July 7, 2008 4:07 PM | Posted by Aaron Davies: | Reply

You're kidding, right? Do you know how many government and government-sponsored jobs depend on no one ever doing those steps?

Score: 3 (3 votes cast)

July 7, 2008 8:15 PM | Posted by lisa: | Reply

It's pretty obvious to anyone paying attention psychology wants to do everything. You just gave one example, another: When a psychologist is brought into court to testify whether someone was sane when they committed a crime, the psychologist wants to decide whether the person is guilty or innocent, instead of just giving the specialist opinion and leaving that for the judge and jury.

I liked the movie Twelve Monkeys. It had psychologist judge and jury and a cuckoo who escaped them.

Score: 0 (0 votes cast)

July 7, 2008 10:21 PM | Posted by Anonymous: | Reply

Bravo. You said what needed to be said, but will give people with names (ah, blogs!) the label of "racist," which immediately ends all intelligent conversation.

Score: 0 (0 votes cast)

July 8, 2008 3:46 AM | Posted by David Johnson: | Reply

You write: identify why there are increasing numbers of people who are falling through the cracks, despite universal education, social security, and gigantically abundant healthcare.

I live in Washington State. I need a hip replacement and I'm no longer covered by health insurance but I'm not indigent. No, I don't own a house. Could you please direct me to the "gigantically abundant healthcare" I seem to be overlooking.

Thanks so much.

Score: 1 (5 votes cast)

July 8, 2008 1:10 PM | Posted by Anonymous: | Reply

Two nights before I completed my residency at LAC-USC, I was admitting at the County psych ER. Until then, I had only been assaulted once, by a truly delusional Russian immigrant who mistook me for the KGB (I do have a port-wine stain on my forehead). The roving Crack-heads were two weeks into their county checks (or broke) and filing in for their week of withdrawal "3 hots and a cot". One of them was recognized as a "frequent flyer" antisocial who had previously choked one of my colleagues (back at the scene of the crime... awesome arrogance!). As he bantered with one of his buddies, it was obvious he was coherent, logical, affective, and NOT responding to internal stimuli. His chief complaint flowed uninterrupted... "I'm suicidal, homicidal, hearing things, seeing things, and people are after me." With counter-transference in check, I warmly offered him a prescription, an outpatient appointment, and delivery to the nearest shelter. He responded by launching a blood pressure monitor at my genitals and jumped on my face. It's primal needs, folks. They tuck you in, feed your belly, and take your temperature. The psych ER has replaced home as the hotel du jour of the common addict.

Score: 6 (6 votes cast)

July 8, 2008 2:38 PM | Posted by Row1: | Reply

what? explain this psychology thing to me.
i saw nothing about psychology in this blog.

Score: 0 (2 votes cast)

July 8, 2008 6:31 PM | Posted by Silver: | Reply

I like step 3. Also step 1, come to think of it. "Not all suffering should be treated" would be a spiffy bumper sticker.

Here's my social-label makeover population: I provide the psych consults for the patients at the womens' shelter who are (mis)diagnosed by the shelter's FP as having "anxiety disorders," thus pathologizing a very appropriate response to a violent situation.

However, I, like Mr. Johnson, am unclear on the 'gigantically abundant healthcare.'

Score: 3 (3 votes cast)

July 8, 2008 9:13 PM | Posted by therapyfirst: | Reply

as a psychiatrist, your perspective is accurate from my ongoing experiences working in a hospital outpatient clinic. With the increasing socioeconomic strife, I see more people who come in with psychiatric symptoms exacerbated by Axis IV issues and want drugs to make them better. Doesn't seem to fix the ARM matter, the credit card carelessness, being outsourced, continual illicit substance abuse/dependence, and numerous other tangible factors that patients don't want to problem solve.

I have some people at another blog site who bark at me to go to the unemployment office and offer services there to "treat" their problems. Last I checked, psychiatry can't treat poverty. Thank you for writing this here. I'll direct these clueless souls to read your point of view, and hope they will get it.

Have you read Theodore Dalrymple's book "Life at the Bottom"? I think it illustrates a lot about society, even though written from a British point of view.

For other commenters, consider this reference too.

therapyfirst
board certified psychiatrist

Score: 2 (2 votes cast)

July 8, 2008 10:19 PM | Posted by Sally: | Reply

Thought provoking blog entry. As one whose job it is to know the numbers in the labor market, I assure you there are not plenty of job opportunities. I think you must know this and maybe I missed the sarcasm or not. I think it's true that the standard of living has improved overall in the last 100 years or so more than those of us living now can imagine. Humans have figured out how to produce enough food to feed all humans, but just not how to distribute it. We figured out how to get the resources but how do we allocate them? I don't think zoloft or zyprexa can answer this question. Here in the US two of our biggest problems are homelessness and empty homes, and yet I'd be pretty p*ssed if we just let folks like me, the working middle aged renters stay in our situations and passed out vacant houses to the homeless or excused the outstanding debts of those who took mortgages they couldn't afford, but there's got to be a way we can all share, maybe we just haven't evolved into a species that can figure out how. Sheesh...good post. Poor woman.

Score: 1 (1 votes cast)

July 9, 2008 9:52 AM | Posted by Sally: | Reply

After seeing some other blogs takes on this tragic, yet common occurance, I re-read your entry. I don't think you're blaming the victim here and I think these' days it's important to admit that there are actual victims around who suffer normal reactions to inhuman conditions. And we have video camereas that occaisionally catch such things.

You touch on the crux of the problem here: " reclassify those poor black people as mental health patients, and you have just made an entire social problem disappear." You've also placed the blame on an entire group of people for a situation completely out of their/our control. If you're freezing and the only place you know of to warm up is a psych hospital, you're not just sane to go there and try and get in, instead, you'd be crazy not to. So we have the tauntology you mentioned, if you decide to freeze while starving outside rather than go into a psych hospital, you're crazy, but if you go to a psych hospital you're crazy because as you write "if you go to psychiatry for help, you must need it." In other words, asking for help is a symptom of mental illness and not asking for help is a symptom of mental illness.

There's no other field of medicine in which this is the case. If I go to a doctor because I have a sore throat, the doctor can culture me to see if it's strep and through various other tests determine if I'm sick. The doctor may tell me in the end that there's nothing medically wrong with me and send me on my way. Not true with psychiatry.

I agree there should be limits on who is treated, but we don't agree on who is ill. If I lose my house and gradually everything else and find myself on the street on a cold winter night and feeling frostbist set in, beat on the door of the psych hospital begging to get in out of the cold, psychiatry should in essence diagnose me as sane but paniced because I was freezing to death and the treatment should be a warm bed not a medical diagnosis. Unemployment is a condition so frightening that psychiatric services should be available at unemployment offices for people who want to manage their rational fear so it doens't make their situation worse. To say that psychiatry can't treat poverty because it didn't cause it (a debatable assertion in itself) is like saying that ER doctors can't treat gun shot wounds because the ER doc didn't fire the bullet. Maybe if would looked at mental problems more like trauma wounds than like chronic diseases, it would help.

It's sort of like the ptsd quandry, I don't deny that soldiers returning from war have mental troubles or that these people should recieve help if they want it, I deny that their troubles are illnesses in the way that word is used when pared with mental.

I'm not sure what needs to happen but it seems that if society continues to refuse social responsibility for normal individual responses to life, problematic though they may be, we'll get more folks brutalized by the system. And psychitrists continue to be angry about the reasons people come to psych hospitals, bizarrely thinking that the wrong people are coming in, imaging a perfect mental patient that simply doesn't exist.

Though I must point out Esmin Green was being held against her will because she had anxiety attacks. What part of being held prisoner and ignored is treatment for an "anxiety attack?" Your piece addresses the issue of psych hospitals as homeless shelters and to some extent low income housing, the psych hospital as jail is another interesting area. What was it about this woman's anxiety attack that made someone choose to imprison her, I wonder.

Score: 3 (3 votes cast)

July 9, 2008 3:53 PM | Posted by Jade: | Reply

"She died at Kings County because society didn't want her dying anywhere else."

Oh, well, as long as she was disposable anyway, I guess it's beside the point that the security and health care professionals who were ostensibly there to provide security and health care ignored her while she flailed and died on the floor. Thanks for clearing that up.

When you look at that video and read about her life, do you even notice she's a real human being, an individual person with a life she probably would have liked to continue? Or is your only reaction "Society is screwed up." Shrug. At least you've got yours, right?

Score: -8 (8 votes cast)

July 9, 2008 4:50 PM | Posted by Sally: | Reply

Jade, You are right that Ms. Green's death was tragic, that she was an individual. It's that awareness that feeds my informs impression that society is screwed up, but I'm just speaking for myself. What's to be done to appropriately punish the people responsible? To prevent this sort of thing from ever happening again? Hard questions. And then there's all of the evidence that this sort of thing probably happens every day in psychaitric "hospitals."

Score: 2 (2 votes cast)

July 10, 2008 3:48 AM | Posted by Dee Plum: | Reply

The only thing I ever hoped to find in shrinks was common sense.

Score: 0 (0 votes cast)

July 18, 2008 2:02 AM | Posted by Anonymous: | Reply

http://www.theopalproject.org/vigil.html

On July 25, 2008, we invite all people to join us and stand united in
support of the demand that everyone receive the full benefit of their
human rights and the preservation of their liberty, dignity and respect.

Who: All People.

What: Candle Light Vigil to mourn the loss of Ms. Esmin Elizabeth
Green and condemn violations of human rights.

Why: WE THE PEOPLE call for an end of abuse, torture, and neglect in
the wake of Ms. Green's Death on June 19, 2008, while detained at
Kings County Hospital Center's Psychiatric Emergency Room.

Where: Kings County Hospital Center, Psychiatric Emergency Room,
Building G. 606 Winthrop Street Brooklyn, NY 11203

Date: July 25, 2008

Time: 5 PM - 10 PM, Candle Light Vigil, 8:30 PM

We welcome your involvement as an organizational co-sponsor or an
individual endorser of this effort. If you would like to speak at this
event, please contact us.

WE THE PEOPLE

###

Score: 1 (1 votes cast)

July 18, 2008 7:50 AM | Posted by Alison Hymes: | Reply

Ms. Greene died of blood clots that travelled because she was involuntarily committed as a psychiatric patient rather than treated as a medical patient by medical doctors. All the rest is defensive spin of psychiatry's complicity in involuntary detention and dehumanization of people with psychiatric diagnoses. I won't be reading you again. Sad really this

Score: -2 (2 votes cast)

July 25, 2008 11:50 AM | Posted by whatever: | Reply

Could you possibly tell me in what city or state you practice your "medicine" so that I may avoid every running across the likes of you in my "treatment".

What a cold post you write in response to such a horrible thing happening. I would expect maybe you would at least write of how the people involved in this should be punished, how wrong it is, but no just another thing you can use to try and prove your world view. Oh poor psychiatry having to tend to these unmentionables of society. Oh poor psychiatry, why must you be the field that is left having to try to help people that no one else is helping. Boo-f*ckin-Hoo! You poor things, making those hundreds of dollars an hour and having to deal with all these indigents that are so self entitled as to want comfort and help when thier lives have become unmanagable. (yeah who really has the sense of entitlement here? you maybe, feeling like you shouldn't have to deal with these people)

You know what, if someone comes to your profession for help, and they aren't actually DSM standard MENTAL cases, then for the love of god don't diagnose them with an illness they don't have and then treat them for it. If they've hit a bottom in life that sucks so much that they feel like they're "loosing it", and they don't know where else to turn, then why don't you damn doctors and mental health workers keep some f*cking information handy for these people on how to get benefits and council them on what they need to do and what sort of help other than mental health they need to get back on thier feet...Or is that just way too much to ask of you all?
Let em stay in the hospital a few days so they don't freeze to death or end up killing themselves out of the desperation of being a hard spot and send them on their way with the info of what they need to do to deal with the life situation that is causing them so much mental disstress.

Yeah you aren't social workers, I get it, you're doctors and nurses... so what? If the person needs help they need help, and if they're just going to end up back in the psych ward if all you give them is meds while they are there and offer no info on what other help is available... well don't whine about how they come to you to die and that's all societies fault when you damn well could, if you made an effort as a profession, help them find other ways to continue living than to take meds and remain ignoratnt and helpless as to what needs to be done to really fix thier situation. And if you don't have the time to do it then rally the system to get more social workers in the hospitals to help these people out.

Shoving meds and diagnosises down peoples throats and then ignoring them for the rest of their visit to the hospital, when what they really need is a little direction as to how to get other help in thier lives isn't doing anyone any good. Obviously you're not happy about it, whah whah whah... so why don't you try and do something to change the way people who are suffering more due to life situations and poverty than actualy mental illness, are "helped" when they come to the hospital as a last resort when they don't know what else to do ??? huh? Why? Too busy writing this blog and trying to make people think you're oh so smart? Too busy using your knowledge and education to help those that are worth it in your eyes?

Obviously you feel entitled to not have to deal with "these people", so if you really think you shouldn't have to deal with them as a profession, but you are the last resort, the last place people know to turn when lfe is falling apart around them, then why don't you and your profession find a solution, find some way to help them? Or should you not have to do that... cause well, you're doctors and have more important things to do?

You truely do disgust me, but that's the way many psych docs are. I dunno what it is about the field that attracts such arrogant bigoted self entitled jerk wads, I just know that other doctors, you know the ones who actually deal with verifiable illnesses and such... well they get pretty disgusted when they hear about how I've been treated by psychiatrists and have always been more than happy to take over my medication management when I tell them I simply can not stand dealing with the psych profession anymore.

Score: -7 (7 votes cast)

July 25, 2008 6:45 PM | Posted by Dana: | Reply

I think that the post by "whatever" hits it most on the head. But let me say, I cannot understand how we have lost all human decency period. I can promise you this, sleep outside a night or two (without your fancy RV & extra sleeping gear that most poor people would die to own), put your kids to bed in a car or the park, go hungry more often than not and your view will change. You look at poverty like it is some illness that people petition to own, and the benefit to them is that it allows them to sleep overnight in some city/county-run, psych freak, bottom of the barrel domain. How lucky can a person get. 3 hots and a cot (as posted by a DR??? ~ hope I never run into you or your stupidity). Indeed. Having gone hungry, slept with my children in many questionable environments, etc, I should have gotten so lucky. And as for those "abundance" of jobs??? When was the last time you went to an interview with no shower, no clean clothes? The smartest thing I ever learned was how to wash my kids & myself in a gas-station restroom, but of course those have been mostly eliminated as well. We weren't all born with someone to pay for a college education, empowering us to look down our noses at PEOPLE. And don't tell me, years of hard work and blah blah blah. Live in the real world and then tell me you know ANYTHING. We outnumber you. Face it. You can't control poverty any more than you will ever be able to control anything outside your little psycho-babble environment. Those people who sat next to that lady in the waiting room and those lazy security staff are a perfect example of what is really happening to society: People do not care about other people. "It's not my problem".

Your assertion that most people can be "cured" of the poverty that is creating such a burden on your venerable profession if they would only get a job & get out there & apply for Social Security and seek that abundant healthcare is so out-of-touch with reality that I think maybe you should be diagnosed with some form of illness yourself. Social Security is difficult for intelligent people to obtain, if you have the resources available to you to fight for it. Healthcare does not exist for those of us who work and are not offered "group rates" (i.e. some of us don't make over $150 a patient). And universal education???? Well, that would take a whole book to show you the very, very many errors in your rich-boy thought process. You need help.

Score: 1 (3 votes cast)

July 25, 2008 6:45 PM | Posted by Dana: | Reply

I think that the post by "whatever" hits it most on the head. But let me say, I cannot understand how we have lost all human decency period. I can promise you this, sleep outside a night or two (without your fancy RV & extra sleeping gear that most poor people would die to own), put your kids to bed in a car or the park, go hungry more often than not and your view will change. You look at poverty like it is some illness that people petition to own, and the benefit to them is that it allows them to sleep overnight in some city/county-run, psych freak, bottom of the barrel domain. How lucky can a person get. 3 hots and a cot (as posted by a DR??? ~ hope I never run into you or your stupidity). Indeed. Having gone hungry, slept with my children in many questionable environments, etc, I should have gotten so lucky. And as for those "abundance" of jobs??? When was the last time you went to an interview with no shower, no clean clothes? The smartest thing I ever learned was how to wash my kids & myself in a gas-station restroom, but of course those have been mostly eliminated as well. We weren't all born with someone to pay for a college education, empowering us to look down our noses at PEOPLE. And don't tell me, years of hard work and blah blah blah. Live in the real world and then tell me you know ANYTHING. We outnumber you. Face it. You can't control poverty any more than you will ever be able to control anything outside your little psycho-babble environment. Those people who sat next to that lady in the waiting room and those lazy security staff are a perfect example of what is really happening to society: People do not care about other people. "It's not my problem".

Your assertion that most people can be "cured" of the poverty that is creating such a burden on your venerable profession if they would only get a job & get out there & apply for Social Security and seek that abundant healthcare is so out-of-touch with reality that I think maybe you should be diagnosed with some form of illness yourself. Social Security is difficult for intelligent people to obtain, if you have the resources available to you to fight for it. Healthcare does not exist for those of us who work and are not offered "group rates" (i.e. some of us don't make over $150 a patient). And universal education???? Well, that would take a whole book to show you the very, very many errors in your rich-boy thought process. You need help.

Score: -2 (2 votes cast)

July 26, 2008 10:35 PM | Posted by lame-o-alias: | Reply

to the above psychiatry haters:

being an anonymous hostile writer gives you no validation to criticize and spew venom. So easy to judge, so hard to walk in the shoes. This woman was not treated responsibly, but to generalize this is the work of a whole profession, you are wrong.

get a life, you disordered freaks. This blog author tries to bring attention to an unmentionable incident, and you bash the messenger. No, my mistake, you shameless, disordered freaks.

Do professionals a favor, don't seek out treatment.

Score: 4 (6 votes cast)

July 28, 2008 2:16 PM | Posted by Alone: | Reply

Alone's response:

To clarify my post-- as if it needed clarification:

You are missing the big picture, and you are worsening it. You're saying, "the poor need help, how terrible that you're justifying psychiatry's abandonment of the poor!" I'm telling you SOCIETY has abandoned you and has relegated you to the psychiatrists. If your apartment burns down because it is not built to code and the fire department didn't bother to respond at all, and psychiatry isn't equipped to help you, you don't solve the problem by fixing psychiatry. Get it? They're feeding you the illusion of psychiatry so that you don't get angry at where the problem really lies-- and you're buying it.

Of course Kings County failed and of course they were negligent, but the larger issue isn't Esmin Green but a) why the poor have no where else to go but psychiatry; and b) why people are so brainwashed that it doesn't occur to anyone to ask why Esmin had to be in the ER in the first place-- how could 40 years of American society have failed her so consistently, such that the only place she could go was a psych ER?? And all you think to do is say, "psychiatry needs to do a better job!"

Score: 9 (9 votes cast)

July 28, 2008 3:57 PM | Posted by Brian: | Reply

"...if they would only get a job & get out there & apply for Social Security and seek that abundant healthcare is so out-of-touch with reality that I think maybe you should be diagnosed with some form of illness yourself." Perhaps the good Dr will write about the trend towards "diagnosing" those with whom we disagree as having psychiatric illness.

Score: 0 (0 votes cast)

July 28, 2008 9:59 PM | Posted by therapyfirst: | Reply

I assume Alone is Last Psychiatrist, so if this is correct, I hope my following comment is of value:

Psychiatrists are the whipping boy these past two decades, and I think because we knew better how to have a healthy and responsible impact on mental health care, and too many careless, incompetent, and greedy competitors and charlatans took advantage of those of us who instinctively cared and hoped for our patients. We let managed care dictate our actions, then let social workers become "therapists" when too many of them just directed people, allowed pharamcology to become our one and only expertise, and now are letting psychologists, nurse practitioners, and primary care/family physicians be the main prescribers of meds and minimize the role the therapy even lower than it had been the past 10 years. And in the end, we as a whole profession of psychiatry have ourselves to blame for some portion of this, as we tried to be nice, rationalize, and minimize the consequences as too many of us focused on our wallets and not the bigger picture, CARE.

Well, Alone's above comment is right in several ways, the two biggest is how people continue to miss the big picture, that their strife is multifactorial and will not improve just by being on a pill and seeing a support system ever month or less often; and, we treat people, not societal entities like poverty, famine, mob mentalities, greed, and in my own opinion, hate. That is for society to address and try to fix or eradicate, not physicians.

And that is why I come onto sites like this and refute these claims by others, who I sense are not physicians, much less health providers of any designation. Lies, innuendos, and myths must be refuted, because our silence only validates the roars of falsehoods and misunderstandings. Observers both want and must hear both sides of the debate. As long as responsible and caring doctors say nothing, as I read years ago as a headline on a Time magazine cover, "silence is death".

Just my opinion, but one of a good number of years of experience.

Thanks for the opportunity to write.

therapyfirst (board certified psychiatrist)

Score: 3 (3 votes cast)

September 14, 2008 10:16 AM | Posted by OhioSuz: | Reply

I'm 56 years old. I have been working all my life, raised 3 lovely children, pretty much on my own, and have been divorced for 15 years. I had a great job in the technology field with all the benefits including bi-monthly back massages. Unfortunately I happen to be diabetic. Because I worked for a small firm and was the only chronically ill person, I was laid off under the auspices of dwindling work. My performance was constantly praised by clients and co-workers, and there was never an obvious lack of client work. The only time I missed work in over 3 years was when I caught the flu from the boss's son who stayed in my office because he was too sick to go to school.

My layoff came just one month after the company owners reviewed health care costs for the company. You draw the conclusion.

In the ensuing months, because I was over 50, chronically ill and out of work, I was not able to get a full time job. So, I worked 12-14 hour days creating my own work; built a technology job and was hired by a small company who does my billing and writes my check. I do everything else. I do not have the "abundant health care" that's available. It is available only if you can afford to pay for it and are not chronically ill!

In the process of creating my job while trying to afford my medication, I lost my home. It was a highly emotionally charged year when that happened and now I receive indigent health care (even though I still work 10-12 hour days usually 7 days a week) because no on will insure a 56-year-old asthmatic diabetic at a cost that is affordable on my salary. I am grateful for the indigent care but am livid at the stigma of being indigent, when I am a bright, hard-working proud woman.

Losing my job and home threw me into a deep depression. I sought help from my doctor, who prescribed Zoloft immediately without trying to find out what the root cause of my depression was. After two weeks on Zoloft, major panic attacks, nightmares, severe anxiety and crying jags that simply would not quit, I returned to my doctor, and broke down, telling him that the depression was situational and no drugs would sedate away the problems. He sent me immediately to the local crisis center, where I sat, without food, for 6 hours while they processed me in. I kept asking for food, and reminding them I was a brittle diabetic. I was given a small green salad that consisted of about 5 lettuce leaves and a wedge of tomato. At hour 6, while I was sitting in the waiting room begging for food, my sugar level dropped so low I was completely non-functional. Instead of feeding me, they called an ambulance, and whisked me off to the hospital. En route to the hospital they took my blood sugar ... and the reading was 59. When I got to the hospital emergency room I was given a snack box that included a sandwich on white bread, potato chips, a cookie and soda. I drank the soda quickly and began to regain my awareness. I finished the meal and sat for 3 1/2 more hours in the waiting room until I finally got up and asked to leave. Because I was sent there from the crisis center it was mandatory that I return to the crisis center, and I had to wait another 45 minutes for the crisis center driver to pick me up. Once back at the crisis center I told them I was leaving and I would take care of myself, because they nearly killed me!

Two weeks later I got a bill for $600 for the ambulance ride and $1200 for the emergency room stay. A $2.00 Happy Meal would have prevented the drop, the ambulance ride and the emergency room stay.

It's now 2 1/2 years later. My home is gone. My job remains and I still am unable to get health care beyond my indigent care. At 56 years old I have had to move in with my mother, which in itself is not all bad as she is a cancer patient and I can help take care of her. I still get depressed at times, but I will keep it to myself. No one will ever convince me to take anti-depressant drugs again, and I will NEVER seek assistance from any medical profession about my mental state again!

And, lest you think I am a reckless person who caused my own illnesses, I don't drink or smoke. I do most of my own cooking, and choose whole grains, lean poultry, fresh fruits and vegetables and garden to be sure most of my vegetables are organically grown.

Score: 5 (5 votes cast)

December 30, 2008 5:57 AM | Posted, in reply to therapyfirst's comment, by jennylee: | Reply

board certified my ass

Score: -1 (1 votes cast)