wish. This is so unlike the standard hospital “treatment” model.
Kudos to all involved in obtaining the grant and designing and running the house.
Beautiful work. We need more of this.
Alice Keys MD
Report comment
Faith,
Thanks for all your time and effort to put together this piece.
Keep up the good work.
Alice Keys MD
Report comment
Nijinsky,
You’re so funny.;-)) the secret of the other fingers.
Alice
Report comment
Stephen,
I’ll carry a bucket of water with me. ;-))
Alice
Report comment
Stephen,
Your kind words give me a bright happy feeling this morning. I like it when I find out that something I write effects another person. I feel supported and appreciated by your words.
Thank you also for the time and effort you put in to help raise your brothers and sister. I have a friend who raised her younger brother and sister after their parents passed away. She was hardly more than a kid herself back then. I know your hard work made a difference.
This “all one” is an important concept to me. When I hurt another, I hurt myself as well as everyone else. When I help or give comfort to another, this is done for all. I like knowing that a person like yourself, a kind-hearted being with lived experience, is there working in the state hospital. This is courageous. You bring the seeds of kindness and understanding in your pocket with you to work. This is impressive and important to me. Thanks for your work there.
Oppression anywhere effects everyone everywhere. Loving kindness anywhere reaches everyone everywhere.
Knowing this keeps me going.
Ah yes. The rest of the story. Even in the best of best there is no one purely good. But also in the worst of worst there is no pure evil. Knowing this gives me hope that things can be better. Knowing this also gives me caution. I am encouraged by this knowledge to study the contents of my own purse regularly.
Much love to you and yours.
Alice
Report comment
Nijnsky,
Wow. I learn something new each time you post here. Did Babyloniuns have fewer fingers? ;-))
I stopped using alarms to get up years ago (Unless I’m freaked out about catching a plane. Then my head wake me up before the clock anyway.). The alarms jolt too much. My head naturally wakes up in the morning. I suppose I’m just lucky that way.
Thanks.
Alice
Report comment
Chrys,
Thanks for taking the time to be a support to your children when they were small. I’m sure this is important. Many parents today in America no longer have the luxury of spending this kind of time being acively involved in their children’s upbringing. It takes multiple jobs to keep the roof and food. Parent are forced to be away from their kids in order to provide for them. When babies cry “too much” and children are anxious and depressed, we call the babies mentally ill and drug them.
Like you say,”it’s a crazy world and getting crazier all the time.”
I agree, there will always be mentally distressed people in the world. Even the Buddha noticed there was a lot of suffering in human existence way before psychiatry was invented.
I, too, would like there to be better ways to support our family members and neighbors through times of mental distress. To me, we are all connected. When we treat people in distress badly, we treat all of us badly.
I’m grateful to you for your efforts as a psychiatric survivor advocate, a writer and a campaigner. I hope you will be here working for a lot longer.
All the best.
Alice
Report comment
Nijinsky,
Thanks for reading my post and supporting my writing efforts. I always enjoy hearing from you. You have an elegant way with words. I appreciate you reassurances about the illusion nature of illusions.
I find that kids are great sources of wisdom when they’re allowed to be.
I like your thoughts about the universal light source with each of us as light bulbs. You made me laugh with your light bulb analogy, the part about it being a hopefully green flourescent bulb that will save electricity.
I also don’t percieve of time as being linear. Dr. Who (British sci-fi time travelor) calls it “wibbly wobbly timey wimey”. We humans fractured time into bits and began counting the bits like beans not that long ago. Breaking and counting time in equal-units was part of the mechanistic industrial revolution. The modern concepts of time clicking away, wasting time, saving time (as if seconds are pennies to be piled up and used later) is transmitted through our education system so we can keep to a work schedule. We have to remember that modern education and beliefs about how time works came as part of industrialization. Public education and clocks came hand-in-hand with the change from agrarian/community life to factory/city life. To me, there have been some losses incured by humanity in this transition.
Thanks again for writing. You get my thoughts jump-started.
All the best.
Alice
Report comment
fstmarie,
Thanks for reading and supporting my writing adventures. I’m the lucky one to have support from folks like you and to have my family to guide me when the path is uncertain.
I wasn’t sure exactly where this essay belonged so I’ve also posted this one on my personal blog: alicekeysmd.wordpress.com
All the best.
Alice
Report comment
Ted,
Thanks for taking the time to read this morning. As a writer, I always feel better knowing that I’m being read. Knowing that what I wrote is meaningful is even better.
Thanks,
Alice
Report comment
Alix,
Thanks for taking the time to read my post today. I appreciate your interest and support of my writing.
Home education is not for everyone. In fact, the vast majority of folks turns out just fine with their school educations. It sounds like you’re making the asumption that school is equivalent to the “real world” and that it provides tools to kids to resist temptations. This could be a good area of research.
Staying friends with your children is mission critical in my book. Good job to be able and available to do this for them. Our children face a challenging world.
I agree. There’s nothing wrong with going out and earning a living as long as the parameters involved can be managed in an honest way. This can be the trick since an employee may only have something less than half of the say in the matter.
All the best.
Alice
Report comment
Ivana,
I’ll comment on this.
I don’t yet know the impact that DSM 5 will have on providing or preventing access to care and special education. I suspect there will a continued push for more drugs and away from other kinds of services. This is the direction we’ve been going for a long time here: more drugs and less supportive avenues toward better lives. With or without DSM 5, this is the road we’re on.
All the best.
Alice
Report comment
markps2,
Thanks for reading my blog and commenting here.
That cargo ship’s another big polluter. Buy less imports that are shipped here? I stay away from imported food. I skip the apples when they’re shipped from New Zealand and wait till the local ones are in.
Walking is good for your health as well as the health of the planet. Except when you get crushed in a crosswalk and killed (Woman in Portland OR last Tuesday. There are bound to be lots more examples).
Cars are the deadliest killing machine on the planet just for out and out direct daily kills. We kill 89 Americans a day every day year round (2010 CDC statistics). There are lots of inury statistics as well with this.
Thanks for checking in here.
All the best.
Alice
Report comment
Dear “The madness of…”
I suppose since your comment is addressed to another person, I should stay out of it. But since it is posted in the comments to my blog, I suppose I could say something with regard to the part that effects me and everyone who has been the target of bigotry of any kind.
“Typical Psychiatrist” is the same kind of comment as “typical black” or typical woman” or “typical mental patient”.
Alice Keys MD, Psychiatrist
Report comment
yobluemama,
Thanks for reading my blog and your support of my writing here. I feel so powerless to make a direct and significant impact the larger political, economic and environmental issues myself. I have to find small things that I CAN do. I park my car and walk to save lives. I think and read and write and encourage others to do so. I hold my own family close. I cook dinner. I focus on my own internal locus of control and support others in finding their own power. I can do these things every day.
I believe that combining the little things I CAN do with the small things that others CAN do will add up to the big changes we need.
All the best.
Alice
Report comment
Stephen,
I believe that each of us must be the change we can be in the world. I have felt so overwhelmed at times by the enormity of the situations that need reparation that I’ve wanted to give up. I finally had to get busy doing things that I know I can do and hoping that everyone else pitches in.
Thanks for doing your part too.
All the best.
Alice
Report comment
Ivana,
I just got back to MIA this morning on the west coast. It looks like I missed some conversations here. I shall have to go back and read the post where this discussion began.
Thanks for the suport you’ve given my writing here on MIA.
All the best.
Alice
Report comment
Ivana,
You make me smile. I like the idea of an “unconventional psychiatrist association”.
I got an email from another doctor I know. She liked the leaflet link you posted. Information in this comment section reaches a lot of people.
All the best.
Alice
Report comment
Ivana,
The nathuropathic physicians in the state of Oregon recently aquired full “prescribing priveleges” for allopathic drugs. Naturopathic physicians have been (in the past) the doctor one went to to avoid pills. They were the specialist for “natural” healing processes like lifestyle and nutrition. Now they are yet another avenue for faster and cheaper prescription refills.
The Osteopathic physicians (“O.D”, whose medical theories depend upon manipulations of bones) are interchangeable with M.D. here. We all train in the same specialist residencies after attending different medical schools. An O.D. Psychiatrist is the same as an M.D. psychiatrist now.
I haven’t looked into what prescribing priveleges the homeopathic physicians have. Homeopathic remedies are sold at food stores here.
In three states in the US, so far, psychologists (not medical at all) have aquired “prescribing priveleges” for psychiatric drugs. Social workers advocate for the ability to prescribe psychiatric drugs as well. So far the social worker initiatives have failed. Most states have authorized nurses and nurse midwives to prescribe drugs as well, with additional training.
Child psychiatry has lost “family first”. In Oregon, masters level educators (school teachers. non-medical) can legally give pychiatric diagnoses to children. They then pressure family members to go to the pediatrician (non-psychiatrist) for fast prescriptions of psychiatric drugs. They may refuse to allow the child to return to school unless the parent puts their child on drugs.
Many parents rely on school as the place for their child to go so they can work. No school means no work. Loss of work here can mean loss of housing. Loss of housing can mean loss of your kids. The kids will certainly get drugged in foster care. The family is not coming first in this situation.
Thanks for giving me the opportunity to think and write more. This is a good discussion. Perhaps we can have a conversation in person some day.
Alice
Report comment
Ivana,
I read the leaflet. It is very good.
Alice
Report comment
Ivana,
I also think family connections and leadership of elders is important. Family and community conections have been shown to lower the incidence of psychosis and improve outcomes in other places. Also the Buddhist philosophy must help.
It would be nice to know what’s working for this population. Perhaps there are way we can reduce the incidence of psychosis and manage it better here.
Thanks for your ideas.
Alice
Report comment
Ivana,
Thanks for the link. I hope that others will also look into these to use.
Every small thing we do to move in the right direction helps. It’s easy to think that only BIG efforts can make things better when we are up against such big problems. There are a lot of us. Each of us doing some small thing can make a big difference.
You are right. Everyone has losses.
All the best.
Alice
Report comment
Maria,
I’m sorry for your loss and struggles. A thousand years from now, you will be your son’s mother still.
Thanks for your clear exposition on the differences between legality and ethics.
In the US, it’s not always easy to get people to see past legality and liability to actual patient dangers; to get from “I might get sued” to “A person could die.”
As a nation, we in the US have a very attorney-heavy population. These are busy professionals. So, we are very “legality” conscious to the point of maintaining some losses in the ethics department.
The legal system (corrections) is a strong presence in this country. Our nation has both the highest numbers of prisoners incarcerated and the highest rates of imprisonment of any country in the world. This pushes us to be more focused on legalities as well.
I have found that people who would ordinarily be kind and ethical away from work become much more focused on legal liability within their corporate employment. I have had trainings to ensure this and been given suggested scripts to work from.
This is not meant as an excuse and may not be the case in this corporation’s tactics but with you. It is only my opinion. (Legal disclaimer).
Thanks for writing here.
Alice
Report comment
Steve,
I know we will, when we do.
Alice
Report comment
Ivana,
Thank you for staying in touch. I enjoy hearing your point of view on things and appreciate your encouragement.
What a lovely idea these leaflets are. Do you have a link to locate them on line? It would be good if every patient were given information like this BEFORE drugs are considered. If people know what to expect and what the wide range of normal human experience is, they will cope better and use fewer drugs.
There were times people came to me to be told their experiences were NOT crazy. Leaflets could help.
I do not have an office now or treat patients. If I had an office still I would certainly put something like this out in the waiting room. The “informational” and “educational” leaflets available from organizations here have a strong medication bias. When I had a private office, I made up some of my own leaflets and left them out. One was on Sleep Hygiene, how one could improve and regulate sleep without drugs.
One could not leave out leaflets in a “doctor as employee” office situation. This is how most doctors work here in the US. In my experience, informational leaflets here are carefully controled by management. They come from NAMI or drug companies. The leaflets carried the drug bias of those who paid for them.
Thanks for sharing your ideas. All great things start with ideas.
Alice
PS I did get back and reply to your comment of december 8 on “Just the way things are”.
Report comment
Ivana,
Sorry to be slow responding here.
I think that the differing structure of our medical system does explain a lot of the differences in health care between the US and France. Our system is made of a changing web of profit making organizations all battling for market share. Units of health care are sold to those that have money. No money, no health care.
Also poorer people have less access to healthy food here. There are areas of towns and cities that have no access to food unless it comes from fast food chains. Our small corner groceries sell snack food and beer, not produce or good bread.
It is interesting to me that the Buddhist immegrants have a lower incidence of psychosis. Do you suppose social support and family support is stronger?
HAve a good holiday season and new year as well.
All the best.
Alice
Report comment
Karina,
I, too, think that re-building communities that can sustain us is very important. I wish I knew how to go about doing this in these modern times.
I think that many of our modern human (and planetary) ills are the result of the ongoing industrialization process and an unrestrained capitalistic economy. These processes have slashed and burned families, farms, forests and communities the world over.
I know how to “network” with people today (emails, drive to meetings, texts, phones, co-workers and classmates) but I have no idea how to re-build actual communities. I grew up in a small agricultural community. When I think of community, I think of sitting on the front porch to see what’s happening in town, walking across the field to dig potatoes, sharing the extra tomatoes with grandma and sitting outside in the evening with neighbors talking as the night falls. You helped your neighbor, not simply because it’s the “right” thing to do but because next time you’ll need help. You weld my plow and I’ll can your pickles, kind of thing. We lived near the same people for a long time to get there. You didn’t always get along with everyone, but you knew what to expect from them.
That’s what I think of when I think of community.Can we get there?
All the best.
Alice
Report comment
Alix,
Thanks for reading, thinking and writing.
Your pensioner life sounds lovely.
The American way of life is very busy and filled with stuff and noise. We have no time to be with people, even our own families. Babies go to day care at six weeks of age. However nice the workers may be, they are not the parents. No amount of “quality time” can make up for this. I feel pity for little children today as well.
I read today (in drug company sponsored education material) about three year olds diagnosed with anxiety disorders, depression and elective mutism. Perhaps a three year old in day care for ten hours a day since the age of 6 weeks is right to feel anxious, depressed and not want to talk.
All the best.
Alice
Report comment
MJK,
Thanks for reading and writing here.
All the best.
Alice
Report comment
Lisbeth,
Thanks for your work and clear writing about the important practice of hope. I especially appreciate your comment that “hope can be messy and spacious”.
Personally, I like to zoom right past “reasonable hope” and into hope beyond reason. This is the hope I like in my daily practice.
All the best,
Alice
Report comment
MJK,
Your writing is so powerful and you have so much to say that there. There is little I can say in response, beyond this:
I am sorry for all your losses and hurts, pain and suffering.
I wish you the best.
Alice
Report comment
Stephen,
Back to my premise that professionals should all be very thoughtful, careful and considerate of the records they make. Medical records, psychiatric records, credit records, work performance reviews, police records, school records all (especially in the electronic age) can follow us.
I wonder if it would be possible to go back and have the record ammended now? I’ve amended charts for people in publicly-funded mental health clinics. For medical-legal reasons, even I (as the doctor) can’t erase or cross out anything I’ve written so as to make it illegible. I was told that files can’t be altered because there is a concern that if the records go to a court of law, it will look like an intentional alteration of the record to cover something up. But it’s possible to enter additional information and corrections as an addendum, even in electronic medical records. The old record stays legibel with a line through and the time and date the change was made is next to it.
It is also possible that your records have been destroyed already, depending on how long ago it was. Medical records don’t have to kept forever. Depending on the state and the year, there is a finite numer of years after a patient is last seen that records have to be maintained.
In my private office, I aged out and destroyed medical records in line with the state laws of Oregon at the time. I have had individuals look me up to find out if their old records were discoverable years after the fact. Nope. Without a record I can only reply that I have no record of you.
You could always check with the medical records department and find out their policies and procedures. Medical records staff are generally helpful.
ALl the best.
Alice
Report comment
Steve,
Thanks for reading and writing. Every time I log on to MIA and look through the comments, I am amazed all over again at the depth of wisdom I read.
I smiled a lot when I read this. You sound so much like the inside of my own head and how I think about things that I feel like I know you from somewhere. I can only say that I wish I’d written what you just wrote here. You spell things out so clearly and concisely. Very nice.
Your experiences with what healing takes is exactly what mine were during the ancient days of yore when I still was allowed to practice psychotherapy as part of my professional work. Even before I knew of the serious medical side effects of psychiatric drugs, I was still reluctant to hand them out. Once I gave a person that first prescription, they stopped working for change and growth. They went into “waiting for the meds to kick in” mode. If they felt better on drugs, then there’s no need to grow or change. Then when “the meds pooped out” we’d have to “try” other drugs.
There is something very dis-empowering about handing over the locus of control for your happiness to a bottle of pills. If not this one, then perhaps the next, or the next, or the next.
Thanks for checking in with us.
All the best.
Alice
Report comment
Oh Stephen. Thank you for asking after my happiness. Every day I am surprised by the ability to touch one another using words alone. Words are powerful, aren’t they?
I take great personal joy in my writing. This is the thing (beyond caring for my family) that gives me pleasure and personal meaning. I get up before dawn while it’s quiet every day and write. This process clarifies my thoughts and directs growth and change in my life. I have done this for many years.
Having gained a small readership here gives me joy as well. I love that people read what I write and then write back to me about it. I can imagine few greater pleasures.
I’m sorry if so many things I write here are so sad and desolate. I am, by nature, a hopeful, energetic and happy person. I shall attempt at some point to write about the immeasurable joy of life on this planet.
Thanks so much.
Alice
Report comment
MJK,
You write like a poet.
Alice
Report comment
Alex,
To have the patient and doctor work together to populate the information of the file is a great idea. Once upon a time, when I had a private practice and still had my own little boat to steer, I did this.
The first time I came in contact with the medical profession and medical records was when I was in college and accessing the “free” medical-student-run clnic as a poor patient. An unlabeled student doc I’d never met and didn’t expect clumped in, plunked down and, without so much as a howdy or introduction, began grilling me on intensely personal aspects of my life. I was not happy or pleasant with the young woman. The supervising doctor (himself a trainee) came in and caught me reading what the other young ass had written about me in my own record. None of it was pretty. This supervisor snatched my medical record out of my hand and verbally chastised me for reading it and for treating the medical student in a less than polite manner. I lectured him on polite behaviors to supervise his trainee in.
I can see how easy one may get the medical record reputation of having authority conflicts.
All the best.
Alice
Report comment
Nathan,
Thanks for hanging in with our discussion in the comment section.
I found this part of your comment particularly well stated and in line with my experience as a physician in relationship with the “insurance industry” and “health care industry” over the past twenty-five years.
“This is complicated by the resiliency of industrial complexes, as they respond to challenges and challenge by trying to maintain itself, often seamlessly reconfiguring and disciplining the components of the system to stay functioning. There is not all that much agency for individuals or individual parts, because the parts of the system become themselves only as part of the system.”
It has been my experience that, as an indiviual physician, I have been relegated to the position of being an interchangeable cog in a larger machine. There is one role, writing prescriptions, allowed me. The mass of the industry is such that, even when experiencing and expressing concerns about real dangers, I could have no impact on the larger system. No one, including the top managers, CEOs and governemnt funding gatekeepers could shift things either. When I did get someone to talk to me, the answer was “It can’t be changed”.
Yes. The bottom of the “dupe” pyramid is the patient. But duping travels pretty high in the pyramid and doesn’t seem to thin out until close to the top of the upper management levels. Even those that invest their retirement stocks in nice medical investements are duped. But earnings on your investment makes it easier to turn a blind eye.
Prisoners are the stock in trade of the prison industrial complex. Those bad people half a planet away and our young soldiers are the “cannon fodder” for the military-industrial complex.
All the best.
Alice
My choices were always only two: play along quietly or go away and be replaced by the newest cog. Guess which ultimately happened?
Report comment
Alex,
Nicely put.
Alice
Report comment
Alex,
Yes. If more people requested their own files (It is your right to have them.), folks would be more cautious of the things they said in them and how they said them. These files are passed between providers whenever you sign a “release of information”. They are accessed by any third party payor for care. If you don’t sign a release, they won’t pay.
All the best.
Alice
Report comment
Peter,
Thanks for taking the time to read and especially the time to write here.
My “random thought” from reading yours:
The entire medical system is a for-profit “industry”. I cringe when I hear the word “industry” these days. “Prison industry” comes to mind at once to me. Then I have to think about the millions of prisoners we keep locked up as part of a for-profit “industry”.
Once upon a time, “industry” mean you produced or manufactured a product. What is the “product” in the “insurance industry”, the “health care industry”, the “military-industrial complex”, the “defense industry” and the “prison industry”?
More to think about.
Alice
Report comment
MJK,
Thanks for clarifying for me.
Alice
Report comment
John,
“Pants”. I like it. “gobsmackingly unbelievable that anyone should take this idea seriously” What a way with words you have. I may have to steal this phrase with regard to having a diagnosis if your grief runs beyond two weeks.
The human relationship is the most powerful healing tool I know. I’d like to think it was the time you put in with him as well. It supports my belief.
Thanks for your support of my writing here. I enjoy your commentary and your point of view from the other side of the big pond.
The discussion helps keep the ideas percolating
Alice
Report comment
MJK,
I agree with Louise says.
Yes. You are still a mother. Keep writing.
Alice
Report comment
Louise,
Thanks for your support. “Ex-patients” would be all there is for me right now. I and the American “prescription-pad style” practice of medicine have parted ways for now.
I, also, would have a hard time making a diagnosis of schizophrenia in the absense of symtoms for 12 years. This is rather like the habit of continuing to say a person is diabetic when they’v lost weight, changed their lifestyle and have normal blood sugars with no medical intervention. But this is done. Or continuing to be labeled as hypertensive with normal blood pressure off medicines. Once you get a diagnosis, it’s yours forever.
There are no “cures” in Amreican medicine. Everything in maintenance and requires pills.
Sigh.
Thanks for reading and writing. Encourage others to do so as well.
Alice
Report comment
Emily,
Thanks for bringing more hope here to the pages of MIA today.
Alice
Report comment
Alex,
Thanks for reading here and taking the time to respond. It means a lot to me to know that people are reading and thinking about what I write. Thank you for this gift.
I can tell a lot of thoughtful consideration has gone into your remarks. I appreciate the time you took to review your life experiences and get clearer about what worked for you and what didn’t. I’m glad you’ve been able to find your way beyond fear and despair by using your “energy and vibration theory of health and well-being”.
Thanks for telling about your experiences in the mental health systems. These make a strong contrast with how you transformed your life by looking at your experiences in very different ways and trying new approaches.
I like “miracle” stories. The world can always use more hope.
If the ways you’re looking at things and doing things isn’t working for you, try different ways.
Thanks for reading, thinking and writing.
All the best.
Alice
Report comment
Stephen,
I’m sorry for your losses. I have known people who grieved their whole life from losses as deep as yours. How is this psychopathology? You’re right. Grief is a highly personal process. The DSM 5 allows two weeks for grief? The idea that grief is mandated a problem to be medicated after two weeks is beyond insanity.
Keep us up on the DSM 5.
Alice
Report comment
MJK,
I’m so sorry for your losses. And you’ve had a lot of them. You’re not the only person I’ve met whose children were held hostage in exchange for medication “compliance”.
Alice
Report comment
MJK,
It sounds like your shift to a spiritual perspective has been a good one for you.
However much people try to categorize the universe, all things are not knowable. It comes back to how much uncertainty one is comfortable with.
All the best,
Alice
Report comment
MJK,
I apologize in case you took my question about the diagnositic criteria for insane in a way I did not intend. I did not mean to make light of any of your “diagnoses”. I was not aware that “insanity” was in the DSM anything, that’s all.
I’m sorry for your suffering and hope for any tranformation that can bring you more happiness in your life.
Thanks for reading and writing here.
All the best.
Alice
Report comment
Stephen,
Thanks for validating my perception that psychotherapy has been lost to psychiatric hospitals.
You’re right. Sometimes psychotherapay is long and difficult work. But not always. It depends on the person and the situation and the therapist. Research on outcomes of psychotherapy show that the most important aspect that effects outcome is the realtionship formed.
So we’ve traded treatments that work well and give lasting benefits (a variety of therapies including “talk” therapy) for pill treatment that is medically dangerous, expensive and don’t work so well. I wish a bean counter in charge of treatment dollars would calulate all the costs. They would come up with very different sums.
Hospitals are now used for short term “stabilization” ie fast behavior control. This is not therapy or treatment. Therapies take a bit longer but have more lasting results (and less medical side-effects).
Thanks for your viewpoint.
Alice
Report comment
I’ll see if I can recall her name. She worked with me in the Portland VA A and D residential treatment program in about 1987. I will email you her name.
I recall she talked about other nursing research about locus of control at the time.
Locus of control has been a useful concept in my work with folks.
Alice
Report comment
John,
I’m glad to hear your friend is doing well. Nine diagnoses and five drugs for seven years with no improvement. That’s an indictment of the treatment he recieved.
Sorry. I don’t follow that last line.
“Psychiatry – my diagnosis – Pants, possibly, Big Pants.”
Perhaps a British turn of phrase or I’m completely out of the reality loop (possible).
All the best.
Alice
Report comment
WW,
Thanks for reading and posting here. You’re right. The names of the diagnoses are problmatic as well.
Changing the names to new names doesn’t always help a great deal either. Thirty-five years ago there was a push to change the diagnosis from Schizophrenia to Bipolar disorder for many patients. The more common diagnosis was schizophrenia. Bipolar disorder was fairly uncommon then. I was told that bipolar disorder was a “more hopeful” diagnosis and we should always start with this one, rather than say “Schizophrenia” when a person first presented.
Over the years the “popularity” (if I may use this word) of the bipolar diagnosis has skyrocketed with each new drug approved for its treament. This is a case of the diagnosis being sold to sell a drug.
I have even heard of people being given a psychiatric diagnosis because they took a drug and felt better while taking it. For example: You are have trouble sleeping. You are given a drug that has been marketed for bipolar disorder. While on the drug you sleep better. This means you have bipoar disorder. This is very bad reasoning. One can’t reason backwards from what a drug is marketed for to make a diagnosis. If the drug was originally sold for siezures (drugs marketed for bipolar disorder frequently are), does this mean you have a siezure disorder?
Psychiatry (and all of medicine) is plagued with this kind of bad reasoning. If an antidepressant makes you feel good, you have depression. If an antianxiety drug makes you feel good, then you have an anxiety disorder. If amphetamines make you feels more focused, then you have A.D.D. Come on. Most anyone feels more focused on a stimulant.
In my private office, I knew that saying “adjustment disorder with depressed mood” had fewer negative effects to a person’s insurance status. This implies you’re adjusting to a stress that could cause depressive symptoms in anyone. Once you say “Major depression, single episode” you’re on the lookout for recurrance and chronicity. You have a permanent risk mark on you from an insurance perspective.
There are clinics that cannot get paid for treating anyone with a “lesser” diagnosis. You have to have one of the big Axis I diagnoses for the govermental agency to approve payment. How do you think this effects the diagnosis made at the time of evaluation and intake?
Thanks for reading and writing.
All the best.
Alice
Report comment
Emily,
Thanks for pointing out the truth here.
Alice
Report comment
MJK,
What are the diagnositic criteria for this one? 🙂
Alice
Report comment
MJK,
Thanks for reading my post and writing back. I appreciate your willingness to share so openly here.
Wow. What a collection. How is it possible that these are all accurate medical diagnoses based on careful examinations?
I’m sorry you’ve been hurt by this pack of words. To throw this many labels at a single individual demonstrates my point. The words that are being tossed around by psychiatry today as if they are medical diagnoses are not useful for communicating an individual’s situation or useful in planning a course of action. They are being used in other ways.
For me, psychiatric dianosis has gotten in the way of my work with people. It was something I worked around and tolerated and kept to a minimum. In order that a person can access their insurance benefits, a diagnosis is required. In my private practice, I worked together with individuals to determine what we both thought would be an accurate (by the official lists) and the least damaging label to use to bill insurance. There were times that these discussions lead people to skip the diagnosis and skip the insurance payments.
The way these words are used hurts people. I think we agree here.
I suppose your final question is meant to be rhetorical and aimed from you to the “you” of the larger psychiatric community you’ve had contact with. I won’t address it personally.
All the best.
Alice
Report comment
Dr. Fisher,
Thanks for writing this piece. I especially like your premise “We are the ones we have been waiting for.”
In addition to illustrating how people with lived experience can provide transformational support to one another, it also reminds me of the concept of “locus of control” in wellness.
For me, your premise cuts right to the heart of the matter of “locus of control”. So much of routine medical and psychiatric care removes the percieved center of control from inside the individual and hands it over to “care providers”. Waiting on “meds to kick in” is placing power well outside the individual. To say the least, this is dis-empowering.
I worked with a nurse many years ago who did reserach on patient’s perceived locus of control and their recovery from medical illnesses. People who saw themselves as being in charge of the process had better outcomes than those who believed the “locus of control” was outside of themselves.
Yes. We are the ones we’ve been waiting for.
Thanks for your “lived experience” shared here.
Alice
Report comment
Dr. Datta,
Thanks for the well-written portrayal of medical training. It gave me flash backs.
There were not so many drugs being marketed when I was in training. Equating “doctor” with “prescriber” is a transformation that has occured gradually over the past 25 years. Especially in the field of psychiatry, this has meant the loss of many skill sets and the devaluing of the therapeutic relationship.
Thanks for the eloquent post.
Alice Keys MD
Report comment
Stephen,
I would really like to hear about small individual steps anyone has made as well.
My own efforts have been focused on myself and my own family. I have stepped away from the prescription pad for now to give myself time to think. I have simplified my life in many ways.
Your NP must be allowed more time with you. You are fortunate to have found a place you can afford medical care that works for you.
Thanks for you contributions here.
Alice
Report comment
Karina,
I found the whole video and watched it. Thanks so much.
Your recommended documentary:
http://www.youtube.com/watch?v=lMD8J3W9Mj
Alice
Report comment
Karina,
Thanks for reading and responding here.
I watched part one on youtube just now. Thanks for the recommendation. Do you have a link to the entire program you could share?
This video validates the essence of my concerns about industrialization and “progress”. This is a very big and interconnected issue.
All the best.
Alice
Report comment
Dr.Fulli,
Thank you very much for offering a French perspective. I am honored that you would take the time to read what I write here. Thank you.
I meet doctors in this country (besides myself) who have also decided to stop the practice of medicine. I suspect that more would stop if they were economically able. The numbers of women practicing medicine here has been on the increase as well. The highest numbers of women work in the lowest paid specialties (pediatrics, primary care, psychiatry).
We have also been licensing nurses in the USA to practice medicine here for many years. The “nurse practitioner” profession is a field dominated by females as it is a a graduate nursing degree. They work as independent practitioners and are used as a low-pay doctor equivalent for the same work.
I have heard that private insurance companies are making inroads in France, as in England. I have heard of a push to “privatize” medical care in France. I would like to hear your thoughts about the impact this will have.
What are the costs for a routine medical check up there? My Primary care doctor’s fees for an annual check up (about 45 minutes) runs around $500. This does not include any lab tests, xrays or medicines. An uninsured person could not afford this.
Thanks so much. I would like to hear more from your perspective when you have the time.
Alice
Report comment
David,
“Yet is cause and effect thinking to shallow, and far to mechanical to capture the nature of being?”
I am personally unable to capture the “nature of being” with thoughts. I find words get in the way for me. Of course there are different paths for different folks.
Thanks for your expositions.
Alice
Report comment
David,
Thanks for your support of my writing here on MIA.
I can tell you put a lot of time and thought into your writing here.
I wonder if “cause and effect thinking”, as you put it, is a natural and built in feature of the human cognitive operating system. For example, if you stub your toe your toe hurts and if you eat rotten food you get sick. “Cause and effect thinking” sounds like a good thing for everyday life.
I certainly hope we are entering a time of more unity of spirit and understanding.
All the best,
Alice
Report comment
MJK,
Thanks for keeping up with the comments section. This is a good place for discussion. I like to know there are people out there reading.
Alice
Report comment
Richard,
Thanks for your support of my work here. Thanks for your comments.
The conversations in the comment section give me an opportunity to explore the issues we will all have to work with if things are to get better.
I learned long ago, in biology 101, that a “radical” is the central core root without which the plant is unlikely to thrive or survive. The meaning of the word “radical” has changed so far that it now means its opposite: an extreme view that can be pruned away to relieve distress of the core group.
Those I talk to about my “radical” views (neighbors, friends, doctors, nurses, social workers, administrators, patients, the insured and the uninsured), agree that things have gone very wrong with medical care. The current “medical system” is not meeting needs on many levels. I guess this means that I and my radical views are closer to the core of things and more in line with the old biology 101 definition.
Yup. Our medical system is pretty broken, indeed.
I have always taken seriously the doctor’s’s mandate toward education of patients, co-workers, the public and the medical community. I was taught in medical school that one aspect of the word “doctor” is “teacher”. I took this lesson to heart that day and still do. As a doctor today, I am left with this role: doctor as teacher.
I’m glad to meet you in the “movement”. My hope is that the energy invested in “barricades” can be instead used find ways to better meet the needs of everyone.
Thanks for reading, thinking and writing.
Best regards.
Alice
Report comment
Stephen,
Thanks for taking the time, enegy and thought that have obviously gone into your post here. Wow. It’s a blog in itself.
So I’ll follow it with what should probably be yet another blog.
The fifteen minute (or less!) appointments are a contruct of the insurance/medical corporations and have nothing to do with providing care. Personally, there is nothing I can get done in fifteen minutes outside of hello, goodbye, typing a progress note and data entering prescriptions. This is not care. It’s a payment pump.
Even patients have come to believe in the fifteen minute appointment as a stadard of care. For the last two years of my private practice (2002-2004), I kept my rates down so low that I could only pay the overhead of a low overhead private practice. I had 30 and 50 minute appointments for the price of the usual “med checks” at the medical school clinic. I was still trying to practice medicine in a way that made sense to me.
9 of 10 calls that came to me were from people only wanted a fraction of an hour every six months or a year so they could obtain prescriptions with endless refills. They looked for the cheapest, easiest access to the brand and type of drugs they wanted. Period.
Physicians did not invent the “managed care” companies. Physicians do not run medical corporations. Physicians do not make policies for these corporations. At times, to add an air of legitimacy or as a liability foil, physicians are hired as figurehead “medical directors” or “advisory panels”. These docs still have to pump “billable units of care” as fast as they can to keep their jobs. Lower paid providers (nurses or social workers) are put in the position of directly “managing” care (limiting access and expenditures). But they must follow the corporate rules. It gives an air of validity to be turned down by a licensed professional even if they are following a corporate script.
Doctors are employees of corporations these days. Nothing more. They’re not allowed unions. The days of a “private practice” of medicine in this country has been dead and gone for over a decade.
“Medical system” means “for-profit medical services corporation”. Don’t be fooled by a “non-profit” label. This is a tax designation. They are not working for free. They still pay their top management very well. These medical services corporations have every bit of the medical field tied up tight. They will not simply roll over and play dead. There’s way too much money involved.
The largest third-party (insurance) payor in our country is the US government. Money is paid from tax coffers through medicare and medicaid entitlements. This is a big pool of dollars. This is the reason for the big push in the past twenty years to get everyone possible on disability. Each disabled person is another cash cow.
Medicare prescription coverage was a great win for the pharmaceutical companies. This additional “benefit” for the disabled and retired make each one into another lucrative place to stick a straw.
If I (or any other physician) decides not to play ball by corporate rules, we are out of a job, out of the game. Period. For me, there was no union, no benefits, no unemployment, no retirement. I’ve spent my life training and paying off loans for training and working as a doctor.
What was my backup plan to earn a living? I don’t have a back up plan. Neither does your doctor.
I think you are right when you say we are all to blame for this mess. We all must work together. It is, indeed, very complicated.
I’m sorry. I really, really wish it were simpler.
All the best.
Alice
Report comment
Richard,
Thanks for your support of my writing and processes. As a writer, I enjoy being read.
Although I do feel professionally alienated by the current system of profit driven, mass-marketed and drug-based “health care”, I’m not the “overthrowing” and “dismantling” kind. That takes an outwardly aggressive edge I was not born with.
And I honestly cannot say that I’m “anti-” psychiatry or even “anti-” biologic psychiatry on the whole.
I am a physician. I am a psychiatrist. I have prescribed drugs to people and found that there were times that the drugs were useful to specific people.
Before going much further, please notice the quotation marks around the word fragment “anti”. This is the pivot point of my thoughts on the matter.
In my experience, any time I’ve focused on what I “didn’t” want, that very thing came into my life. When I spend a lot of time thinking about anything, it becomes more apparent in my life. When I proudly proclaimed that I’d “never” do something, I invariably came to the point of doing just that. I learned not to say “never”. Focusing on “fat loss”, for example, has ones eyes glued to “fat” and “loss” rather than health and vigor. “Mad” in America, draws anger like a lightening rod. “Pain” management draws the focus to what hurts.
How I use words directs how I think and feel and how I live.
I certainly encourage every physician I talk to to re-evaluate their notions about medicines, their relationships with their patients and their relationships with their employers, the medical corporations.
I’m very much in support of finding and developing more humane ways to take care of one another.
I hope this addresses your questions.
Thanks for reading, thinking and writing.
Alice
Report comment
Dr. Datta,
Good job on writing the historical review of the system of classifications.
I’m reminded of what my mentor of long ago, Dr. George Saslow always said when I came to him for supervision:
“Don’t tell me a diagnosis. Tell me about the patient.”
It was clear to me that he believed sticking psychiatric labels over people kept you from understanding what was going on and how to help.
I would like to hear what you think about the financial conflicts of interest that have gone into the making of the DSM. Is there any treatment purpose in sticking labels on a person?
All the best.
Keep reading, thinking and writing.
Alice Keys MD
Report comment
Stephen,
It’s a good thing to do.
Alice
Report comment
John,
Thanks. I am a great fan of poetry. One can say a lot with a few words.
Love is the answer. We are all one. Even “them”. ;-))
Alice
Report comment
Stephen,
Thanks for spelling it out so clearly. You are better at the BIG picture than me.
Thanks for reading, thinking and writing.
Alice
Report comment
Not so alone today.
Alice
Report comment
MJK,
What a lovely response you’ve written today. Very thoughtful.
I have additional thoughts about liberty. Buying anything on credit makes a person less free. Any time you’re obligated to make payments, it influences your decision-making. No one is immune to this.
Every doctor I know leaves school with a lot of debt. There is no other way for a person of less than independent means to become a physician. Medical schools accept a lot of fundng from pharmaceautical companies. This doesn’t prevent the schools from demanding enormous sums from the trainees as well. Banks are out there, ready to loan money to earnest young people who want to help. These loans can no longer be discharged through bancruptcy.
Back to my recent re-read of “Grapes of Wrath”. People lost their family farms after accepting bank loans against them that they couldn’t pay. Steinbeck mentions that the people who worked for the banks didn’t want to do what they did (ie take away the homes and farms) but that they had no choice in the matter. Disobeying would mean job loss to those workers and loss of livelihood.
Everything’s connected.
Thanks for reading, writing and thinking.
Alice
Report comment
John,
“Private health care is not good for the poor but neither is it good for the moderately well off.”
I agree. But that’s another story for another day.
All the best.
Thanks for your support.
Alice
Report comment
John,
You sum it up so much more clearly than I can. From what I’ve been able to gather with regard to the 2008 banking crisis, much of the banking crisis came from unregulated financial institutions, the “shadow banking” industry. This “shadow banking” industry vanished very quickly, as did the money invested in it.
We all still ride out the waves of economic consequence from this.
Thanks.
Alice
Report comment
Stephen,
Thank you.
Alice
Report comment
Duane,
Thank you.
I’m very happy to be back writing on MIA. I’ve had a busy interlude working on other life and writing projects.
A peaceful holiday to you as well.
All the best always.
Alice
Report comment
John,
Thanks. I enjoyed it.
My inspiration for this piece came from a recent re-read of John Steinbeck’s “Grapes of Wrath”. Not much has changed in the tactics of Corporations since the 193o’s when the small farms of our country were turned into massive agri-business.
Alice
Report comment
Stephen,
Thanks for reading and sharing your thoughts here. I appreciate you’re validation of my observations of the history and changes in health care.
I’m skeptical of the Affordable Health Care Act and will wait and see how it pans out. So far it’s boosted the premiums of my $4000 deductable insurance to “add” a few scraps of “well women’s health coverage” we already had. I count myself lucky to have insurance at all and do everything in my power to neither use it nor lose it.
I have talked to people who are trapped in unhappy work, unhappy realtionships, unhappy locations because they are held hostage by health insurance. They can’t leave without losing access thay may never be able to re-gain. I know people who are impoverished by insurance premiums. These are the lucky “haves”.
Then there’s everyone else, the uninsured without access to medical care.
“Affordable Health Care” can only work when the for-profit insurance corporations are removed from the picture and all care is delivered through one equal single payer system with everyone in one risk bucket. Insurance works by averaging risks among high and low risk people. If you “cherry pick” the healthy young ones and put them in a separate low-risk category and keep out anyone with a “pre-exsisting” condition you apear to lower costs (and you REALLY increase profits), But you kill the whole principal of shared risk in the process. This is one reason why early “managed care” plans seemed to work so well. They sold these plans to companies with young healthy worker populations.
Thanks for your input.
Please, everyone, keep reading, thinking and writing.
Alice
Report comment
Happy to be here. Thanks.
Alice
Report comment
Thanks for your observations from the UK.
Alice
Report comment
John,
Thanks for more clear thoughts. I wish I could say I thought you were wrong.
Alice
Report comment
John,
Thank you so much for reading and connecting the dots.
I have watched management corporations chew through health care systems in Oregon for two decades now. The timing is different in different locations. The poorest people have least voice so they go first. It’s taken a while for the chomping jaws to make it around to the better-off layers of communities.
Where I am right now has had a lot of budget and program cuts but, I am told, hasn’t been stripped down to the bare bones of medication as the treatment for everything yet. These look like temporary budget cuts in a bad economy. There’s a lot of denial.
I doubt that “Preventative” medical care will be excericise programs, talk therapy or life changes. It will be pills.
All the best.
Alice
Report comment
Hey Ruby,
I’m glad to see you’re still around the MIA to greet me on my first return blog. You have a good way with words and raise some good points.
I agee. Multigeneraltional poverty is a problem. I don’t like to see poverty or unemployment being used as an excuse for poor health care. Good health care should be available equally to all without regard to their employment or finanacial status.
Yes. We each have to be the change we wish to see in the world.
Thanks for reading and commenting.
Alice
Report comment
Alix,
I’m so sorry this happened to your son.
You are absolutely right. Drugs do not compensate for a friendly, human approach. From either end of the relationship.
Thanks for reading and commenting.
Alice
Report comment
Emily,
Thanks for reading and replying. Sorry if I’ve missed the mark for you. You ask some great questions.
“Multigenerational poverty” and lack of money was/is used as an excuse to market “meds only” treatment in every part of medicine. I was taught that when medical care failed, it was not because medical care was lacking in any fundamental way, but because the patients were lacking somehow: being “non-compliant” and taking bad care of themselves.
In essence, I was taught to blame the victim when they only came in for care when things had reached emergency critical proportions.
The latest marketing of all drugs, including psychiatric drugs, is that we physicians need to “treat” people that do not yet have an illness with pills to “prevent” the possible onset of illness i.e. cholesterol lowering drugs to “prevent” coronary artery disease because the patient cannot be counted on to make pro-active life changes toward health. Cholesterol lowering medicine have never been shown to prevent anything in an otherwise healthy person.
Thanks for your comments.
Alice
Report comment
Jeanne,
I have never denied the genocide of the war.
I don’t have another word for “targeted mass poisoning”.
Alice
Report comment
Anonymous,
Thanks for your kind words about my efforts here. I want to get people reading, thinking and writing so we can find new ways to do things.There have to be better ways.
I hope I have not come across as trivializing damage done to anyone by any means.
The “head in the bucket” is something avery human has. It ois part of the human condition. I did nto mean to imply that only psychiatrists wear these.
Thanks for everything.
Alice
Report comment
Friend Dr D Lightful,
Sorry to see you go. I appreciate your input.
I know what you mean about leaving a system. I skipped out of the AMA in the late 1980’s, dumped the APA about ten years ago, closed the office in 2003 and haven’t worked as a psychiatrist since last August. But the system chugs on just fine without me.
Kermit is an editor here. He occasionally edit posts. My understanding is that they watch for things that may be considered personal attacks that would make people not feel safe to post here. I’m certain you can email him at this site directly. All my dealings with Kermit have been good.
I also have the capacity to remove or edit any posts on my own essays but have only removed two by specific requests of the people that put them up. I’m not real celar how this works for sure.
Funding this place? I have no idea if there is any. I write for free here for the fun of it. Robert Whitaker invited me after he read something I wrote. I hope to have an impact on making things better through the use of my writing. I’ve written eleven (I think) essays here about my own personal experiences, thoughts and opinions with regard to the field of psychiatry.
My understanding of the agenda is to promote conversations that will lead to re-thinking psychiatry and making the future of care for people that have been labeled as mentally ill better. I’m certain you could email Robert Whitaker care of this site and have his own ideas. It’s his webzine. Other agendas may also be here. For example, he is a writer and speaker on these topics. Some of the bloggers may have their own books or businesses related to this field.
I hope this covers your questions. I’m pretty new around the word of on-line conversation and this webzine. A couple months, I think.
All the best,
Alice
Report comment
mjk,
Thanks for the link. Everything is mixed up together. I find it impossible to make clear lines between food and health and mental health.
Alice
Report comment
Dr. D L,
fun (fn)
n.
1. A source of enjoyment, amusement, or pleasure.
2. Enjoyment; amusement: have fun at the beach.
3. Playful, often noisy, activity.
I meant fun in the “enjoyment” sense. Not like a day at the beach.
The guys on that first VA ward taught me how to shoot pool after lunch. They smiled and laughed and talked about thier lives. I enjoy listening to people and learning about them. This is fun to me. Maybe it wouldn’t be to everyone.
Those guys seemed to have fun (ie enjoyment) as well. The job I referred to specifically was my very first time working in psychiatry as a required part of my neurology training.
Remember, psychiatry was not so much about drugs in those days. We had “mileau therapy”, “occupational therapy”, group therapy, family therapy, individual therapy. We had “therapeutic relationships”.
Today’s psychiatric units and hospitals do not sound like “fun” to me. I do not work in those. I’ve spent decades doing everything I can to keep people from going to psychiatric hospitals.
I appreciate your contributions here. Every time you reply I get to think more. I enjoy this. It’s fun.
Alice
Report comment
Dr D Lightful,
What people need more is jobs. Absolutely true.
I would never suggest that money should be an acceptable motive to drug a child. However, a psychiatric diagnosis is sometimes required to access special educational services, health insurance and income. A psychiatric diagnosis often comes with a prescription.
Disability payments do not come from simply being unable to perform life functions, they require diagnoses. These days a diagnosis frequently requires a prescription. If the prescription goes away the disability may go away.
Sometimes stopping medicines means a person will lose their income. This doesn’t make sense. And loss of disability also comes with loss of medical coverage.
How is it that we’ve tied prescriptions to diagnosis to disability to health insurance and income?
I was taught (long ago in the history of my own medical training) that one can never reason backwards from medication effect to diagnosis. For example, if one focuses better on psychostimulants this does not mean you have ADD.
Somehow, we’ve gotten into the habit of saying that taking an antidepressant means he’s depressed and taking an antipsychotic means she’s psychotic.
This ‘stinking thinking’ happens in internal medicine as well. For example, if a histamine blocker makes your stomach pain better then you must have had overactive histamine in your stomach. If a medicine for reflux makes your stomach pain better then you must have reflux.
I have treated stage fright with blood pressure medicine (in addition to cognitive and behavioral interventions) This doesn’t mean the person has high blood pressure.
Thanks for reading, thinking and writing.
All the best.
Alice
Report comment
David,
Good. You are a philosopher.
Alice
Report comment
In Light, I Meant
Howdy. I tried to come up with a response as clever as the question but you win. I have no idea. It goes with “Tomorrow never comes”
Best,
Alice
Report comment
Dr D L,
Were there really tennis courts for prison guards? You hav a real interest in history, then. I had no idea.
Actually, my motivation for stopping my practice of psychiatry did have a lot to do with a lack of fun. Fun has been gradually drained from the whole medical world over the decades since I went to school. The practice of psychiatry has come to focus more and more on medicating people and less and less in helping people grow lives that work better for them. Being a psychiatrist has turned into writing prescriptions as an interchangeable cog on a too-fast conveyor belt. This doesn’t help people. It’s also not fun at all.
What do you do for fun?
All the best,
Alice
Report comment
Marianne,
Thanks for your kind and supportive words.
I think a lot. Writing helps me think. Writing conversations with people helps me think even more. I am very grateful for the opportunity to converse with all kinds of people from all over the world here on MIA. What a miracle. I enjoy everyone I meet here for as many different reasons as there are different people.
I’m downsizing here as well for several years. Downsizing is a philosphical stance as well.
I’m still a doctor and a psychiatrist, though. A person doesn’t stop being these even if no longer praticing medicine or psychiatry. I had a friend that was a psychiatrist till he died at 99 even though he hadn’t worked in a long time. He was a reader, thinker, philosopher. Many things.
I hope that more people can see that being a psychiatrist is not just one thing.
Thanks for talking here.
Alice
Report comment
Dr D L,
Nope. I didn’t answer your question directly. You asked one of those questions that it doesn’t pay to attempt to answer directly. It’s very much like the classic “Are you still beating your wife?” question that implies guilt and is aimed to “trick” a person into admissions of guilt.
You are not the first here in MIA comment land to take on this approach with me. Probably not the last.
The best I can do is tell you what I lived and experienced there. If you or someone you loved was there at the time, I’d be happy to compare notes.
Imagine. I do this for fun in my spare time.
Thanks for reading, thinking and writing.
All the best,
Alice
Report comment
David,
Thanks for your supportive and kind words.
I like this: I have an “infamous need to have fun.” I suppose if one has to be infamous for something…
I agree that being stuck in the ““Pain – Anger – Rage – Revenge,” stage” keeps us from moving forward into the future. The anger/retribution stance interferes with thoughts and both emotional and physical well-being. It blocks cooperation. (Even worse, it blocks fun).
My ever-so-small suspicious streak would have me thinking that the great American “us vs them” attitude is indeed the result of divide and conquer propaganda. It works so well in so many ways to keep grassroots campaigns from going anywhere. We have the perfect channels in place to promote these attitudes.
Thanks for reading, thinking and writing.
Best,
Alice
Report comment
Dr D L,
Thanks for posting the link.
Alice
Report comment
DR DL,
You sound serious about amnesty hearings. I got that.
Are they really making foodstamps only for “healthy food” and taking away bus passes to make people walk and be healthy? That’s what I was referring to when I said careful or they’ll pick it up as a cost savings measure. Perhaps these have already been done?
Alice
Report comment
Dr D L,
Changing the money would change the flow of drugs.
Alice
Report comment
mjk,
It does make you wonder what they were thinking.
Alice
Report comment
mjk,
I love the engagement. I keeps me writing and thinking and smiling. Wait a moment. Am I allowed to have fun here?
If drugs weren’t in the way I would, indeed still be in the field of… whatever it is.
Words rock.
Thanks for your kind words.
Alice
Report comment
Dr D L,
You got this one right.
Be careful what you joke about. It could be picked up as a cost saving planin the next budget hearing.
Best,
Alice
Report comment
wiley,
Good one.
Alice
Report comment
Steve,
Dang! Thanks. You said it all so much better than I could.
Keep reading, thinking and writing.
Ask questions.
All the best.
Alice
Report comment
Stephen,
I like the give and take. I think more when I have intelligent, thinking people to communicate with. This all helps me get clearer about things.
Have there been zings? Nothing but sweetness and light on MIA. ;-))
Seriously. People here know me by the words I write. I try to be clear. Some make assumptions about who I am and how I’ve lead my life based on me being a doctor and psychiatrist. Sometimes they’re right. Sometimes they’re wrong.I try to sort it out as it comes but I can’t always do this.
I’m still having a good time here.
All the best.
Alice
Report comment
Dr D,
I am certain that others will disagree with my answer on the grounds that I was a psychiatry resident and worked there. I also worked there as a neurology resident and as a medicine resident in addition to a psychiatry resident. The years were around 1981-84.
Charity was a difficult setting for all patients. Dusty wind blew in the halls. People were assualted in the stairwells. Patients were cared for in open wards with curtains betweeen the beds. All the patients we cared for had no alternatives for care. People remained in lines to be seen in the “emergency department” for days at times. I worked long hours and through the night to provide the best care I could given the resources available at the time. Everyone I knew there did the same. There were months at a time that we lacked basic equipment to work with (ex. 10cc syringes). Nursing coverage was so short I had to stay up at night to change IV bags so the lines wouldn’t clot off and to pass vital medicines to the critically ill.
It was a rough time. It was the only care available to those with none. Because of this, people were very,very ill by the time they came in.
Is there a reason for your interest in the history of Charity Hospital? Have your had personal experiences there as well?
All the best.
Alice
Report comment
mjk,
Wow. Thanks. You got it. This is what I meant. Your personal comments say it so much better than I could.
Thanks for the vivid and vital re-stating from your experiences.
Turning off the TV won’t make the wars end but it will reduce the impact of the terrorist media on our own emotional selves. Terrorizing ourselves by watching will not make the wars end, either.
Yes. These symptoms we label as “mental illness” could be caused by the real life experiences. Of course. But our minds really can’t sort the deaths and explosions we get from vivid second hand sources like TV out from things that happened to people close to us. I have had Viet Nam “PTSD” nightmares from running therapy groups with combat veterans. I have had nightmares from media exposure.
I can understand about having to wear other people’s clothes. I grew up in a materially poor “hand-me-down” family. I reacted for a time in adulthood by wanting a lot of stuff. Thankfully, I am back to living with few things and haunting thrift shops to clothe me and my family. Yes. I do know the difference between making a voluntary choice to live with less and having no choice.
Thanks for your well-thought comments.
Alice
Report comment
Stephen,
You’re right. This one didn’t “grab me” as much either. This is not the first one to make a softer landing here. Perhaps the muses have days off, too.
I will work to give people more to argue about (smiles).
These are questions for us all.
Thanks for reading and commenting.
Alice
Report comment
Dr D L,
Thanks.
Alice
Report comment
anonymous,
You are absolutely right. It is what came out of the hands that morning.
I think there are “on-topic” things woven in. This more accurately reflects how I feel psychiatry is embedded in the bigger picture of living life in our country.
I will aim for 200 comments.(smiles)
Thanks,
Alice
Report comment
Paula,
You’re right. It’s bound to be more complicated than this. Everything is.
From my own personal experiences as a psychiatrist (and this may be too limited a view) I don’t recall wanting more mental health workers. I do remember hoping that the phone would ring and there would be a person I could work and help using psychotherapy who didn’t want pills. I hoped it would be a person that could afford to pay something to offset the rent and liability insurance. This was a money motive for me. I couldn’t be in business without income. Any doctor’s office is a business. I obviously wasn’t so good at “creating patients” as I ended up working without paying myself the last two years. (smiles) I did enjoy (happy) working with patients a lot or I would have closed my office years sooner.
I used the (“science”?) of human relationships and cognitive/behavioral therapy to help people get on a path of a happier life that worked better for them.
Perhaps you’re looking at things from a more global perspective here?
Thanks for reading, thinking and writing.
Best.
Alice
Report comment
David,
I’m glad to hear that South East Asia has retained community and extended family relationships. The loss of both of these in our post-industrialization cultural has been devastating for us mammals that live here. We all need a web of others in order to be healthy. This concept, that we humans need close relationships, may be part of the underpinnings of why the Soteria model works.
I was taught that the “full blown euphoric psychosis” you describe is self-limiting and was the experience that made the “diagnosis of Bipolar disorder” for a person. I was taught (before the advent of the many marketed products) that with time (weeks), this would pass and go completely away. I was taught that many would only have one “episode” and that those with recurring “episodes” would “return to their baseline of functioning between episodes”. I was taught that the “diagnosis of bipolar disorder” was “a hopeful diagnosis”, that people with these experiences were, between episodes, the same as anyone else ie would have jobs and families and “lead normal lives”. Who are the ones now labeled as having “bipolar disorder” and why are they in need of lifelong polypharmacy?
I think we do have to look at real life experieinces for our evidence now. With marketed products driving diagnostic labeling, “research” and education, there is an unmistakable bias in the literature.
Another of your great questions:
“How we use the intellect to dissociate from our own visceral nature? We might think with our brain, yet do we still react with gut instinct?”
I don’t believe it possible to dissect out the visceral from the thinking part. The theoritical chemistry of all of this is the same. “Stimultions” like anger, fear, excitement seem ot run on similar chemicals. All of these change the wy we think about things and our opinions.
Keep reading, thinking and writing.
Your thoughts help me think more.
Alice
Report comment
mjk,
I skip the sunscreeen and go out in the morning and evening.
I keep the internet down to a dull roar…email mostly. This is the first time I’ve done the interactive online thing. I use wikipedia when I don’t know what something is. I don’t have much luck with accuracy when I look for a business on line. I still get calls from the internet on a practice I closed in 2003.
Certainly. I am on a quest.
I’ll let you know when I figure out what it’s for. 😉
All the best,
Alice
Report comment
David,
Thanks for reading my essay, giving it thought and writing your comments here. I like your additional questions. All of us have to formulate our own questions.
To me, the questions that arise in the field of psychiatry and psychopharmacology are mixed in with questions about everything else. I suspect the “epidemic of mental illness” in our country is not so much an actual epidemic as a wider and wider casting of the net for new drug customers. It’s more a case of diagnosis expansion. For example, I do not believe that autism prevelence is increasing as it seems to be. Only the diagnosis is. It’s one of the steps to getting special services in school systems. Getting an evaluation and diagnosis from a psychiatrist then leads to increased drug prescribing. When all you have is a hammer, everything begins to look like nails.
“80 million deadly bombs left over form the Vietnam era” “farm children get limbs blown off”
It’s like we are still at war with today’s children there all these years later. I suppose if we, as a country, are not taking responsibility for this that we will take responsibility for other things. BTW, there is some lovely radar mapping technology for finding buried landmines that could be used for cleanup of old minefields.
“Can you invest your previous experience as a psychiatrist in this much needed paradigm shift in human awareness?”
Here I am. I’m a writer. I write. I can do words.
“Has psychosis always been an aspect of human experience for a reason?”
Can you ask yourself “if madness is not what psychiatry says it is, then what is it?” _M. Cornwall
I believe that psychosis is culturally defined. The definition of a “delusion” (a sub-type of psychosis) is “a fixed false belief in spite of evidence to the contrary”. I can find these in almost anyone, not simply those defined as psychotic. If you belong to a culture that values direct messages from God, these would be fine. If not, then they may be labeled “psychosis”.
Poorer countries cannot afford the drug products that drive the “epidemic”. So maybe it’s not the trauma behind the “metal illness” boom?
Keep reading, thinking and writing.
Best,
Alice
Report comment
mjk,
Some of these questions I already have a good feel for myself. This was one of those mornings when every question seemed to raise five more. I decided to write the questions down.
I’m not so sure I understand all the questions. Some seemed to be for me. Some seemed to not be for me.
I haven’t seen either movie. But I’m out of the broadcast media zone as much as I can be. The media seems to be unrelenting in the agendas it promotes. Money is the motive force. I’ve had to “vote” with the “off” button for myself and my family. Ten years now away from broadcast media. I’m a bit out of the cultural loop but folks generally tell me when an earthquake happens or a tropical storm hits.
Broadcast media (if you turn it on) gives people you don’t know direct access to the inside of your head. It is a common misperception that we can sort and filter this and not be effected. If it were true, that the mute button protects you or that you can be too clever to be effected, there would be no money in advertising. Nothing would get through. But it does get through. A lot.
If there’s too much money in drug advertising to ever get it banned (likely), then that leaves us no other choice than to turn off the media at the user end, one at a time. This would be true grassroots rebellion.
Once I “detoxed” from TV, radio, newspapers and magazines I found I was more relaxed and less materialistic. These are both good.
Thanks for reading, thinking and writing.
Best,
Alice
Report comment
Dr. D Lightful,
I’m pretty good at being happy. I’m also pretty good at loving people. I even love folks that have less than glowing feelings about me. These have always been two of my specialities. I suppose one could do both of these (be happy and love people) just about anywhere and in any situation.
I also don’t believe that being “loved back” figured into my motives back then. I was there because I believed I could help people. That’s why I went into medicine. That’s why I became a psychiatrist. That’s why I worked in the field of psychiatry for years.
I love it when folks are “stunned” by my profile. There has been a bit of that going round. There may be other surprises in store for you. All psychiatrist are not cut from the same cookie cutter. There is a range of individuality in psychiatry that you could find in any field.
All of us have to seek meaning in our lives. It’s a good lifelong practice. Spiritual guidance has always been a big part of that search for me. I hope spiritual guidance part for you as well on your own personal search for meaning.
Thanks for taking the time to go back and read my other posts. It’s an ongoing story.
Thanks for reading, thinking and writing.
Best,
Alice
Report comment
Alix,
This was one of those questioning days for me.
You’re right: “each of us has to find answers for ourselves and life is all about balance”.
Everyone has to find which of the questions are the most compelling to pursue. I like asking the same questions over time and seeing how the answers change.
Thanks for reading, thinking and writing.
Best,
Alice
Report comment
Dr D Lightfull,
Thanks for adding your own questions to the list. I could have gone on. It ws one of those mornings when every question I could think of to write about presented more questions. I try to keep things to a thousand words.
I wasn’t sure…are your questions for me personally?
Thanks for reading, thinking and writing.
Alice
Report comment
Becky,
I do all I can to encourage everyone I know to look at the MIA website. I may get a nuisance award for sending emails with links but…
I suggest that everyone forwards links to favorite videos or articles to friends and family.
If we all spread the word, the word will spread.
Alice
Report comment
mjk,
Thanks for the lyrics and link.
All the best,
Alice
Report comment
marcellas,
Great idea. These discussions are great. I know people that read them closely that don’t post. There are many silent readers. There are many more “hits” than “comments”.
I’m happy to take my writing to a broader readership should this become available. In the meantime I spread the word and send links to people I know each time I post.
I don’t know if we can take the commentary elsewhere. People may not want what they’ve written put somewhere else. How could you get permission from them all? This is an administrative question to look at should a bigger venue become available.
“I was particularly disturbed by the recent comment that “the biggest problem facing psychiatry today is untreated illness”. I believe it was the current APA president who stated this.”
This statement bothers me as well. I see way bigger problems than this.
All the best.
Alice
Report comment
Marianne,
Wow. I hadn’t thought of multiple bracelets in different colors. One each “diagnosis” or each hospital stay or drug you’ve taken? How could severity be depicted? Maybe brighter colors?
How would severity be judged? Who gets to decide?
Alice
Report comment
Nijinski,
Thanks for the re-post.
Yes. Writing can come out of nowhere. Sometimes it works that way for me as well.
“Drugs…are a convenient way for many people to ignore that there’s a big problem. Sort of like taking the battery out of the fire alarm and being happy; and then when the house burns down…”
I like this part you wrote. I ran a mostly psychotherapy private practive. I discovered that when I gave people the pills they wanted, they often quit working on change. Later the “meds quit working”. Pills can block uncomfortable but natural feelings about a life that’s not working. No bad feelings, no motivation to change life. They keep doing what doesn’t work for them.
I hadn’t heard of this aboriginal vanishing. Interesting.
You have enough ideas to explore for a book. I especially like the following:
“we have a spirit that’s beyond time and space”
“letting go of fear”
“If you decide to use it for love, you are part of forever and everything there is real.”
“having an enemy to fight against as a group doesn’t create a community or a society”
Yes. Our culture has a lot of “fixed false beliefs in spite of evidence to the contrary”. You’ve pointed out several. This part in quotes is what I learned in psychiatry training as the definition of “delusion” which is a subcategory of “psychosis”.
I resist the urge here to launch into my own list of cultural “delusions”.
You are right to wonder who is crazy and who is sane. Who gets to decide?
Keep reading, thinking and writing.
Best,
Alice
Report comment
A Howell,
I just have to tell you I love your use of language in this phrase:
“metaphor can help us to peel away the epidermis of linguistic mischievousness and discern the moral truth.”
All the best.
Alice
Report comment
A Howells,
I have seen children be very concerned about the feelings of others and also completely self-absorbed. I’ve seen the same range from other-concern to self-absorption in every age group.
You’re right. None of this warrents abusing them.
Best,
Alice
Report comment
A Howells,
First, thanks for taking the time to read my post, think about it and respond. Most people that read here don’t take the time as you have to put their thoughts into writing.
There are a couple of things in your post I’d like to touch base about. The first is the following phrase:
“Psychiatry’s current agenda is, inter alia, crypto-eugenicist”
Sorry. Your use of metaphor ran straight past my head on this one. I have no idea what you mean by “inter alia, crypto-eugenicist”. I generally have to translate the big words into plain talk. Is this a phrase you’ve created or one from somewhere else?
Next, I’m getting the idea that you’ve had some experiences with “mental health treatment providers” and pills.You write as if from personal experiences.
I’ve clipped out these three statements and put them together below. To me, they seem to be linked by feeling tone. I apologize for taking them out of context like this. I didn’t want the feelings you are expressing here to be lost among the words.
It sounds like speaking up, letting people know what you want and expressing your feelings hasn’t been well recieved.
“all this criticism only serves to augment whatever disregard they have for our feelings.”
“the all too human desire to mercilessly crush your enemies, and we are their enemies.”
“discrepant interests and mutual contempt”
I’m sorry this has happened. Thanks for bringing your concerns here.
Keep reading, thinking and writing.
Alice
Report comment
A Howells,
I personally resonate with the use of metaphor. At times metaphor is the only way to get a message across for me. Poetry uses metaphor to take communication from the concrete and literal into the depths of the soul. Metaphor can bring understanding not otherwise reached with ordinary words.
There are times, however, that the use of metphor deteriorates to infammatory name-calling and personal attacks. At this point it no longer is a tool for comunication and becomes a weapon.
I know, I know. My mom told me that “sticks and stones can break my bones but words can never hurt me.” Except words are way more powerful than we are taught. Words can and do hurt.
The use of inflammatory name-calling and metaphor as a weapon backfires onto the one who raises this in a conversation. The use of inflammatory language that slides over that line into the war zone brings the level of the entire dialog down a notch. This loses readers and participants.
The vast majority of readers never sign in on the comment page. Every word I write here, I am aware of this silent audience. There are a lot of folks to get these messages out to. I am reluctant to turn any of them away.
Thanks so much for bringing this topic up today. It’s good for all of us to remind one another of the consequences of our use of words here.
Keep reading, thinking and writing.
Best,
Alice
Report comment
Marianne,
The “metabolic syndrome” side effect didn’t get talked about in the drug “educational” literature till we hit Zyprexa.
I did hear a lot of people complain over the years that the medicines, all of them at one time or another, made them gain weight.
None of this would be good for health, eh?
Alice
Report comment
Marianne,
I have to admit that I’ve chased a lot of disability paperwork and free medicine paperwork and samples for patients.
Disability payments can mean the difference between a roof and homelessness but it comes with a diagnosis and medical insurance that buys drugs. This is all so mcuh more complicated than I ever thought. When I thought I was helping by assisting someone with disability paperwork I was putting them right into the paying customer category for drug companies.
Alice
Report comment
mjk,
I like using this webzine as a focal point. This is a place where people read, think and write together. I have learned so many things in such a short time right here.
Thanks,
Alice
Report comment
marcellas,
Persistance is good. You have that. Keep spreading the word. I hope that there will be some tipping point and the message will take off.
Thanks for your work.
Alice
Report comment
mjk,
Thanks for your perspective on this. We have to look at things from all directions to see them clearly.
Best,
Alice
Report comment
Kermit,
I’ll get it when I get back to Portland in the next few days.
Thanks,
Alice
Report comment
Duane,
Thanks for your kind words.
Yes we did lose so many young people.
Alice
Report comment
Altostrata,
Which one? The only one of hers I’ve read was “Operating Instructions”.
Alice
Report comment
marcellas,
So where do we go with this? New narratives? How do we spread them and encourage them?
Alice
Report comment
EAC,
They would not be a group of 45 year olds. There may not be “equal numbers” in opposite age ranges. Countries with high infant mortality rates score low life expectancies because the infant deaths are averaged in.
The average life expectancy of Americans is 78-80. Women tend to live longer then men. Some live to be 105. Some die in infancy.
Thanks for reading, thinking and writing.
Alice
Report comment
Duane,
Thanks again for the resources for vets. This is a Memorial Day theme for Memorial Day.
Best,
Alice
Report comment
mjk,
You have a very visual and poetic style with words that I enjoy.
Alice
Report comment
Jeane,
I think “genocide” is a great word when it’s used for an ethnic or national group that’s been singled out for extermination. I certainly know there has been a history of murder of the mentall ill. Genocide happens around the world with wars today.
The use of psychiatric drugs is so widespread now that they no longer encompass a defined group of people with a “mental illness”. Everyone everywhere in this country and many other countries (any country with finanacial resources) is now in the target market population.
With the new DSMV push to “pre-diagnosis” this is a clear step toward marketing to people who someone thinks might someday become mentally ill. Even now the target market population is so big and vague as to be non-specific.
The edges of a “genocide” boundary for meantl illness are gone. Everyone is at risk in any country with money to purchase the products. People die. But I have a hard time labeling what’s happening right now as “genocide” or “nazi”
What would be the word for selling products with disregard to health and safety to anyone with money to buy them? There must be a more accurate word than “genocide” or “nazi”.
My concern is that when we use these less accurate and inflammatory words, we will drive away the people who need most to hear the messages.
There are a lot of people who may not know they are at risk. The message must get out to them. This is important.
Keep reading, thinking and writing.
All the best,
Alice
Report comment
Anniken,
I’m sorry for your loss. This is waht I mean by a “face” on the statistics. People are interested in people more than numbers. This is why the faces sell drugs better than numbers and text.
Get the message out.
Thanks,
Alice
Report comment
Stephen,
You’re right. I suppose if he knew up front about the intensity that occurs here sometimes that he would be prepared for it. He sounds like he has a lot of useful experience and ideas. I like a person with ideas and experience over what can pass for education.
It sounds like you do good work from the heart. I hope they know that where you work.
You’re right. It’s the person that’s important, not some arbitrary category they’ve been placed in.
Thanks for your work,
Alice
Report comment
Nijinsky,
Thanks for another commentary. You put a lot of thought into your writing.
All the best,
Alice
Report comment
Duh?,
Your creative thoughts are refreshing. This sounds like the basis for a screenplay.
Maybe we could use bright colored plastic bracelets for this. More durable, The color could show the diagnosis or drug from a block away and wouldn’t be mistaken for anythign else. Brave new world material.
Keep reading, thinking and writing.
All the best,
Alice
Report comment
markps2,
I think that Robert Whitacker’s information is more current than this study. Could this report be based on a study done in the last nineties? The difference between life expectancies of the “mentally ill” Americans and the American population has been getting bigger over time. It was 10-15 years in the early nineties.
This difference is big. It’s even more frightening that the gap is increasing even with of our ever increasing diagnostic nets.
Alice
Report comment
Lowry,
Yes. Using “managed care” i.e. medical service provider corportions as middle-men between doctors and their patients is a big issue.
Best,
Alice
Report comment
Lowry,
Is there one or are you starting one today?
Alice
Report comment
Lowry,
Thanks for putting eugenics on a timeline perspective into history with regard to psychiatry. I’m pretty sure that money is the big driving force behnd the rapidly expanding market for pills today.
Alice
Report comment
Stephen,
Stubbornness can be a grand thing indeed. You are here. I have seen it be the deciding factor in recovery.
I just listened to his talk while making dinner. He’s great. I wonder if he, in his retirement could be convinced to do an occasional piece? Do you think people here would be open to something like that?
re diagnoses: I have always found it more useful to learn about the person, not the diagnois. The diagnosis is not a useful treatment decision tool or predicter of outcome to me. It was meant to be a way to have diagnostic uniformity for research. It’s been used (sadly) for SO MUCH MORE.
Alice
Report comment
Stephen,
We are all lucky you are here.
Alice
Report comment
Barbara,
I took this straight out of Robert Whitaker’s talk in the video side bar. I was so impressed with the number that I didn’t stop to look it up for myself.
Sorry.
Alice
Report comment
Barbara,
The same folks own everything and have for a long time.
Pervasive.
I watched some old videos with my kids last week. Even without commercials I could see them promoting soda brands a chips. The characters always had the drink can labels pointed at the camera and their backs to the vending machine.
Ads are embedded in the programming. The mute button doesn’t stop it. It’s like the old movies stars all smoking.
Alice
Report comment
Stephen,
I will always be grateful to the people that came to Charity Hospital for their care. They taught me to be a doctor more than any teacher could. Many of these individuals are printed on my mind. After medical school at Tulane/Charity. I stayed for two years of residency.
State funding of Charity hospital and the Charity clinics kept things a bit “cleaner” from a drug money point of view. We could do research on things like the causes of Schizophrenia (I helped with a blood viscosity protocol) and undiagnosed medical conditions among psychiatric inpatients. Since the state put money into patient care and medical training, there was room for non-drug research there.
Thanks for the support and kind words.
Alice
Report comment
Barbara,
I bet the number of drugs (in all categories) is much higher now in geriatric nursing home patients. These are very sensitive people biologicaly (as are young children). These are some of our most vulnerable family members and neighbors.
Polypharmacy has always frightened me. I have no idea how one can tell what is going on inside a person with so many drugs on board.
Alice
Report comment
Stephen,
I hope that by pointing out the enormous percentage of those effected, that people will come to understand that this is not about those mental patients down the street but is about themselves and their family. I got a message recently from woman concerned about the school mandated drugging of a friend’s grandhild. Word’s getting around and people are concerned about folks that they never thought about before.
There are times I have more hope that the word is getting out.
Alice
Report comment
Ruby,
The number one cause of death in adult “psychiatric patients” is the same as the general population only much earlier; cardiovascular disease. This fits with the information you gave the links to.
I’m puzzeled at the impulse of the prescribers I talk to about these issues to attribute the increasingly early deaths to “lifestyle choices” such as smoking, overeating and inactivity rather than the drugs. Certainly in adult patients the drugs cause over eating and inactivity.
Smoking? I was taught (by an academic researcher funded by a drug company) that the mental illness itself caused people to smoke more, something in the dopamine system. But the drugs muck about in the dopamine system. Could they cause increased smoking and make it harder stop?
There is a new epidemic of cardiovasculr disease and metabolic syndrome in children, including what used to be called “adult onset diabetes”. With over 21% of kids under the age of 17 taking psychiatric drugs, has anyone looked at concordance between the psychiatric drugs and the increasing rates of CV disease and metabolic syndrome in kids? Perhaps its not all “lifestyle choices” like fast food and inactivity. Perhaps the drugs cause over eating (as they are known to do) and low energy (as they are known to do). Could doctors be looking at side-effects of the drugs (obesity and inactivity) and mistaking these for the causes of the metabolic issues?
Good thoughts. Good information. Keep it coming.
Alice
Report comment
Stephen,
I think 80% alternate prescribers sounds right, but I haven’t seen numbers. Since the drug companies can and sometimes do track every prescription I personally write for their products (for sample distribution), I know the data is out there. I’m sure insurance companies know. We lack tha unified data base of a national health system.
I think that most people that get psychiatric drugs don’t see a psychiatrist at all.
Some may see a psychiatrist once but then get “refered” to a GP (primary care) by the insurance plan. A lot of insurance doesn’t pay for “specialists” without a referal from the primary care “gatekeeper”. Some of the reimbursement plans take money away from the primary care every time they refer out. It keeps the gate locked.
Back to my contention that the drugs are about money and corporate profits (rather than intentional and planned harm directed at specific groups). Probably I repeat myself too much on this.
Twice, when you ran out of insurance, you had to go off “cold turkey”.
No cash, no pills.
I’m glad you were able to stop the medicine without symptoms. Easy for some. Not so easy for others. I’ve seen both and a lot in between.
I will watch the video. What sorts of questions would you like to hear his viewpoint on?
Alice
Report comment
Stephen,
Sorry to intrude (I do it alot).
Alternative radio perhaps? KBOO in Porland Oregon just interviewed Robert Whitaker last week. There is a national alternative radio (not to be confused with “public radio”). They have a genuinely liberal alternative viewpoint (at least in Portland). does your town have one?
We all have to get past the “fighting with one another” thing. It eats too much band width.
Thanks for your participation in these discussions.
Alice
Report comment
markps2,
Also, I suspect that government bean counters have been convinced that the pills are cheaper than providing healthcare.
They may have also been convinced that the poor physical health is secondary to causes other than medicines.
When the states finally got it that tobacco and alcohol was costing them a lot of medical expenses, they shut down advertising and added taxes to cover their increased medical expenses. In Oregon, gambling profits are required to pay for gambling treatments.
Best,
Alice
Report comment
Marianne,
The “help” programs are very short term and meant to start a patient on a drug while that patient gets signed up for state and federal funding to continue them. They are also useful PR campaigns that promote the idea that the for-profit corporation “cares” and “helps”. “Free samples” are only given for the newest and most expensive drugs. There are no “free samples” of generics.
In my experiences working with the “free help” medication program, they are VERY “prescriber” time intensive, paperwork intensive and short lived. The “hoops” vary with the drug. These things make them hard to access. Drug conmpanies do not intend to give away quantities of drugs to those that can never be “funded”. They are bridges between “free samples” and government funding sources to buy them for the patients.
Even the “free samples” come with “prescriber education” obligations. No talking, no pills. Now, the number of samples are directly linked to the numbers of PAID prescriptions for that product coming from my specific pen. If I don’t write paying prescriptions, my unfunded patients cannot have access to “free samples”.
Both of these “free help for the poor” programs (samples and patient assistance programs) are in place specifically to increase PAID ongoing prescriptions, get the company direct access to “educate” staff and physicians and to provide friendly PR for the company.
You probably already knew all this but maybe some folks missed the details.
Medicines are available for the funded. There are lots of poor people in Oregon that are not funded and will not be unless someone will declare them to be “disabled”. Follow the money trails.
All the best,
Alice
Report comment
Stephen,
I grew up in Ohio on a farm (potatoes and vegetables), lived in Georgia for 7 years where I worked construction then went to college (sunshine and grits) and spent 6 years in New Orleans in medical training(beans and rice and Mardi Gras) before moving to Oregon 26 years go (the land under the Great Gray Cloud). I’m in Santa Cruz right now writing (sunshine, sand and surfers).
Bingelybingelybing. You’ve got it. “it’s one, huge, convoluted mess”
The rest of my message is this: You may be able to find helpful people from any of the groups involved. You, for example, work at a state hospital. If we threw away every state hospital worker as if you were the cause of the problem, we’d lose you. Then there’s me, and maybe other psychiatrists, that we would lose to the effort if we vilify all psychaitrists. Who knows, there could even be (dare I say this?) a former drug rep that could play a an important and useful part in making things better.
When over 69,000,000 Americans out of 311 million are taking psychiatric drugs, YOU COUNT.
What other group has this kind of “count”? This is a lot of votes. This is a lot of black arm bands. This is a lot of occupy. This is a lot of human and financial resources.
Best,
Alice
Report comment
markps2,
I suspect that the “whole point” of selling pills is to make money. The “weaken the patient” is an unfortunate “side-effect” you have to “educate” your way around.
Thanks.
Keep reading, thinking and writing.
Alice
Report comment
Steve,
Long ago. I was trained that it’s my role of a psychiatrist to see past the “symptoms” and provide a thorough medical evaluation of the underlying medical conditions. The woman that complained of a dog in her stomach had ulcers.
The expectation of me as a “prescriber”, now, is that I’ll precribe, fast. I’m actively discouraged from doing medical evaluations both from a “no money for it” and “no professional liability to cover it” perspectives. The assumption has become that if it looks “psychiatric”, it is this and only this.
Tha practice of psychiatry, for me, has changed a lot.
Today, I’m a writer. I write.
Thanks,
Alice
Report comment
Faith,
I would never dream of “taking away” a medicine that’s helping.
Thanks,
Alice
Report comment
AA,
Absolutley right on this one.
We did research on undiagnosed and untreated medical conditions among our hospitalized psychiatric patients at Tulane/Charity Hospital. There were a lot. A resident doctor was hospitalized in the unit. It turned out to be a hyperthroid condition. All the medical screening missed this because it “looked” psychiatric. We also diagnosed a man’s brain tumor that had him on the psychaitric unit. He could only rock and hold his head and moan. Had to be mental, right?
I thought that psychiatrists were the ones that were better at diagnosing medical conditions because we knew to and could see past the “symptoms” to the underlying medical conditions. We had complex screening protocols required for every new diagnosis looking underlying medical conditions. Whatever happened to medical the “workup” in psychiatry?
Thanks for the reminder.
Alice
Report comment
Rossa,
You are a fountain of inforamtion. Thanks.
Follow the money.
Wow.
Alice
Report comment
Philroy,
There are bound to be other contributing factors. I’ve seen it laid at the door of tobacco. Tobbaco use takes off about 12-14 years of a life. With “mental illness” we’re talking about the difference between 45 and 80 years.
What precentage of people with mental illness diagnoses smoke? The American population is 23%. I read that with “addictions OR mental illness” “75%”. No separation of the two groups was made. The arithmatic doesn’t add up for me.
The gap is widening at a frightening (to me) rate.
Research priority?
Best,
Alice
Thanks,
Alice
Report comment
Duane,
Wow.
Alice
Report comment
bjcirceleb,
As each new addition of “prescribing priveleges” has come along in the Oregon, I was told it was to cure a “shortage” of psychiatrists in “undereserved” areas. Any questions I raised were shut down with accustions that I didn’t want any competition for my cash cow or “trough”.
I did not “ask” it to happen or requests this. Check who paid for the potilical campaigns. Not me. Follow the cash trail. The “blame” is easy to place on psychiatrists in retrospect (A lot of this happens). But I was there. I am here.
I have finally learned to shrug (rather than spend my time defending myself against accusation of greed) and say “Go ahead. Get “prescribing priveleges” for your profession (most recently for naturapaths, psychologists and social workers). I told anyone that would listen that they would NOT like what happened when all their professional skills were reduced to this one final common “prescriber” pathway.
Becoming “prescribers” guts out and destroys all other professional skills.
Psychiatry was gutted of all other skills when we were taught (and bought) that “prescribing” was the thing that made us “special” and meant we could “charge more” than other mental health providers. These are the same “baits” being offered to other professions to take on this “presriber” role.
It was once rare for primary care doctors (GP, family practice) doctors to prescribe psychiatric drugs in the USA as well. This “prescriber of psychiatric drugs” role by GPs has been pushed by drug marketing and by the medical service provider corporations as “cost saving” and providing “accessible care” (back to the old “shortage” story).
I feel sad at the situation we are trapped in. Wait a moment. Isn’t there a pill for this? 😉
Thanks so much for the perspective from Australia.
Alice
Report comment
Emma,
Thanks for reading, thinking and commenting here.
I also have a hard time believing that either the “mental illness” itself or individual “lifestyle choices” can account for the increasingly large gap in life expectancy between those with diagnosed mental illnesses and the rest of the population.
Thanks,
Alice
Report comment
Mary,
Thanks for the link.
Alice
Report comment
Alexa,
It sounds like you’ve found a health care team you’re satisfied with. You’re lucky. You’re also educating yourself and doing waht you can to moderate the health risks. The metabolic issues you mention are one of the known health risk side-effects of atypical antipsychotics.
Thanks for reading and commenting here.
Alice
Report comment
Scott,
Perhaps people are just keeping their heads down.
Best,
Alice
Report comment
Duane,
Thanks for reading and commenting here.
Best,
Alice
Report comment
Marianne,
I read today that 21% of American children from birth to 17 are on psychiatric drugs. (Internet)
Sorry. I have no more words for this one.
Alice
Report comment
Altostrata,
Each of us has to bring what we can. I like the “bird-by-bird approach” phrase. I may borrow it from you some day.
Mine is word-by-word.
Thanks,
Alice
Report comment
Duane,
Thanks for your support.
Alice
Report comment
Mary,
Great ideas. I’m a psychiatrist and I’m writing.
Rememeber the public direct marketing. I had a steady stream of patients to my private practice requesting (and demanding) drugs. I had a CB therpay based practice and turned away nine out of ten potential patients because they wanted drugs and nothing more. This was from 1989 through 2003. I closed when there were not enough therapy patients to pay my overhead. Things are not better since.
Thanks,
Alice
My rant:
Ban the ads. Ban the ads. BAn the ads. Ban the ads.
Report comment
Marianne,
I’m not sure of anything. 20% sounds way too low to me too. Interent research. Not science.
Does NAMI recieve donations from any corportions? I’ve seen patient educational literature imprinted with both NAMI and drug company names in years past.
Thanks,
Alice
Report comment
33,
From a quick scan of internet today: (Yes, I know this doesn’t constitute “real” medical research.)
In the early nineties the life expectancy of people with “mental illnesses” was listed as “10-15 years shorter” than the national average.
In 2007 it was said to be 25 years shorter than the national average.
Today? Robert Whitaker reported a recent study that showed the “mentally ill” now live an average of 45 years? The average American lives 78-81 years. Now “the mentally ill” live 35 years shorter on average?
Things are changing. They’re going in a very wrong direction.
I’m so sorry for your loss.
Alice
Report comment
easy,
No worries. I over-personalize routinely.;-)
Alice
Report comment
Barbara,
Thanks for your support and encouragement.
I appreciate your ability to see things from other perspectives. Seeing things from wider perspectives is not the same as making excuses. I think of it as gaining useful understanding.
The increasingly stretchy criteria for bipolar disorder have troubled me as well.
Best,
Alice
Report comment
Bolo,
This webzine, in my mind, is one such “grassroots” campaign.
Thanks for the encouragement,
Alice
Report comment
Steve,
I’d love to see a comparison study of average age of death in one of the “poor” countries without so many psychiatric drugs. It might be easier to get a less/non drug effected current comparison group. Compare those with the psychiatric diagnoses with and without drugs to the general population. This might help sort out the drug impact. Maybe the data is already out there? Anyone know?
Thanks,
Alice
Report comment
John,
Isn’t a radio PR piece on psych drug treatment the same as a drug advertisement? Thanks for speaking up over there.
Alice
Report comment
Steve,
I don’t know how to sort out the specific causes and effects. They weren’t listed.
With the expansion and changes in diagnostic categories, the expansion and changes in medicines and the tendency toward polypharmacy how could we even be compare old data with new? Were these “earlier deaths” you learned about assoiated with psychiatric diagnoses studied before the time of medicines? How much earlier were they? Were they attributed to any particular causes? Were these numbers before “de-insitutionalization”? How many years earlier were you told?
I was taught this once as well (I don’t recall where, when or by whom), that people with psychiatric diagnoses die younger than the average population. I was taught it was for unknown reasons. I don’t remember the average age at death being 45. This number got my attention (obviously).
I was also taught that risk factors and associated findings are not the same as direct causes.
Just the same, if I found myself in a category associated with such significantly earlier deaths, I think I’d find a way to mosey out the back door while folks talked it out.
Thanks for reading and commenting.
Alice
Report comment
Altostrata,
Good. I’ll move on to other topics. I wouldn’t want anyone to forget.
Alice
Report comment
Altostrata,
Today, I write essays on MIA to encourage all of us to re-think what we do. I’m a writer. I write.
I’m glad to see you are here re-thinking as well.
“What would you do to have a a more immediate effect?” is a question each of us must ask ourselves. If I ask you this question, how would you answer it? If you ask it of yourself, how would your answer change?
Perhaps you’re right. If we wait quietly, the drug companies will gradually stop marketing on their own as drugs go off patent. I’ll be over here waiting with the flying pigs. (humor intended here)
Keep reading, thinking and writing.
Alice
Report comment
anonymous,
Sorry to pop in here. You say things that make me think. This is good. I hope others read and think as well.
Could people be taught to care about 69,000,000 real people who are at increased risk of early death by their exposure to psychiatric drugs? Over 20% of American children and over 20% of American adults are prescribed them.
These 69,000,0000 people include teachers, mechanics, hair dressers, software engineers, mothers, florists, firefighters, grandparents, police officers, unemployed,social workers, construction workers, doctors, xray technicians, meter readers, TV repairmen, ministers, soldiers, plumbers, electricians, nurses, environmentalists, bill collecters, car salemen, retirees, fathers, postal workers, CEOs, realtors, shop keepers, students, psychiatrists, farmers, insurance salesmen, airline stewards, tour guides, bus drivers, drug reps…add everyone you know to this list.
No one is immune. The marketing is pervasive. We are way past “us and them”.
Other causes have used “poster children” because suffering kids draw sympathy. Perhaps we need postors of all 69,000,000 people? That’s a lot of posters.
Best,
Alice
Report comment
Marian,
I was speaking of Americans here. Over twenty percent of all Americans are prescribed psychiatric drugs. This is 69,000,000 Americans at risk for early death.
Talking about eugenics with regard to drug prescribing today implies there are special categories of people based on genetics or ethnic characteristics that are being targeted for death. If this were true, the customer base in some targeted group would be declining behind these efforts.
This would not make financial sense. Drug companies want an increasing funded customer base, not fewer cutomers.
Where’s the target in America TODAY? The wallet. The third party payments. Government insurance comes with the disability payments.
Today’s drugs are about money. Nothing personal. No ethnic cleansing. Simply cash profits.
Perhaps I should write an essay about the financial motives of capitalist corportions to clarify how this works.
Thanks for your thoughts.
Best,
Alice
Today’s rant:
Ban the ads. Ban the ads. Ban the ads. Ban the ads.
Report comment
Altostrata,
You would think this true. If only it were. In the face of overwhelming marketing, no doctor can convince another doctor or patient of anything. I’ve tried. Perhaps I’ll write an essay about these failed efforts.
Thanks,
Alice
My rant of the day:
Ban the ads. Ban the ads. Ban the ads. Ban the ads.
Report comment
anonymous,
Thanks for your support and reading today.
I wish we had real numbers or, better yet, real names. With over 20% of the American population now being prescribed psychiatric drugs, arithmetic can give us the number of Americans that could be at increased risk of early death.
.20 X 311 million = over 62,000,000 Americans are at risk.
You may believe that psychiatrists, and the many other health car providers prescribing these pills, are “safe” from the effects of psychiatric drugs. You would be wrong. I know an awful lot of physicians, psychiatrists, nurse practitioners and mental health professionals that are on mental health drugs as well. This would be a good percentage number to discover. It may be a lot higher than the general population.
Please understand that people that prescribe these drugs believe in them, take them and give them to family members as well.
Thanks again.
Whenever I hear from you, I think new thoughts.
Keep readin, writing and thinking.
Alice
Report comment
Corinna,
Thanks for reading.
Genocide is a strong word indeed. In this situation it is inaccurate as well. “Genocide”, by definiation, requires the group being killed to be of one genetic or ethnic group. For example, killing people of Jewish descent or middle eastern descent or Albanian desent is genocide if the aim is to destoy the entire group.
Putting over 20 percent of the adult and child population of the USA at risk for early death is big, important and scarey, but it’s not genocide. Currently, these people are not being sorted by genetic or ethnic similarity (unless you believe there is a genetic predisposition for “mental illness”)but rather by access to third party payment for drugs. You don’t have money, you don’t get the drugs.
I include the following 1944 defintion of genocide from wikipedia:
By ‘genocide’ we mean the destruction of an ethnic group . . . . Generally speaking, genocide does not necessarily mean the immediate destruction of a nation, except when accomplished by mass killings of all members of a nation. It is intended rather to signify a coordinated plan of different actions aiming at the destruction of essential foundations of the life of national groups, with the aim of annihilating the groups themselves.
How we use words is important.
Thanks for your input. It gave me a chance to look it up today.
Alice
Report comment
Ted,
Ban the ads. Ban the ads. Ban the ads. Ban the ads.
“Criminal prosecution” is only possible if there are laws broken. One must first have the laws. I am not an attorney (perhaps one could respond) but I believe that one would have to pursue other legal measures besides “criminal prosecution” it the behaviors engaged in have not been legally made “crimes”.
Another important point is that “us is them”. Twenty percent of the American population is “us” now according to a Fox News report from 2011. I think this is a low estimate. Psychiatric drugs are handed out to everyone by every health care provider.
By your thoughts, do we have to send every physician to prison that has prescribed a drug that had a bad outcome? We already have 25% of the world’s prisoners from 2% of the world popualtion. Perhaps other solutions could make an impact?
My rant:
Ban the ads. Ban the ads. Ban the ads. Ban the ads.
Thanks for reading,
Alice
Report comment
Rob,
A friend forwarded me a couple of chapters from an ACT made Easy book that covered the basic principles in an understandable manner. Thees sound quite a lot like my own variety of CB therapy I used in my private practice. I wasn’t so clear as to organize the material into six pillars of teachable material for others to use.
What I read sounds like it’s based on Beck’s “Cognitive Therapy” and Seligman’s “What you can change and what you can’t” with a spiritual buddhist seasoning.
Am I in your ballpark yet?
BTW. The other (F)ACT model works well, too. There’s nothing like getting food, shelter and assistance with the legal system to get one’s feet on the ground.
Best,
Alice
Report comment
Donna,
Thanks for sharing your personal experiences here. I’m glad things have gotten better.
Thanks also for pointing out the variability of the effects of pot. I have know many people told me their use for many years had no effects other than “getting high”.
I have also met individuals who told me a little bit of pot caused serious problems for them.
Best,
Alice
There’s a lot of variability and all is not known in the world.
Report comment
AA,
Some people came to my private office and paid cash out of pocket rather than leave a paper trail of their treatment in insurance land. As long as they never admitted to anyone and never signed a release of information I could never say a word to anyone.
I also was careful to keep personal details out of the medical records text. Only the minimum necessary. Insurance companies have access to your records if they are paying. Sometimes the employer is also the insurance company.
Privacy tactics are necessary in general medicine as well. I met a slim healthy young man (not a patient of mine) who was having trouble sleeping. His primary care doc sent him for a sleep study. He has “sleep apnea” only if sleeps in one specific position. This requires no treatment. He was given the “sleep apnea” diagnosis. Now, as a consequence, he cannot purchase private health insurance.
Any time your medical information is written down anywhere it will be used.
Here’s a related tangent:
Having huge medical service delivery and insurance corporations owning the doctors, hospitals, clinics, labs, test equipment pharmacies, pharmacists, nurses and “members” is filled with enormous potential financial and information conflicts on interest. The insurance company in charge of approving government payments for treatment also owns the treatment providers. Do anti-trust laws come into play here?
Best,
Alice
Report comment
EAC,
I see your point with the antipsychotics. I wonder if this holds true with all the psychoactive drugs. It seems the benzodiazepines and stimulants (diet pills and “Bennies”) were very popular among GP prescribing long ago (60’s-70’s) without much encouragement from psychiatry. Valium and tranxene. Antidepressants? They may have had a good go with the GPs and with no psychiatric help as well.
Thanks,
Alice
Report comment
marcellas,
I, too, am grateful for these discussions. I’m learning all sorts of things. Thanks for your lovely post. I was stuck on how this “anosognosia” word got to be used in psychiatry. I hadn’t run into it. But then, I’ve never been great with big words and doctor-speak. I have to translate them into plain-speak (as you’ve done a good job of doing with this) before I can understand things.
I’ve always been a big believer in believing. It is core to making a life.
Best,
Alice
Report comment
Altostrata,
I missed this.
Thanks. Apparently, I am not one of the psychiatrists that knew this. I still don’t.
Alice
Report comment
Stephen,
I miss responding to some posts. When there are alot, I lose track of the threads. Some are obviously meant for another responders
I do the best I can to keep up with the conversations. People that read and think and respond are the important “rest of the story”.
I’m happy that people are reading what I write. Even the strong disagreements mean folks are reading and thinking.
I agree that it will take all of us to make meaningful changes in how mental health works in this country.
Thanks for the encouragement,
Alice
Report comment
anonymous,
If this is as prevalent a psychiatric usage as you say, it’s a miracle that I have not heard of this innaccurate use of the neurologic term. Perhaps I do not travel in the right circles or search out the right propaganda channels?
I learned of this first, here, on the comment section on MIA in the past few days. I had to google the term to be sure I was right with the neurologic definition from my long ago neurology training.
All the best,
Alice
Report comment
jeremy,
My neurology training would have me agree with you on this definition.
I hadn’t run across this book. I’m not much of a book burner, though. Once you start, where do you stop? Who gets to decide?
Thanks,
Alice
Report comment
Anon,
Do we have one of those vote counters here on MIA?
Thanks for checking in on this one.
Alice
Report comment
Rob,
Thanks for the correction. The ACT acronym sounded the same. You may certainly send me any information you think useful through this website.
Alice
Report comment
Altostrata,
I hear what you’re saying:
“Concerned psychiatrists need to turn their attention away from the crumbling of their hegemony and towards truly taking care of patients. If this had been the focus of the profession all along, it wouldn’t be in the pickle it’s in now.”
I agree all doctors need to turn toward truly taking care of their patients. How that would look or transpire for each individual doctor would be beyond me to dictate.
The second half is much too narrow a view of the causes of the pickle. It hands doctors more power than they ever had.
Best,
Alice
Report comment
Lowry,
What you say makes sense to me. Thanks for walking through the process. I’m sure this must happen.
Alice
Report comment
EAC,
You’ve missed the point.
Even if psychiatry had never exsisted (no cheering out there) drugs would have been invented and marketed. If you’ve seen no parallels among the Primary care drugs of over-prescribing and later discovery of bad side-effects (ex: cholesterol lowering, antibiotics, bone hardening, hormone replacing, allergy relief, anti-inflammatory,weight loss, blood pressure lowering, GERD drugs) then you haven’t done your research yet.
And the for-profit medical service provider organizations would have sucked up the practice of medicine just as they have today.
Keep reading, thinking and writing,
Alice
Report comment
Altostata,
Honestly. Reseach goes where the money is. There is no money for long term research. Turning out drugs for short term profits is what the for-profit corporations do. That and enormous ad campaigns.
I presented a research proposal in my short-lived attempt in academics. Since it was for a prospective study concerning the efficacy of group therapy in A and D treatment, there was no money.
No federal grant money. No drug company money. No research. No academic position. No job.
Yes. There should be long term research. There is no money in this country for it.
Best,
Alice
Report comment
David,
I thought (maybe I’m wrong) that the word “anosognosia” was a neurologist’s word for a brain injury that did not allow the patient to know they had a brain injury, a phenomenon discribed in stroke patients and others with injured brains.
Is this term used in psychiatry?
Alice
Report comment
Marianne,
Thankyou. I really appreciate having a “personal cheerleader”.
How could I be anything else but who I am? 😉
Best,
Alice
Report comment
Rob,
I am familiar with ACT model. I worked half-time for six months a couple of years back with a start-up FACT (forensic community action team). This evidence-based treatment model seems very much like the old multi-disciplinary treatment team appproach I remember that offered way more than pills. I wasn’t looking for work at the time but when they described the level of support available and the resources we could offer people, it made sense for me to do it. We were able to help people with housing, food, clothes, support to manage the legal system, access to medical care, personal and A and D counseling, vocational support, financial support in addition to medicines. We could go pick them up and give them a ride to an appointment if that was what was needed. This is waht I remember the “old days” of community mental health to be. Much less about pills and more about the whole person and situation. That specific team is no longer around.
Thanks. There are excellant ACT trainers in Portland. I have met some of them and done trainings.
Thanks,
Alice
Report comment
easy,
Things are a big mess. Telling anyone that I can fix this whole big mess alone would be a lie.
Best,
Alice
Report comment
Jeremy,
If we could get non-medication open-dialogue treatment that helps people here without medicines I am all for this. I could learn to do this kind of treatment or I could go drive a cab and cheer things on from the sidelines. Good patient care and patient choice comes first.
Why would a psychiatrist be precluded from providing this kind of treatment? I have years of experience and much training in non-pill therapies, individual and group. Sadly, there has been no request for these other treatments. I asked and suggested to administators for years if I may run therapy groups or provide counseling. I finally stopped asking.
I love providing other types of care. Sign me up for open-dialog training.
I can’t imagine being “threatened” by good care that works.
Best,
Alice
Report comment
Duane,
I am and I have. Here I am. Writing. For me things are in place.
Thanks for your kind thoughts.
Best,
Alice
Report comment
EAC,
I presume you are in the US (I can’t always tell).
I haven’t watched TV since 2002. I understand there are some pretty high end commercials out there for prescription drugs. I’ve heard of a bouncing blue face that really sold an anitdepressant. I’ve seen a couple drug ads by accident when there’s a TV in a waiting area. Do you think the marketing campaigns have had any influence on the popularity and widespread use of these drugs?
Thanks,
Alice
Report comment
Stephen,
Thanks for the thoughtful and understanding post. I do know that people here only know me by what I write, my name and the initials after my name. I choose my words as carefully as I can. When people come to inaccurate conclusions about me I first I look at what I’ve written. Sometimes I’m not as clear as I thought. I take into account the experiences people have had. I always learn something from them.
There is a huge problem here. I may not get all the details but I get it that there is a huge one. It’s way bigger than me or anything I can do about it alone.
So I write.
Thanks again,
Alice
Report comment
Stephen,
Freedom of choice and alternatives. Good.
Alice
Report comment
Stephen,
Thanks for your reminder that this pill epidemic is not a psychiatric problem alone. It is a medical problem and a cultural problem.
Your personal experiences match my own.
Best,
Alice
Report comment
Heidi,
Thanks for your thoughts concerning my blog.
Keep reading, thinking and writing.
Alice
Report comment
Duane,
Thanks for the enouragement.
Best,
Alice
Report comment
Altostrata,
You would have to give me the specific patient and the specific missed side effect that I, specifically missed for me to answer your question about MY thoughts at that time. It is not possible for me to answer such a general “if” question. Perhaps you could take a swing at it yourself?
Best always,
Alice
Report comment
Steve,
It’s what I did for 14 years 1989-2003). It quit working financially in about 2001.I could pay everyone except me those last two years before I closed up shop. I also (by virtue of enormous federal debt) had to pick up hourly clinic “prescriber” work to pay the loans every month.
I doubt you’ll find what you’re looking for in a “job”. You’ll have to invent something on your own. An employer will not pay you to “think and cultivate relationships with your patients”. Yes, this is what works. It’s the right thing to do.
Best to you,
Alice
Report comment
David,
Right now I’m a writer and a mom and a wife. I haven’t worked as a doctor in nine months and my dance card is pretty full. I’m not looking for another career path. Will one find me? Will I want it?
Maybe I’ll pack up the kids and head off to Africa where doctors can still be doctors. I could brush up on tropical infectious diseases, baby birthing, bone setting and sanitation. I was a pretty good wound stitcher in my time (This is mostly a joke.)
Thanks for reading and commenting,
Alice
Report comment
Ruby,
Hmmm… Can’t say I understand all either.
Alice
Report comment
Duane,
This give me an idea for an essay on Diagnosis creep.;-)
Alice
Report comment
Hey Duane,
I’m not so personally concerned about whether psychiatry survives either. I was asked what I thought and answered as best I could.
I am here writing because I’d like to imagine that I could have an impact on making things better. That’s all. Maybe I will. Maybe not.
I had hoped that looking at the “bigger picture” would help us all understand the forces we’re up against and where best to point our energies.
I do believe that the loss of the therapeutic alliance has taken the heart and soul out of psychiatry in the process of the transformation into a pill model of care. There were not “third party payments” to me in my “good old days”. If my patient got good value from my work, he/she paid me. This seemed fair.
Thanks for checking in on this one.
Alice
Report comment
Ruby,
Sorry to misinterpret what you wrote as being a suggestion that I (or another psychiatrist like me) pursue medicine tapering as a line of work. Folks misintepret what I write as well. It is one of those foibles of using only the printed word to communicate without the other non-verbal and vocalizations. Perhaps there are other psychiatrists reading here who could work this into their practice.
For sure. Money colors decisions for every person. Money is a fact of modern living. Of course, greed exsists. I’d be a real polyanna if I said it didn’t. No one group has the market cornered on greed. I remember the doctor “across the river” who kept his schedule full of cash-and-carry ten minute prescription appointments till the state pulled his license.
I have no idea what kinds of people would be presenting to me today if I made myself available to do tapers. I can only report my personal experiences as a psychaitrist who did make myself available to do this in years past. I can’t assume to speak for the experiences of anyone else but myself or for any time but then.
There were people that called me asking to be “tapered off” (believe it or not) that took higher than the doses prescribed to them, that got medicine and sold it to other people, that had been “tapered off” by their usual prescriber without actually stopping, that “collected” a stable of “prescibers”.
I’m glad you found a doctor to work with you on your slow taper. You are fortunate.
It sounds like you are good at collecting resource lists. Others here are as well.
All the best,
Alice
Report comment
Diana,
I’m glad you found someone willing and able to help with your medicine taper.
There’s a lot of interest in gathering such resources here.
Best,
Alice
Report comment
Alix,
Thanks for your thoughtful post.
You’re right. Psychiatrists have not always been psychopharmacologists (“pill pushers”). I was trained by psychoanalysts, hypnotherapists, a great gestalt therapist, gorup therapists, A and D treatment therapists and CB therapists, all psychiatrists. I was also trained by teachers from every related field. But my best teachers have always been my patients.
How can we begin teaching a broader range of skills to psychiatrists? How can we put the time back in the day to use them?
I was taught by an excellant old-school neurologist that there are times when the only thing you can do is be there and hold your patient’s hand. This is good for all of us to remember. We doctors want to do something, give something. It’s good to remember that this is something that can be given.
Thanks. Your thoughts help me think more.
Alice
Report comment
Ruby,
It’s easy to make assumptions about rationales for the professional decisions of others. It’s also easy to get things wrong.
When I did handle “tapering” as a professional direction (I did that already years ago), what I found was that most patients who said they wanted to taper were actually shopping for another supplier. It put me in the situation of continuing prescriptions for people I would never had started on the drugs in the first place. I stopped doing this for drugs started by other doctors because it did not go well.
Perhaps things would be different today. I couldn’t presume to say.
Alice
Report comment
Steve,
Thanks for reading and responding.
Thanks for pointing out that focusing on psychiatrists will have limited postive results. It will have results. They may not be be those hoped for.
I’ll bet the patients and other psychiatrists that have had good results with judicious prescribing wouldn’t dream of poking their heads up here. There are times when being a psychiatrist writing here is rather like painting a target on myself and walking into a firing squad. I have also seen people who have had good experiences within mental health treatment systems take it pretty rough when they spoke up.
Don’t get me wrong. There are lovely, supportive and thoughtful replies. There are just a considerable amount of the others.
Thanks for writing here.
Alice
Report comment
Ruby,
Funny you should mention this. A few years backI left my dog with a house sitter. She wasn’t so good at getting her outside to the bathroom. When I discovered this, she told me the dog was depressed and the vet wanted to put her on prozac.
If I wanted to make money on this, I’d be out there doing it. This is, indeed, the land of opportunity. They can also prescribe ANY psychiatric drug. All of them.
Thanks,
Alice
Report comment
EAC,
Family doctors and counselors do this “brain disease” convincement every day in this country. The biggest pressure I used to have in my private practice (behind the direct cold-call demands from patients) to prescribe psychiatric drugs came from counselors, therapists and family doctors. They have also been convinced of the “brain disease” model and spread it around. All psychiatrists could vanish tonight and this would live on.
I don’t know what percentage of “research” of psychiatric drugs is done by “academic psychiatrists”. Certainly academics must “publish or perish” in every branch of medicine,in every branch of academics. During my brief attempt in academics I was unable to get funding for a study of group therapy in A and D treatment from the feds. I didn’t know, then, of their funding sources or priorities. Pif. That was it for me and academics. I was a stupe (I discovered 25 years later).
There are private clinics that do a lot of these “studies” for money. Look around for the ads for patients/subjects. I know of one in Portland. There is a psychiatrist (to validate the “research”) and many other clinicians to process the research subjects. There will always be those willing to perform if the money is there. This is not limited to psychiatry or medicine. Every field has them.
Thanks for reading and asking questions. It keeps me thinking and writing.
Best,
Alice
Report comment
John,
Do you think we sould start an anti-GP movement then? (Sorry. Bad joke. Not a joking matter at all.)
I’m sure the GP’s have been just as persuaded by the marketing hype as all the various “prescribers” in the US. I had heard rumor from UK that GP’s are required to refer to other treatments before starting antidepressants (ex. exercise, counseling). Any truth in this?
Thanks,
Alice
Report comment
Stephen,
Wow. I wish I’d written this piece. You write very clearly with plenty of personal experience to back it up.
1. “the ones who are willing to walk with people on their journeys of the dark night of the soul, the ones who aren’t afraid of huge emotions, the ones who care enough to actually listen to the people in their care, the ones who realize that the “expert” in a person’s life is only that person, the ones who let people drive their own cars and care, the ones who minister to people out of their own humanity and who are transparent enough to admit that they don’t know everything, the ones who are humble and know that even they can learn some valuable things from their patients.”
You are right. There is no place for psychiatrists like this in the current systems. Neither is there room for any “service provider” like this.
2. “Be careful what you pray for because you just might get it!”
I was thinking this when I was writing about all those that have lobbied for “prescribing priveleges” and thought they would be winning a prize. “Prescribing priveleges” is the fastest path I know for social workers, psychologists and naturopaths to lose everything else they now do. They can do this. But they may not like when they end up.
I don’t know where to break this cycle. It has already eaten psychiatry.
I hope that those who habitually scapegoat and vilify psychiatrists as the root cause of all this can step away from their anger and target practice long enough to find answers, if not for systems, then for themsleves.
All the best,
Alice
Report comment
Darby,
You are not the first to suggest this carreer path to me. Thanks for your suggestion.
Best,
Alice
Report comment
anonymous,
It is the same dance no matter who writes the psychiatric prescriptions. Others may do so. They may not like where it takes them.
I’m glad to hear you’ve found good doctors.
Best,
Alice
Report comment
Mark,
Thanks for your thoughtful approach to this issue.
You would have us step back further than I did and take an even wider view. Beyond our corporate approach to medicine and psychiatry, there is this culture of ours it is all embedded in. The systems and corporations and organizations have sprouted from the soil of our own country.
Nine out of ten calls in my private practice came in search of pills and nothing else.
You say we can only have two out of three of the following:
quick fix
low cost
high quality
Fast, good, cheap. Pick two.
I’ve got it. But sometimes we get only zero or one.
Thanks for putting your spin on this. More thinking together is good.
Best,
Alice
Report comment
Ruby,
You ask, “How can one revert to a state that they’ve not experienced prior?”
This is a really good question.
I’m glad you’ve found a path through the really slow taper that’s working for you.
Keep reading, thinking, writing and asking questions.
Alice
Report comment
John,
I had a conversation with a friend this weekend about a child that must take stimulants to be allowed in school. This is routinely done in this country both in private and public schools. When a family depends on school to provide day care for a child so they can go to work, they are in a real bind. Staying home means job loss. What can the parent(s) do?
Since many of the children’s drugs come through pediatrician’s offices on the recommendation of educators, where can this be stopped?
Thanks for bringing this point up.
Alice
Report comment
anonymous,
I compare the marketing of drugs to the marketing of drugs. Both categories of drugs have serious side-effects and are used for things never approved. I review the programmable cognitive filters we all have and how drug marketing works with this.
I am certain our (you and I) programmed cognitive filters do not match perfectly. It would be unlikely that any two humans would ever be identical.
I don’t believe I’ve written yet to address “force” and “involutary psychiatry”. I believe others write widely about these issues here.
I’m sorry my posts don’t work for you. I hope others here on MIA do.
Keep reading, thinking and writing.
Best,
Alice
Report comment
Stephen,
Perhaps my reply was misdirected. I get things in order of time they are posted, not by the comment thread.My machine refuses to process the scroll view. Perhaps you are not the person who said he was a “chaplain” in a nursing home. That is the only one I recall saying anything like “man of the cloth” to.
Perhaps my answers are going awry when I answer from the “dashboard” mode.
Apologies,
Alice
Report comment
Heidi,
I get these posts in order of time stamps so the threads are jumbled for me. Apologies if I repeat myself. You are not the only person who misunderstood my point. I shall truely have to work more at clarity in my writing. I suppose there will always be some I cannot reach. It is as it is.
All of us, every single struggling, searching, thinking, researching human has a programmable cognitive filter in place. Me. You. All of us.
Having very real “obligations” to patients does not change the limitations of this operating system every human organism has. Me. You. All of us.
I, also, wish I had been bequeathed with special and different powers, for example: to see the future, see what’s hidden, to be immune from marketing.
Some people THINK they are different and immune. This frightens me.
Others imagine I am. This frighens me as well.
This is the point of my “bucket metaphor” stripped of the bucket. This is as clear as I can be.
I hear your wish for an apology. If I have done something to harm you personally, here with my words, be sure it was not intended. For that I am willing to say I’m sorry.
All the best,
Alice
Report comment
Anom,
What were you hoping that I (or another) would say or do? Is there a specific set of words you await?
I’m curious to understand exactly what you are looking for and the changes you hope these things would make.
Thanks for reading, thinking and writing.
Alice
Report comment
Altostrata,
People driving deadly cars every day is an illustration of the programmable cognitive filter all of us wear. It allows all of us to miss important information. Sorry you missed the point. You are not the only one. I will work toward more clarity in future posts. I’m new at this.
All the best,
Alice
Report comment
Ruby,
I’m glad to hear you’re in recovery.
Best,
Alice
Report comment
Heidi,
You’re right about some of this.
The part about how I ran my professional practice. Wrong. You weren’t there. You’ll have to take my word for it. Or not.
The other part about us “not being in this together”. There’s some truth in that. I’m here “in it” because I thought there may be a “snowball’s chance” of me helping make things better with words. You can stand a little further way, if you like, while I try. Me and you being together to work on making things better? You get to choose.
All the best, whatever you choose.
Alice
Report comment
Nijinsky,
These are not meant to be direct correlates of psychiatry but rather examples to demonstrate my idea of a programmable cognitive filter on all of us. You are not the only one to miss this so I shall have to get better at tossing them.
Best,
Alice
Report comment
Marianne,
Wow. I’m glad I got back on line this evening. Thanks for the moral support.
Best,
Alice
Report comment
Jen,
Glad to hear it. Perhaps your social worker can get prescribing priveleges. They are working on this in some states.
Alice
Report comment
Jen,
In the view that I use here, I see comments by time posted so can’t always track the complex web. If I used the initials “APA” in a post, I would have meant Psychiatric. I have associations with neither organization.
Alice
Report comment
anonymous,
I’m sure I didn’t use “funding cuts” as an “excuse” to “terrorize with forced drugging.”
I’d remember if I used these words.
Best,
Alice
Report comment
Jen,
The car example is to illustrate the programable cognitive filter we all wear.
Thanks for reading.
Alice
Report comment
Stephen,
I was referring to the other patients. But, yes. everyone is effected.
Alice
Report comment
Marian,
Certainly not you. But I am learning what topics are “hot buttons” here and introduce them with caution.
How is one to immediately know that a dangerous situation is the result of drugs and alcohol? When the knife is swinging or the fists punching and dangerousness is occuring one cannot always know the immediate cause. One is morally and legally obligated to make things as safe as one can as gently as one can.
As you say “we have laws in the regular legislation that allow, even demand, everybody to intervene at a dangerous situation, if necessary using physical force, to prevent the danger.” We are also bound, in this country, by both morality and laws, to use the least force necessary.
I met this specific gentleman when I came to work in a psychiatric emergency area. He was already in restraints. The PCP in his blood was discovered only after the police brought him in.
PCP has a tricky way of repeating on a person based in its metabolism. A person can seem well out of the grips of its fury and then “relapse” hours or days later. There can be a return of the drug effect and more assaultive behavior. This is unpredictable. This did happen when he was up around around later a few hours later. I’m certain that the necessary action taken to make the small, crowded area was hard on everyone there. Still. What were the choices?
Long ago, when I worked in this emergency hospital area as a part of my training there was not separate place for A and D related assaultive behavior or separate legal codes for responding to dangerousness. And yes, the dangerous behavior had to be immediate and witnessed to bring you there.
This is not meant to be coming down on the “side” of forced drugging and restraints or “against” it.
My point is that everything on this planet has more than two sides. Sometimes there are as many “sides” as there are people.
Thanks for reading and commenting,
Alice
PS: The phrase “talk somebody down” was used in quotes as I was responding to another commenter who used this phrase. Of course there are other ways to say this. I also like your phrase “meet people where they are at”. I feel a better sense of communication when I use the other guy’s words and meet him where he is.
Report comment
Heidi,
This article is not only about the “head buckets” (programmable cognitive filtering systems) of psychiatrists. Our deadly habits of driving cars is meant to be an example of how any human, including psychiatrists, could “not know” something even IF the information is right in front of them. It is meant to be an illustration, in the ordinary human words that work best for me, of how all of us are vulnerable to this built-in operating system.
Sorry the metahor didn’t work for you. Back to the drawing board… I mean lap top.
Keep reading, writing and thinking.
Best,
Alice
Report comment
Maree,
Of course, there are other ways to enforce without a court order. Parents are forced to drug their children to access both public and private schools.
True statement you make “… you either take what they give or you go without.”
As you say, “(medication) is very largely the only thing on offer what choice do they have.” Drugs are the only thing many clinic have left to offer. Funding for every other service has been methodically cut from above, even before the recent economic down turn.
Thanks for the post,
Alice
Report comment
David,
Thanks for your essay from the front lines of changing systems.
Clear, specific directions on how this can occur gives my heart hope that change is possible.
The movement to re-make mental health care needs leadership and input from all kinds of people from many backgrounds.
Good writing. Thanks for being here.
Alice
Report comment
Sascha,
Thanks for the personal story of your experiences and what you’ve gained from them.
You are a clear writer. You are an example of one who can provide both leadership and communication. What a wonderful combination.
Your essay is an excellent reminder of the power of language and the need to exercise care in its use in order the achieve the goals of any movement.
Thanks for writing here.
Alice
Report comment
Altostrata,
The huge mess of modern society IS the point and not a digression at all. Herein are the aswers you seek.
Thanks for reading, thinking and writing.
Alice
Report comment
Alix,
Forward him links to my posts if he will only listen to a psychiatrist. Foreward the link to MIA if he’s more open to the points of views of others.
I was taught by a very wise mentor that I have to adjust my use of language to meet the person I’m talking to. For example, if someone tells me he feels like his motor’s not running right, I’d better talk to him about his motor and not his heart and lungs.It’s part of human communication.
Yes, it’s his job to be open and listen. As an outspoken doctor, I’ve had no better luck getting my own doctors to listen to me over the years.
“What is getting between all doctors and hearing what their patients are saying?” This is a book’s worth.
Thanks for your post,
Alice
Report comment
Marianne,
You are exactly on topic. Our pill culture is big. Psychiatric pills are a part of a much bigger problem.
If all psychiatrists vanished today (Okay. No applause ;-)) the problem of overprescribing on all fronts would go one unchecked. People still would be clamoring for pills (supplements are in this category to me). All the other “prescribers” would go on filling the artificially created “need” for pills.
Thanks for stepping back and looking at a bigger picture.
Alice
Report comment
Philroy,
Everyone tells themselves a powerful lot of lies to feel safe and in control.
If we can blame a bad happening on someone else’s bad judgement or choices, then we’re feel safer. This is pretty universal.
I’m certain I’m the “safe driver”in my “safe car”. Therefore I can drive to work in the morning.
All the best,
Alice
Report comment
Altostrata,
One of the purposes here is to help people find resources and support.
Thanks,
Alice
Report comment
Altostrata,
Sorry for the misunderstanding I had about the help and advice you offer to people about medications through your website.
All the best,
Alice
Report comment
Greg,
Isn’t it nice that we don’t have to agree on everything here. Each of us has our own viewpoint.
Sorry you “sting a bit”.
When people who were not there in my skin and shoes make presumptions about what I knew, didn’t know, could have done or should have known, they are engaging in Monday morning quarterbacking. It happens all the time.
Another way I see this is looking through the “retrospectroscope”. Perhaps there are more palatable metphors for the human habit of imagining that one could have done things differently had one been there. This goes on in the aftermath of lots of really bad happenings from ten-car pileups to genocide. We all would like to imagine we would have known better and that it could never happen to us.
We still kill more Americans “by accident” with cars each year than in our intentional wars. We’d like to think these won’t happen to us because we’re smarter, safer drivers.
Keeping writing, reading, thinking and talking.
All the best,
Alice
Report comment
Pliny the middle-aged,
Yes there are. I have seen many ICU pateints in restraints, many geriatric medical patients in “posey belts” (restraints) to keep them from falling out of bedor wandering. I have had to “restrain” confused or intoxicated medical patients in ED to perform necessary life-saving care.
I have seen chidren and adults have treatment for acute medical illnesses forced upon them against their will. This depends on the state. Some states will remove a kid from parents’ for withholding care for religious reasons.
Verbal coercion is used every day in the offices of primary care doctors. I have experienced this first hand in protecting myself and my spouse from toxic cholesterol lowering drugs. Even the insurance company and corporate employer got in on the act. They charge an extra $600 a year in premiums for our making the choice of not taking the unproven and toxic drugs.
Coercion, forced medication and restraints are not just a psychiatric issue. No legal committemnt or review document is required for any of this in the medical environment or nursing home.
Thanks for stepping back and broadening the view. This is important.
Alice
Report comment
Maree,
Yes. This is all much, much bigger than psychiatry.
Yes, there are experience, exsistential and cultural things (to list only three) that play a huge part in pain and suffering. Imagining that we (or our mothers) are “responsible” for all life’s suffering is narrow. I think that exploring these is an important part of cognitive and behavioral therapies. I’ve successfully “prescribed” (in my version of CB therapy) a wide range of life changes including relocating to a sunnier climate. I’ve successfully “precribed” to a young person trapped “in the box” of public education a change to another education venue. I’ve prescribed pets, plants, walking, smiling, food changes,playing, laughing, meditation, tai chi…the list is long and always growing.
While addressing how we run our thoughts and feelings is an important part of CB therapy, the ways to make a life that works better for an individual are as different as there are numbers of people.
It’s also important to know what you can change and what you can’t.
Thanks for the lovely post.
Best,
Alice
PS We are still killing more Americans with cars in the USA every year “accidently” that our intentionally fought wars (by my internet sources of statistics). This is not counting the emmissions poisoning the planet or any deaths from manufacturing, fuel aquisition or auto maintenance. We need more work on safety standards or less driving.
Report comment
David,
Thanks for a lovely post and taking the time to explore my use of metaphor. I like metaphor (and poetics) because they cast a wider net of understanding for a visual thinker like me. I move a past words in understanding with metaphor. The ones I choose work for me at the time. They may not ring true for all or even anyone else but me.
I have no need for metaphor for this thing:
Psychotrophic drugs for two year olds as way past “the height of insanity” in my book. I have not personally “gotten” precribing psychotrophics for children. We’ll have to get a hild psychiatris on board to discuss this. I’d have to stay out of it.
I would also not “categorize” an “overwhelming sense of oneness” as psychosis. This has been the goal of mystics for as long as there have been mystics.
But I’ve always been a bit shakey on the DSM.
Thanks again,
Alice
Report comment
Nijinsky,
Thanks for the link. I have seen lovely, skilled clinicians in the crisis area I’ve worked in talk people down. This is always the best way.
I also know one lovely skilled worker who was slashed badly with a knife by a customer in the front office of a clinic because he walked into the room. No talk time in that moment.
I remember long ago (I risk buckshot on this one) a gentleman who had injested considerable PCP (veternary tranqilizer/anesthetic) and was on a crowded street fighting wildly with a knife to cut his own parts off and anyone who was near. There was no talking that would get through the drug confusion and agitation. This was decades ago. I don’t remember more about what was going on except that PCP (angel dust) was big in New Orleans then.
For most things, I can see more sides than two. Maybe this is my “flaw” as a doctor
Different things work in different situations and with different people on different days.
I’m ducking now for the buckshot.
Alice
Report comment
Nijinsky,
You are indeed a creative thinker. Thanks.
Perhaps others with more legal savvy would like to take this on.
Even when a hospital nearly killed my oldest child through the use of another child’s chart, missed xray diagnosis and the wrong medicines, I did not sue. I did speak up. But I’m not a law suit pursuing kind of person. From what I’ve seen with law suits (limited experience) the only winners are the attorneys even when the suit is “won”. (This is not meant to be bashing of attorneys. They work for a living and have to be paid for their time and services like anyone.)
Thanks,
Alice
Report comment
Marian,
I’m a library user so I read them but they’re not on my shelf.
The bucket is a big deal. It is our belief system. This is part of the human condition. I work on making more of mine on my own by exposing my head to what I want in my belief system and avoiding the media. We all got one. I kind of have fun tipping mine up and looking around.
Best,
Alice
Report comment
Ninjinsky,
If only it were true. Then I could be the emperor of the world.
You are an idea person.
😉
Alice
Report comment
Nijinsky,
Sorry. I have no lawyer at all and no bucks to chase one down.
Great idea though.
Alice
Report comment
Philroy,
Thanks for your support here. Thanks for reading and thinking and putting so much time and effort into your lovely exposition.
Best,
Alice
Report comment
Margarat,
I’m sorry you’re not well today. I’m sorry you’re not able to get the medical care you need. If Stephen Boren is directly involved in your care, you may wish to contact him through other channels. If he is not, then your “vitriol” is mis-directed.
In any case your post has crossed the line from dialog for solutions to personal attacks on an individual’s character. I, myself, was called to task today for this and took a few minutes to tone my post down.
We hope to invite as many different kinds of help as possible to the table here. I, at least, don’t want to run anyone off.
I hope you’re better soon.
Best,
Alice
Report comment
Marian,
My apologies for any words that could have been construed as aspersions to your character. You will notice I have edited the above post to remove things objected to by another commenter.
If there is further moderation that I can perform, please let me know. You can contact me [email protected] or through this commentary conversation.
All the best,
Alice
Report comment
Greg,
Lack of finding does not imply lack of looking.
There was not “an abundance of information” for “half a century” in any place that I could find in public libraries, medical school libraries, professional books or journals. Sorry. The information, in those pre-internet days, was not findable even by a well-meaning, well-read professional like me. Even now, the internet is a wasteland of mis-information. It may be even harder to sort anything out.
When I figured out (by attending classes, reading and pondering) that there were some holes in the theories (as early as the early ninties) I did begin informing my patients of this and talking to people around me. I changed how I practiced. I think that’s as good as one can do. I expect there are many who did likewise.
Monday morning is a great time to re-play the game for the quarterback and find him lacking. It looks much easier after the fact.
For me to say that I didn’t look, ask, search and read to the best of my ability at the time, would be a lie. This is why I don’t say it. It’s not “hard to say”. It comes across in the commentary section here like people want me to make a forced confession of wrong doing. What goal would be furthered by this?
If me taking personal blame and being scapegoated for many things that were clearly beyond my control(ex. hidden information, marketing disguised as education) or taking the blame for not knowing things that only became widely known at a much later date would help us move forward on the re-make of our system, I could do this. Perhaps
Except it won’t move us forward. It will only serve to further the anti-psychiatry bigotry that is no prettier than anti-patient bigotry. It will become the required hazing process for anyone that presents wanting to help.
We can’t afford to chase away mental health workers who may be able and willing to help witt the remaking of mental health. Some of them may have good ideas.
Best,
Alice
PS My student loans didn’t force me not to find information. It only enforced work choices. You will be there any day now. (My loans acrued compound interest while I was in school at 18-22 percent. Doctor loans for those rich doctor-types.) You loans will force your work choices for decades. This is a long time. Sorry.
Report comment
Nijinsky,
You’re right. My interpretation of the tone of her report as “gleeful” certainly overstepped my usual boundaries of decorum. You will see I have intentionally edited this out of my post because of your point here. This is a public apology for using the word “gleeful” in my response. Only she can know the truth of her personal feelings with regard to her own post. Thanks for pointing out when I step over the edge.
Is this the extent of your concern or is there more?
Thanks,
Alice
Report comment
Nijinsky,
Thanks for another lovely sensitive post. I like cognitive and behavioral approaches to helping people feel better and suffer less. Thanks for remembering I said this.
This is where I spun off from what you wrote today:
Any repetitive thoughts or behaviors (including feelings, words, physical movements, marketing, visualizations etc) will re-wire your brain at any age. This is the miracle of our neurology. This is big to me. You can put in new wiring in your head with music practice, repeated affirmations and repeatedly summoning up emotional states (just to give three random examples).
Any time. It’s never too late.
Replacing fear habits and anger habits with other more positive feelings will “re-wire” (electrochemical and structural) your brain.
Chronic fear and anger wears us out (bancrupts us) from physical, spiritual, cognitive and emotional respects. Did I miss one?
Our culture in America is largely fear and anger based. Fear turns to anger. The media hammers it home and then we hammer it home on ourselves and those around us.
Scared and angry people are easier to control than calm thoughtful ones. There are 311 million of us to control here in America.
When we let ourselves be habitually angry, we are handing the keys to our freedom over to someone else that may not have our best interests at heart.
Peace and love 😉
Alice
Report comment
anonymous (with a lower case a),
You are right on this.
Thanks for posting again.
Alice
Report comment
Marian,
Of course I knew you meant me. You’re sweet as pie.*
*intended as lighthearted humor.
Peace and Love.
All one.
Alice
Report comment
Marian,
My reading is not limited to “science” at all. How dull that would be.
I read fiction (Terry Pratchett is an all time favorite), poetry (Rumi translated by Coleman Barks and Walt Whitman. Jimmy Carter is a fine poet), how-too, self-help, history, anthropology, biography (Lillian Carter was a wonder), education (Must read: Gatto), arts and crafts , cooking (“Wild Fermentation” is great), health and fitness, nutrition, philosophy (Dalai Lama’s good). Heck, I even read investigative journalism (check out Robert Whitaker’s books). Oh yes. I do read science. I love natural sciences like ornithology and botany. Physics is fun where it bumps up against philosophy.
Thanks for taking an interest. How else can we get to know each other here unless we can step past assumptions?
From your description (I wasn’t there) it sounds like the poor woman was terrified of a big, loud threatening male up close. That would work to generate fear in most folks. Probably on me or you as well. Well, maybe not you. 😉
You’re missing a (or some) steps in your logic. Scaring a woman does not equal psychiatry being “fear based”. Psychiatry may be fear based. Scaring a woman with direct threats to her physical safety doesn’t prove this.
Me angry? Heavens no. I’m not a human or anything. I’m one of those mythologic psychiatrist creatures.I just do “existential angst” 😉 But thanks for asking. It’s good to hear concern for my wellbeing here. I just got back from a run. It does wonders to help manage those pesky human emotions.
Thanks for asking. I hope you’re doing well, too.
Best,
Alice
Report comment
Marellas,
Cool. I get to be right about something. Thanks. I still like the “bucket” metaphor. I’m a visual thinker. I can “see” it better as a bucket.
Best,
Alice
Report comment
Stephany,
I’m sorry these things happen. Thanks for bearing witness here.
All of us together will be necessary to change the system.
Thanks for your comments.
Best,
Alice
Report comment
Stephany,
Your child was fortunate to have you as an advocate.
Alice
Report comment
Lowry,
Thanks for your support.
Here’s another ehug.Pass it on.
Best,
Alice
Report comment
Lowry,
“people jump from “I don’t understand” to “I am afraid” to “You are a danger to me” without any logic necessary.”
“When I can locate the problem in YOU, I do not have to look at ME”
Very nicely written. I think you may be able to add “I’m rightfully angry” in after the “I am afraid” in many human situations. Scared shifts to mad pretty fast for most folks.
I’m curious what state you live in that has a law that allows committment based upon noisy, odd and eccentric behavior alone. I’m familiar with “dangerous to self and others” having to be witnessed attempts or actual harm.
I live in a financially resource poor state. This may help protect the rights of some. Psychiatric committments are paid for by tax dollars. Although Oregon does have involutary committment laws, money is channeled into keeping folks out of this situation. The financial bottom line ends up as a protector of human rights.
Thanks,
Alice
Report comment
Ruby,
Thanks for information and resources. I’m new here. Do we have someone collating these kinds of links?
Alice
Report comment
Vanessa,
Not surprised at all. I think it’s important to point out good when I see it.
Alice
Report comment
Ruby,
I, too, get angry at the condition of our medical system. I, too, have “fired” doctors for not listening to what I said (six of them over the years to be exact). One would have let me bleed to death from a miscarriage at home rather than take my call.
I once had to remove my child AMA from a pediatric hosptial to save his life from the wrong treatment when he was small. I had to pull his IV out of his arm myself at one in the morning and carry him through the front door on my back to save his life. Turned out later they had the wrong kid’s chart, missed the collapsed lung on his x-ray and held him down to give him the wrong medicine.
This is not all about psychiatry. The medical system is no different for an outspoken, reading, thinking doctor with blue cross insurance than for anyone else. Things have been way broken for a long time.
Internal medicine and primary care has been just as swept away in this pill culture as psychiatry.
All of us have very good reasons for anger. I’m convinced that the only ones our anger serves are those running the profit-driven corporations that have a death-grip on so much of our country. I will not give my thought capacity away to them by falling into rageful bickering, finger-pointing and name calling. There is way too much work to do. The only tools I have are my words.
When I feel too angry to moderate my communications, I go for another brisk walk. Some days are three walk days.
After writing this one, I’ll go for a run and see if I can come back to write later.
All the best,
Alice
Report comment
Marian,
You’ve obviously put a lot of time and effort into your comment here. Thanks for that.
You make assumptions that I have not questioned, not asked, not read. You also assume that psychiatrists don’t question, ask or read. These are poor assumptions to make. You throw away many kind people who could help.
I’m impressed by the level of anger expressed in your post. Not your own, perhaps, but certainly through the descriptions of the behaviors of others.
As a human rights activist, I’m surprised that you would vividly describe and then justify your large male friend’s loud threatening behavior toward a woman. Of course, she would be frightened. I’m not sure what one can infer from this except that she was afraid. Of course.
When one justifies aggression in words and behaviors, one sides with aggression everywhere.
All the best,
Alice
Report comment
Skyblue,
Thanks for sharing your personal experiences.
No, I don’t suppose this to be a “fair and just” society. I don’t think this is restricted to psychiatry. We are embedded 24/7 in marketing. True.
While I would never suggest than anyone succumb to the pressures and let go of the dream of making things better, I would make two suggestions.The first is about living a life built of anger. The second is about doing things that will result in being sucked up by the system as it currently exsits.
First. Anger is unhealthy and unhappy, especially when there is so much of it. When I feel angry, I feel bad. I want to feel better even while we work together on this. The hormones released when angry trash the body and unplug the thinking brain. Angry displays drive away others that could help. Is it possible that your anger could play into the other guy’s plan? Likely.
Second. The laws are unfair and the sytem wrong. But it is there now. Bashing yourself against the laws will result in you becoming yet another unsung martyr. What good can you do from there?
If you like the Nazi metaphor (and I’m getting it that some people here do) think of the French resistance fighters. They did not go out and throw rocks at German soldiers in the street. That would have meant one less to work for the cause of French freedom. They went underground and worked quietly.
We need all the clear thinking help we can get to turn things around.
My apologies to those that have been troubled by the Nazi rhetoric on this web site. Please hang around.
Best,
Alice
Report comment
class of 1,
I appreciate your support but…
I hope we can all find ways to remember to work politely together. I hope not to take shots at anyone, even if they do support a “pharmaceautical model”. Being on the attack creates more hostilites and a closes the doors of communication. I believe a peacful, understanding and cooperative approach is necessary if we hope to have a real impact on changing things.
All the best,
Alice
Report comment
John,
Thanks for information from your side of the pond.
Alice
Report comment
Ruby,
I’m glad you’ve found good help for your efforts of tapering off medicine. All the best.
The “bucket” I referred to in the article is not the exclusive domain of doctors or psychiatrists. We all have our unique belief systems we each call ” the truth”. Fascinating.
My hope is for cooperative healing relationships here that allow people from all disciplines to come together to make mental health into a better and more humane process for all. Everyone wants to feel better and suffer less.
There are times when (understandable) anger makes the conversation less open to anyone from the mental health field. If excluding mental health workers in the point, we should be clear up front. No one comes here to be blasted. I don’t. We should post a warning sign or something.
More wag. Less bark. (bumper sticker I saw recently)
I appreciate you posting here. Welcome.
Best,
Alice
Report comment
Altostrata,
Others may be interested in doing what you do from your website, giving advice to people about getting off their medicines. Have you run into any legal stumbling blocks with this that others should avoid? You’ve told me you can’t get any doctors to help you do this. It sounds like the market is wide open to provide this type of online service.
Alice
Report comment
Altostrata,
“What’s in it for me?” is a question all of us should ask. “Heroic self-images” are hard for anyone to give up.
Thanks,
Alice
Report comment
Kermit,
Thanks for your support. What a heart warmer to read.
It is a bit for me to juggle so many conversations. There is one me and (Woo Hoo!) a whole bunch of you. This is great. Unexpected. I’m so happy that so many folks are taking the time to speak up and be counted toward finding solutions.
Probably you’re going to get tired of hearing this:
We’re all in this together.
Best,
Alice
Report comment
Stephen,
Thanks for welcoming new commenters here. Thanks for looking for ideas. We have a lot of room for ideas for positive changes.
Alice
Report comment
Anonymous,
You do have to knwo what to say nd not say. The laws state real clearly the things a “designated” mental health professional, ED doctor, police officer must do if someone makes threats to self or others in front of them. They are bound by law. A person has to know not to say those things or behave in a threatening way. You are absolutely right.
Alice
Report comment
Stephen,
Something very right is happening here.
All one.
Love,
Alice
Report comment
Marianne,
Thanks. I appreciate your support and trust here. My heart feels better reading this.
On a website like this we are all driving blind. I never see get to you and you never get to see me. I’m out here with my real picture and real name. That’s as good as it gets.
To be honest, there are times I forget everyone here is driving blind. I wonder, how could they think this about me? How could they say something like that?
I have to remind myself that no one here actually knows anything about me except the words I type. It’s likely people have a lot of hurt and anger from bad things that have happened somewhere else and some other time. I want them to feel better and suffer less.
I’m here writing because I wanted to see if one voice could make a difference. I’ve read all this philosophical stuff about a butterfly wing on this side of the world resulting in a typhoon on the other side of the globe. I’m a believer in peaceful cooperative approaches to change.
Who knows what could happen?
All the best.
Alice
Report comment
Stephany,
Being a psychiatrist, I risk another volley of cannon fire but here is the truth from 8 years of experience from 2004-2011. This is not a stance for or against “forced drugging”. It is simply a report from recent experience at work. I hope it’s useful information.
I have worked in a crisis clinic for the uninsured that handles (among many other things) temporary medicine continuation post-hospital discharge. These people were not “mandatory” or “forced” to take drugs even if they had been on an involuntary committment at the hospital. There were “no court ordered medication compliance” in their discharge plans. These people came on their own and asked for the medicines. The people I occasionally met with court mandated drugs were involved in the criminal justice system, not the medical system. The medicines were part of a release from incarceration ordered by a judge. They also walked in.
I contend that, at least in my city, forced drugging is NOT “status quo for hospital discharge” at you say.
Alice
Report comment
Vanessa,
Thanks for offering support to others that are suffering.
This is open hearted.
Best,
Alice
Report comment
Stephany,
I’m sorry that such things happened to your child.
If others back legislation that remove freedom of choice, then back legislation that promotes freedom of choice.
This is Mad In America, where people who have been harmed can have a voice. Absolutely.
It is also (maybe I’ve gotten this wrong) where people who have been harmed and know people that have been harmed find cooperative ways to change things for the better.
Thanks for your post.
Alice
Report comment
Peter,
Lovely piece.
You are very right. There is no paying work for a psychiatrist who will not prescribe drugs. This is not a “pay cut”. This is zero. Most of this is happening through other channels now anyway, cheaper ones like PAs, NPs, primary care, obgyn, psychologists. Even the social worker lobby want in on the act.
And, ah, the student loans that have everyone in a lifetime of financial disaster today. There is no bancruptcy discharge for these.
The trap snaps and we blame those caught in the cages.
Thanks for posting.
Keep talking and writing, reading and thinking.
Alice
Report comment
John,
Good one. Clear and to the point.
“It is about drug company marketing and PR influencing practitioners and the public by using huge, multi-million dollar budgets.”
“profit driven madness”. It’s good to know which way to point the eyes and arrows.
Thanks,
Alice
Report comment
Skyblue,
Thanks for your complex and intense thoughts about the cultural bucket.
We are all in this together.
Alice
Report comment
Altostrata,
Thanks for being out there and thinking. It will take us all to get things turned around.
You have suggested to me in the past that you think my energies would be best spent working in an office to taper people off medicines. Thanks for your thoughts on how I can best live. Advice and opinions are great, but we each have to find our own paths.
Perhaps if the rhetoric were toned down just a hair it would help others who could help hear the messages and respond. I doubt that many are willing to walk into the blasts of accusations and name calling. At times, I have doubts concerning my own skin being thick enough for this.
If your approach is working to achieve your goals, good. If not, maybe it’s time to try something a little different. Perhaps not.
We are all in this together. Still.
Best to you,
Alice
Report comment
Altostata,
Thanks for another enlightening post. I’m glad you figured all this out through self-education. The real task today is finding ways the message can get out. I fear that your “big stick” approach may run off the folks that need to hear.
Best,
Alice
Report comment
Greg,
“Caught up in the mental health system” certainly describes my experience from the time I set foot outside the halls of my training programs. I don’t recall being in charge of anything beyond my small psychotherapy (no cash flow) private practice and the prescription pad I was allowed at the hourly pay/no benefits jobs. I had a LOT of high interest medical school loans to pay.
Thanks for your post.
Best,
Alice
Report comment
Vanessa,
You make assumptions about how I grew up and my personal experiences that may be incorrect. The “trust” I have has been intentionally cultivated later in life. My own starting point was pretty suspicious, angry and accusing.
We live in a cultural bucket of deeply-embedded mistrust, fear and anger. True stories. I had to rent an electric piano in another country. My language is poor. They had little English. My credit card wouldn’t work because they use an imbedded ID chip we don’t have. They handed over a new-in-the-box piano for 70 euros cash rental and my word I’d bring it back. They didn’t know me and only had a hotel address in another town. When? Last October. Another time, I was on a crowded city street, same other country. A four year old girl raced between our legs with a money in her hand. I was freaked. No one else noticed her. She ran into the news shop up the block and came back with a paper in one hand and her change in the other. She vanished into the crowd behind me. Both these are normal and everyday in other countries.
We are different here in America. Very, very different. Sometimes one must get “outside the bucket” to see things
More trust is good.
Isn’t it nice we don’t have to agree on everything?
Alice
Report comment
Marianne,
We need all kinds of people in the room. Thanks for your support.
Alice
Report comment
Marianne,
Thanks for pointing out that the pills culture is not “all about psychiatry”. It’s much bigger and more widespread.
Alice
Report comment
Altostrata,
I’m a marketing dupe. We’re all marketing dupes. This is the point of “Bucket”article. Thanks for getting it.
Are you German? I’m not. My extraction is Portugese, Italian, Irish, Dutch etc. Excuse me. Maybe I mistake your “good German” comment. Are we back to the Nazi rhetoric again? There is no place for bigotry and target practice of any kind in an open, solution-focused discussion.
Maybe I’m wrong about the goals here on MIA.
Best,
Alice
Report comment
Marianne,
I’d not heard that specific one. I’m heard similar kinds of things about psychiatrists, attorneys, internists, priests, ministers, software engineers,jews, hispanics, Italians, Poles, gays and lesbians.
Alice
Report comment
Altostrata,
Sorry. I knew that. That was my attempt at light-hearted banter with a keyboard. Your comment that you’d “answer to Buddha when you saw him” made me smile. I admire the independent thinking you show in your comments here.
Sorry again. I meant no offense.
Alice
Report comment
Marianne,
Thanks for your support. I’m sorry you have suffered so much.
“Most medical doctors” don’t do research.They work in the clinical office with patients. Research is left in the hands of the medical schools and academics or the “research for hire” clinics that do just this all day.
Most medical doctors are not trained or exeprienced in research. It is very expensive and time consuming and would not allow time for patient care. We generally choose one path or the other. Research findinbg must be found and generally is.
Thanks,
Alice
Report comment
NIjinsky,
Thanks for telling me more about your friend. Perhaps “Sorry for your loss” isn’t quite right considering your experiences of her death. Still. I’m sorry this happened. I am sorry for your loss.
You are not the first I have heard this types of experince from. All is not known in this world.
Best,
Alice
Report comment
Christian,
Thanks for your well-thought, well-written description of your work and professional background. This helps give balance to the discussions here.
Welcome,
Alice
Report comment
Nathan,
I use “I don’t know” a lot. This has been met with a range of reactions. You’re right. “I don’t know” is good to say when it’s the truth.
Alice
Report comment
Nathan,
Yes, yes. Cars are safe. It’s worth the trade-off in deaths. We’ll have to get into that another time. I have something more important to say. Time’s short.
I am away from work and writing here to see if one psychiatrist (me) can make any meaningful change in the “mental health industry”. I really don’t see how I could. But I try.
I hate hearing any helping profession referred to like a cash factory, don’t you? Oil industry. Automobile industry. Medical industry. Mental health industry.
Open dialog is critical. The “anti-psychiatry movement” has gotten so locked on a “target” painted on “all psychiatrists” that I’m not so sure it can move beyond this anger to solutions. If you killed all psychiatrists (“hung by the neck till dead” has been hinted at with the nazi rhetoric used on this website) you would still be left with a pharmaceutical industry marketing to the public and scads of “prescribers”; NPs, PAs, primary care docs, ob-gyn, psychologists. All this gratified self-righteous retribution and nothing would change.
I’m not wanting to “take the heat off the mental health industry”. I’d like folks to step away from the target, unlock their eyes and take a wider look. What if, for example, (this is just supposition) the pharm companies could throw psychiatrists to the wolves as scapegoats and continue to make their profits just fine? We are there now.
The media would have us believe that those interested in reform are a bunch of dangerous “scientologists”. If I believed this still I wouldn’t be writing. I did once. I risk sharing this brand with you all when I speak up here.
How has the entire responsibility for all that has gone wrong as we’ve been swept away by a culture of pills been placed at the feet of psychiatrists? Is anyone looking closely?
Keep thinking. Keep reading. Keep talking.
Alice
Report comment
Stephen,
Most patients I see come in search of pills and nothing more. Much of our culture has been “educated” through the media to the pill culture as well.
How would one “defrock” a culture? Or would one “defrock” the advertising campaigns?
I love that word, “defrock”.
Best,
Alice
Report comment
Stanley,
I haven’t made it to these other websites at all. Neither have I read Dr. Balt’s blog.
Thanks for clarifying.
Alice
Report comment
Stephen,
Another metaphor coming here (a true story from a friend long ago and how she ran her personal life):
I know I’m on the attack with you but you’re a blond man. After all I was hurt more than once by a blond man. Many people I knew were hurt by blond men once. Those blond men were in positions of power and trust; arrogant, not listening. Some of us were hurt by blond men they didn’t even know very well. Why should any of us trust any blond man anywhere any time? I have every right to call you names because you’re a blond man. Any of us that were hurt or ever heard of anyone being hurt by blond men has the right to stay angry forever at every blond man. Nothing personal. You’re a blond man. You should know better than to be here. Even if I really whack you hard and hurt you, I have the right to. How else will I know if I can trust you?
How can I trust you? You’ve been taking some mighty broad punches for a man of the cloth. Are you “worth trusting”? Why and why not?
“If you need somebody you can trust, trust yourself.” Bob Dylan
Best intentions,
Alice
Report comment
Stephen,
Firefighters. Police. Chaplains,too.
Alice
Report comment
Stephen,
Back to nazi rhetoric here in comment land?
Will this further peaceful discussion?
Will this lead us to solutions or simply through fuel on anger and kill thought?
What’s your goal for participating in the discussion here?
Chaplain? Man of God and peace?
Oops. Too many questions.
Much love,
Alice
Report comment
Michelle,
I don’t prescribe simulants for anyone at any age despite the big demand (generated by marketing to the public) for them at all age groups.
I have been told repeatedly that “stimulants unmask early onset bipolar” by drug sales people (that the employer allows in) that corner me, by the clinical staff that have been to the drug lecture lunch, by required continuing medical “education”, by the PDR (before I realized it was a paid ad catelog). I never bought this. It’s speed, for goodness sake.
I have also been told by a drug rep over and over about a type of depression (that doesn’t exsist even in the DSM) that should be treated with her antipsychotics. I have had to be less than polite on more than one occasion to make her go away. High energy emotions power the drill. I remember the days, the person and the lies. I didn’t buy those either.
Try “generated by the pharmaceutical company marketing campaigns” in place of “by the psychiatric community”.
Thanks for the reminder to set the record straight.
Alice
Report comment
Stephan,
What are you calling “a long time ago”?
If he just published the 20 year study this spring (2012?)this would have been too late for me to read in 1983, or 1993 or 2003. How would I, or anyone out there, have heard of this? I still hadn’t till the past couple of weeks.
You certainly are on to something important here:
“the journals etc. are controlled by Big Pharma and it decides which articles are going to be published so it’s very difficult (read impossible. The information legally belongs to the one that paid for the research) for people with information such as this to get their information out to the public. And the media won’t cover things properly, and even the NIMH didn’t mention Harrow’s studies.”
I learned back in training (believe it or not) that 1/3 get better, 1/3 stay the same and 1/3 get worse or people with the diagnosis of schizophrenia in a big long term study. This is old information. I heard thatbck then. You don’t even hear this older information in the ever increasing flurry of drug funded marketing “education”.
Thanks,
Alice
Report comment
Stephen,
You rock. Thanks for choosing more safety for yourself, those around you and the planet.
I am in the process of re-making our life where all can be done without a car. It took a step outside the box (to another country) to see back inside the box (move the bucket around) and discover the truth of our car dependency in this country.
I was convinced there was no way to change, that an American life couldn’t be lived without a car. I think there are many places where this is true. I had gotten the clue it was wrong to drive so much but felt trapped and hopeless to do anything about it.
I’m down to 1-2 trips a week total for a family of four from two commuters and several trips a day running kids and getting groceries.
Like most American homes, the old place is in a car dependant area. We bought it 22 years ago while working under the influence of another bucket drill pattern; privacy, space, investing in an asset, the American dream of home owership, mortgage interest deductions, pressure from ever-increasing rents.
It’s possible to make decisions while under the influence of bucket drill patterns (cultural, marketing, educational) that don’t play out very well later.
Everyone can.
Thanks for leading the way on this one.
Alice
Report comment
Anonymous,
There’s a “forced drugging lobby”? Like paid political lobbiest that go talk to politicians to influence their votes?
Catch me up here.
Alice
Report comment
Anonymous,
Thanks for having the courage to take a stand about what you believe.
Thanks for reading and offering commentary here,
Alice
Report comment
Steve,
What a good project. Perhaps a student teaching device for trainees?
I liked to talk about how the “mechanism of action is unknown” and that the neurotransmittor theory is just that, a theory. Not a fact.
The people I have treated have come requesting drugs for the most part. I have been able to “unsell” the drugs to a few customer by saying these truths.
Keep thinking. Keep reading. Keep writing.
Thanks,
Alice
Report comment
Nijnisky,
It’s good to hear you loggin in on this one.
Spending a life being angry at or hating anything can become a life defining “hole in the bucket”. My theory is that, with practice, you could make a “love” hole instead. It seems a more a pleasant one from inside, maybe from the outside. I’ll let you know how it goes.
I’ve been thinking more about the “bucket metaphor”. I notice a big “cultural” bucket sometimes. It seems there’s a lot of anger in our country. Maybe I’m wrong here.
Okay. No electrical or carpenter metaphors. Where did it come from anyway? Sorry.
Best,
Alice
Report comment
Arta,
In a similar area: As a new medical student on my first clinical rotation, one of my first medical patients was a doctor/teacher from the medical school. He had terminal metastatic liver cancer. This really got my attention about mortality and banished any young illusions I may have had about fighting death and winning.
There’s nothing like experience. I have know several psychiatrists that were hospitalized for psychiatric reasons over the years. I can’t speak for the impact this must have had on their practice. I’ve also worked a lot in A and D treatment. The thought from those working in the A and D field is that I can’t “get it” till I develop an addiction and go through the recovery process. However, I have known very good counselors who were not in recovery themselves.
Thanks for your contribution to this discussion.
Best,
Alice
Report comment
Anonymous,
I don’t belong to the APA. I gave up “psych journals” years ago because of the dense marketing. I have spent no time defending coercion. I am a psychiatrist.
I know you don’t mean me personally. You’ve told me this before (If this is the same Anonymous).
One role I’ve taken on here is helping folks remember that all psychiatrists are not cut from the same cookie cutter any more than all memebers of any other group.
Thanks,
Alice
Report comment
Micheal,
Thanks for all your active participation in what is turning out to be a great conversation. I always appreciate hearing your point of view.
Alice
Report comment
Doctor,
I read the “Deference” piece. Commented. Will get around to reading the other after done here in comment land.
So you were never a paid a member of a multidiscipinary treatment team? You spent all your career getting everyone off the evil drugs? You never saw any person’s life on medicine work better than without? Never wrote a diagnosis on a piece of paper for anyone, not even so they could get on disability?
I don’t quarrel with the battles you say you’ve fought and won. Good for you.
Tossing the phrase “drinking koolaid” around with regard to my professional life sounds like you may be referring to the old LSD experimentation days of psychology. Those days were gone by the time I came along
Much love,
Alice
Report comment
Vanessa,
My comment that it may take a few psychiatrists to help turn things around is not intended as snide. I intended to convey the idea that I believe the system is very broken and requires repair. I mean to imply with this statement that it behooves a movement looking to fix such large and broken things to get together all the help they can. Help could come from unexpected places. It could come from the ranks of those being vilified. I’m sorry that some people have been hurt through the actions of some psychiatrists. Some does not equal all.
I’m certain I didn’t call myself a “victim of a broken system”. Thanks. I’m pretty good at using my own words. Or perhaps I did and I forgot.
Blind eye? If there is no “alternate point of view” being presented then there is no blind eye. There is an assumption being made that information was available and in plain sight. “Koolaid” implies I was too drugged up something, acid?, to see something that was there to see. I suppose if you had been there with me in my training program, in my private practice, in the clinics where I worked you may be able to say this. Until then… I suppose you can say it all you want. It’s a “free country”*.
*(This is intended to be snide)
My biggest personal liability is my habit of trusting what people tell me, presuming good intentions and seeing the basic goodness of human spirit in everyone I contact.
Sometimes it lets me down. But not so often that I shall stop.
Here’s to the basic goodness of human spirit.
Alice
Report comment
Altostrata,
Not a buddhist then, eh?
Best,
Alice
Report comment
Kermit,
Thanks for your thoughtful post.
Best,
Alice
Report comment
Emma,
Of course. I have always explained the risks and benefits to the best of my knowlege and the information available at the time.
Would you fault your carpenter for building a house that got eaten by termites because termite resistant materials came on the market later? Old electrical code is not safe by today’s standards. Old cars lack modern safety features. New information comes up in every field.
Thanks,
Alice
Report comment
Dr. Cornwall,
I only assume you have a cognitive filter like the rest of us and maybe don’t see your own holes any better than the average bear. But I don’t know you so I could be wrong. It wouldn’t be the first time I was.
Tell us more about the job you worked at for thirty years where you knew psychiatrists. Did you have a separate solo private practice or were you a member of their treatment team? This could give me a bit more understanding of where you’re coming from and how you could have spent all those years not drinking koolaid.
I wonder if there were ever a psychiatrist who ever did an act of kindness and caring for a patient. Yes. There is evil afoot. But every psychiatrist is not always evil. All or none, black or white.
By the way, my mom used to put koolaid in my bottle as a baby. I liked the green.
All the best always. Me and you. We’re not so far apart as it may seem.
Best always,
Alice
Report comment
Vanessa,
Every step of the way I studied the research that was available to me. I was motivated by a desire to help others. I believed what I was taught because I had no reason to question. I had respectful relationships with the patients I treated. I offered choice and the information that I had to share. When I had questions about things, I shared them. When I came across Robert Whitaker’s book at the library, I read it. I went back to work and shared what I learned. I changed how I worked. Then I left. Now I write here to have a bigger impact.
When the information was available I read it and changed.
I think the part where I feel like I was given no choice is the part where the research was hidden, surpressed and lied about and I believed it. If I had the information back then that I have now, I would have made other choices. But I didn’t so I didn’t. Isn’t the “retrospectroscope” great?
I’m actually fine with the choices I’ve made over the years. Each one was made based on the best information I could get at the time. Who could do better? A psychic?
I’m advocating for a more tolerant and understanding attitude toward the psychiatric profession. I understand that a lot of folks have had bad experiences with psychiatrists. But I imagine there may be others that have been well-meaning and done the best anyone could do with the information available at the time. We need these people here in the discussion. When people shoot at every psychiatrist because they were hurt by one once, it can be counterproductive to the goal of making things better.
We are all in this together.
Thanks for reading and thinking and writing. We need you as well.
Alice
Report comment
Steve,
Thanks for responding here. Good luck finding a job.
Unfortunatly I have seen no employer in decades that want more than a fast note and a quick prescription. Many of those jobs are going to lower priced NPs, PAs and (in 2 states and the military) psychologists. Interchangeable prescribing cogs is the deal in most medical systems. I have done my best to sneak in a bit of therapy between the closely counted “prescriber” minutes. I had a therapy based private practice for many years. You may have to make your own way if you want the practice of psychiatry to allow you to be more than a “prescriber”. There are also hourly contract jobs doing disability evaluations out there.
If you’ve been immune to the forces of marketing, you’re lucky. They must not allow drug reps and samples into the training program you’ve been at. Some do not. And those teachers must not have passed on what they “know”. And I imagine the APA no longer takes money from pharmceutical companies to fund presentations. I’m glad your bucket has remained unscathed. My has not.
Thanks for reading and commenting here. I’m glad to know that you’re reading outside the box. Welcome to MIA.
Best Wishes,
Alice
Report comment
Arta,
Once upon a time back in the olden days these were taught in school. Interviewing classes with clinicians demonstrating with real volunteer patients. Observed and critiqued interviews and examinations of real live patients.Perhaps they still are. I haven’t been there in a long time.
Any younger docs out there to respond? I graduated in 1983. This was a big part of clinical training.
Alice
Report comment
Nathan,
I don’t think that most psychiatrists have the new information. Some may read it. All don’t believe it. We are up against a wall of expensive “education” (marketing).
“Should people seeking support for distress trust psychiatrists/medicine?” I would not. And, yes, I am a doctor.
Thanks for asking hard questions. Sorry I don’t have answers to them all. What it will take for trust? Don’t know.
Alice
Report comment
Stephen,
Cars. Number one cause of death in children in the US. They cannot be “safe drivers”. We’ve built a car dependent culture because of marketing that began with Henry Ford. Park your car one day in protest. Reduce your risk in a “dose dependant” way. No driver is “safe”.
Thanks for your thoughtful post,
Alice
Report comment
Mark,
Thanks for taking the time to compose such a thoughtful and complex commentary. This is a good summry of the complex web of pressures and information we are all expected to navigate, especially those of us in medicine. Most doctors I know do want to help.
I have explained over and over to patients next to me in the office that, indeed, we are doing an experiment of “1”. Everything is not known. Much of what is believed could be disproven. These are theories, not facts. Most have been relieved. Some have been aghast.
This is not the sole territory of psychiatry, the unknown. All is not known.
There are also different standards of marketing pharmaceutical products in Europe as well as differnt standards for drug approval.
Lovely post.
Thanks for reading and writing.
Alice
Report comment
Anon,
You assume that psychiatrists are a special and separate breed of humans that are not trapped with the same cognitive system as others.
Oh how I wish it were true that I had special powers to see past marketing and see information that’s been hidden form view. But it’s not.
What you were taught about depression and medicines is what I was taught is what everyone with a television was taught.
We are in the same boat here.
Being given the “right to take away liberty” can be addressed through the courts and elected officials. These laws are made our elected representatives. Remedy for these comes through those channels. The psychitrists, ED doctors, police, mental health professionals are legally bound to comply with the committemtn laws of the state. Laws can be changed.
Thanks for reading and commenting. Good discussion.
Alice
Report comment
Diana,
The bucket is big and thick, isn’t it? I find it’s always easier to see when someone else’s is on crooked or has the holes in the wrong place than to see my own.
It will take all kinds of people working together to make substantial changes in the way we handle mental health in this country.
Yes. Some psychiatrists have done bad things.But perhaps you have not yet met every psychiatrist. Perhaps there are some who could make useful contributions here. It would be a shame to run them all off by assuming all are “dangerous”. Perhaps the one that spoke in BC? She changed her practice and teaches others. Could she join in here and help? How would she be recieved?
We are all more alike than different.
Thanks for reading. I’m glad to have your commentary here.
Alice
Report comment
Vanessa,
Recruiting “sympathy” here is not a goal of mine.
Recruiting a more tolerant and open-minded approach to one another is. It will take all kinds of people, maybe even the occasional psychiatrist, to get this boat turned around.
If the goal is to re-make mental health care into something that works better, then more understanding of one another is in order.
“I have worked hard in life, personally and professionally, to listen to people, to connect with them, to investigate truth, to be honest about what I know and what I don’t. I work hard to look beyond the simple answer…”
This sounds like it could be a quote from how I’ve run my professional life. Perhaps we are more alike than you imagine. Turn the bucket and tilt it just a bit. You may see me, yet.;-)
Much love,
Alice
Report comment
Emma,
I did “know” the tools of my trade as well as anyone else practicing in the field did at the time. The great “retrospectroscope” has vision that no one, not even us God-like shrinks 😉 have. All of us humans, including psychiatrists, are limited to the information available at the time. All of us are “victims” of the same cognitive operating system being manipulated by media/marketing.
Subsuming the question IS my point. We are all more alike than different. Holding psychiatrists to standards of human cognition (like knowing information not available at the time and being immune to market-driven education) only gives us self-rightcheous reasons to shoot at them.
I don’t think it wise to drive every psychiatrist away from the discussion table. Occasionally one of us may want to help.
We’re all in this together. It will take all of us to make things better. Maybe even the occasional psychiatrist.
Thanks for reading and commenting,
Alice
Report comment
Amen Kermit. Or add a hole.
Alice
Report comment
Nathan,
You say this so well. The only assumption I would have you question is whether this is limited to psychiatry.
Thanks for reading and responding here.
Alice
Report comment
Jonathan,
Weeping eyes here. You heard the whole message. Thanks for reading.
Yes. Definite yes to society-sized bucket. Yikes. Don’t get me started on this one or I won’t get to the others who have been kind enough to read and respond.
Thanks.
We are all in this together,
Alice
Report comment
Steve,
Thoughtful post and great question.
None us us can take of the bucket completely. It is the operating system sorting for us. The best that can be done is to take the drills away from the pharmaceutical companies. Get the adds out of magazines, television and internet. Get the sweet drug reps and their “helpful information”, “patient training” and “free samples” out of all doctor offices. Unplug the drug cash.
No fast answers here. There is not way to change our heads till we change the messages.
Thanks from “still inside my bucket just with new vent holes”
Alice
Report comment
Keith,
So many questions and so little time. Thanks for “getting” the metaphor.
How about we take the drill out of the hands of the drug companies for starters. Even New Zealand finally did. Outlaw marketing of drugs to the public. Get the “free” samples and drug reps out of every doctor training location. Big financial conflict of interest disclaimers on the DSM and PDR. “Diagnostic criteria brought to youby the makers of… )
I had worked for decades before I relaized the PDR is a paid drug marketing catalog. Doctos BUY this thing for the “i” things now.
Thanks for reading and commenting,
Alice
Report comment
Stephen,
Psychiatry training is DSM and drugs. Yup. That’s right. Education is funded by pharmaceautical company dollars. We’ve long ago voted out state funding of teaching hospitals. Does anyone else even remember when medical education was state funded and the trainees took care of the poor in exchange?
He that pays the piper gets to call the tune.
How can we expect that doctors in training, enslaved with education loans and exhausted by long hours, to know better and save us all? It’s a lot to expect of another person.
Perhaps they do try. Maybe they get swamped. I did.
Alice
Report comment
John,
I am so happy that you got what I meant to say. Marketing is BIG and marquerades as education all the way down to infancy in our country. This is about MARKETING, not science.
One of the reasons I am writing here becasue I finally got it that there’s nothing I can do as an isolated doctor drowning in the trenches. The laptop is mightier…
This will take a lot of efforts by a lot of people from all walks of life to make better. We may even need to let some of the (I’ll whisper this) psychiatrists in on whats happening. We’re all in this together.
Thanks.
As always,
Alice
Report comment
Stephen,
Somewhere in this particular doctor’s training and life experience he got the belief that he can do this. I wonder who drilled this hole in his belief system. Most docs behave better most of the time (I think).
I have also seen non-doctor yell, swear and throw things. Poor behavior comes from all kind of people.
Thanks for reading today.
Alice
Report comment
Stanley,
I was taught that “all antidepressants work 80 percent of the time to relieve the symptoms of depression”. “Each medicine works on a different group of patients. So if the first doesn’t help, the second has a good chance of helping.”
I was taught that antidepressants had few and mild side-effects and no withdrawel.
Each new “indication” for them was presented as a gift to help suffering patients. ex.”SSRIs releive anxiety”
The information you refer to was not “out there” at the time. The above information I quote chapter and verse was repeated a thousand times in every professional conference and magazine and continuing education I attended. This drilled my bucket holes.
I’m not a math wizard. Never have been. But 80% is a lot of help isn’t it?
Thanks for reading and commenting.
Alice
Report comment
Dr. Cornwall,
How often are these “clear warnings” a part of medical education? How often are they a part of psychiatry training. HOw often are they a part of every day life?
I have had to stumble upon each of these one by one over the years through wide personl reading.
Everyone of us is unknowingly programmed by those things we have the most exposure to, what’s right hammering the air in front of us. Repetition. For warnings to be warnings they have to be visible and audible.
Every single one us us has our own invisible “head-bucket” filter. All of us.
Maybe even you.
Naw. Not you. 😉
Alice
Report comment
Alix,
Things are quite a lot the same here. Patients in hospital may be started on a lot of drugs all at once then discharged after a short stay. Someone else, frequently a primary care doc, has to deal with the consequences of sorting out if any of it is necessary or useful or safe. Hospital stays are short. There’s no feedback loop. Every year the list of “brand new to the patient” discharge medicines is larger; bigger dosages, more complex regimens. I have no idea where this “treatment approach” comes from. (Well, yes I do. Post graduate medical education is drug funded.)
The trouble with being really smart and educated is that it gives one a false sense of security in ones ability to see the good information from the hype. It doesn’t. It also leads your patients to believe you may be above it. You’re not.
Doctors are people too and live with the same cognitive processing system as everyone else. It’s just as easy to program by marketing. Maybe more so. How often does a lovely young drug rep drop in on you at work with chocolate, flattery and drug samples to “help” the poor? I guess it depends on where you work.
No one is immune.
Thanks for reading and responding.
Alice
Report comment
Marcellas,
Thanks for your kind words. There will always be a place for therpaists who can teach folks how to manage their own thoughts, feelings and behaviors. Keep talking and teaching. You’re gentle teaching approach is right. Confrontation shuts people off to hearing. But you’re a CB therapist. You already know this.
I find ways to make contributions. Today, I write.
Best,
Alice
Report comment
Stephen,
I agree. It’s easier to feel “they are me and I am them” when the “other” embodies good qualities or is the injured party.
There is a ho’o ponopono (Hawaiian) meditation that goes like this:
“I love you. I’m sorry. Please forgive me. Thank you.”
I read once of a psychologist that used this meditation/prayer in his mental health work in a state hospital. Any time he heard or read of bad things that happened, he took the responsibility on himself as the cause of the harm and did private meditations with this while holding the person in his mind and heart. He took the embodyment of “all one” all the way.
Thanks for reading, thinking and sharing here.
Alice
Report comment
Demo,
In the highly unlikely event that I “ran the show” I would have everyone lay their anger to one side so that we can work together to make things better. Anger clouds thinking when we need clear thought. Anger divides us from ourselves and others when we require unity.
If I “ran the show”, respectful and loving conversation would be how all people everywhere communicated. It would be natural because everyone knew it to be right.
If I “ran the show” everyone would be invited to the table on equal footing and every voice would be heard and valued.
If I “ran the show” everyone would already know in a deep personal way that we are all one; hurting you is the same thing as hurting me. Loving you and loving me is the same thing.
Thanks for asking a great question. You could ask yourself this question as well and see what you’d come up with. I suspect we are surprisingly close together on this.
Perhaps we do “run the show”.
My deepest respect,
Alice
Report comment
Laura,
Thanks for reminding us that every individual in “category” is not identical.
Thanks for supporting my writing here. I hope there’s room at the table for all kinds of thought and input. It’s going to take every resource we can come up with to find new and better ways.
There has to be room for psychiatrists (and everyone) to change how they think. Peaceful nd respectful conversation are essential ingredients for successful change.
Psychiatrists may even bring a good idea of their own from time to time. It may be that one or more of those less than welcoming psychiatrists you saw at the APA could become strong advocates of change. These things happen.
All the best,
Alice
Report comment
Nijnsky,
You are right to point out that we can not know for certain someone’s reasons for action unless thay tell us themselves.
Alice
Report comment
Kermit,
I’ve had to come back and read your post several times throughout the day. You’re saying so many things and saying them so well. Every paragraph or so I take a deep breath and say “Yeah. That’s right. I wish I’d said that.” You have an eloquent way with words.
Our reality is one big thing we all share but we don’t always see things in just the same way.
Psychiatrists (and anyone) who behaves in an autocratic or dismissive way pisses me off, too. If I am vulnerable to their power, this is especially touchy.
We have to keep talking. Ongoing communication can get through a lot. Letting anger run unchecked blocks clear thought and conversation.
“Reading “Mad” and “Anatomy” affirmed things I had suspected or felt to be true.” This could have come out of my own mouth.
We’re all in this together. It will take us all.
“It’s not over yet.” (Yeah. That’ right. I wish I’d said that.”)
I hope people come back.
Alice
Report comment
Laura,
Thanks for your courage to stand and speak your truths in such a public (and unwelcoming) venue. I regret that there is not yet an open forum inside APA meetings for the voices of “patients” and former “patients”.
There is much that needs to be learned by doctors. Open minded listening by psychiatrists would be a good place to start. We psychiatrists are supposed to be specially trained with this skill. We are also supposed to be advocates for those we work with.
You’re right that the field of psychiatry has gotten extreme about labeling and pathologizing many aspects of the human condition and exsistence. So much of the labeling begins early in life, inside the education system, as your story so clearly reveals.
Your writing is eloquent, your story poignant and your energy powerful.
Keep up the good work. Keep writing and speaking. All ears are not deaf. I’m listening.
All the best,
Alice
(Alice Keys MD)
Report comment
Kermit,
I, too, want this to be a safe forum for discussion. Everyone brings a unique and valuable point of view to the meeting table. An open and inclusive conversation is most likely to get us where we need to go to improve mental health (and medical) care.
Thanks again.
Alice
Report comment
robertr,
I am grateful for your kind words.
I’m sitting here re-reading your post to see what else I could add. There is nothing else. This is a lovely, poetic, understanding and compassionate post.
It’s clear to me that your work in mental health is rooted in an understanding of both the human condition and human communication
Best always,
Alice
Report comment
Kermit,
Thanks again for the time and energy you put in here to keep things on track. Thanks, especially, for working on it this weekend.
Alice
Report comment
Gail,
I know that you’re right. Psychiatric drugs can “deaden” emotions. I have heard this directly from people taking them. Many have stopped taking them because of this. Some have kept taking them because of this.
I also know that the “side-effects” can be miserable. I have heard this directly as well. Some “side-effects” do make a person want to stay in bed. Some “symptoms” do as well. This has always been tricky to sort out for me. I have to depend on the person I’m working help with for this.
I have also heard directly from patients that they were having “symptoms” that were intolerable that were better or gone with medicines. For some, the “side-effects” are easier to tolerate than the “symptoms” and they choose to take medicine.
I am certain that the focus of mental health care has gotten too narrow and “pill” focused. There are other known helpful approaches not in widespread use.
Thanks for reading and posting here. You make a valuable contribution to this discussion.
Alice
Note: I use quotation marks around the words “symptoms” and “side-effects” herein because there is disagreement about the definition of each. I use them here as a well-meaning doctor (me) who is willing to hear how the individual before me is defining them. These definitions vary with the person and over time.
Report comment
Patti,
Thanks for this post. This warms my heart to hear. Having fun is, indeed, essential to life and living.
Thanks for reading and responding here.
Warm regards,
Alice
Report comment
Marianne,
It hasn’t been stuffy at all in comments section this week.
It is a lot more “real people” than I imagined.
Thanks for reading and writing here.
Alice
Report comment
Kermit,
Thanks for taking your Sunday evening to assist with sorting this out.
Alice
Report comment
Nijinsky,
Thanks. I will not pour water on the computer.
Alice
Report comment
Joe,
Thanks for bringing your decades of experience to the table. I agree with what you’re saying here.
Arrogant people are everywhere. I’ve bumped into arrogance in every technical and professional field. Maybe there’s a higher percentage in medicine than in other fields. Maybe it’s more obvious and “in ones face” in medicine/mental health because it’s so personal and vulnerable to ask for medical and mental health help.
“One needs to respectfully enter into a dialogue with the “client”, “patient” and together explore what is wrong and what might help.” I like this a lot. Can I quote you some day when they let me teach student doctors? This is the basic tenant of approaching all patients in every field of medicine, likely for every healing/helping professional.
Thanks for putting in your point of view here.
Alice
Report comment
Anonymous,
I knew that. But, like I said, we’re all one. 🙂
Peace and forgiveness has to start somewhere.
I’m okay with this.
Best always,
Alice
Report comment
Donna,
Hang in there. Your contributions here are essential to the mix. I wish I had some magic way to help things feel better all the way around.
Sorry.
All my best,
Alice
Report comment
Kermit,
Thanks. I just got back from the woods a few minutes ago myself.I am also not on line every moment. I am happy to participate in whatever way possible to help the discussions be useful.
Thanks,
Alice
Report comment
ssenTC,
Thanks for including me here. I hope to make useful contributions in necessary changes in psychiatry.
Best,
Alice
Report comment
Anonymous,
I only hope there is room for my sincere “I’m sorry” in all this. I can’t un-ring the bell or rewrite what has happened.
I’m sorry for what has happened to you and those you care about.
I wish you peace,
Alice
Report comment
Jennifer,
I am truly blessed by all the vivid commentary and conversation here. What a great gift Robert Whitaker has given to us with this vehicle for communication and change.
I am amazed by the responses as well.
Hugs back to you, mother bear,
Alice
Report comment
Faith,
I want your every morning to be bright. Thanks for your support by reading and posting here.
Always,
Alice
Report comment
Alix,
I agree with your statement that “no one should have this power over their fellow human beings”. I wish we lived in a culture where saying “sorry” wasn’t an automatic lawsuit liability. I have been advised by auto insurance folks (years before “no-fault” insurance) to never say “I’m sorry” at the scene of an accident, that this implies it was all my fault and I’m taking full legal and financial responsibility.
Here, I hope I can say “I’m sorry” without fear of legal retribution. When this is how I feel, I should be able to say it.
I’m very sorry you and your son have had such bad experiences in your search for help. I’m sorry that those involved can’t say “sorry” as well. I’m glad to hear things are better now for you both.
Best,
Alice
Report comment
David,
You make good points. Perhaps I would amend the “words create the world” statement to “words create our waking world”. My unconcious, nonverbal and dream-self are the bubbling well from which my words arise.
I’m not meaning to be dismissive of reality. When I say “Words create the world” I hope I am suggesting we all use extreme caution and care when we select our words. Especially in this word-based communication on-line environment.
Thanks for reading and writing here.
Best,
Alice
Report comment
Becky,
Yes. And it’s lovely.
Alice
Report comment
Nijinsky,
Dang. Is this you playing? Who is the composer? Lovely.
More tears in eyes this morning from the lovliness of this Suite in Three Movements.
Alice
Report comment
Nijinsky,
I’m not surprised to hear the effect of music on healing the brain. It has been known for a long time that music study makes for more complex brain development in kids. With the new-ish thought that brain developement and re-wiring goes on our whole life, it only follows that music will help this.
Good work.
Thanks,
Alice
Report comment
Nijinsky,
So you know what I mean about Rumi’s poetry, here is one translated by Coleman Barks. Rumi was a Sufi poet from the 1300’s.
Alice
One Song
“Move beyond any attachment to names
Every war and every conflict between human beings has occured because of some disagreement about names.
It’s such an unecessary foolishness because just beyond the arguing is a long table of companionship set and waiting for us to sit down.
What is praised is one, so the praise is one too, many jugs being poured into a huge basin.
All religions, all this singing one song.
The differences are just illusion and vanity.
Sunlight looks a little different on this wall than it does on that wall and a lot different on this other one, but it is still one light.
We have borrowed these clothes, these time-and-space personalities, from a light, and when we praise, we are pouring them back in.”
Report comment
April,
Thanks for being here with me. Thanks for reading and your kind words.
Best always,
Alice
Report comment
Keith,
Thanks for reading and commenting. You’re right. You are obviously an “ah ha” or so beyond me on understanding. I’ll be there soon.
Best always,
Alice
Report comment
Nijinsky,
Very shams/Rumi/Barks Sufi poetry sounding to me. Lovely.Thanks.
Alice
Report comment
Donna,
I hit he “trash” button on the one from you to “Mary” (Marianne) from 7:36 pm today 5/5. I hope this is the one you meant. There’s an undo key but I don’t know how long it will work. Let me know If I got the wrong one. I’m not real sure how this works.
Best,
Alice
Report comment
Donna,
I was warning people off way before that news came out. Nothing is absolutely “safe” for use during pregnancy. We just don’t know everything.
Alice
Report comment
Dr. Cornwall,
We are all in this together. There is, in truth, no other way it could be. It’s only our knowing of this truth that lags.
Thanks,
Alice
Report comment
Marianne,
Thanks for talking about how psychiatrists could be “caught” in the system. They are. The risks for a psychiatrist certainly include the loss of livelihood for themselves and their family.
The hardest part for me has been the loss of my trust in myself and my own personal judgement. If I could be duped about safety and efficacy pharmaceautical products, what else could I be wrong about in my personal andprofessional life? This strikes at the base of personal identity and integrity.
What if all those years I believed I was doing good for my patients (excuse my archaic terminology) and I wasn’t? What if I had unwittingly being “doing harm?” This is a much bigger pain to face than not having a job. This is the complete loss of the foundations of my professional identity and internal sense of integrity.
This was a lot to have crash on my head at home alone one afternoon.
I know I will certainly take flack for saying that I understand and have sympathy for those doctors that don’t “getit” I even have sympathy for those that “get it” and then completely pack it all away under lock and key again deep inside. I have seen people in therapy with me do something quite like this to defend against the excruciating pain of awakening to painful truths of how they’ve been living. If they’ve been living that wrong then they’ve “wasted all those years”. Sometimes it’s easier to shut it all away and keep doing the same old pain you’re used than to face the big sudden pain of knowing.
I’m not saying this is “right” or condoning continued injury to their patients after they see what’s happening. I’m only suggesting that I can see things from their side.
Thanks for your understanding,
Alice
Report comment
Marianne,
Thanks for telling your personal story about your experiences with ECT and at the state hospital. I’m sorry you were put through these. Nineteen is so young. (Not that anyone should have to go through what you went through at any age). I look around and see 19 year olds. They are all so young and growing still and fragile.
Best,
Alice
Report comment
Becky,
Thanks for telling us all how you feel. I’m sorry you’ve felt disrespected, disapproved and invalidated when you posted here before.
I know that anger is a natural consequence of being hurt. No one wants to be hurt again. Disrespect is hurtful. People who’s been hurt can still be pretty angry whether it was long ago or last week that they were hurt. Sometimes hurt, angry people hurt others.
This is a public forum. I’m new to this kind of posting as of April 19. There’s no way to guarentee that hurtful things will never be said. My understanding is that Bob Whitaker wants this to be as open as possible so that people can talk about what’s important and of concern to them (somebody correct me here).
I hope you can feel okay about joining the discussions. I would understand if you don’t. But please keep reading. You can still be in on the discussion even if you don’t wish to post.
I hope for peaceful discussions. I don’t want to run anyone off.
All the best,
Alice
Report comment
Anonymous,
Any time anyone believes another human is “genetically inferior” they have crossed my line as well.
Alice
Report comment
Donna,
I find life in the USA scarey as well.
Last winter on a car trip with a 71 year old lady friend of mine in New Mexico we were stopped and questioned (not in a nice way) by armed uniformed men with dogs over an hour’s drive north of the border. There were banks of cameras on every highway there for “facial recognition” purposes and “border patrol” vehicles everywhere I looked.
We’re killing people on multiple fronts in the middle east with hightech computerized machines. Families with children are homeless. Bank owned houses are boarded up and empty. Food banks are doing a brisk business. People spend so much time indoors that, even in the deep south, there are epidemics of “pathologic” fractures due to lack of sun. The grocery stores are filled with “food products” that are an amalgam of high-fructose corn sweeteners, partially-hydrogenated seed oils and unpronounceable additives. I struggle to find safe food for my family. The polar ice caps melt and we each drive, one to a car.
Donna. There is so much so wrong with how we all live here in the “land of the free and the home of the brave”, that I fear this whole psychiatry thing, however big and important it is to all of us here, is the tip of another iceberg.
Sorry. I wish you were a “conspiracy nut”. This would make the situation very different.
I pray and meditate alot. Now I write. Words are important. Words can re-make the world.
Best,
Alice
Report comment
Donna,
I want to thank you for this series of posts. You have some very good things to say about anger, hate and revenge.
Alice
Report comment
Donna,
I warned people that these drugs are not studied in pregnancy and cannot be considered “safe” even when there are no birth defects known (yet).
Alice
Report comment
NIjnsky,
I’m so sorry this happened to your friend. I’m sorry for your loss. This morning, reading your story, I weep.
Best always,
Alice
Report comment
Donna,
Again. Wow. I like this lovely, peaceful side of you. Good job.
Alice
Report comment
Donna,
Thanks for the peacemaking. You are very skilled at this. There are a lot of people reading and posting here that have been hurt.
Best,
Alice
Report comment
Donna,
“Bwa ha ha”. My kid use this as a joking “evil laugh” in both talking and writing. Maybe it came from a Terry Pratchett book? I was tired after many hours of trying to keep up with the lovely flood of commentary. There is only one of me. It sort of slipped out and I left it.
Thanks,
Alice
Report comment
Scott,
Sorry. There have been times in this discussion that I have felt endowed with powers that I lack.
“Cog” is how I’ve felt working in modern psychiatry outside my private office. And “care managers” of insurance corporations made it more and more so over time.
So much of American living is based on the premises of industrialization and the education process that goes with this. I think the roots of much that’s off-kilter about our culture dates back to the changes brought about by industrialization.
Best,
Alice
Report comment
Scott,
I’ve noticed things you list in your post: bank fraud, wars, drugging of more and more people including infants now. The part I’m missing is how psychiatry is at the helm of all this.
Yes. These things are scarey. No joke.
Alice
Report comment
Marianne,
There are a lot of smart, compassionate humans who believe in the genetic, biological and neurochemistry theories. I know and like many of these people. I’m sure there are other kind, smart, compassionate people who also believe in other theories that I don’t.
Personal tangent:
I’m comfortable not knowing for now. Since no one really knows, I guess I’d better be comfortable with it. I’m better and better with uncertainty in my life all the way around. Not needing to know feels liberating to me. I’m pretty clear on what and who I am right now. This feels liberating as well. I’m not waiting around for anyone else to define me or un-define me.
Thanks loads,
Alice
Report comment
Marianne,
Thanks for the understanding and support. Thanks also for encouraging both my writing and sense of humor.
Your mention of my being educated under the neurotransmitter myth: I remember having so much trouble keeping them all straight. I went up to the medical school to a special grand rounds (many years ago) determined to learn them at last. I listened and took many notes from the several speakers. At the end I realized that if the first guy’s theories were right then the last guy’s had to be wrong. There were mutually exclusive parts in the theories. I wish I had those notes today.
I think that was the day I got clearer about the difference between theories and facts. I decided henceforth to tell people who wanted to talk neurochemistry with me that these are theories. There’s a line in the PDR with all the antidepressants I read to people alot: “the mechanism of action is unknown”.
Yes. I continued to prescribe these drugs. But I knew it was a theory and explained it as such. It was the best I could do at the time with the information I had. Back then I still was working from the literature that said anitdepressants worked and didn’t have withdrawel symptoms. It never occured to me to think these were also “theories”.
My mentor used to call this looking through “the retrospectroscope”. It makes things look different.
Best,
Alice
Report comment
John,
Imust have missed this lovely post of yours. “Service user” is a bit like “consumer” to me.
Alice
Report comment
Donna,
Thanks for the positive and encouraging post.
Right now I’m writing as an alternative path to being a helping person on the planet. Perhaps down the road I will find a satisfying a place in direct patient care or consulting. Today, this is good enough for me.
Alice
Report comment
Mariane,
Yikes. Thanks for sharing your personal experience in the “eugenics” area. Sorry. Especially since there is no known “gene” for schizoprenia. I have suggested people not get pregnant while taking medicines with known birth defect problems. I suppose my “wait till these drugs are not in your body” and “don’t get pregnant while you’re taking this” could be interpreted as “eugenics”.
Thanks for clarifying this to me. I understand things better when given clear, specific, current examples.
I’m sorry these things happened to you. I’m glad you’ve found your way into the clear.
Best,
Alice
Report comment
Altostrata,
I bailed on the APA years ago. I joined and paid membership dues to the national and state groups because it was the only way to access affordable professional liability insurance. I quit when this quit. Perhaps I am unable to speak to the thoughts of “mainstream psychiatry” and the “APA”. Could we get some APA members to comment?
Alice
Report comment
Donna,
Thanks for pointing us in the direction of healthy alternatives to the current “pill” model of medical care.
Thanks for your encouraging words to Duane. He is a resource gatherer who brings a positive flavor to the thought mix here.
Keep reading and posting. You have a lot of energy. Your words matter.
Here’s to the “…one by one…” “…the new paradigm shift…” and “…unified healthy mind, body and spirit.”
Like you say “…spread the word…”.
Best,
Alice
Report comment
Nijinski,
Thanks for the reminder that we are “all one” ( “None of us are separate from each other.”).
Thanks also for the reminder that anger turns off perceptions. (“Sometimes, when you get riled up you can’t see the not so little “little” things that are there for you.”) Fear does this too.
I like this. “… experience what is designed (by nature) to help them let go of fears, find a true community and see there’s something there beyond it that does heal…”
Really great messages can drown and be lost among angry words.
While anger is an understandable reaction to wrong doings, correcting wrongs requires calm thoughts and careful actions, together.(see “all one” above.)
Words are important. How I handle my feelings is important.
The more I study the things you all say, the more I see how we are all alike.
And yes. Thank you Nijinsky. It is a “such beautiful day”, right at this moment.
Alice
Report comment
anonymous, (lower case “a”)
I stand corrected.
You have more experience with committments that I do.
We all depend on each other’s experiences and knowledge to gain a more accurate world views.
Thanks,
Alice
Report comment
David,
Thanks for reading and contributing here. Brainstorming is one of my favorite things to do. I enjoy generating options with other people. A very old book by Napoleon Hill he called this a “mastermind alliance”. You get together people with a variety of different skills and viewpoints and work together in a coopertive manner to come up with options and solutions. This is way better than any of one of us can do alone. I don’t agree with every single thing in his book and his language use is out of date but I like his phrase. The idea is powerful.
Alice
Report comment
Alix,
Change has to come from within psychiatry.
And within the practice of medicine,
And within third party payment corporations,
And within the government (ie stopping drug ads),
And within drug companies,
And from MIA.
Best,
Alice
We are all in this together.
Report comment
Josephene,
YAY? 🙂
This was unexpected to me.
Busy times to sort through the posts. There is but one of me.
I am having fun and learning. Both are good things in my book.
Alice
Report comment
NIjinsky,
“yep irrational sounding beliefs such as these drugs will heal you, negative self-talk such as these drugs will heal you, reactions to trauma such as these drugs will heal you… just fill in the blank
attention deficit such as “these drugs will heal you.”
Bingo. You’ve got it. These “beliefs and thoughts” are irrational and negative and block healing. Thes have been my arguments for years when I’ve been saying “no” to the drugs 9 out of ten patients that talk to me want.
Alice
Report comment
Anonymous,
Read my post below. There is no”testimony behind closed doors to a psychiatrist” happening in Oregon when a person is “placed on a hold”.
Alice
Report comment
Anonymous,
It is the judge who makes this final decision in Oregon, not a psychiatrist. The “holds” (brief) are written by two police officers OR two mental health professionals OR (I think) by two physicians in a hospital(ED docs). I do not have the legal power to wrote a “hold” in Oregon. A judge makes the final decision.
Involutary committment laws vary from state to state and are crafted by politicians. They change over time. Read up on what they are where you live.
Alice
Report comment
Donna,
Thanks for catching us up on the political end of things. I have not kept up with them. We all need to know things from every angle to get clear about what’s been happening here to us all.
Everyone brings special expertise
Alice
Report comment
Greeney,
Forgive me for repeating a post to David here. I think your question bumps up against these same thoughts. As you will see, nurses and naturopaths (and everyone else) already presecribe psychiatric drugs in Oregon. Also, psychiatrists are not neurologists.
Of course psychiatry is obsolete. It has been (at least) since we allowed our profession to be diminished into “prescriber” roles. Read the following.
Thanks for your post.
Alice
David,
I’m not so sure it’s salvagable either. I thought about this while I was cooking dinner for my family tonight. I had one of those “a ha” moments. Probably I’d better write an article about it so the word gets to more people. Others can think about this idea of mine, too. This is a tangent off your topic but I hope worth reading.
More and more psychiatric prescribing isn’t done by psychiatrists at all. (What percentage of psychiatric prescriptions are written by psychiatrists?) Along with the ramped up market demand (through direct public marketing) there has been a long term marketing of the idea of a “psychiatrist shortage”.
I’ve been hearing about this “psychiatrist shortage” as part of the “doctor shortage” since the 1980′s. This was the rationale for licensing nurses to be “prescribers” in Oregon. One post yesterday (Huffman) mentioned that they use PAs and NPs because they cost half as much as psychiatrists and that is all they want us all for, “prescribing”. I knew that. Most “prescribing” in Portland community mental health is done by NPs and PAs.
In Oregon, under funding pressures, we have methodically shifted mental health “prescribing” to primary care docs and pediatricians, NPs. PAs and now, last year, Naturopaths were approved and licensed by the state of Oregon. Social workers also lobbied for “prescribing” in Oregon a couple of years ago.
Psychologists in two states and the military now can pescribe psychiatric drugs. It could be a good piece of research to find out how much of the funding for these initiatives were drug company based. I heard at the time that those helpful pharmaceutical companies helped us out with our psychiatrist “shortage” by lobbying for several other professional classes to be able to “prescribe”. Just to help us overworked psychiatists, you know.
At this point it’s absolutely fine if psychistrists are scapegoated for all the hidden information about drugs, the manipulation of the diagnostic criteria, the artificial “consumer” market for the products.
At this point, from a pharmaceutical market perspective, psychiatrists are completely disposable. While we sit here on MIA and shoot at psychiatrists, the pharmaceautical companies can laugh all the way to the bank. They have new conveyances for their products.
Yikes. I think I’ve frightened myself with this one.
Alice
Report comment
Donna,
You’ve bumped up against an interesting point. “Mainstream” psychiatry” is not run by psychiatrists. The “research” to generate the DSM (also the PDR of ALL medicines) is funded by pharmaceautical money to promote their products.
The laws, made by judges and politicians, decide who is in jail or prison. Not “mainstream” psychiatry. However much there have been times that I would have liked to “put away” an abuser, society has never given me this power.
Rest assured, however, that those incarcerated and on release from prisons and jails recieve their (I hate to use this phrase) “fair share” of psychiatric drugs. This is enforced by judges and police and funded by our tax dollars.
I think you may be granting ordinary psychiatrists more power than we have. Certainly this is more power than I have ever had as a pychiatrist.
I’m finding, here, that I have more power as a writer.
Thanks be to Bob Whitaker for bringing us all together here.
Alice
Report comment
Markps2,
You are right about pharmaceutical corporations making efforts to expand their markets. This is the prime directive of immortal capitalistic corporations. In this country we have given them the same rights as live humans. I find this whole idea frightening. These same corporations will be around to “make profits” from my great grandchildren, no matter what we do today.
You have begun to see through the veils of deception a bit.
I would ask you to step back and broaden your perspective with regard to ALL pharmaceutical products. You may see that there are more people in our boat than you ever imagined.
Think about cholesterol lowering drugs for a moment. These are widely prescibed drugs making recent inroads into off label pediatric markets. They have enormous marketing campaigns that lead us to believe elevated blood cholesterol is a medical disease.
Where is the “endpoint” or the “true disease”? These drugs(All but one with other problems) lower cholesterol levels by poisoning every mitochondria in the body and brain. We depend on mitochondrial function for health. In short term studies (the ones we’ve seen) these drugs reduced the incidence of repeat heart attacks in a few men during a three month trial. The side effects include destruction of muscle tissue that can cause siezures and death, constant aching exhaustion and trouble thinking. There has been no evidence that these should ever been given to women, men or kids that have no history of heart attack.
So. I have another blog here to get the word out to folks not caught up in this conversation. Right?
This is a big boat we are in. Way bigger than psychiatry. Lets all work together.
Alice
Report comment
Donna,
These are great ideas. This is quite a lot like my focus in my old private office practice. I was alternative before alternative was cool ;-). I did a lot of therapy work. I’ve been active in learning about health and nutrition and “prescribed” nutrition, exercise, socialization, education, life-changes etc. I used my prescription pads for “do this week” lists.
I did cash business as much as I could, kept my rates low and gave 20% of my gross back in sliding fee treatment. Dare I use the “F” word again in public with regard to psychiatric work? I had fun. (humor)
The economics of a part-time practice like this didn’t pan out for me. Doctor liability insurance rates were skyrocketing ($10,000 a year with plans to double). Rent and utilities. Accountant. Taxes. The math just didn’t work out. I worked without paying me for a long time then closed up shop. Too bad.
I love to write. I’m doing a lot of it. It’s fun. Words are really really important. They create the world.
I’m not taking the angry posts “personally”. I’m pretty solid in knowing who and what I’m about so I know it’s not me folks are mad at. I know bad things have happened. I know bad things still happen. I’m sorry about all of that.
I’m also hopeful people can move past anger and fighting so we can work things out and make the world a better place. Maybe one small corner over here where we are is a place we could start with.
Best,
Alice
Report comment
Duane,
I’m pretty tired, too.
Get some rest.
Alice
Report comment
Great idea Anonymous.
Alice
Report comment
Let’s all sing. 😉 (humor)
Alice
Report comment
David,
My concern is that by excluding all psychiatrists from a discussion of remaking mental health care you may be losing some good thinkers, some good insights, some good “insider” information that could be useful, some good-hearted and dedicated souls. This would be a loss.
I’m not certain yet where I fit in the big picture of the mental health world of the future, if at all. I have stepped off the train to think.
Alice
Report comment
David,
I’m not so sure it’s salvagable either. I thought about this while I was cooking dinner for my family tonight. I had one of those “a ha” moments. Probably I’d better write an article about it so the word gets to more people. Others can think about this idea of mine, too. This is a tangent off your topic but I hope worth reading.
More and more psychiatric prescribing isn’t done by psychiatrists at all. (What percentage of psychiatric prescriptions are written by psychiatrists?) Along with the ramped up market demand (through direct public marketing) there has been a long term marketing of the idea of a “psychiatrist shortage”.
I’ve been hearing about this “psychiatrist shortage” as part of the “doctor shortage” since the 1980’s. This was the rationale for licensing nurses to be “prescribers” in Oregon. One post yesterday (Huffman) mentioned that they use PAs and NPs because they cost half as much as psychiatrists and that is all they want us all for, “prescribing”. I knew that. Most “prescribing” in Portland community mental health is done by NPs and PAs.
In Oregon, under funding pressures, we have methodically shifted mental health “prescribing” to primary care docs and pediatricians, NPs. PAs and now, last year, Naturopaths were approved and licensed by the state of Oregon. Social workers also lobbied for “prescribing” in Oregon a couple of years ago.
Psychologists in two states and the military now can pescribe psychiatric drugs. It could be a good piece of research to find out how much of the funding for these initiatives were drug company based. I heard at the time that those helpful pharmaceutical companies helped us out with our psychiatrist “shortage” by lobbying for several other professional classes to be able to “prescribe”. Just to help us overworked psychiatists, you know.
At this point it’s absolutely fine if psychistrists are scapegoated for all the hidden information about drugs, the manipulation of the diagnostic criteria, the artificial “consumer” market for the products.
At this point, from a pharmaceutical market perspective, psychiatrists are completely disposable. While we sit here on MIA and shoot at psychiatrists, the pharmaceautical companies can laugh all the way to the bank. They have new conveyances for their products.
Yikes. I think I’ve frightened myself with this one.
Alice
Report comment
Thanks. I’d like the same thing.
Alice
Report comment
Duane,
Is this a metaphor for us all knocking ourselves apart here? Even if it’s not, it’s a lovely sentiment.
Alice
Report comment
True. I am a doctor. Perhaps a doctor (me) could have good ideas to add to the mix.
Alice
Report comment
David,
Thanks for your post. I, too, may have missed a few here. I am certainly behind the curve a couple of hours.
I went to medical school, licensed to be a doctor, started in neurology, completed the “GP” (general practice) training then trained as psychiarist. I was a doctor before I became a psychiatrist and am still one now. If I completed psychoanalytic training I would be a psychoanalist (sp?) and but still would be a doctor.
Alice
Report comment
Anonymous,
You go guy. I like seeing you bring your thinking and writing talents to good use.
Peace,
Alice
Report comment
Peanut gallery,
Did you know that as a writer here I have “edit” and “delete” buttons (plus other buttons of mass destruction) here on my dashboard and could do that to anyone’s post I choose? I feel like writing “bwa ha ha” here but I fear no one would understand the joke. I’m a bit worn out by the mayhem (lively discussions) of the last day but am still having fun here with you all. Together having fun, I hope.
I mean really. I’m the “fox” and you guys are the “hens”? Guys. “flying feathers and more dead poultry”? I love your use of metaphor. Visually evocative. There are a lot of psychiatrists Mr. Whitaker could have invited in. But he asked me. I suppose he could also “un” ask me.
I have only deleted one response of another person (My husband’s several days ago, he asked me to.). I suppose I have the power to moniter and enforce the discussion if I wanted till someone took away my buttons.
I like the free flow of ideas. I like it when I see folks sticking up for themselves and one another. I even like it when somebody sticks up for me. I like finding agreement. I like the energy. This energy pointed in a useful positive directions? Who knows where it could go? We could fix things, come up with better ideas and see them happen.
As I see it, we’re all in this boat together. We may as well take down part of the fence. Okay. We can leave up your part for a while longer. (Again. I’m risking humor here.) Humor is hard on the internet. It works better with voice and facial gestures.
Much love (in the Dalai Lama sense)
Alice
Report comment
Stephen,
Wow. This one brings a tear to me eye. I am indeed struggling here with you all. Thanks for noticing. Alice
Report comment
Stephen,
Thanks for reminding us all that this information was hidden from all of us. I had no idea at the time either. It has been assumed by a some that I (we psychiatrists) must to have known what was going on. Nope. Known “at least by the drug companies” is the key phrase.
This is why I agreed to write for MIA when I was asked.
Alice
Report comment
Nijinsky,
This is a longer and more complicated answer than fits in this moment. But consider that much of the answer will be viewed through my “retrospectroscope” which changes how things look. All decisions are time dependent.
Best,
Alice
Report comment
I had (past tense) a friend long ago who used to tell me “I don’t like doctor-types” and “I don’t like psychiatrist-types and then explain that present company (me) was excluded. He also made derogatory generalizations about “women” (not me, I was “different”). He also said things about a racial minority group and “excluded” another friend of mine . It all felt the same to me.
Alice
Report comment
Nijinsky,
I agree with your statement that “putting them on psychiatric drugs because of their behavior will (not) help them understand themselves”.
I have always had concerns that addicting drugs are addicting drugs, however nicely they’re packaged.
In my primarily psychotherapy based private practice for 13 years, I said “no” giving to a lot of medicines because I knew they would block the work of self understanding.
Be careful. We may have to agree.;-)
I can’t keep up with you on the historic CIA and things. It sounds like you’ve studied it all a great deal more than I.
Alice
Report comment
Jennifer,
This is a nice suggestion. I have always encouraged partnership in treatment relationships.
Alice
Report comment
Perhaps I was unclear about “fun” I had and could have been more specific. It didn’t occur to me that anyone would assume I was “having fun” at the expense of others. “Fun”, to me, in a group environment includes the others in the group. On that unit in 1983 we had a pool table. I would shoot pool with the people (back then they were still “patients” on an “inpatient” unit) and talk with them at lunch.It was a delight to get to know them this way. Relaxed. I certainly remember we all seemed to be havng fun. Perhaps I am a bit dense.
But I am a doctor of medicine. I did the required training as a GP (general practitioner) back then, treated peoples’ diabetes and high blood pressure and stitched folks up in the ED. Why would I pretend not to be what I am beacuse I later recieved additional training as a psychiatrist? Again. I may be a bit dense here. I can’t stop being a doctor. It’s what I am. Kind of like a nurse is still a nurse even after retirement and a teacher is still a teacher and an accountant is an accountant. I know a retired primary care doctor. He’s still a doctor.
I get it that the “pill” model of all medical care is flawed and misleading. I include the “pill” model in internal medicine as well. Since I am a doctor, I do not limit my thought to mental health. I’m thinking of a much bigger picture here.
Thanks for your input,
Alice
Report comment
Scott,
Psychiatric drugs are very prevalent in the USA today. It seems that everyone (across every socio-economic and racial boundary) is taking mood stabilizers, mood elevators and anti-anxiety pills. Some of these drugs have sexaul side effects. If this is a eugenics plot, it’s doing a lousy job. (insert irony here).
The prescribing of antihypertensives (Blood pressure medicines) is very prevalent. Some of them cause sexual side-effects. Perhaps the primary care docs are in on it, too? (insert more irony here).
If we want to make better options to reduce suffering and have people live happier healthier lives, we need all of us together: you, me, families, neighbors. We may even need psychiatrists. Well maybe I shouldn’t go that far (insert third bit of irony here).
Best always,
Alice
Report comment
Mary,
The state laws vary considerably with regard to committments and forcing people to take medicines against their will. The place I have seen mandated long term outpatient psychiatric medications has been in the PSRB (psychiatric security review board) situation where a person committed crimes for which they were convicted. In this case, medicine is part of the their sentencing.
The majority of inpatient and outpatient medications are taken on a voluntary basis.
Yes. All medicines, including psychiatric ones, are released after short research protocols. No one knows the long term effects when they are released. I explain this to people that come in wanting the new drug they saw on television. I recommend, if they must take medicine, to use one that’s been around for years so we have a better idea what to expect from it.
Best,
Alice
Report comment
Donna,
Perhaps you could give specific examples of how “eugenics” is practiced by every day psychiatrists (like me) today. We would be the ones doing it, if it were happening. I’m still confused. Perhaps a clear definition of what you mean by eugenics would help clarify the discussion.
When blanket statements are made concerning any population or group, they mean every member in it. I’m a psychiatrist. It’s personal. If I began making blanket statements about a group of(for example) “teachers” or “therapist” or “baseball players” or “mothers” or “Italians” or “patients” it could rapidly become very personal if you were a member of that group.
One cannot say “psychiatrists” without including me. I am a real person with a face and a name. I am also a psychiatrist.
This is an important issue. Thanks for pursuing it with such vigor.
Alice
Report comment
Marian,
Of course, I’m all of those things inside of different relationships with different people at different times. All of us are. When friends and family eat my bread they are appreciating my individual skills as a baker. They also know I’m a doctor. Being a doctor doesn’t make my bread any better or worse. But I am still a doctor.
I have no answer ot your question of why people would believe that a medical degree qualifies someone to help with emotional distress. This is a great question for which I have no answer. You may wish to pose this question to those people holding this belief. There are certainly many others better qualified and trained to help with emotional distress. That said, any individual doctor could have exceptional skills to help with emotional distress.
You pose a lot of good questions,
Alice
Report comment
Rossa, You’re right that biologic psychiatry doesn’t teach better coping skills.
In additon to “failure of the family” you mention, I would broaden the roots of distress and suffering to include cultural ones. The nuclear family bears a pretty heavy burden in psychological theories of mental health. Although our fragmented nuclear are the closest personal relationships we have, our society is increasingly isolated and lacking in long term community relationships. This puts the squeeze on what’s left of family to cope with a lot lone. I’m not surprised they fail.
Thanks for posting your personal story out here. This takes courage.
Alice
Report comment
Nijinsky,
Thanks for pointing out the complexity in the life of this historic figure. I had no idea. I always learn something from your posts.
Alice
Report comment
Marian,
I agree that no one needs a medical degree to help someone make sense of their experience. I couldn’t have said this better myself.
Of course my medical degree is not the only thing that has given me the skills I have used to help people. Much reading, experince, introspection, mentoring and being mentored has gone into my particular skill set. Other things as well. Medical school and residency training have only been parts of that.
I assert that all physicians and all psychiatrists are not interchangeable parts any more than all social workers or all poets are the same. Although I am a physician, I am (personally) good at things besides writing presciptions.
But I am a physician. It’s what I am.
Thanks,
Alice
Report comment
Duane,
I know you meant this for Philroy, but I enjoyed it, too.
Lovely poem. This reminds me of the feeling of some of the Sufi poetry by Rumi.
Alice
Report comment
Nijinsky,
Thanks for you kind and supportive post to Philroy. These are good suggestions to look at. You’re right. Everything doesn’t help everyone. It’s good to have a lot of thins that help.
Alice
Report comment
Nijinsky,
I don’t know much about “eugenics” except what I read on wikipedia last night. It referred to making changes in the genetic content of a population of people by selective breeding and culling. (This is not a quote but only my understanding by a quick read)
The thought of eugenics horrifies me. This is emotionally evocative language but I’m not sure it’s an accurate use of the term in this situation. I don’t see how your earlier post, repeated here, supports the accusations of “eugenics” toward psychiatry.
Perhaps we can “agree to disagree” at this point?
Best,
Alice
Report comment
Greeney,
Thanks for you kind reply to Philroy.
I agree that we have left behind treatment and healing modalities that work well in the rush for more pills.
You make good suggestions.
Alice
Report comment
Nijinsky,
You may not want to hear this, but I agree with much that you say in this one.
Labeling “abnormal behavior” (outside of the cultural “norm”) “abnormal biology” is far fetched. We also call unwanted behavior “abnormal” even when it is perfectly normal and understandable in the situation. Here are a couple of examples: little kids running around a lot when they’re forced to stay indoors all day every day in school, babies crying (see MIA article on the pathologizing of infancy) or reactions to traumas. We are quick, in this country AND when you can find a source of funding, to drug these behaviors rather than sort them out. Without the funding source, no drugs.
It’s easier for me to hear and understand your messages when the you use language that is less “strong” (This may not be the right word exactly for what I mean). Of course, how you speak is up to you. I understand you have strong feelings.
I kind of like it when we agree a little bit once in a while. It’s fun.;-)
Best,
Alice
Report comment
Philroy,
Yes. The Soteria model does focus on intervention in psychosis. It does a good job, too. Traditionally (this means,I was taught this long ago) the symptoms of psychosis have not been thought to respond to psychotherapy. Soteria is one model that disproves this theory to me.
I think the Soteria model could be used more widely for a broader range of distress.I think the lines between what we psychiatrists refer to as “psychosis” and things such as irrational-sounding beliefs, negative self-talk and reactions to trauma is a lot wider and less clear than we sometimes suppose. Soteria’s community and relationship aproach reminds me of ho’oh ponopono, a traditional community healing process I have read about in Hawaii. I don’t know if it is used any more there.
Thanks for continuing this discussion.
Alice
Report comment
Duane,
Thanks for being so quick to offer Philroy support. You are a kind fellow. Your warmth is great to have here. You are also good with the resources.
Best,
Alice
Report comment
Nijinsky,
I’m not acting as a therapist here.
Alice
Report comment
Donna,
Sorry if you feel you’ve taken “heat” from me. Thanks for being here.
Alice
Report comment
Nijinsky,
Sorry my article didn’t work for you. I suppose I could have written a great deal longer article and clipped quotes from the replies to posts and other blogs to substantiate my observations. Perhaps this would have worked better. But it seems that way would have been more personally intrusive and considerably longer.
Since I have heard talk of nazis and eugenics have been tossed around in reference to psychiatrists, I wanted to bring it up for a more open discussion. Since psychiatrists in general are a customary target here (and I am one), this also seemed a good discussion to open up.
The two points I had hoped to make were:
I think it was okay to have fun at work even if I’m a psychiatrist.
and
The labels you give people matter.
The first point, I will probably not convince you of.
The second point, I suspect you already knew. No one misses being “mis-labeled” in this life.
This is okay with me. We don’t have to agree about everything. Concentration camp metaphors for psychiatric care don’t work for me. Maybe I missed the boat on the iceberg metaphor with you.
Words matter.
Thanks for bringing your words here,
Alice
Report comment
Philroy,
Thanks for your deeply personal post. It takes great courage to reveal your personal story here. You could get some flack for this. I know you know that’s possible.
I know you are not the only one who struggles. This story coming from you is a powerful way to add balance to our discussion here.
I would like there to be other refuge options as well. We’ll all have to put our heads together and design some. Dr. Mosher’s Soteria ideas are good.
If we’re going to make a difference in the direction that psychiatry takes in the future, it will take all of us together. Posts like your help.
Best,
Alice
Report comment
Donna,
I certainly know you are not attacking me personally. I have also been distressed when some people that have done harmful things to others are released from the criminal justice system or the courts.
Thanks for your post,
Alice
Report comment
Donna,
Please. I’m slow. Can you (or someone) explain the “eugenics” accusations being targeted at the psychiatric profession to me? I’m a psychiatrist. I’m not sure what it is I’m supposed to have done that could be considered the genetic manipulation of the human population to improve the race (I looked it up on wikipedia just now).
Are there ways in which you personally have been “specifically targeted” by a psychiatrist or are you referring to someone else you know?
Thanks for your participation in this lively discussion.
Warm regards,
Alice
Report comment
Stanley,
You sound like you are familiar with the laws concerning involuntary committement. They vary from state to state a bit. In Oregon you have to be dangerous to yourself or others and have a mental illness. Dangerous last week or yesterday or might be dangerous next week won’t do it. This has to be an active and current threat.
Dangerous behavior alone may route you to the jail system.
It’s rather difficult to gain access to a hospital bed in Portland, Oregon if you want to go (Yes, some do). They have reevaluate holds quickly to determine if the criteria are still met ie if no longer dangerous, the person is released.
In Louisiana (long ago, may be out of date) there was a third criteria called “gravely disabled” as well. This isn’t used in Oregon.
Thanks for taking an interest here and posting.
Alice
Report comment
Hi robertr,
Sorry to be so slow to get back with you. I got behind the curve today.
Thanks for your support of my writing.
Best,
“The Doctor” 😉
Report comment
Hey robertr,
Sorry to be slow to get back with you here. “Unexpected” level of responses and I was out all day.
You sound like a guy with lots of experience and knowledge about the laws and how things work. Thanks for offering your expertise here.
Best,
Alice
Report comment
Duane,
Your writing is lovely and expressive. Thanks for putting yourself out here.
A lot of conversation today. A lot of energy. A lot of differing points of view. This is all good. Sorry I was out for the day. It was unexpected.
Warm regards,
Alice
Report comment
Hi Micheal,
Nice post.
Where do you work, how did you take up with such a bunch and stay for all these years? Not fun.
I have not been “deferred to” because I was a doctor at work since 1983 when the first task of my licensed medical career (on a medical ward) of “declaring” a poor soul, “dead”. The nurse asked me “Is he dead, Doctor?” and waited. She knew this to be the case as well as me. State law mandated that I was the one legally bound to “declare” this to be the truth. By law, he was not dead till I said so and the hurse wrote the time on the chart.
Or maybe I’m so trained by the “meritocracy” that it is invisible to me. One cannot be an accurate anthropologist inside one’s own culture.
I have had to make the “final call” on some treatment decisions (usually medicines) in a treatment team setting. Most treatment decisions are not mine at all. Half the patients that come there never meet me. Most treatment decisions are agreed upon among the patient and staff.
Heck, there’s only one guy there that will bring me a cup of coffee (thanks for the coffee, if you’re reading this) and, even then, I have to say please (humor).
Keep writing.
Alice
Report comment
Michael,
I came home this afternoon to 67 replies from this morning’s post. “Unexpected” again. A bit much to sort through in one go but I’m having fun.
I am also mostly on first names with people after those first polite introductions. I haven’t spent much time working in years where I see the same person twice. We are always on the polite first meeting terms. I introduce myself as “Dr. Keys” and invite them to call me “Alice” if they prefer.
I’m old school. They are legally my patients and I have legal and moral responsibilities to them because of this from the moment I agree to treat them. Perhaps I should have gone to law school. 🙂
I am dedicated to working to turn this boat around. Glad you’re on board. We can only do this together.
Warm regards,
Alice
Report comment
Becky,
Thanks for coming into this conversation.
Relationships and communication are important. The most important healing tool, relationship, in psychiatry (and all of medicine) has been diminished by the growing focus on pills and by the takeover of the “doctor-patient realtionship” by insurance “care managers”.
Thanks for your thoughtful and caring response,
Alice
Report comment
Anonymous,
I’m not certain what an “outpatient committment” is? Committment laws vary from state to state. I do not sign committments. One of the crisis clinic’s goal where I have worked is to prevent hospitlizations.
Am I getting your question right?
Alice
Report comment
Marian,
I am mom, a writer, a teacher, a baker, a walker, a gardener, a friend, a wife. But people consult me at work because I’m a doctor. It’s what I am.
I also (when I had an office pracice) did much work with cognitive and behavior therapy, relationship therapy, gestalt therapy, hypnotherapy, family therapy. I have always personally preferred the non-pill treatment approaches. But I’m still a physician. Even if I never write another prescription in my life, even if I let my license lapse, even if I never treat another patient I am still a doctor.
So you don’t have any use for doctors? Fine.
Thanks for reading me and responding,
Alice
Report comment
Nijinsky,
The “happy” time I referred that made me turn the corner into psychiatry was 6 months in 1983. The majority of the people there were voluntary at the time.I was also happy for the two years (87-89) I worked on another locked unit. Again, most were voluntary back. Things have changed. I’ve spent my outpatient and crisis work helping people avoid hospitals.
I did not refer to reactions as “unjust”, simply as unexpected to me. I thought it could mean there were more strong feelings that I wasn’t hearing expressed, the “under water” part of an iceberg metaphor. I am, you see, a member of the group of humans called psychiatrists. When the entire group is blasted, it hits me too.
Thanks for reading and responding.
Alice
Report comment
Hi Anonymous,
Thanks for the support. We are all on journeys.
Alice
Report comment
Nijinsky,
Hello. Thanks for reading my rant and for your post in response.
Alice
Report comment
Dr. Cornwall,
Do you have your favorite replacement word then? Mostly in the office I say “Mrs. Jones” or “Mike”, depending on our agreement. I have yet to say “mental patient Mike”. I think of them as “my patient” not “my mental patient”.
Alice
Report comment
Scott,
Thanks for posting here. Yes, I love having fun at work.
Alice
Report comment
Rossa,
Hope is essential to all life endeavors. I also think fun is.
Thanks,
Alice
Report comment
Anonymous,
True. No one has ever said “Dr. Keys is a nazi”.
No. Most of the crisis work I’ve done is not in hospitals.
Best,
Alice
Report comment
Corinna,
Fun is n important part of life that works.
Thanks,
Alice
Report comment
Bob,
Thanks for your support.
Alice
Report comment
Alix,
Thanks for getting what I said. I just got home to look at the posts. I had not idea there would beso much commentary. I guess I’m old fashioned, too.
Alice
Report comment
Sandy,
I have tapered people of medicines and lowered medicine for many years in private practice and in community mental health. Polypharmacy and high doses has always frightened me.
Thanks,
Alice
Report comment
Mary,
It seems a shame to me that human suffering and findinf ways to alleviate human suffering are not in the equation when public policies are debated. It does seem to always boil down to money.
Alice
Report comment
Marian,
This question ventures into the realm of philosophy for me. All human condition is “life circumstance”. If there is such a thing (I have not seen it proven) as spontaneously, random “imbalanced brain chemistry”, then it, too, is a “life circumstance”. Therefore, as Buddha once put it so nicely, “Life is suffering.”
If you’re asking if I, personally, am of the opinion that there are “chemical imbalances in the brain” that just sort of happen and that can only be corrected by taking more chemicals, I would say “no”.
Since there is no one “dependent” upon me as their physician at this time, may I assume I am not responsible for “driving people mad” (as you put it) today.
I love these discussions. They keep me thinking.
Alice
Report comment
Duane,
You have a wonderful dream.
Alice
Report comment
Altostrata,
Check my reply to Katie at 3:30 for the story of my practive closure.
Alice
Report comment
Duane,
Here we are. Taking the first steps.
Alice
Report comment
Duane,
Bob Nikkel and Gina Nikkel (both blog here) have a non-profit to create a find a new mainstream for mental health care. Are you any good at grant writing?
Alice
Report comment
Sandy,
Where is CMHC?
Thanks,
Alice
Report comment
Altostrata,
Yup. We’re talking past each other. I suggest talking to the doctor who is prescribing the medicines as a FIRST move. If you have a relationship with a doctor, even if she doesn’t end up doing what you want, she needs to know what you’re doing.
My advise as a FIRST step stands. Always START with the person you have a treatment relationship with. Then, if you have to cast a wider net to do what you need to do, keep her in the loop. Or change doctors.
Sorry for the misunderstandings.
Best,
Alice
Report comment
Duane,
I like Bob Nikkel’s idea to de-medicalize the payment system and move back to providing funding for the kind of health care that we know works.
This will be better than the continued “medical necessity” model that depends solely on a “prescriber” in order to be paid for their time.
Alice
Report comment
Altostrata,
You are exactly right. I know there aren’t many. There aren’t many psychiatrists available in Portland to do anything, medicines or not. I still get calls and my private practice has been closed for years. Read my reply to Katie today. I think I addressed how the situation panned out for me with an office practice.
When someone says they’re taking medicines, I assume that someone is prescribing them. This is the first stop when looking for a taper off. Bring friend and family to the discussion. Have questions written out.
I tip toe a bit here in the reply area. I don’t want to accidently be seen as a doctor who is providing individual medical treatment advice to someone I’ve never met. There are so many ways that could go really wrong.
Yes. You’re right. The wrong assumption is sometimes made when “discontinuation” or “withdrawel” symptoms occur that this means you “need” to keep taking the pills or that “your illness” is back. It’s good to have a clear list of symptoms before starting a taper. This requires self knowledge and awareness.
There are not enough resources yet to do the jobs that need to be done.
Every bit helps.
Alice
Report comment
Duane,
Thanks for writing more about Soteria and Dr. Mosher.
In our culture, we are starved for human contact and communication. Mother Teresa said it righter than I ever could.
Check out Bob Nikkel’s post from yesterday. He gave me a better understanding of how community mental health was cornered into the medical model (at least in Oregon) through the changing funding streams. It has always pinched me to be cast in the role of just a “prescriber” when I have other skills and gifts.
Thanks again. It’s always a pleasure to hear from you.
Alice
Report comment
Bob,
I am grateful that you’ve made your years of experience and expertise available to readers on MIA.
I had no idea that the Federal financial pressures were driving the “medicalization” of mental health. I experience this as the pressure to be a “prescriber” and nothing more in community mental health. Folks act as if I have nothing else to offer; a prescription and a signature on state and federal paperwork.
It’s easy to make a “medically necessary” case for getting paid for your work when precription medicines are involved. Every person recieving a doctor’s prescription would therefore be eligible for funding to provide for that care.
What I see as the devolution of the practice of psychiatry to a presciption and signature machine has real economic forces behind it.
This approach to funding mental health services has brought us to the point where not much is funded except prescription writing. So not much else happens. The spread-sheet economics mentality of medical care dictates that if it’s not reimbursed, it can’t happen.
Thanks for a real “A HA” moment for me this morning.Keep writing.
Alice
Report comment
Good morning Alix,
Thanks for your reminders. Help and support are a critical ingredients in the process of moving toward a life with less or no psychiatric medicines. This can be a longer process than anyone would like. The repercussions of both having taken medicines and also of stopping them cannnot be forseen for an individual. They must be watched for. Make a clear plan. Take notes as you go. Moving too fast can backfire. Everyone’s process will be different.
Having made this cautionary statement, I have also known people who lowered and stopped medicines and felt better than they had in years. I met one young woman who was taking six different psychiatic medicines. We weaned down to just one pill a day over a year. She had not been on them long. She had an incredibly good support system. Years later, I heard back from her that she had even stopped the last one. She had made good structural changes in her life that made this possible and maintained her fine support network.
Thanks for reading and posting here.
Alice
Report comment
Duane,
I would like to see Soteria and peer-run options everywhere so folks can stay home or close to home and still get help.The internet is good but there’s nothing like looking in another human face.
Thanks for the links.
Alice
Report comment
Duane,
You seem passionate and helpful. I appreciate all your support and energy. I am definitely the “new kid” around here on MIA. Others, like yourself, have been collecting resources and spreading the word for a while now.
I think I know what you mean about being from “hill country”. I grew up on a small family farm in Ohio. “You can take the girl out of the farm, but not the farm out of the girl”.
I’m over here visualizing for a new future, too. There are days I can think bigger and days I have to keep my focus small so as not to overwhelm myself.
We’re planting trees here in addition to the one season crops. Some will bear fruit sooner than others.
Best,
Alice
Report comment
Duane,
Absolutely. Building support networks will work for a lot. So much of our culture is without these. We are left living life as “individuals”.There is no precedent in the history of the world for the level of social isolation and lack of extended family realtionships before about 150 years ago with the advent of the industrial revolution. Social isolation is now the every day “norm” but not “normal”. A life of isolation is neither biologically or psychologically sound for humans. Of course, there are introverts (up to half the population) who function better with contemplative time alone. I don’t suggest everyone has to be “out there” all the time. But people do need relationships to thrive.
One of the reasons that community mental health centers work less and less well has been the draining away of support networks they once provided; art groups, socializations centers, classes, etc. There are people now who’s only contact with community mental health center is occasional 15 minute “meds only” contact with a “prescriber”. It’s difficult to imagine how this can benefit. This is expecting prescription to do an awful lot. Relationships heal and support.
I like the Soteria House model of Dr. L Mosher as one approach to helping people in crisis situations. I’m sure there are experts in this area that can speak more fully to this topic.
Thanks for your input here.
Alice
Report comment
Emily,
You are in the driver’s seat of your life. You are the only expert on you. Get as much advise and information as you can from every source you can and then decide how you want to do things. Watch the life timing. I’m sorry I can’t give you specific advice for your personal situation.
If you(or anyone) wants to taper down or off medicines, it would be best to do this in the context of a relationship with someone who knows you well that you trust. It’s good to have a support system in place. You and this treatment provider would need to make a clear list of symptoms and management interventions for them and then play it slowly. Write things down in a journal because memory is notorious for forgetting. Being in a hurry can trip things up. There are medicines that give a person “symptoms” when stopped that they never would have had otherwise. Don’t confuse these with “symptoms” of your illness if they are new and different.
If you decide to stay on medicines, this is a personal choice as well. Get information and advice. Work with people you trust that know you well. Don’t let someone else’s agenda decide for you.
Neither path is risk-free. Everything is not known.
If I can come up with better, I’ll write a post.
Thanks for your questions.
Best always,
Alice
Report comment
Corinna,
Great article.
I am reminded that no one will ever take care of my best interests the way I will. I have fired doctors, dentists and an accountant in the process of discovering this basic truth in my life.
However much advice and directions I ask and get from others, this is my life and I’m driving it. Our advisers are only that. They will not be with me and see and feel what I do. I am the expert on my own experiences. When things happen in my life, I am the one there, the one that has to take action.
I hope that no one really imagines that “wearing a white coat and taking the Hippocratic Oath gave them some kind of expertise” as you say. If that were true we could all be “experts” by chanting a few words and dressing for a costume party. It would be like the Wizard of Oz handing out heart, brains and courage.
Thanks for your reminder that there is nothing like personal experience and self-education. I believe all true education to be self-education. Anyone willing to read and dig and study with access to information can become an expert.
Thanks for all your expertise,
Alice
Report comment
Duane,
Thanks for reminding us all to be pro- rather than anti-
What I am is a clearer and bigger part of the picture than simply what I’m not.
Alice
Report comment
Philroy,
Here’s one:
One treatment approach to explore is that of Dr. Loren Mosher and the “Sorteria House”.The original Sorteria House in San Jose is closed, but there are other outposts of psychosocial community care and “open dialog” treatment such as in Alaska and Lapland (Finland). Little to no antipsychotic drugs, no restraints, no hospital stay, good outcomes, reduced financial costs, reduced disability, reduced relapse of psychosis.
This takes more forethought and planning than a pre-loaded syringe but the outcomes are so much nicer.
I don’t remember “mainstream psychiatry” gathering around Dr. Mosher’s bandwagon when he was alive. I’m not sure how to get “mainstream psychiatry” to get serious about making alternatives a reality.
That said, I was somewhere in the “mainstream of psychiatry” till a couple of years ago. I have met others as well who are shifting their perspectives. Perhaps we can enlist “mainstream” psychiatry to leave the familiar old channel and help design alternatives as well. There must be others out there.
Best,
Alice
Report comment
Keith,
Thanks for identifying that song. That one song from elementary school has influenced how I view the concept of “free”.
Do you have a link for the “landmark forum”? It sounds like another venue for thoughtful folks to grow ideas.
Are you asking for my personal ideals, wishes and dreams for providing care if I could carve out a hidden niche and work the way I would like as a psychiatrist? Are you asking where I can imagine having the most impact on changing the whole huge snarled healthcare delivery system as it is today toward something that will work? Either of these two are huge topics. Are you asking something else?
Thanks for reading and posing such thought stimulating questions. Another writer for MIA, Bob Nikkel, is a former commisioner of mental health and addictions from Oregon. He and his wife recently started a non-profit whose focus is the design of a “new mainstream” in mental health. He and Gina both write here and would be good to have in this kind of discussion. I’m certain there are others. I’m the new kid on the block.
Thanks again for reading and posting. Welcome to a discussion that impacts all 311 million of us in this country.
Alice
Report comment
Dr. Cornwall,
Thanks for your enthusiasm. We need rocket fuel.
Alice
Report comment
Altostrata,
I like idea of looking at public health costs and disability payments numbers. These have skyrocketed with the “epidemic”. These are line item dollar amounts on a politician’s budget. I agree with you that human costs with regard to issues like safety, efficacy and suffering are immeasurably more important than dollars. However, political policy makers look at the dollar costs of a specific line item on their budget spread sheets. For the most policy change effects, talk to their spreadsheets. I bet that one of the pressures that forced legislation to get tobacco and liquor ads off television were the health care costs from the consequences of tobacco and liquor use. Once an individual’s financial resources are gone, medical and nursing home care falls to the Federal government’s budget. This is bad for the Feds but good for big pharm.
These are the kind of conversations that can lead to effective strategies.
Thanks,
Alice
Report comment
Good morning Altostrata,
Thanks for your concern about my well-being. Rest assured I am well. Thanks for the links. I feel very supported here.
Really, I thought this morning’s post was about hope and working together for common goals. About avoiding fighting when other approaches can work more effectively. About the hope that can be found even when you do have a big mess of trouble. I must have missed my mark. Ah well. Another day, another post. I do hope you enjoyed the read, nonetheless.
Thanks for reading and commenting.
Best,
Alice
Report comment
Doctoro,
I listed these two cateories, life circumstance and medical conditions, as examples. They are not intended to be an exclusive list. Sorry for the misunderstanding. If you want the entire list, read the DSM.
I see stopping public ads for pharmaceutical products as a way soften “consumer” demands for all prescription drugs. A move toward use of “cheaper drugs” is a rationale to nudge policy makers to move along in direction of outlawing advertising to the public. Budget cost savings is one thing policy makers will listen to.
I appreciate your energy,
Alice
Report comment
Mary,
I like this a lot.
Thanks for the review of the financial budget end of pharmaceautical products. There is nothing like budget bottom lines to get the attention of policy makers. This could be a great selling point for legislation to ban advertising of all drugs to the public.
If we soften the market for the enormously expensive brand new drug at the patients’ end, it will save the government a lot of money.
The Federal government is the largest third party payer of health care costs in the USA through the medicare and medicaid programs, Veteran’s administration and the military medical services. Simply making the choice of a $4/month drug (that’s been around a long time) over a new and less tested $2000/ month drug easier for all physicians would add up to costs savings at the Federal budget level.
$4 drugs are not marketed. At all. To anyone. The overall demands for drugs would eventually fall off with more longer term costs savings.
Patient ardent demands for their entitled “right” to have the newest and hotest (most marketed, most expensive, least tested) drugs can be hard to dodge for a doctor. This is actually easier when the patient is uninsured. Especially if the doctor’s office refuses to carry “free” samples (hooks to get patients on the spendy drugs. No one “samples” the $4 meds). You simply point out the price tag and a $4 drug becomes worth a try.
Sad but true. Economic arguments speak loudest and are the most convincing at the level of policy makers and at the level of individuals.
We have to find more clever economic arguments.
Thanks,
Alice
Report comment
Altostrata,
Thanks for the encouragement. I am spreading the word every day. Likely I am designated as spam in some former colleagues’s email filters. I tell them to read the book and give them links to MIA. I talk to people on the street. Anyone that will stand still and who shows the slightest interest gets to hear about it from me.
Best,
Alice
Report comment
Maria,
I am so sorry for your losses. As a mother, I can imagine none greater. Thank you for telling your story here.
Thanks also for clearing up my illusions about health care, mental health care and attitudes toward children and families being “better” and more humane in New Zealand. The long web of multi-national corporations reach around the globe.
Thanks for saying what you say so eloquently.
The schools in my home state of Oregon recieve more money for each and every child that has an “IEP”, paperwork that asserts the child has “special” educational needs as determined by the teachers. Masters level educators can legally give a child a DSM psychiatric diagnosis.
Much of the diagnosis made in a child psychiatrist’s office rests on information from the teachers. Teachers can and do demand that the parent drug their kids before they may return to class. Parents home with their children risk job loss and all that comes with that.
I am made so heart-sick by the drugging of children and now babies,that I’ve run out of words.
Thanks for using yours where I have none left.
Alice
Report comment
Marian,
Thanks for your thoughtful post and the energy you bring to this discussion. We have to hear about all the issues in our current medical system to find our way home together. We have a lot of work to do.
I hope to hear more from you.
Alice
Report comment
Jennifer,
What a lovely, strong and pure voice you bring to the task at hand. I agree with your thoughts concerning the similarities between the recovery process of an individual and the recovery process of the medical profession.
Indeed, it is a spark of hope that recovery is possible which brings me here to write. The process of sharing our various truths and experinces with one another to awaken the sleepers among us and to open the path to unity of spirit is essential to recovery of such an enormous patient. 311 million Americans is a lot of people.
Thank you for your message of hope.
Alice
Report comment
John,
Yes. Of course. There are so many things that need to happen here, many tasks for many hands. And I only feel I have a “one in a million chance” of making a difference for the better. But, as Sir Terry Pratchett said,”One in a million chance things happen all the time.”
Best,
Alice
Report comment
John,
I like to hear from you. It really gets me going with new ideas. Diagnosis “creep” is a misnomer. It seems to me more of a diagnosis “flood” here.
Stay with us. Plus write the radio stations. Plus read books. Plus eat well and exercise and have fun with friends. These are all necessary to your “human potential”. Human potential is so much bigger than the “task at hand”. It’s all important.
Thanks,
Alice
Report comment
Altostrata,
I think doctors are very, very busy. It takes time, at least a few minutes to say “no” and explain why in a polite manner.
I spoke to a neighbor yesterday who’s wife is a primary care doc. She just saw 27 patients in one 8 hour day, 5 of them brand new to her. I have only seen her outside once in six months. She spends all of her mornings and evenings at home typing reports on patients so that she can spend those few minutes allowed with each person making eye contact, talking, listening and examining them. This is her usual work life. Many of her patients are “psychiatric”. She is head down, bailing the ocean with a teaspoon. To me she’s a hero. What could I teach her?
Another primary care doc I met last spring at an educational conference (not drug funded) told me she sees four patients an hour, all day, every day. This time includes typing, chart reviews, interviewing, examining patients, lunch, bathroom breaks. Four patients an hour. Nonstop.
I think doctors don’t have time to pee, much less provide polite explanations and and make thoughtful prescribing decisions. It’s not that they don’t understand side-effects or are unable to say “no”. It’s that they run all day every day on a too-fast treadmill in the factory-style doctoring institutions that have taken over.
Sorry. I wish I were more hopeful about all this.
Thanks for your thoughtful contributions to this discussion.
Alice
Report comment
Scott,
I don’t know the right words for the system we are lost in right now in our country; whether it’s capitalist or corporate or fascist. I’ll leave the labels to those who know. I do know that things have gone seriously wrong. I’ve been watching the threshold for “mental illness” and for drugging people go down and down and the net grow wider and wider my entire professional career.
I read recently of public elementary schools where 40% of the children are being “treated” with drugs for ADD. When exactly did a relatively uncommon “disorder”, well-treated with social and behaioral interventions become drugging of so many kids? When did everyone who has moods that change during the course of a day (everyone human) and people who get angry (everyone human) become candidates for drugs?
I am regularly horrified by the lists of medicines that patients come out of hospitals on after a three to seven day stay. I have been told that the hospital docs are under pressure to get people out fast so the next ones waiting in the ED can come in, a bed shortage issue. This makes no sense to me.
Psychiatry is not “heading” there. We have arrived. Oppositional defiant behavior in adults translates into bipolar disorder.
Thanks for the clear headed talk. We need a lot more of that.
Alice
Report comment
Doctoro,
With the same respect you offer me as a “particular” doctor and psychiatrist, I disagree. Making conclusions about an entire group based upon one quality held in common (in this case, completing psychiatric residency) is plain old, garden-variety stereotyping.
I had a friend long ago who used to say to me “I don’t like doctor-types” and “I don’t like psychiatry-types” and assert unpleasant qualities they all shared. He would then carefully make noises to exclude “present company”. I have also heard similar remarks made with regard to members of racial groups, ethnic groups, socio-economic classes, psychiatric patients, pretty much every group one could put together and call a group.
What seems obvious from one position may be less so if you stand somewhere else.
Thanks for bringing your energy to this discussion. Making things better for everyone will take all the energy we can get together. Isn’t it nice to know we don’t all have to agree on everything here?
All the best,
Alice
Report comment
Altostrata,
Psychiatrists can and do decline to make psychiatric diagnoses and decline to prescribe drugs. I did this a lot. There is chart “coding” to be done in medical records. This coding must be completed for medical-legal and insurance reasons. There is a code for “no psychiatric diagnosis” and codes for life circumstances and medical conditions that cause symptoms that look psychiatric. There are a lot of “non-psychiatric” “diagnoses” codes to choose from to fill in the little boxes.
Nine (or more) of ten people that I see these days that walk in the door saying they have “bipolar disorder” do not. The drugs sold to treat this are heavily marketed and the symptoms are vividly displayed by actors on television all day long. “I’m like just that lady on TV” they tell me. “I know I have bipolar. I know that’s the medicine for me.” They are in effect “coached” with the symptoms to display for me by the television marketing. The prevalance of this disorder has sky-rocketed in the past ten years. As ENORMOUSLY expensive new drugs are brought out for sale, the criteria are bent and bent by the marketing reps. Other psychiatric symptoms are dragged into the treatment pile for the new medicine till everyone qualifies for it. There are drugs that cost over a thousand dollars a month being marketed for bipolar disorder today IF the person is only on “monotherapy” (one drug).
Remember, the cheap drugs are not on TV. Frequently they are not in the “PDR” (Physicians Desk Reference), an enormous drug marketing catalog that only lists prescribing information if the company pays for it. Most folks think this is a reference book. It’s a marketing device.
I have developed what I hope to be polite and diplomatic ways of saying “no” to these requests for psychiatric diagnoses and the drugs that go with them when they are not warrented.
Keep writing.
Alice
Report comment
Good morning Anonymous,
I agree. I can’t imagine a “good experince” that involves “forced drugging and forced electroshock” or “forced” anything for that matter.
Best always,
Alice
Report comment
Alix,
Your son is very lucky to have you.
Alice
Report comment
Marian,
Thanks for your thought provoking response.
I’m glad to hear you also have “fun” at work as I do. It sounds like the things that make you smile are what make me smile. I also enjoy upbeat co-workers.
I DO introduce myself as “Dr. Keys”. In crisis work, where I rarely have the opportunity to see the same person twice, it’s important to let people know who I am and what my role is. They see so many providers at one visit. It can be confusing. Especially as a woman doctor with a big smile, they are uncertain if they’ve gotten to the “real doctor” yet.
I suggest they may call me Alice, if they prefer. I ask them what they would prefer to be called.
But I am an “old school” physician trained by old school physicians. The doctor/patient relationship is one of mutual respect and trust. I feel okay about that.
Everyone doesn’t have to agree on everything here.
Best always,
Alice
Report comment
Duane,
It’s not going to get better very soon. Sorry. But it sounds like you figured that part out already
Alice
Report comment
Duane,
Ah,smart kid. The old advertising premise is that even bad advertising is good advertising. If it catches your attention you remember it. Hence annoying ads are good ads. Ads that blither of about side-effects catch your attention. It all sells. We imagine our concious screening process does a better job of protecting us than it does.
Drugging kids worries me as well. Drugging old people worries me. Drugging pregnant ladies worries me. Drugging everyone else worries me. Drugs are a worrisome treatment modality.
Here’s worrisome. In the state of Oregon the Naturopaths recently fought and won the privelege of prescibing all medical and psychiatric drugs (except one). How much “integrative” work do you think they will be doing now? To me it seemed a movement in the wrong direction for them, away from their professional specialty and into mainstream prescription expectations.
Best,
Alice
Report comment
Anonymous,
Thanks for listening to my explanation with regard my comment on the old happy times (“fun”) that lead me to my professional career choice. I believe that work and career choice is best lead by good feelings. It stinks to have to take jobs that are not happy places to be. I’ve done it. People do it every day.
I don’t believe in ALL my profession’s belief systems either. You’re in good company that way. Most of the folks writing and reading here also do not believe in them ALL. Welcome.
I’m glad to hear that you have found your “third choice” path. The “two paths” I referred concerned some less fortunate people I have known who perhaps have less resiliance and self-reliance abilities than yourself. All humans are not equally capable all the time.
Everyone is at their own place on their own path. Everyone.
There are those who would like help and support managing life for a time. Some people I have spoken with would like there to be a safe haven for them away from the streets, even for a while. I think safe housing should be available to everyone regardless of any “psychiatric diagnosis”. It is irresponsible as a society to leave people living on the streets who don’t want to be there.
As a physician, I have referred to people as “my patient” and shall continue to do so. I am honored by “my patients” when they likewise refer to me as “my doctor” or “my psychiatrist”. I’m a doctor. I have patients. It’s the deal I make with people and they make with me.
I’m sorry you’ve had such bad experiences. I’m glad to hear you of your recovery. The story of your recovery is one that can give hope to others coming along.
Warm regards,
Alice
Report comment
Micheal,
When I was early in training in an analytic based program I studied dream analysis. I had Jungia dreams when we studied Jung, Freudian dreams with Freud and Viet Nam PTSD dreams when we studied those. I’m too suggestable. Thanks for the Jungian view. It is good seasoning to the mix.
Alice
Report comment
John,
Wow. Good job with this. There is nothing I can add here.
Frightening. Where does one shove a stick in the spokes to stop the wheels from turning? Or do we have to wait for the wheels to come off the bus naturally?
Thanks for the interesting and thoughtful conversation.
Alice
Report comment
Xavier.
Good point.
Alice
Report comment
Patrice,
That one brought a tear to my eye. Thanks.
Alice
Report comment
Steve,
Thanks for your response. I am actively reaching out to people I know and inviting them to read Robert Whitaker’s book and join the discussions here. I welcome everyone who wishes to talk to the discussion table. There is so much to learn from all sides of this matter.
I don’t mean to dwell on the past with historical material so much as help understand how well meaning people could have gotten where we are today. I’ve lived through and watched changes unfold around me without knowing what it would mean for us all.
Thanks for your support.
Alice
Report comment
Anonymous,
Please read my post with regard to your earlier commentary. I hope this will clear up some of your questions. One additonal thing: At that time, residents in training had no choices about where they went for training. You signed up and awaited a “match”. Once you got the “match”, the program you were assigned to put you where they wanted yo to work. I had a little leeway as per timing but no choice as to the venue. I was not looking forward to the psychiatric rotation at the time as I was a neurology trainee. I saw it as “something to get over with” so I could get on with my career path as a neurologist. The happiness I felt working there was unexpected. I genuinely enjoyed spending time with my patients there. I still enjoy working with mental health patients.
Thanks again for writing. I have no idea how the things I write strike people unless I hear back. I hope this clears it up for you. If not, ask more.
Best always,
Alice
Report comment
Altostata,
Thanks as always for your warm support. This give me courage. Better and safer care is the whole point here.
Alice
Report comment
Anonymous,
Thanks for adding your post to the discussion. The only way we can hear all sides of the story is if people like you speak up.
Yes. The hospital I did my psychiatric training in during the early 80’s sounds a vastly different place than your current experiences. We did zero ECT. No forced drugging. There were a lot less drugs in play then. People stayed long enough to benefit from the alternative the therapies provided: OT, PT, art therapy, group therapy, individual and fammily therapy. Respectful treatment. A calm atmosphere. Although the doors were locked, most of the guys were voluntary, most of the time. There were times we had to keep a close eye to keep someone safe. It was the Veteran’s Hospital in New Orleans. I think that most of the time, the guys (mostly men) that stayed there were okay about being there. What I found “fun” was developing warm relationships and seeing people go back home in better condition, better able to cope, than they came in. It was a pleasant and hopeful environment to be a part of.
I’m sorry that things have devolved to the point that “under the bridge” beats care. You are not the first I’ve heard this from. I’ve heard stories from the over crowded and understaffed state hospitals. They are not easy places for anyone. I have worked hard to keep people out of hospitals for years. I’ve also worked in downtown shelters and seen people come in having been assaulted while living outside. Women and young people with disordered thoughts are very vulnerable to being preyed upon by the more “capable” folks that live outdoors. It’s a rough life. I’m sorry these are the choices available. I hope we can do something to change it.
I’m sorry if my use of the word “fun” sounded flip or heartless. That happy feeling was genuinely what caused me to make the shift, that feeling and the hopefulness of the times, the great guys in the wards where I worked and the staff.
Best always,
Alice
Report comment
John,
In my opinion, unrestrained capitalism has been a big factor in getting us where we are. But I am not a political scientist. I seemed to have missed much of high school civics class where we were supposed to have learned the whys and wherefors of our fine and free government system. Capitalism does what it’s supposed to do very well: it makes a few big piles of money (capital) from small piles of money. The more unrestrained and deregulated things are, the better it is at this. I have wondered for a long time if a system which has as it’s bottom line the goal of collecting a few big piles of money is the best route to building health care, education and human services sytems. Probably Capitalism is good for something, right? Oh yeah. Making a few big piles of money out of little piles of money.
Best always,
Alice
Report comment
John,
My recollection of the history of what is being passed around as “the medical model” of psychiatry today is that this “medical model” came about after the advent of pharmaceuticals. I started training in a program that was based in psychoanalytic psychotherapy. At that time, the foundations of the program were under attack by the purveyors of “rapid tranquilization” drugs for acute psychosis; big, fast, injected doses. The pharmceautical company was paying a young staff psychiatrist to do the “research” there at Charity Hospital.It was a time of validating psychiatry as a “real” branch of medicine. We had our drug treatments.
What we call the “medical model” in psychiatry today is actually the “pill model”, a marketing strategy initially rolled out for doctors and which now saturates our entire culture. The “chemical imbalances” are marketing inventions. Antibiotics and vaccines were designed to treat and prevent medical disorders with known pathogens and causes. The “chemical imbalance” theories are all made up.
This “medical model” (pill model) has its hands around the throat of all of medicine today. We no longer describe a medical condition and explore its pathology and cause. We now reason backwards from pill effecst and infer the cause from this. I recall being taught in school that one can never, ever do this. Faulty ad hoc reasoning. NOT medical, scientific thought at all. For example. Your car is running too hot. You open the hood and hit it hard with a big rock. It stops running and cools down. Therefore, the overheating problem was due to a rock definciency.
Thanks for your participation in these discussions,
Alice
Report comment
Duane,
I took the time to look at the ISEPP website. A lot of energy and work has gone into crafting this complex proposal.
Alice
Report comment
Thanks. I can always use a cheer.
Alice
Report comment
Mark,
Thanks for your dedication to the field of nursing and for your move into the role of educator. Every professional nursing student you touch will carry a bit of you out into their professional career.I hope you talk about your doubts, experiences and concerns with them every day.
I write here today, in part, because of the guidance of a mentor of mine from many years ago. We will never know how far the ripples we make will spread.
We have to make good ones.
Alice
Report comment
Thanks for your support here. I am enjoying the writing. What a great opportunity we all have here.
Alice
Report comment
John,
Thanks for your show of support. Yes, there is much to do beyond this.
Some medical schools have thrown out the drug reps, drug samples, drug lunch “lectures”. It is an individual institutional moral stance. Oregon Health Sciences University is one who has a “no drug samples” policy. I know they still do a lot of drug funded research there. Drug company funded research is a well-known path to academic tenured teaching positions.
It’s a tangled mess everywhere I look.
Alice
Report comment
Stephen,
Here we are today, beginning our own marketing through this webzine. Move the information outward like ripples in a pond.
Our government is us. Perhaps government representatives could be convinced by a “cost savings approach”, less tax dollars going for expensive drugs through medicare and medicaid. Money talks.
Not only psychiatric drugs but all medical drug ads need to go. The whole of medicine is in the same boat. Patients show up demanding specific pills, the newer, the most expensive, the most advertised.
The psychiatric field does not have the market cornered on toxic drugs and deceptive marketing. For example, most cholesterol lowering drugs work by poisoning mitochondrial function throughout the body and brain. We require healthy mitochondrial fuction for life. How can we hope health to be conferred by this process? A friend’s husband nearly died from the muscle breakdown side-effect of cholesterol lowering drugs last year.
Blocking drug ads to the public needs to be for all drugs, not a pick and choose category. It’s too easy to side-slip categories.
Let’s begin today. Spread the word.
Alice
Report comment
Altostrata,
Perhaps speaking will come about naturaly for me as a process of writing here.I’m really much better at writing than talking, though. And I do talk to people I know, one by one. I have also been emailing links to these posts to the local community mental health leaders that I know. It only seems fair to give them a chance to help. Others here may want to invite mental health professionals, physicians, friends and family to join the conversation. Every person’s voice counts and matters. E pluribus unum. Many together,one. Look at the back of a penny when you feel isolated. We are all out here.
Alice
Report comment
David,
Thank you very much for encouraging words. I believe in the power of words. Just think of the influence of the media and advertisements and “medical education” process that keeps us so stuck. Words are powerful.Let’s all use them to remake our medical system. Other countries have done this. We can too.
We may have to start with outlawing advertisements of prescription drugs to the general public as the rest of the world has done. Cigarette ads were banned on TV. Marketing prescription drugs like they are breakfast cereal and box juice is a travesty. We have to break the thrall of the general public somewhere at the beginning I think.
Trying to break free of the “pill culture” without taking away the customer base is like trying to fight the war on methamphetamines while prescribing stimulants to our children. How well it that going so far?
Thanks for listening. There’s a lot to say.
Alice
What do others think?
Report comment
Yes. I know. Sorry. I have seen these wild hospital discharge medicines a lot. I have wanted to pick up the prescribing physician and shake him/her.
Alice
Report comment
I’m having a lot of fun with this. I’m so happy that you and others are finding value in these conversations.
Back in the olden days when I was still allowed the time and space to be a group therapist (Imagine. A psychiatrist running a therapy group. Is there a billing code for this today? ;-)). Anyhow, back in those days, I tried to remember not to enter the group with expectations or agendas. This way I could let the process lead the way.
Writing here, I’m reminding myself of this. I have no way of knowing where these writings will lead or what precise good things will come of it all. I write with an open heart and look for what arises.
All the best. Enjoy your grandkids. Family of very important.
Alice
Report comment
Rossa,
Thanks for your personal story. I hope your son continues to do well.
I have been able to help people manage with less drugs by having a clear individual written action plan we make up together. They keep it where they can see it. There are specific interventions for specific symptoms. One of these interventions could be short term doses of medicines. This is certainly not the only intervention.
Thanks again,
Alice
Report comment
A long and winding road from contruction laborer and a series of chance meetings brought me to psychiatry. This was not a long term or lifetime plan. We didn’t have psychiatrists down on the farm growing up. We barely had doctors at all. That final jog in the road from Neurology into psychiatry was made because it was fun and I came home from the hospital smiling.
Mysterious.
Alice
Report comment
ALT,
Writing makes me feel more hopeful. It’s fun. I’m happy there are readers reading.
Thanks for your support.
Alice
Report comment
Emily,
I’m happy to see you posting here. The state of medical care in America today is not just a mental health situation. Not at all.
You are absolutely right. Patients’ situations (like all of ours) are complicated and very individual. There’s a lot to take into account before you make your best judgement.
Thanks again for you post.
Alice
Report comment
Alix,
I believe I’ve helped some people with pills. I’ve seen myself as a well-meaning psychiatrist. I’m also know there have been unintended bad consequences to my prescribing. It’s very complicated and not about to get simpler.
You’re right about guidleines and rules. There is also something called “the community standard of practice” that all physicians are held to. It frequently includes prescribing drugs in “off-label” ways. There are a lot of people in my consulting room besides just me and my patient. Enough for a whole rant blog.
Thank you for your thoughtful, caring post.
Alice
Report comment
Chrys,
Thanks for your enthusiasm and positive energy. We all need more of that.
Best,
Alice
Report comment
Bill,
I love connecting with people like you. There are times I have felt like the “lone stranger” out there, but not so much any more.
Thanks for joining in the discussion here.
Alice
Report comment
Thank you for bringing your personal story to the forum. I understand your preference to hear it from another doctor but I hope you will except my heartfelt sympathy for the suffering you and your son must have gone through. For that, I am truly sorry. Maybe you can consider me the “next, next lot”, even though we only meet through words, here. I wish you and your son genuine healing.
Alice
Report comment
Thanks for your encouragment and support.
Best,
Alice
Report comment
The motives and life circumstances that bring helping professionals to their work varies considerably. During my training years, psychiatrists were required to undergo therapy themselves as part of the training process, rather like analysts undergoing analysis during their training. I don’t know how common this is today. It seems a good idea for all those training in the helping professions. I think psychotherapy could be of benefit to anyone who would like to sort out their motives.
Thanks for your reply.
Alice
Report comment