Tuesday, January 10, 2012

Psy Treatment Ambivalence

Before I start exploring the side of this situation that I actually find interesting, I want to make something very clear. I am (currently) very happy that the intervention of my loved ones and medical professionals, medications, therapy, and even hospitalizations have saved my life more times that I really like to admit. I am happy to be working on making my life better in ways that I think are necessary and to be on medications that I believe allow me the breathing space to do that. This post is not the predecessor to me stopping either my therapy or my medication, as I have absolutely no plans of doing either. But, as my mother told me recently, I've never been able to not ask "why" of anything and I've been thinking more and more about the other side of this issue, to possibilities other than the current accepted treatment of mental illness in the U.S.

TV junkie that I am, some of this thinking was prodded by a quote I heard on a tv show, the finale to FX's American Horror Story. Though it was only meant to be a cutting comment to one of his former patients, psychologist Ben Harmon declares,“Therapy. Doesn’t. Work.” When the patient then asks why people do it is “Because they don’t want to take any responsibility for their crappy lives. So they pay a therapist to listen to their bullshit and make it all feel… ‘special’ … so they can blame their crazy mothers for everything that went wrong.” I would add 'absent fathers' to that. Of course I heard this only days after I was released from my latest (not exactly voluntary) hospitalization, typically a time of both hope for future treatment as well as bitterness about the circumstance surrounding the hospitalization itself. I have to admit that one of my problems with past therapists I've seen was that I didn't feel like I was progressing anywhere, but just dealing with the problems of the week, a season of Buffy without any overarching, linked storylines. I wasn't getting better. I just had a disinterested third-party to bitch to now. One of the biggest draws to the DBT therapy that I'm currently in is that my individual therapist and I clearly stated goals for what I want to accomplish through therapy while the group sessions are teaching and reinforcing the skills that I'm using to accomplish them. But it's hard to deny some level of truth to what Dr. Ben says.

The next dominoes to fall came after I started receiving bills from my hospitalization. While I find it difficult to say to anyone, especially people who have lost someone to suicide, that anyone, especially their loved one, should be (have been) allowed to die if that is what they want(ed), even if they had the option of medical assistance, when I am said person and that medical assistance costs tens of thousands of dollars...well, let's just say that I was not quite as enthusiastic about those prospects.

In one of the recent GOP presidential nominee debates, this exchange occurred:

Wolf Blitzer, debate moderator: A healthy 30-year-old young man has a good job, makes a good living, but decides, you know what? I'm not going to spend $200 or $300 a month for health insurance because I'm healthy, I don't need it. But something terrible happens, all of a sudden he needs it. Who's going to pay if he goes into a coma, for example? Who pays for that?

Ron Paul, Republican nominee, but often described as libertarian: Well, in a society that you accept welfarism and socialism, he expects the government to take care of him.

Wolf Blitzer: Well, what do you want?

Ron Paul: But what he should do is whatever he wants to do, and assume responsibility for himself. My advice to him would have a major medical policy, but not be forced

Wolf Blitzer: But he doesn't have that. He doesn't have it, and he needs intensive care for six months. Who pays?

Ron Paul: That's what freedom is all about, taking your own risks (applause from many in the audience)

Wolf Blitzer: But Congressman, are you saying that society should just let him die?

Audience: Yes!!!

Ron Paul: No. I practiced medicine before we had Medicaid, in the early 1960s, when I got out of medical school. I practiced at Santa Rosa Hospital in San Antonio, and the churches took care of them. We never turned anybody away from the hospitals. And we've given up on this whole concept that we might take care of ourselves and assume responsibility for ourselves. Our neighbors, our friends, our churches would do it. This whole idea, that's the reason the cost is so high. The cost is so high because they dump it on the government, it becomes a bureaucracy.

Now, liberal commie me and the me who knows how high my uncle's medical bills were even with insurance and Medicaid doesn't really agree with that and, if you judge by the laws of our country, our country largely doesn't believe that the choice of whether people receive life-saving treatment should be left to charities and chance either. Emergency rooms are lawfully required to give whatever treatment will continue the life of a patient, regardless of if they have the ability to pay or not. I understand why this is the law of the land and agree that life-saving medical treatment should not be withheld because a person cannot pay, especially if they desire the treatment, but that does not mean that they will not be required or at least asked to pay.

Now, currently, if a person is not competent to make medical decisions for whatever reason and they do not have a specific DNR, living will instructions with them, and no medical proxy to make the decision to refuse treatment for them, doctors will give them the proper treatment to save their life. For the most part, even if they are conscious, people who have tried to commit suicide are automatically assumed to be not competent to make the decision to refuse life-saving treatment. If the person is not able to refuse medical treatment for whatever reason, they will be billed for whatever services are rendered, even though they did not consent to the services and might not have, if able to. For people who are being saved from an attempted suicide, a several day psychiatric hospitalization will be tacked on to their treatment, after their physical health is established and stable. Though the patient is nominally given the choice, this isn't really true. For those people lucky enough not to have experienced this, a person is usually given the chance to decide whether they will be transferred to a psychiatric unit "voluntarily" or the attending psychiatrist can commit them involuntarily with a 72 hour hold, to a dreaded "state hospital" if they do not have insurance. A patient can fight the hold and can fight further commitment afterwards, but, whether true or not, as I've never actually challenged it, patients are told that judges don't usually find in favor of the patient and resisting the hospitalization is generally seen as continued mental instability so no doctor will let you out. Even signing in "voluntarily" doesn't necessarily mean one can just sign out again. Doctors and nurses will tell a patient that their insurance will not pay for their visit if they sign out AMA (against medical advice), which is what they are requesting to do. If this doesn't work, patients will then be told the same thing that people who do not want to be voluntarily committed will be told, that their doctors can decide to put their hospitalization on a 72 hour hold, at which time they can challenge it, but they won't win and it will just be wasted time, since their resistance is seen as further instability. I'm not sure if these are scare tactics or not. I just know that this is what patients are told, from both my experience and the experience of my fellow patients.

My point with all of this is that, while I am not arguing that anyone should just be denied life-saving medical treatment just because they don't have health insurance or the ability to pay for the treatment, I am starting to wonder about our inability to refuse medical treatment on the basis that we cannot pay. I guess maybe I'm just surrounded by (too many) conservatives, but all I seem to hear lately is that people should not do things they cannot pay for and that no one should rely on the government to pick up the slack when they do things they cannot pay for. But in for a dime, in for a dollar, right? Just some examples: Should people not be allowed to drive if they can afford car insurance, but just the bare minimum, which covers anyone they might hit or any damage they might do while driving, but not whatever damage they might do to themselves and end up in the hospital needing life-saving treatment for? Also, if a person cannot work, cannot find work, or just doesn't want to to work, can they kill themselves so they do not require anything anymore? Oh wait...currently they can't. I'd been pondering all this since starting to deal with the bills, but came up a bit short on finding an audience for these views. Then again, I guess my mother was not the best person to start with and the best time was not just as we were about to get to my uncle's grave.

Then, a few days ago, catching up on my RSS feed, I saw this blog article From Risk to Harm and from Harm to Suicide. For some reason, now that I'm writing this I can't find the area of the article where the author discusses how true liberatarianism should advocate against forced hospitalizations and such. Crap. Either way, this article, the second in a series, after Mad Not Crazy, raises questions about the ways race and psychiatry intersect, helped me realize that not only was I not the ONLY person who questioned the mainstream ways of treating mental illness in North America (the author is a Canadian, living in Toronto), but that there is a WHOLE MOVEMENT (however small), called the "mad movement" (not to be confused with the Make A Difference, or M.A.D. movement), which, from these articles, seems to refute the idea that someone who thinks differently is ill in a manner that needs medical or psychiatric treatment, but asserts that there are many different ways in which people think and experience the world which should be embraced. When reading the above articles, my thinking about mental illness and the appropriate ways were challenged in ways that my thinking about anything probably hasn't been challenged since Miss Kee was alive. Though the articles are in depth and full of ideas on race that I'm not sure many of my readers will agree with, I still recommend them as they offer different ways to think about mental illness, about what I'm going through, about what some of you are living with, though I obviously am not telling ya'll to just throw your pills in the toilet and the rest of your life will be all daisies and roses.

I did want to share these ideas with a larger audience though, to show my dear readers that there are other ways to think of these things that are worth thinking about, and that even a person devoted to their current treatment can still be ambivalent about it and the way mental health is currently dealt with in this country, the country most of you are from and reside in. Please read those other articles when you have some free time. Comment. Thanks for reading.

About the title of the post: Quote from "Mad Not Crazy"
"Members of the Mad community may also identify politically as psychiatric survivors. Psychiatric survivors are people who have experienced the mental health system and feel psychiatry, psychology, psychotherapy, and similar helping professions (called the “psy” complex) can be ineffective, harmful, and even violent. The “psy” complex does not just exist in the hospital or the therapy room, but is pervasive in other spaces such as schools, settlement services, and prisons. It’s present any time behavioral language and psychological practices are put into effect in a workplace. Psychiatric survivor scholars and activists explore how psychiatry is a tool for detention and social control. We lobby to end forced drugging, electroshock, restraint, seclusion, institutionalization, and outpatient torture."

Yes, I am aware that this is a rather non-mainstream view of things, but that is what makes it all the more interesting to me to contemplate.

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