I spend a fair amount of my work time listening to the sad, the despairing and the mad. The hallucinating, the deluded.
And those who are despairing for the things they built their lives on… their jobs, their spouse, their kids… have been taken from them: by accidents, by the court (which is no accident) or as a consequence of their disability.
When you listen to them, being a prig is not an option. Nor is saying that one cannot think that. We are allowed to be desperate. There is no medication for reality.
1 O LORD, God of my salvation,
when, at night, I cry out in your presence,
2 let my prayer come before you;
incline your ear to my cry.3 For my soul is full of troubles,
and my life draws near to Sheol.
4 I am counted among those who go down to the Pit;
I am like those who have no help,
5 like those forsaken among the dead,
like the slain that lie in the grave,
like those whom you remember no more,
for they are cut off from your hand.
6 You have put me in the depths of the Pit,
in the regions dark and deep.
7 Your wrath lies heavy upon me,
and you overwhelm me with all your waves. Selah8You have caused my companions to shun me;
you have made me a thing of horror to them.
I am shut in so that I cannot escape;
9 my eye grows dim through sorrow.
Every day I call on you, O LORD;
I spread out my hands to you.
10 Do you work wonders for the dead?
Do the shades rise up to praise you? Selah
11 Is your steadfast love declared in the grave,
or your faithfulness in Abaddon?
12 Are your wonders known in the darkness,
or your saving help in the land of forgetfulness?13 But I, O LORD, cry out to you;
in the morning my prayer comes before you.
14 O LORD, why do you cast me off?
Why do you hide your face from me?
15 Wretched and close to death from my youth up,
I suffer your terrors; I am desperate.
16 Your wrath has swept over me;
your dread assaults destroy me.
17 They surround me like a flood all day long;
from all sides they close in on me.
18 You have caused friend and neighbor to shun me;
my companions are in darkness.
It does not help when we are in despair, because the feelings are valid. But while we stand, we can recall that we are chose by God. We can approach God. And to him we can be honest.
12So then, brothers and sisters, we are debtors, not to the flesh, to live according to the flesh – 13for if you live according to the flesh, you will die; but if by the Spirit you put to death the deeds of the body, you will live. 14For all who are led by the Spirit of God are children of God. 15For you did not receive a spirit of slavery to fall back into fear, but you have received a spirit of adoption. When we cry, “Abba! Father!” 16it is that very Spirit bearing witness with our spirit that we are children of God, 17and if children, then heirs, heirs of God and joint heirs with Christ – if, in fact, we suffer with him so that we may also be glorified with him.
One of the basic principles of cognitive therapy is to challenge the accuracy of our perceptions. When we are anxious, sad… and particularly when things break, and depression rides through our life, we lose sight of those who love us. We become entrapped. At this times, people like Paul can speak: writing these words of comfort when he himself was not getting an easy ride in this life.
But pious hypocritical happiness? The use of medications so we do not feel good? Excuse me, no.
“But pious hypocritical happiness? The use of medications so we do not feel good? Excuse me, no.”
Does your NHS push for the use of psychiatric medication [as opposed to prescribing cognitive behavioral therapy]?
Here in America, private insurances are hesitant to cover cognitive behavioral therapy. I believe my old private insurance would only cover therapy if their client had been diagnosed with a mental illness and psychiatric medications were not effectively treating their illness. Alternatively, if a client suffered from substance abuse.
Despite my rheumatologist recommending therapy [and studies showing that cognitive behavioral therapy helps improve Rheumatoid Arthritis symptoms], my parents still had to pay out of pocket for my treatment. The last time I saw my shrink, he joked about how shopping addiction is included in the revised DSM. If had waited a few years to seek treatment, I would have been covered by insurance [...I sorta coped with my Rheumatoid Arthritis by going shopping].
Addressing the topic of this post: as much as I complain about the Pentecostal faith-healing nonsense; I think spirituality is one of the most powerful means to cope with an illness. It doesn’t heal you directly; it helps you deal with the constant uncertainty. It gives you hope [although I respect and trust my doctors and the medical field in general, there's realistic limitations. Doctors aren't magical healing deities]. Not everything is certain; self-righteousness is fueled by a person believing their perception is absolutely correct. They are wrong, of course. The only thing absolute in this world is God.
BF
You can access short bursts of CBT (4 -6 sessions) fairly easily in NZ, but longer work is very diffcult to access. And we use a lot of medications.
CBT isn’t very common in America. Since it’s rarely covered by
insurance, medication is really the only treatment option psychiatrists
here can prescribe. My doctor is an adolescent-family psychiatrist; I
think that’s why he doesn’t medicate as much and still offers CBT.
In America, It’s easier to access non-psychiatric therapy [which is
cheaper]. However it doesn’t appear to be a well regulated
industry. Just in NYC alone you can receive therapy for coping with past
life trauma, alien abduction regression, reiki to strengthen your aura
and disperse negative energy, aromatherapy, etc. A good example of this nonsense is Dr. Doreen Virtue [Ph.D in
psychology; not, like, a medicine doctor]. She’s famous [been on Oprah!]
for writing books about healing trauma by seeking guidance from angels and fairies that live in the spirit world. I can’t even make a witty comment about that – it’s just so out there.
Since I spent part of this week telling my employers that there are now three meta analyses saying debriefing after trauma does not work and may be harmful, and they were more concerned about the culture of care than the evidence, the choir is singing behind you.
Over here there is basically a max charge of 700 a year for psychiatry if you have private insurance. I work for a state owned health authority and a university. I don’t do private. Very few psychiatrists in NZ do — and when we do we get the therapy done by people who charge less.
…so retail therapy might be more effective than therapy-therapy? Lol
In America max charges depend on your insurance plan [there isn't, like, a state regulated max charge]. So a doctor’s pay actually varies by patient. I think my doctors [specialists] get around 200 bucks a visit.
No, economics. I cost about $300 an hour. A psychologist charges half that, and a nurse therapist a third. All three can read a CBT manual and use it.
I’m not sure how much my doctors cost an hour; they run their own
practices, so probably a lot. They have to pay rent/utilities, nurses,
receptionists, medical billers, and the worst of all insurance. Unfortunately, there aren’t many laws here to protect doctors from
frivolous malpractice lawsuits – so American doctors have to purchase
high-deductible insurance to prevent getting taken to the cleaners by a
malpractice lawsuit.
Anyway, I don’t mind my medical care costs. I value my doctors’
services, they deserve to be paid well. To be honest, I kinda pity
doctors. American society just isn’t very friendly to the medical
profession, law wise and attitude wise. Our media tends to portray
doctors [especially psychiatrists] as comic book supervillains; well educated fabulous greedy individuals trying to
“poison” you with unnecessary vaccines, or prescribe you unnecessary dangerous addictive medications. That’s why I was confused about the usage of psychiatric medications; all I’ve ever been told about them [via news, articles, etc.] is that they’re dangerous, addictive, and don’t work. For example, the media blames Xanax for Whitney Houston’s death. All the popular news and talk shows reacted to Houston’s death by bringing in a drug addiction expert to talk about how benzodiazepines are so dangerous and will harm you.
Um, sorry for going off topic.
Well, some of my academic colleagues mine the popular hollywood examples of psychiatrists and patients: it has become a topic of discussion.
Basic economics of professonal practice. The way to make money is to keep your overheads down. Below 50%. The traditional way a NY Psychiatrist did this was use his wife as his receptionist and book keeper, use the APA for insurance and certification (which is why they attend the conference: you can get 60 credit hours in a week) and that gets the overhead down to supervision, renting a room, and computer time.
The way most partnerships do it s cut the time you spend down. This includes hospitals self insuring for malpractice, 20 minute or ever 15 minute followup appointments, and the use of assistants to take histories. In NZ< we work on one hour for a new assessment and 30 minutes for rollowup — and we use nurses a LOT to do outreach. (we use the UK model, not the American one. We worry a lot less about things like the Bill or Rights)
One of the things you need to think about if and when your husband sets up by himself is that anything that you can safely and ethically do DIRECTLY INCREASES HIS INCOME. It means that eh is out making money — contracting, seeing clients, something he can bill for & not doing paperwork or paying someone to do it.
That includes selecting offices, decorating, book keeping, orgainzing the peer groups… typing … because any work hour he is not billing is a COST.
Me? I'm on a Salary. Much simpler, but I am choosing NOT to maximise my income for other reasons.