Monday, July 13, 2009

Psychological Fail, or Fair?

In the last thirty years, the mental health industry has shifted from the idea that patients can talk through their issues to a push of managed medicines. I've been highly suspicious of psychological programs for as long as I can remember, and as a teen preferred a "brain doctor"- the psychiatrist. The biggest issue I have with psychology is that the studies of the human mind have swayed from that of comprehending, and resolving issues to that of placating and adding the concept of generalizations to the point where we have psychologists running lives via television, and people blindly believing in all these people say without question. There is a drive by managed health care to keep people under umbrella diagnoses, and we, as a species, don't always fall smartly into categories.

You can surmise I'm not a fan of Dr. Phil. This person has crafted his manner of generalized pop psychology to the detriment of anyone who believes or is easily swayed to believe that s/he is suffering a psychosis, rather than simply experiencing real life issues. If Dr. Phil has a show about bad parents who are cruel to their step children, suddenly mental health clinics are filled with parents and children who are frought with issues brought up by the television show. In fact, all families are dysfunctional, and all families work through quirks. The same goes for Dr. Laura- who has somehow managed to bring women to tears believing that they lack the skills of a Donna Reed 1950's TV character and therefore should be ashamed, as women. It's just not a realistic expectation- our mental health experts must be aware of individual needs and not so eager to label people through conveyer belt psychology.

In the United States, the word "therapist" is greatly abused by those who are not licensed through medical boards. It takes a business license and not a history of education, years of experience, nor reviews of peers to wear that title. This is why you can look through any phone book or search engine and find therapists who only use "Color Wheels", others who use "Smudge Sticks and Reiki", and still more who are "life coaches". Psychotherapy is the notion that you and your medical professional work to find a common goal of mental wellness, or at least a position of mental strength so you can live a life as normally as you wish. I've said this numerous times- My Normal isn't Your Normal, nor should it be.

Last week's post was skipped due to the inundated news wire sources that were focused on the mental state of Michael Jackson. I did not know the man nor do I know of his life other than what the media portrays so I have no comments on his state of mind prior to his death. I did read that one of the children was made to speak to a mourning fan base at a memorial, and again, her normal is not my normal so I don't know what damage this did to her, or if it was just another day in the life for her. Yet, pop psychologists all had commentaries regarding the life of the children, the man, and the family. I will not make any conclusions because I lack the knowledge to do so.

I do know a bit about the changes in the field of psychology over the last thirty years. In the late 1960's and early 1970's, a revolution of sorts was started by the increased use of antidepression medications. There was a time when psychiatrists would sit with patients, and take the time to learn about their illnesses. With the return of veterans from Viet Nam came the increased studies of prescription medications. By the mid 1970's, Prozac became a household word. In the 1980's, the release of seratonin and neurotransmitter based drugs were not only prescribed by the psychiatric professional, but by the general practitioner, the gynecologist, and DO's. And, television commercials have increased our vocabulary regarding Uptakes, Inhibitors, and Blockers. Children are now versed on Ritalin and Risperdal as well as they are Flinstone Chewables. We are prescribed mental wellness, yet we have no long term proof that every drug works for everyone. Just as we have no long term proof that one form of psychology is the best for all, yet we are often find that psychologists place cookie cutter expectations on our mental health.

How do you know you are receiving proper mental health when the methods of assisting seem to come not from medical journals, but from magazines? Everyone has times in life that are stressful, or too painful, or even times that seem to change who we are. Job cuts may make a calm, relaxed man turn into a scared, unsure boy. A divorcing couple may experience entirely different responses to the event- one partner may be relieved and feel elated, the other may feel grief, remorse, or even self-blame. A child who fails at class task may become self destructive in other ways, and yet another child may use that failure as a challenge. How do we get the right mental health for our conditions, and how do we ensure we are getting medications when we truly need them and not just because a doctor was swayed by media and sales pitches?

First, realize that a psychotherapist, a psychologist, a therapist, and a psychiatrist are each different job titles for completely different reasons. You may find that just talking to someone will help you clear your mind and see what it is that is causing you stress or pain. For this you would do well with a therapist, social worker, or psychotherapist. You can speak to each one for far less than you would a psychologist or psychiatrist, and you can expect the time spent will be shorter.

A psychiatrist is a medical doctor who studies the disorders of the mind, just as a cardiologist studies the disorders of the heart. For years, the amount of time alloted by patients to see psychiatrists has greatly been reduced, and some Managed Care programs only leave you with 15 minutes per quarter to talk about medications and side effects, and nothing more. Although a psychiatrist is most skilled at determining a prognosis between neuropathy, psycopathy, and psychosis, the patient to doctor time is limited. If you have a true mental disorder- hear voices, believe two people live inside you, or even believe you are the sole being on the planet and the rest of us are your imagination, if you are two people inside, and just can't win an argument with either one- you probably need a psychiatrist, but will likely see a psychologist because of the health care system.

Psychologists go to graduate school, some are PhD's and can use the title Doctor. Some are specialists, and I find those who specialize are likely to be better aware of particular illnesses, but may label all who come to them with that illness. The meaning of the word Psych-ologist means LOVE of the Mind, not scientist of the mind. So they have definite ideas of people, thoughts, and reactions. A psychologist whom I find to be greatly helpful may be someone you think is completely off base and not worth speaking to- and that would be great if it happened more often. Unfortunately, managed health, and insurance companies, limit who we can speak to and about what, so we may find ourselves in the office of a very religious, or polar political opposites to us, and we are expected to speak comfortably to the professionals due to a title. This isn't good medicine.

We need to have the ability to interview our mental health professionals as we would any employee we would hire. We need to find ourselves at ease in their company, and in complete trust of their abilities to understand who we are as people. If they can comprehend our manner of thought, then they are better equipped to help us be our best "normal". We don't need them to simply label us, package us, and send us out on their mental health conveyer belt of "cured" patients. We shouldn't feel manipulated by our therapists into thinking that their version of normal is ours. A good psychologist understands this. The problem is very few good psychologists are available, and far fewer still are able to fit us into their schedules.

Ask your mental health professional some questions to find your correct fit- and you will probably find yourself without a handful of pills, and with a better sense of self.

1. Do you have any qualms talking about sex, or other intimate topics? -Your care may depend on the ability of your professional to speak as freely or as infrequently as you do on this.

2. Can you tell me what experience you have with...- then fill in the blanks as to what you THINK may be the reason you're not feeling your version of normal. For some, it may be self-persecution, for others it may be narcissism. Be very clear about what you think you are going through- even if you think it may be wrong. The better you are at understanding your needs the better the professional will be in assisting you with them.

3. Will you expect me to be in group sessions for my issues? -Some professionals find that patients with similar issues, backgrounds, and needs do better in group situations. Others find that groups are a failure of self-discovery. Be clear in what you expect, and don't accept a group session if you feel that it's not what you want.

4. Can you be reached in case of emergency? -Many mental health clinics expect you to visit an emergency room rather than speak with someone who is aware of your situation. If you are going through a personal crisis- career, health, marital, et al- and you know you may have cause to call a mental health professional during this time, ensure you have a way to contact someone you feel most comfortable with before you are handed off to an emergency room.

5. How long do most of patients stay in your care? -Some mental health professionals believe that people with issues of the mind will have them for life, and others think that most are situational. Decide if you're getting into a marriage, or a short term relationship with this person.

6. Do you often give prescriptions to your patients, or do you prefer other methods of treatment? -Learn this from the start! If you don't feel your problems will be solved by a drug, studies have shown that you are less likely to have positive results. (In fact, the FDA studies on a majority of psychiatric medications show that the efficacy rates of antidepressants are no better than placebo in many trials- be sure you understand medications!)

7. Have you published any works in your field? -Get to know your doctor before you get to visit him. If he writes about fetishes and abuse, chances are your treatment will focus on such things.

8. Do you take part in clinical trials? -This is a huge question many doctors will not answer right away. You may be pressured into taking a particular treatment simply because the doctor is involved in the research of that treatment. Do not walk, but run away unless you want to be involved in the studies.

9. After the treatment, is there follow-up care? -Can you come back to the mental health clinic if you have any relapses and if the issues you face seem to return? Many doctors sign you out of their care and completely out of their practice. Ensure you have the right to come back if you need to.

10. How many visits does my insurance cover with your office? - Be SURE to ask this question. So many health programs limit mental health coverage by the number of visits to ALL professionals. For instance you may be alloted 10 mental health care visits a year. This must be shared between a prescribing psychiatrist, a therapist, and a psychologist.

Keep in touch with your insurance, or state care agency to learn what mental health options are available to you. The United Way, for instance, is a private organization that maintains databases of sliding scale or free mental health clinics. Do your homework before you walk into the door, as much as you can.

Today's questions- What have you noticed as a patient in the change in mental health care? Do you find pressured to take medications when you don't want to? Do you ask for medications and aren't given them? What can you see will improve mental health in the future?