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.
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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Stephen,
Thanks for you’re input with regard to the education system. I’ve seen all these things happen as well.
Alice
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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
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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
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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
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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
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Maxima
Good for you and good for them.
Alice
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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
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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
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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
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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
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Philip,
Thanks for reading and for your support of my writing.
All the best.
Alice
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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
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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
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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
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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
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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
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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
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Stephen, The entire “system” we live within today is totally corrupt AND I’m getting crotchity and old.;-)
Alice
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Stephen,
I like to think that today’s heretics could be tomorrow’s saints. Reassuring to hear.;-)
Alice
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Duane, Nice to have you here. Alice 🙂
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Madness of C the B, B,
Very nicely said. You make me think.
All the best.
Alice
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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
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mcoma,
I was so entranced by your words that I forgot to judeg your spelling.;-)
Keep writing.
Alice
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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
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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
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Stephen,
I agree. This is bigger than doctors. It has been decades since doctors were stripped of the power to direct patient care.
Alice
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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
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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
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John,
Yes. I know.
Alice
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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
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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
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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
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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
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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
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Chuck,
Thanks for the resources. Information is good. History tells us a lot.
Alice
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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
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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
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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
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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
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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
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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
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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.
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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
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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
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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
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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
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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
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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
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Susan,
Your support helps me keep talking. Every day I find more questions to ask.
Thanks.
Alice
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Stephen,
The world sees us in a very different way than we see ourselves. Media filters do this very well.
Alice
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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
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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
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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
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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
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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
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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
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Duane,
But if the Capitalists own the government, then who is for the people?
Alice
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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
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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
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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
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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
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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
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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
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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
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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
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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.
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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
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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
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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
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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
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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
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Thank you. What a lovely thought. I will look into this. Relocating a medical license to another country is not so easy.
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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
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John, Thanks for doing a good job of clarifying the situation. There are similar issues here with regard to clinician attitudes. Alice
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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
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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
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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
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Licinia,
I resonate with your sadness. Yes. Something is very rotten in America.
Alice
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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.
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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
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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.;-)
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You’re a funny guy..er…cowboy.;-)
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I’m afraid you’ve got it pegged. Sigh.
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Glad to see you here.
Alice
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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
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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
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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
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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
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Ute,
I’m sure you’re right.
Alice
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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
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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
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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
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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
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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
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David,
Where do I sign up for classes at the Cyrenaic school of hedonism? ;-))
You made me smile. Thanks.
Alice
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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
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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.
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Nijinsky,
You just went right over my head. Music theory. I was never so good at that part of piano.;-))
All the best.
Alice
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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
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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
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Faith,
Thanks for all your time and effort to put together this piece.
Keep up the good work.
Alice Keys MD
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Nijinsky,
You’re so funny.;-)) the secret of the other fingers.
Alice
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Stephen,
I’ll carry a bucket of water with me. ;-))
Alice
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Ivana,
I read the leaflet. It is very good.
Alice
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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
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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
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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
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Steve,
I know we will, when we do.
Alice
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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”.
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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
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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
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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
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MJK,
Thanks for reading and writing here.
All the best.
Alice
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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
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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
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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
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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
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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
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MJK,
You write like a poet.
Alice
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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
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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?
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Alex,
Nicely put.
Alice
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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
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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
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MJK,
Thanks for clarifying for me.
Alice
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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
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MJK,
I agree with Louise says.
Yes. You are still a mother. Keep writing.
Alice
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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
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Emily,
Thanks for bringing more hope here to the pages of MIA today.
Alice
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Emily,
Thanks for pointing out the truth here.
Alice
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MJK,
What are the diagnositic criteria for this one? 🙂
Alice
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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
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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
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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
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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
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Karina,
I found the whole video and watched it. Thanks so much.
Your recommended documentary:
http://www.youtube.com/watch?v=lMD8J3W9Mj
Alice
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Stephen,
It’s a good thing to do.
Alice
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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
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Stephen,
Thanks for spelling it out so clearly. You are better at the BIG picture than me.
Thanks for reading, thinking and writing.
Alice
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Not so alone today.
Alice
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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
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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
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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
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Stephen,
Thank you.
Alice
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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
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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
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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
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Happy to be here. Thanks.
Alice
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Thanks for your observations from the UK.
Alice
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John,
Thanks for more clear thoughts. I wish I could say I thought you were wrong.
Alice
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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
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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
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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
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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
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Jeanne,
I have never denied the genocide of the war.
I don’t have another word for “targeted mass poisoning”.
Alice
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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
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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
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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
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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
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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
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David,
Good. You are a philosopher.
Alice
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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
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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
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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
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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
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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
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Dr D L,
Thanks for posting the link.
Alice
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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
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Dr D L,
Changing the money would change the flow of drugs.
Alice
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mjk,
It does make you wonder what they were thinking.
Alice
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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
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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
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wiley,
Good one.
Alice
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Steve,
Dang! Thanks. You said it all so much better than I could.
Keep reading, thinking and writing.
Ask questions.
All the best.
Alice
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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
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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
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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
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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
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Dr D L,
Thanks.
Alice
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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mjk,
Thanks for the lyrics and link.
All the best,
Alice
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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mjk,
Thanks for your perspective on this. We have to look at things from all directions to see them clearly.
Best,
Alice
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Kermit,
I’ll get it when I get back to Portland in the next few days.
Thanks,
Alice
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Duane,
Thanks for your kind words.
Yes we did lose so many young people.
Alice
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Altostrata,
Which one? The only one of hers I’ve read was “Operating Instructions”.
Alice
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marcellas,
So where do we go with this? New narratives? How do we spread them and encourage them?
Alice
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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
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Duane,
Thanks again for the resources for vets. This is a Memorial Day theme for Memorial Day.
Best,
Alice
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mjk,
You have a very visual and poetic style with words that I enjoy.
Alice
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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
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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
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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
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Nijinsky,
Thanks for another commentary. You put a lot of thought into your writing.
All the best,
Alice
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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
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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
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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
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Lowry,
Is there one or are you starting one today?
Alice
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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
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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
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Stephen,
We are all lucky you are here.
Alice
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Faith,
I would never dream of “taking away” a medicine that’s helping.
Thanks,
Alice
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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
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Rossa,
You are a fountain of inforamtion. Thanks.
Follow the money.
Wow.
Alice
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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
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Duane,
Wow.
Alice
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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
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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
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Mary,
Thanks for the link.
Alice
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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
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Scott,
Perhaps people are just keeping their heads down.
Best,
Alice
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Duane,
Thanks for reading and commenting here.
Best,
Alice
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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
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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
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Duane,
Thanks for your support.
Alice
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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.
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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
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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
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easy,
No worries. I over-personalize routinely.;-)
Alice
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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
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Bolo,
This webzine, in my mind, is one such “grassroots” campaign.
Thanks for the encouragement,
Alice
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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
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John,
Isn’t a radio PR piece on psych drug treatment the same as a drug advertisement? Thanks for speaking up over there.
Alice
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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
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Altostrata,
Good. I’ll move on to other topics. I wouldn’t want anyone to forget.
Alice
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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
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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
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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.
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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.
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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
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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
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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
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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
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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.
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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
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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
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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
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Altostrata,
I missed this.
Thanks. Apparently, I am not one of the psychiatrists that knew this. I still don’t.
Alice
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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
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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
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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
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Anon,
Do we have one of those vote counters here on MIA?
Thanks for checking in on this one.
Alice
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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
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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
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Lowry,
What you say makes sense to me. Thanks for walking through the process. I’m sure this must happen.
Alice
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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
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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
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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
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Marianne,
Thankyou. I really appreciate having a “personal cheerleader”.
How could I be anything else but who I am? 😉
Best,
Alice
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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
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easy,
Things are a big mess. Telling anyone that I can fix this whole big mess alone would be a lie.
Best,
Alice
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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
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Duane,
I am and I have. Here I am. Writing. For me things are in place.
Thanks for your kind thoughts.
Best,
Alice
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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
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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
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Stephen,
Freedom of choice and alternatives. Good.
Alice
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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
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Heidi,
Thanks for your thoughts concerning my blog.
Keep reading, thinking and writing.
Alice
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Duane,
Thanks for the enouragement.
Best,
Alice
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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
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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
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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
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Ruby,
Hmmm… Can’t say I understand all either.
Alice
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Duane,
This give me an idea for an essay on Diagnosis creep.;-)
Alice
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Darby,
You are not the first to suggest this carreer path to me. Thanks for your suggestion.
Best,
Alice
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Ruby,
I’m glad to hear you’re in recovery.
Best,
Alice
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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
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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
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Marianne,
Wow. I’m glad I got back on line this evening. Thanks for the moral support.
Best,
Alice
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Jen,
Glad to hear it. Perhaps your social worker can get prescribing priveleges. They are working on this in some states.
Alice
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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
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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
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Jen,
The car example is to illustrate the programable cognitive filter we all wear.
Thanks for reading.
Alice
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Stephen,
I was referring to the other patients. But, yes. everyone is effected.
Alice
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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.
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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
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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
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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
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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
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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
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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
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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
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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
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Altostrata,
One of the purposes here is to help people find resources and support.
Thanks,
Alice
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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
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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
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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
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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.
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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
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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
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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
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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
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Ninjinsky,
If only it were true. Then I could be the emperor of the world.
You are an idea person.
😉
Alice
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Nijinsky,
Sorry. I have no lawyer at all and no bucks to chase one down.
Great idea though.
Alice
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Philroy,
Thanks for your support here. Thanks for reading and thinking and putting so much time and effort into your lovely exposition.
Best,
Alice
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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
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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
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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.
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