Category Archives: Healthcare

The Stigma of Mental Illness Extends to Healthcare Providers, Too

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I am going to write about something that very few therapists discuss – the common myth that therapists “have their shit together”.

And the reality that they don’t.

There’s a reason why you won’t find support groups titled “Therapists Anonymous”, “Bipolar/Depression Support Group for Therapists”, or “Help! My Significant Other is a Therapist!” and so on.

It’s simple, really, as oft-quoted by people who work in the mental health community, “We are supposed to always have our shit together.”

“Supposed to”.  Not, “actually have”. I can count on one hand the number of therapists I have met who are not suffering from some form of mental illness or substance abuse themselves.

It’s (maybe) surprisingly common.

The number one malady I have observed?  Substance abuse. Particularly of benzodiazepines (i.e., Valium, Xanax) and alcohol.

The number two problem? Mood disorders (major depressive, bipolar).

And a close third?  Personality disorders.

This last is truly alarming, because personality disorders are hard to spot and almost impossible to treat – for one thing, people so afflicted quite often do not think they have a problem.

Aside #1: There are 10 types of personality disorders, according to the DSM V (psychiatric diagnostic manual) – paranoid, schizotypal, schizoid, antisocial, borderline, histrionic, narcissistic, avoidant, dependent, and obsessive-compulsive. 

Mind you, I want to make it clear that this is based on my observations.  So this is my subjective opinion, nothing more.

The substance abuse issue usually will trip a therapist up in the end, because he or she will often violate boundaries with patients (especially if he or she is a drug and alcohol therapist), act inappropriately (as in, being obviously impaired at work), or get into trouble with the law (DUI, for example).

Although it’s not good for addicted therapists to be treating anyone, for anything, it is at least somewhat self-correcting before too much damage can be done.

The mood disorder problem is the most tragic – for the therapist, anyway – because since a therapist is often unable or afraid to get help, he or she can needlessly suffer for years without anyone knowing.  It’s tragic because it doesn’t need to be that way, but it is that way because there’s no quicker way to get fired than to admit that you have a mental illness.

So no one admits it.

Hiding one’s mental illness is critical.

In other words, the people who are supposed to be so tolerant, so understanding of people afflicted with mental illness are they themselves some of the most judgmental hypocrites around.

The same people who will tell a patient, “Depression is the common cold of mental illness” (6.9% of the American population – and that’s just those adults who are diagnosed – according to the NIMH) in order to reassure the patient that he/she is not some freak of nature, are the same ones who will go to a colleague’s supervisor under the guise of “helping” and relate that so-and-so is on antidepressants that “don’t seem to be helping”.

Aside #2: I have seen it happen to others.  I have had supervisors ask for my clinical opinion of colleagues, and I have refused to give it.  I have heard colleagues complain about other “crazy” therapists, therapists who were good at their jobs and were just too open about having a mental illness – thereby “tarnishing” that “got your shit together” reputation.

It’s tantamount to a doctor getting fired because he/she caught the flu, broke a leg, or suffered from a chronic condition like migraines.  Doesn’t make sense when you look at it that way, does it?

But this is also a good segue into the third mental health problem amongst therapists that I have observed – personality disorders.  And those people are truly dangerous, to patients and staff alike.

Manipulative, self-centered, and fond of drama, a therapist with a personality problem delights in treating very sick patients because he or she – and there’s no polite way of saying this – enjoys seeing people suffer.  And, in fact, I have seen and heard therapists like this make fun of patients in treatment team meetings, display a horrifying lack of empathy, and basically treat the patient as a form of entertainment rather than someone with whom to conduct therapy.

A therapist like this will also cause disruption between staff members, just to sit back and enjoy watching the chaos.  This behavior is evident to staff when patients do it – in fact, the term is called “staff splitting” – but seldom recognized in another staff member until it’s too late (when someone usually gets fired, and it’s not the “sick” therapist).

Aside #3:  I have also seen this behavior in nurses and hospital administrators.  I don’t know if healthcare facilities/professions attract this kind of person, or if I have just had more experience recognizing it.  But I have seen situations where a nurse will go after another, “more popular” (with patients and staff) nurse and get her fired before she knew what hit her.

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Ready…Steady…Work!!

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I have been thinking a lot about work lately. Because I want to go back.

I want to pay rent and bills, and have money left over to save for things like a car, a passport, and travel – particularly back to my beloved Belfast (which I still can’t see pics of without crying).

I want to be able to go shopping for food and not have to constantly add up prices, and reluctantly put things back.  I cannot even recall what that’s like, for the brief times I wasn’t poor.  I do recall it felt good, though.

I am not one of those people who, even when they make a decent living, pinches every penny and eats crappy food to save money.  I find them really annoying, those “cheap bastards”.

Anyway, I got to thinking, as I was reading websites yesterday.  Since I subscribe to a lot of healthcare blogs, news sites, and so on, I read a lot of stories about people who either are in therapy, or conduct therapy as trained and educated professionals, or “conduct therapy” as laypeople who think “I can do that, I don’t need education”.

I have softened my stance a bit on this last group.  It used to annoy me to no end when people would ask, rhetorically, “Why do I have to jump through a bunch of hoops to get a degree and get licensed, when doing therapy is so easy?  All my friends come to me for help, and they tell me I’m better than any counselor they’ve ever paid to see.”

I used to think, “You arrogant so-and-so!  Therapy isn’t just letting people state their problem, and then you tell them what to do, ala Ann Landers!  It’s nothing like that!”

But, oh, it is, to a certain extent.  It’s not supposed to be, but it is.

I have worked in quite a few places, mostly hospitals but some outpatient places, and with the rare exception, that’s exactly what the average person will find when he/she goes to a therapist.

Aside #1: Yes, my master’s degree is in experimental psychology, with a minor in special education. But, most of the core requirements are the same as clinical – until you get to the “practicum” part and the graduate level in counseling etc.  

However…when you have access to academic journals and read a lot of research on therapeutic techniques, plus get a lot of continuing education mini-courses/training seminars/conferences through the workplace, you tend to get a lot of clinical knowledge and can use that to drive your therapeutic techniques.  That’s what I did.

Example: The last place I worked at was a methadone clinic.  In my opinion, methadone maintenance is a good idea – in theory.  The theory being, of course, that you switch people from heroin to methadone, then get them off that completely via therapy and tapering.

What a stone pity it doesn’t work that way in practice.

At this particular outpatient facility, the clients had to have failed rehab a lot of times to even get in (not sure why that was a supposedly clinical requirement – but it sure makes for a profitable business).

Some clients came via court order, in lieu of jail.

Some came because they were pregnant (and Pennsylvania, unlike Tennessee and other places, does not automatically charge a woman with child abuse if she becomes pregnant while addicted).  They were worried about their babies.

Some came because they wanted a free alternative to heroin.

Only a few ever came because they wanted, really wanted, to get clean.

The program goes like this: You come in for your dose, and on days when you are required to go to either group or individual therapy, you do that first AND THEN dose.

Let me tell you, there’s nothing like leading group therapy at 5:30 AM with a group of people who are in various stages of withdrawal.  It’s not fair to them, and the fact that usually that was the ONLY way the company could get them into therapy speaks volumes about how ineffective the program is.

And how ineffective the screening process is.

Aside #2: When you admit patients to a program who pretty clearly do not want to deal with their addiction and get off heroin, you can be assured that those patients are going to be quite profitable for your business – because they’ll never get better, and they’ll consistently resist tapering off.  

Cha-ching!  Client for life – or until the insurance runs out.

I sat in on a couple of these “group therapy” sessions when I first started working there.  The first one involved the “therapist” (I cannot and will not call these people therapists, degree or not) playing Hangman with the group.

Hangman!  You know, the game where you guess the word by guessing letters.

Hangman!  Not “Hangman-and-then-we-discuss-these-terms-you-just-guessed-and-apply-them-to-your-addiction”   That might have actually counted as “psychoeducational”.

But just the game?  No, that doesn’t count as anything but “time-filler-for-someone-who-doesn’t-know-how-to-conduct-group-therapy”.  And, “easy-thing-to-do-with-clients-so-they-won’t-hate-me-because-I-won’t-let-them-dose-until-we’re-finished”.

This was typical stuff.  The other things the “therapists” did for group were:

~ Picked a topic and let clients ramble.

~ Brought a Bible and conducted Bible study under the guise of, not in addition to, therapy.  I am all in favor of using the Bible – or any other religious/spirtitual text – if the client’s beliefs are important to them, and if it is an adjunct to therapy.  But in place of therapy?  No, that’s completely unprofessional.

~ Went around the room and asked each client, “So, how are you doing?”  That usually ate up the entire time, and the “therapist” didn’t even have to talk.

Group therapy interventions like showing videos had to be approved by the director (who had no degree in anything, nor had any experience with addiction).  I wanted to show part of a video from PBS explaining where heroin comes from, and how it contributes to terrorism.

My idea was that maybe some clients who couldn’t be reached other ways would possibly be reached by this little nugget of knowledge. Especially if they were Gulf War veterans.

I wasn’t allowed to do it.  Why?  “Showing how heroin is made might trigger them to use.”

Trigger them to use??  When 80-99% of them are testing positive not only for methadone, but for illegal opiates, alcohol, and benzodiazepines?

Aside #3: “Benzodiazepines” are drugs like Xanax and Valium.  If you take them with any kind of opiate or alcohol, you get higher than a kite.  Or stop breathing and die.  Or both.  

This decision of hers just illustrated how little she knows about addiction, therapy, or…well, or about people in general, and addicts in particular, really.

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There’s an App for That: Hysteria Over Technology-Fueled STDs?

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I am pretty sure some people – who either ought to know better, or should keep their mouths shut – do not understand the difference between “correlation” and “causation”.  And they use this to stir-up hysteria over one thing or another.

This crossed my mind due to 2 articles I read: one was about the DEA’s claim that heroin use is on the rise, and that this is caused by pain medication availability; and the other is an article about Rhode Island’s increase in STDs that are supposedly due to the increase in “hookup” apps like Tinder.

Aside #1: I really don’t understand how my dad could have been the assistant director of the DEA, knowing how opposed he was to the war on drugs.  I guess he thought he could change things from the inside.  He believed that, basically, all drugs should be legal.  And the difference between he and I? He never got fired – a fact that I find astounding even to this day.

So… the first article was called “National Heroin Threat Assessment Summary”.  It begins by reporting that deaths due to heroin overdoses tripled from 2010 to 2013 – a total of 8,260 people.

I think it’s horrible and devastating when anyone dies, but let’s put this in perspective.  8,260 people out of how many people in the US?   324,892,909 and counting (“Worldometers Population Live Counter”, 5/27/2015 5:57 PM EST).  Although tragic and painfully meaningful to the families and friends of those who passed, this does not indicate an epidemic by any stretch of the imagination.

That’s the first thing that jumped out at me.  I wondered how it was that conservatives freak out over this.  But, let’s read on…

Aside #2: The DEA report PDF file keeps timing out and resetting.  I hope this isn’t a problem for you, too.  But now, as I write this and it has timed out for the 3rd time, I have to go to a secondary source, which I hate to do.  Sorry.

I am switching to a Rhode Island source, which will dovetail nicely into the article on STDs.  Rhode Island seems to have a lot of problems these days!

According the the Providence Journal

“The higher demand for heroin is partly driven by an increase in controlled prescription-drug abuse over the past decade. A recent study by the Substance Abuse and Mental Health Services Administration found that four out of five recent new heroin users had previously abused prescription pain relievers.” (“DEA Report: Heroin Use, Availability is Climbing”, Lynn Arditi, Providence Journal, 5/22/2015).

First of all, SAMHSA is widely used by rehabs, psych hospitals, and other mental health institutions for material on drugs – it’s a federal agency.  They do not have a vested interest in anything but a total ban on drugs, and they make that very clear in the literature they hawk to therapists and others.  They oppose legalization of marijuana and they also want to include “marijuana addiction” as a legitimate addiction for which people need treatment.

Because there is a lot of money in drug rehab facilities, and the more people you can diagnose as “addicts”, the more people you can get into rehab (using not only conventional tactics but also the drug diversion programs).

Anyway, I have a few issues with this “pain medication leads to heroin abuse” idea.  For one thing, the report often referenced by the good ol’ DEA is a self-report…by heroin users.

This is one study that makes such claims, and it is cited on the webpage National Pain Report (a site that purports to be pro-pain patient but isn’t really):

“Cicero and his colleagues analyzed data gathered from more than 150 drug treatment centers across the United States. More than 9,000 patients dependent on narcotic painkillers, or opioids, completed the surveys from 2010 to 2013. Of those, almost 2,800 reported heroin as their primary drug of abuse.” (“Study Finds Most Heroin Users Start with Painkillers”, Pat Anson, National Pain Report, 5/28/2014).

So, addicts who use heroin are saying they started with painkillers?  No, even their own quote which I just cited doesn’t say that.  If anything, it says that of the 9,000 opiate addicts (and it doesn’t say which opiates), 2,800 prefer heroin.

That’s all.  It does not say that heroin users started with painkillers.  Don’t people read??

But yes, I have heard that many, many times as a drug counselor, and I have already written about this in this blog.  The “prescriptions lead to heroin” trope.  And I have seen no real evidence of it, not in the way the anti-drug people mean, anyway.

“I had a back problem and the doctor prescribed narcotics, then cut me off so I had to turn to heroin.”

“A friend gave me pills and I got addicted.”

And so on and so on.  These reports are not reliable, and the reason?  Addicts lie.  A lot.  They will never say, “I love to party and figured I could get high on pills, but they got too expensive so I switched to heroin.”

Or, “I wanted to get high and another addict turned me on to some heroin.”

Many have had no history of pain medication abuse.  Many, particularly here in Central PA, have multi-generational heroin addicts in their families.   They start, and stay with, heroin.

I have only had one client tell me that the reason she used heroin was that it was fun, and she was also the most successful at getting and staying clean.  She was honest, which is the first step an addict needs to take before he/she can stop.

So the DEA trots out that tired old chestnut about painkillers and heroin in order to support its war against pain clinics and pharmacies.  And who are the real victims?

The pain patients.  Because it is getting harder and harder to get pain medication now.

What people fail to understand, besides that addicts lie, is that just because someone used pain meds earlier in life, and now uses heroin, does not mean one caused the other.

They used to say that about marijuana not too long ago, remember?  Heck, they still say that about marijuana here in Central Pa, because there is a heroin problem here and they don’t understand why, or how to treat it.  Their solution is to just toss everyone in jail.  And then let many plead out to go to rehab.  Cha-ching!

The DEA reminds me of a desperate, spurned lover who will do anything to achieve his/her ends.  Even when most critically thinking adults read the DEA report, and conclude that the DEA is grasping at straws, it still doesn’t deter them from proclaiming that prescription pain meds are evil and lead to heroin addiction.

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Sudden Falls, Parasols, Walking in Malls: Fitness Challenges for Those Over 50

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No ranting today, I think.  This is the fitness program part of my blog.  Because I figure if I write it down, I will be more likely to stick to a program – and can also come back and read my posts for motivation.

My goal is to lose a certain amount of weight by December, 2015.  Since it is May, I think that’s doable.  Not saying how much, but suffice to say I am now a size 16.   I am a lot more comfortable going by dress sizes than weight, because it isn’t so embarrassing to me.

So, by December, the goal is also to get to size 10.

I don’t remember when I was a size 10.  I was a size 8 at age 18, and can you believe I thought I was fat?!  I weighed 120 lbs at 5’4″.  That’s only fat by modeling standards.

Yes, the skinny standard has really not changed much since 1974, sad to say.  Women still think they are fat, pretty much no matter what size they are.

If it isn’t fat, it’s wrinkles/sagging/grey hair/arm flaps (don’t ask if you don’t know, but even Madonna has them, and she works out!).  Women are not really allowed to grow old gracefully.

But I digress…size 10 by December, ok.  That’s really only 3 dress sizes, and I think I can manage that.  If I drop more, my goodness I will be over the moon!

My plan is simple: Walk 30 minutes per day, at least 5 days/week.  And since my Oster “MyBlend” blender arrived today, it’s smoothie time!!

1-2 smoothies per day in place of meals.  I am aware of the calorie trap smoothies can be, so I bought whey powder, 1% organic milk, nonfat yogurt, and frozen fruit.  Protein and carbs.

No green smoothies for me!  Sorry, but I think that green smoothies are the most disgusting-looking drinks on the face of the planet!  I do not like green drinks to slam, I do not like them Sam I Am!

Plus, kale is notorious for having oxalates – and if you get kidney stones, oxalates are a huge no-no.  That includes nuts and nut butters (awww), rhubarb (yuck), potato chips/french fries (awww again), and beets (awww x 3!).

Of course, health websites also say that large amounts of protein can help kidney stones develop.  Damn!  Can’t win!  I’ll take my chances with that one.

What kind of monster would tell someone to give up cheese??  Ain’t happening.  I love love love cheese of all kinds.

So, that’s the plan.  Since I now eat almost nothing but fruit and vegetables – and cheese! – it should be easy.  Oh yeah and the beans and rice thing, too, got to get back to that.  Increasing fiber to a goal of 20-30 grams/day.

If I am still hungry after that (and I’m usually not, fiber is filling!), I tell myself I can eat whatever I want.  Since that is mainly whatever is in my apt, it’s limited.  If I want sugary yummy goodness, I have to either walk to the store, or pick it up once a month when I go food shopping.  That limits it quite a bit.

And even if I just HAVE TO HAVE A DONUT, the donut shop is nearly a mile away so I reckon I would walk off those calories in no time.   The fact that it is so far away, though, deters me from going there (that, and the fact that they replaced the Dunkin’ Donuts with a local, not-as-good donut shop).

The gas station that sells junk food is not far, but they don’t have the kind of junk food I like, so….the local Sheetz, however, does.  It’s half a mile from my apt.  I might actually walk there some time, but since I am so tired most days, it won’t be often.

I have been walking for a week now.  Down to Basin Park, then twice around the trails that go by the Juniata River and the band shell.  It’s a really nice park.  I will show pictures when I actually take good ones (didn’t know Moto had a zoom function, so all the pictures I have taken thus far are teeny tiny).

I have to admit, up until today, I hated my walks.

It wasn’t always that way – any time in the past when I did the walking-for-fitness thing, I enjoyed it for the most part.  But this last go-round, it’s different.

For one thing, I have to get up early so it isn’t hot by the time I get walking.  This is no easy feat, as I have two extremely annoying cats who seem to think it is their life’s purpose to wait about 3 minutes after I have closed my eyes…

Crash! A lamp, a glass, some books?  One cat on the dresser, looking pleased with himself.

I have a floor lamp that has shelves.  One of the cats likes to pull it down.  It’s fun to see all that stuff go flying, I guess.

Or…they could be sleeping on my bed, but a few minutes after I turn off the light to go to sleep myself, one gets up.  Taps me with his paw, on my arm or my face.  The other one finds a box and starts hitting the flap, over and over and OVER again (ok, got to get rid of boxes, I know, but I have no storage space).

So, there’s that issue – getting enough sleep so I can wake up decently at 8 am.  So far, I am dragging my ass outta bed with 4 hours of sleep.  I know it’s just a matter of time before I decide to walk later in the day.  But for now, I am cranky when I get up.

Aside: I can’t kick the cats out of the bedroom and close the door, because I only have one window a/c unit, and that’s in the bedroom.  They would get way too hot – I live upstairs and so it can get mighty hot in my small apt.

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It’s Just Getting Worse

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I was going to write about the horrible “religious freedom” (anti-gay) laws being passed in Indiana and Oklahoma, and being proposed in Georgia, because I think it’s bigoted and unfair.

However, I am now way too upset to do that.

Every 6 months or so, I am required to recertify for the SNAP program (food stamps).  After receiving my new card in the mail, courtesy of the efforts of my new caseworker (so I wouldn’t have to go through the embarrassment of my card not working properly)….

Now I no longer have food stamps.

When I got my recertification in the mail in February, I called my caseworker and asked what info he needed me to send in.  He looked stuff over and told me I didn’t need to send anything but the signature sheets.  I asked if he was going to do the phone interview that they sometimes do, and he stated that no, he didn’t need to do that but would call if anything changed.

I then told him I didn’t see the return envelope in the packet.  He said he would send one.

When I went to get the mail the next day, I noticed the return envelope had fallen on the stairs.  So, happily I put my signature sheets in and put it out for collection.  As it was gone the next day I just assumed the post office had delivered it.

Food stamp day came and went – it was April 10.  I bought my groceries as usual.

I didn’t give any thought to the return envelope my caseworker said he would send that I didn’t receive…until yesterday.

Yesterday I got a return envelope in the mail, POSTMARKED IN FEBRUARY, from the Dept of Welfare.

“Oh well,” I thought, “no big deal, as I already sent the info in.”

Today I got a letter from the Dept. of Welfare dated APRIL 7, telling me that as of April 1 I was no longer eligible for food stamps.  And that I can appeal if I want.

The reason?  “You failed to provide the information we asked for.”

I went online to check my status.  My SNAP balance is $12 and my account is active.

It is too late in the day to call my caseworker.  I will try calling him tomorrow morning.

I don’t understand this, but I am upset.  I cannot afford to feed myself and pay my bills too, without food stamps.  And I had just gotten to the point where my budget covers my monthly expenses – just barely, but it does.  I don’t owe anything to anyone at this point.

I have been fairly ill for the past 2 weeks, with the fever having returned, along with the other symptoms.  I feel like shit and I am in no shape to fight the Dept of Welfare over this, but I have to.

I am really hoping it’s all some kind of clerical mistake.  If I could use my EBT card on April 10, how could it be that I lost my benefits as of April 1?

I really like my caseworker and I hope he can explain this to me.  And why was my return envelope, which was sent in February, just turning up in April??

I mean, I didn’t need it, as I had found the original one and mailed it back in February, but it makes me wonder.  Hmm.  The address was correct, so I know it wasn’t misdelivered.

It didn’t have any markings on it, except the bar codes that run along the bottom of the envelope my caseworker sent it in were blacked out.  Hmm.

I am the least paranoid person on the planet, I truly am.  But even I have to scratch my head and wonder what is going on here.

This incident comes on the heels of my interaction with the pain clinic personnel last week, which was not pleasant.

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A Long Post/Rant: What’s the Question? What’s the Answer?

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I feel stuck.

Right now, in 2014, I am on disability.  In terms of disclosure I want to make it clear that my disability is based on having PTSD and……horror of horrors, bipolar disorder.  (Eventually they will add the mystery illness and degenerative disk disease, but that’s more paperwork than I can handle right now.)

I put it that way – “horror of horrors” – because I am really reluctant to disclose this.  The reason is because there is still a great deal of stigma attached to mental illness – and if a therapist has been diagnosed with it, it’s pretty much the end of his/her career.

Since I haven’t worked since I lost my last job in 2010, I think it’s probably a bit silly to think it’s going to matter if anyone – or everyone – knows about my struggle with a mood disorder.  After all, I have already disclosed about my experience as a domestic violence survivor, from where the PTSD came.

The bipolar disorder diagnosis is another matter, and I will get to that farther along in this entry.  Suffice to say. I am nearly 100% sure that was brought on by the use of antidepressants.

Side note: Even the DSM (Diagnostic and Statistical Manual. the book from which all psychiatric diagnoses are made) acknowledges that “antidepressant-induced hypomania or mania will now qualify a patient for a diagnosis of bipolar disorder” (“DSM-V Won’t Solve the Overdiagnosis of Bipolar Disorder – But Clinicians Can”, Psychiatric Times, 5/9/2013).

See anything wrong with that?  I do. 

The drug companies cause the disorder and then treat it as a disease.  And I can tell you from experience, even if you could convince a doctor it was antidepressant-induced, the usual treatment is still adding more medications like mood stabilizers or anticonvulsants.

Or perhaps by adding one of the newer antipsychotic drugs – they are being advertised all over TV and the internet for “when your antidepressant doesn’t work, add this.”

Back to the main idea…

I want to write about some things regarding the mental health system, criticisms mostly, and I feel it only fair that I disclose I now have experience on ‘both sides of the desk’.

Not that this makes my experiences any more valid than anyone else’s, but tell you what – I am really sick of people who have only had the experience of being a client/patient rant and rave against psychology as a legitimate field, because they have no idea what they’re talking about.

Oh! I bet you expected me to say something completely different, didn’t you?  Something like how sick I am of mental health professionals inflicting harm on patients?

I am sick of that, yes.  It’s the main reason I have lost jobs on a number of different occasions.  I have advocated on behalf of patients against hospitals who have not treated them properly, or haven’t treated them at all, or have treated them when they didn’t even need treatment.

I have convinced psychiatrists to release people who did not have a severe mental illness, and were being held against their will, because some admissions person lied about their assessment.

It happens.  Especially in the case of teenagers being committed because their parents couldn’t handle their behavior.  Or in the case of elderly people whose relatives wanted their money.

Another side note: I still have a lot of respect for some psychiatrists I have worked with, who backed me up and released someone against the screaming of the hospital administrators.  Hint: They’re all in practice in Memphis or Mississippi, in case anyone believes the only ethical professionals are in northern states.

I have gone to bat many times for patients – and have gotten fired.

Even worse, in some cases the patient’s family or the patient him/herself filed a grievance against me (!) because they didn’t think I had gone far enough – in other words, I had failed to obtain a discharge and so, because the patient or family didn’t have the guts to blame the hospital administrators and their lawyers, they turned on me.

Minor digression ahead…

I have had parents of patients demand that I lose my job because I had the nerve to suggest the parents might be part of the problem, that I couldn’t just “fix their kid” and hand the child/teenager back to them, all perfect and well-behaved.

Change?  Why should the parents have to change?  After all, they had “tried everything”…everything except consistency, that is.  In other words, they ground their kid “for a month!” then back down when they can’t take the whining, surliness, or other tactics kids use to get their way, usually only after a few days.

All the kid learns then is that they can outwait their parents.  Kids can whine seemingly until the end of time, and they know their parents have a limited amount of patience to ignore it.

In one job I had, I used to have a supply of earplugs I would give to parents, and instruct them to use them with their favorite music…so they wouldn’t engage in useless arguments and debates with their teenagers.

Because, as anyone with a teenager knows, it’s like arguing with a particularly obnoxious attorney. They’ll talk circles around you until you give in – just so they’ll shut up.

I have given parents behavioral charts and chore charts so they can let the child/teenager know what is expected of them (don’t just say, “clean your room,” because your definition of “clean” and theirs will probably be very different – be clear about what you want).  Complete with a point system and meaningful rewards for the child/teenager – not meaningful to the parents, and not “you get an iPhone for cleaning the bathroom on Saturday”.

To that, add consequences to the chart, if they don’t do things.  Not, “pull Jimmy off the sports team at school”, because that is what we call a “pro-social activity” and not something up for debate or loss.  More like, “Jimmy can’t go to the movies that week” or something like that.

If the parents do not see the difference between a pro-social activity like sports/choir/science club and a privilege like going to the movies, I know I have a lot of parent education to do.

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Ready to Roll!

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If you read my post yesterday, you know I was upset and crying.  Mostly because I still don’t know what in hell is wrong with me, and because during a routine test the doctor found some not-so-good things.

Today, I have a different attitude altogether.

Many of you who read my blog are friends of mine since high school.  You know that, back then, I was often in detention, once suspended (for saying the word “shit” in a speech at school), and more than a few times called into the principal’s office to argue politics (he thought of it as, “disciplinary action”; I thought of it as, “arguing with the fascist administration that runs my school”).  I was a hellraiser, no doubt about it.

Not so unusual these days, I guess, but when I was raising a stink about things, it was 1970.

I was a sarcastic, mouthy, sometimes foul-mouthed little thing who looked at the world in terms of capitalism vs everyone else.   To my friends, I was a source of amusement and a ‘nice, sweet girl’.

Hey, we’re all mutidimensional beings, yeah?

And, in some ways, I haven’t really changed much.

I have dialed down the sarcasm, a lot.  Sarasm can be terribly passive-aggressive, and in a few cases has gotten me in more trouble than it’s worth.  Like, “Ah’m gonna beat yo’ ass” kind of trouble.  That’s a southern accent, in case you’re wondering.

I am not really foul-mouthed, or I try really hard not to be.  I realize I called the anesthesiologist a “bitch” in my post yesterday, but I didn’t call her that to her face (but to be fair, it was probably because I was unconscious).  And I stand by that assessment.  Bitch, and a sadist.

I can get mouthy.  I find that things irritate me at pretty much the same rate they always have, when it comes to people being treated unfairly or unkindly.  The difference is, I don’t get mouthy with people with whom I disagree – it’s just not worth the aggravation.  If all they’re doing is thinking wrong-headedly about something, well ok.

Now, if they try to impose their wrong-headedness on me or on someone they are hurting, all bets are off.  I am going to say something.  Probably not loudly, and definitely not passive-aggressively.  I will address someone straight to their face, in as calm a tone as I can manage.

Sometimes that works, sometimes it doesn’t.  It works well in PA because people do NOT expect others to be like this.  But, to be fair, I haven’t seen a lot of Central PA folks trying to impose their wrong-headed ideas on others.  They seem to be, on the whole, live-and-let-live kind of people.  I have had 2 run-ins with people hitting me with sarcastic one-liners as they were walking by (yeah, strangers too, I have no idea why), but in general – ASIDE FROM THE HEALTHCARE PROFESSIONALS – people have been really nice to me.

So….anyway…I woke up today thinking about that anesthesiologist.  And I got angry.  Then I got an email from the colonoscopy folks, asking me to evaluate my experience (they are all into customer service, don’t ya know).  So, gleefully, I let them have it about the whole propofol/no lidocaine experience, told them I blogged about it, wouldn’t return AND would tell others to avoid them, and by the way was going to file a complaint against her.

Man, that felt good.  I even left my name and phone number, in case they call and I can rail against them some more.  Or find out the anesthesiologist’s name.  Hard to file a complaint if you don’t know their name.  I’ll find out eventually.

This got me thinking about Dr. Manic from State College, and another doctor (whom I have not yet blogged about) who actually made me cry during our appointment.  I made a big stink about him to his agency but I doubt it will do much good.  He is really a dickhead.

You might think, if you don’t know me, that I cry easily.  I don’t.  Well, I don’t think I do, anyway.  I think I cry when it’s normal to cry.  And when someone is putting me down, yelling at me, and/or playing head games with me – and it’s unexpected because I was there to see a professional as a patient – that’s going to make me cry.  After I get over the shock of being treated like that.

I am sick of it.

I am sick of being treated like crap because I am an ELI (extremely low income) person on Medicare/Medicaid.  And it doubly pisses me off because I am physically sick, so at a disadvantage in terms of being ready and able to defend myself.

Look at that – “defend myself”.  Why in hell should ANYONE have to be ready to defend themselves when they are going to a doctor for help or a procedure?  “Defense” shouldn’t even come into it!

No. No more.  I am currently looking to see if there are any consumer agencies in PA near me that I can join.  Because I want to cause problems for these healthcare providers and I don’t know how to do it alone.  Of course, I would guess that 90% of these agencies have a
*wink wink* “adversarial” relationship to the healthcare folks they are supposedly at odds with, so this is why I need to take awhile to find the one right for me.

Like, Minnesota has a patient advocate in every hospital there.  But they are employed by the hospital, so there are limits to how far they will go for a patient.  I know how that works, I’ve been fired enough to know.

Side note: I know that in some ways, Central PA can be really cliquish.  I learnt that when I was job-hunting last time, and when I worked at a local clinic (whose director was the sister-in-law of the business manager for the clinic, and there were other “personal connections” to the home office *wink*), and when I was subsequently fired from said clinic, and my subsequent (but few) attempts to find work in my field after that.  “Cold day in hell” I think is a good way to describe it.  Because they all know each other.

Now that the mental healthcare “community” knows me from the other side of the desk, so to speak (I have PTSD from the domestic violence and job loss), there isn’t one mental health/drug&alcohol agency that will hire me. There is that much stigma connected with a therapist actually going for help with a mental health problem. 

So I know what I am sort of up against.  That’s why I need to look at what agency I contact/volunteer for really carefully, because the last thing I want to do is waste my time and talent on an organization that’s as corrupt as the system I would like to take on.

So the search continues….and I will let you know what I come up with.

The bitch is back.

Today’s weirdness comes from the Huffington Post:

“Pizza Hut’s New Menu Supposedly Reads Your Mind…”

Apparently there is a new menu being tested in the UK for Pizza Hut, that uses eye-tracking software to make a pizza suggestion for you.

And we thought basic research had no real-world uses!  Eye-tracking was just beginning to be a hot research topic when I left the Cognitive Science Lab in 2000.  We didn’t imagine how this would impact the important world of pizza!!!

Movie recommendation, though I haven’t seen it…

“The Imitation Game”, starring the wonderful (Sherlock) Benedict Cumberbatch, Keira Knightly (Elizabeth Swann from “Pirates of the Caribbean”), and Matthew Goode (“Masterpiece Mystery: Death Comes to Pemberley” on PBS).

It’s about Alan Turing, how he cracked the Enigma Code during WWII, and how horribly he was treated because he was gay (which contributed to his suicide in 1954).  If you don’t know who Alan Turing was, go here.  If you don’t know how important his contribution was to the future discipline of cognitive science, go here.

I think this will be a good film.  Certainly the acting will be top-notch.

Until next week, or sooner as news develops….

Well, This Is What I Started This Blog For…

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I had a colonoscopy today.  I won’t go into details except to warn you all to DEMAND your anesthesiologist inject lidocaine into your IV line before he/she injects the propofol.  I forgot about this, and the sadist who was administering the anesthesia either didn’t know or care because it burned like nothing I have ever felt.  I kept asking her, why does this hurt, it’s never hurt before?  And all she said was, “take deep breaths.”

It wasn’t until I got home that I remembered that, EVERY OTHER TIME I have had to have propofol (for a lithotripsy, for example), they administered lidocaine so it wouldn’t burn.

Stupid bitch.  I am going to complain to my pcp, who I see on Friday.  It won’t do any good to complain to the colonoscopy dr, as he was right there when it happened and didn’t do anything about it – nor did the other 2 nurses.

Oh and one of the other patients who had a different anesthesiologist didn’t have any discomfort.  So I guess I got the incompetent one.

Right, so, back to the reason I started this blog – to keep family informed of medical issues so they won’t have to pull medical records and such when it comes to their family history, at least not from my side of the family.

The doctor found 4 polyps, which he removed.  He has sent them off to the lab to see if they are cancerous. The sheet he gave me referred to them as “adenomatous” (which means “might turn into cancer”) as opposed to hyperplasic (which means “never turn into cancer”).  Being a busy doctor, and me being groggy, I tried to get a straight answer out of him before he left the room – why the sheet on precancerous ones, if they weren’t?  He didn’t really give me an answer.

He said they will call with the results.  He left before I could ask him what the other part was, the “diverticulosis” mentioned in the diagnosis.  And why he now wants me to take a laxative every single damn day for the rest of my life (also in the notes, minus the ‘damn’ and ‘rest of my life’ part – those are just my assumptions).

So,,,according to WebMD, all diverticulosis means is “pouches in your colon”.  They don’t know why, they don’t usually cause issues, but one thing it does mean is someone needs more fiber.  Ok, a vegetarian needs more fiber.  *Confused look*  I guess I didn’t re-start my vegetarianism soon enough, and my former bad diet is catching up to me.  So THAT’S the reason for the daily fiber.  Ok, at least that’s one fewer thing to worry about.

Now I am just worried about colon cancer.  And I want to thank that moron in State College (see “Manic Medicos” blog entry) for bringing that up, because now I am beside myself with worry.  I don’t think fever and malaise are symptoms of colon cancer but hey, I am one of those people who thinks that if I don’t worry about something, it’s sure to happen.  Like I was so sure today would be a ‘find-nothing’ kind of day.   I didn’t worry, and sure enough he found something.

Conversely, if I worry myself to death about it, maybe it will be ok.  Like the breast biopsy I had 2 years ago – benign.  I nearly flipped out completely when I had to have that done, considering I lost a sister to that disease.  I was a nervous wreck, so much so that Dr. Wonderful called me on a Friday night to tell me it was benign, right after he got the results – he didn’t want me to spend all weekend worrying.

Why can’t all doctors be like him?

I am very superstitious today, and maybe I am worrying about the wrong thing.  Maybe it’s cancer of something else, something I hadn’t considered before.  And I have a feeling that when I go see Dr. Wonderful on Friday, he is going to schedule me for a mammogram, a pap smear, and whatever else he can think of.   Just to make sure I don’t have cancer.

Don’t get me wrong – I have my scheduled tests, always.  He was going to do them after I went to State College, because he is also convinced I have lupus or something similar.  Now perhaps the priorities will change – I don’t know, I’m not a doctor.  I trust him, though.

This day highlights the problem with living far from kin.  I really could use a shoulder to cry on.  I did cry on the way home, as my friend Nancy drove me, and she was very supportive.  And since she lives downstairs, she is always around in case something happens.  I am very lucky to have a friend/neighbor like her.  I am going to see what really nice thing I can get her for Christmas.

But it’s not the same as family.  And, no matter how much of an animal lover you are, cats are NOT the same as family, not really.  For one thing, they can’t talk.  For another thing, unless these 2 get up to weird things while I am asleep, they can’t access the internet and look up medical things for me to ease my mind (I assume they can’t use the internet, because I don’t have weekly deliveries of cat treats coming to the apt, which for my cats would be the only reason to use it).  They don’t know what ‘crying’ is – hey, if your cats do, great, but mine don’t seem to.

Just another reason to consider moving.

Anyway, once I know the lab results, I will post them.  Because it’s important for my kids to know.  They might all now have to have colonoscopies starting at age 40, according to the ‘fact sheet’ I got from the doctor.  But only if the polyps are the bad kind.  So they need to know.  And have a record of it (that’s what this is).

See you tomorrow.

And if you’re 50 or older, get a colonoscopy but remember the lidocaine!

Manic Medicos, Nitwit Nurses, and Fernando

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Oh, and a van driver who looked kind of like Boromir from LOTR.  But wasn’t nearly as charming.

I finally went to my much-anticipated doctor visit in State College.  Maybe I was going to get a hint about what ails me, or at least more tests.

I got neither.

You know, for a pagan I really do not pay attention to ‘signs’.  Maybe I should.  The day didn’t exactly start out on a good note.  Let’s start with the 40 mile ride to State College…

On the ride over, the van driver regaled me with a somewhat graphic description of falconry.  He really enjoys it.  I wanted to throw up.  This chick’s a vegetarian not just for her health.  I won’t even describe it because it is pretty disgusting, except to say, “Poor bunnies!  Poor squirrels!”

Now look, if he really were Boromir and we really were in some mythical land where, for some bizarre reason, the only modern convenience was a medical transport van AND we had no other way to eat…ok I still wouldn’t do what he does but I might be able to understand why he would do it.  Kind of.

Actually, I don’t think there is any justification for falconry, and his only explanation was that all the falcons in the US would die if it were not for people like him to capture birds, hold them as prisoners, and make them hunt.  Because, you know, falcons wouldn’t hunt on their own? They just sit in trees thinking in their little birdy heads, “Gosh, if only a human would come along and capture me and take me to where all the prey are, because I can’t work out how to find something to eat!” ??

So…….then the conversation turned, for some reason, to cat-calling.  Maybe thinking of birds made him think of cats (who, by the way, he doesn’t believe have the ability to think, but that “God just programmed them to survive” – clearly this man does not have pets besides falcons). And then for some reason, “cats” made him think of cat-calling, because he said, inexplicably:

“You know what I don’t understand about this whole ‘talk to women’ thing?”

(“Why they won’t talk to you?” I am thinking)

“They wear these sexy clothes and then get mad when a guy looks at them!”

I wanted to jump out of the van.  Or push him out.

Instead, I said something like, “It’s the fact that we can’t walk down the street without men demanding we respond to them speaking to us, is all.  We are not on this earth to be at y’all’s beck and call.”

Turns out, as I found out on the ride home, he is a Christian and, indeed, does believe that women were put here to be at men’s beck and call.  But to this remark of mine, he said nothing.

Fortunately, we had arrived.  At a destination in State College.  Unfortunately, it was not MY destination.

The van company gave him the wrong address.

I had written down the right one, though, but it was all the way back about 10 miles the way we had just come.  I assured him I would not get him in trouble, as it was his first day, or so he said.  Wasn’t his fault anyway.

So I was late for my appointment.

Upon arrival, I was impressed by the doctor’s waiting room – quiet, well-lit, small but cozy, with a really nice receptionist.  The nurse who called me back was nice, too, until….

(You expected conflict, didn’t you? Admit it!)

…we got to the question about allergies.

Nurse Nitwit (not her real name!): Allergies?

Me: Yes, blah blah blah sulfa drugs blah blah…

Nitwit: Wait! You can’t be allergic to sulfa, you take ___________ (a sulfate drug).

Me: Sulfate and sulfonamides are not the same.  I am allergic to sulfonamides.

Nitwit: But they both contain sulfur!

Me: Yes, but….sulfur is everywhere, even in our bodies.  “Sulfa” allergy just refers to sulfonamides, not sulfates or sulfites.

Nitwit: (blank stare)

Me: Look, if you give me a sulfonamide antibiotic or diuretic, I am going to break out in hives.  I took ___________(sulfate drug) today, and have been taking it for 2 years.  Do you see any hives?

Nitwit: I don’t believe that.  I think you should see an allergist.

Me: Please put this in my chart and we’ll let the doctor figure it out, ok?  I mean, you wouldn’t want to be responsible for an anaphylactic incident if she prescribes something I am allergic to, would you?

Nitiwit: (sighing) No…Ok.

The rest of the intake was uneventful, but I was fuming.  Why should a patient have to argue with a nurse over drug allergies?  What about other patients this nurse may have put in danger because she is an idiot?  No, nurses should not be completely versed in pharmacology but they should at least be aware of common drug allergies and cross-sensitivity.  Because those things can result in death.

She left, and then the doctor came in.  Or, I should say, “jogged in” because that is precisely how she entered the room.  And would not shake my extended hand.  I don’t know why, but I always take the ‘not shake your hand’ thing as a bad indication.  And I am always right, the interaction will go downhill from the get-go.  As it did this time, too.

“Hi, how are you? Why did you come to see me today? Let’s pull up your medical records,” she said all this as one huge run-on sentence, not giving me any time to reply.

In my profession, we call this “pressured speech”.  It is one of the clear symptoms of:

Stimulant abuse, bipolar disorder, or too much coffee (yes I know coffee is a stimulant, but, unlike the geniuses who wrote the DSM-V, I differentiate between too much coffee and, oh say, cocaine abuse).

So now I am caught off-guard.

Side note for all you cognitive psychology fans: There is something called “schema theory”, which is the idea that we all have ‘scripts’ for situations like “going to the doctor’s office”.  If we are asked to imagine that, most of us will usually say, “go to an office, sit and wait, go to exam room, get bp and temp taken…” and so on. 

Nowhere in my “going to the doctor” schema does it include rapid, pressured speech.  So already I am a bit thrown because this interaction doesn’t fit.  It fits the “working-as-a-therapist-in-a-psych- hospital-and-interviewing-a-bipolar-patient-who-is-having-a-manic-episode” schema.

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Bedlam Over Halloween

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Before I start ranting, I have an update on the strange occurrences in my apartment.

After the box-tossing incident in the hall, I had another experience later on that night. My cats, who were on the bed, suddenly both turned, froze, and stared at the bathroom. I thought, “Oh no what now??”

The toilet flushed.

By itself.

Both cats, being brave little kitties, once again dove under the bed.  Times like these, I wish I had a dog.

Oh sure, it’s funny NOW, but think how you would feel when it’s late at night, you’re already tired and still a bit freaked out due to the weirdness of the past 2 days, and suddenly this happens!

It’s creepy from the get-go, seeing both cats freeze and stare like that. Because I know they are looking at something I can’t see.

I really hope it stays quiet now. But since I don’t know what it is or why it’s doing things, I am still somewhat unnerved. And while flushing a toilet is hardly menacing, it’s still weird.

This is not helping my health, either, as I am now having trouble sleeping (well, wouldn’t you??). My low-grade fever continues, though the stomach issues seem to have resolved for now. But I am glad that my doctor’s appointment is rapidly approaching. Maybe I can get some answers.

Feeling like crap AND feeling scared is not a good combination.

Anyway, on to the article…

bedlam: noun:  1.  (obsolete) Madman, lunatic  2. Popular name for the Hospital of St. Mary of Bethlehem, London, circa 1529   3. A place, scene, or state of uproar and confusion
(Merriam-Webster online dictionary)

This article is not going to be amusing or funny, until the weird news part at the end.  But I hope it at least makes some people think.

I chose the word “bedlam” instead of “confusion”, “uproar”, or any other synonym, because this article is about the portrayal of people with mental illness (or developmental delays) through Halloween scenes and costumes.

The people who adhere to the concept that most people with mental illness or developmental delays are dangerous and scary are, to put it mildly, confused.

And I am in a uproar about it.

Yes, people who are mass murderers and serial killers are frightening – of course they are. No one disputes that. Someone in a haunted house attraction chasing people with a fake chainsaw is not offensive to me. But I am not writing about that.

According to “Serial Murder: Multidisciplinary Perspectives for Investigators” (U.S. Department of Justice and the Federal Bureau of Investigation, published results of symposium in San Antonio, Texas, August 29 – September 5, 2005), “as a group, serial killers suffer from a variety of personality disorders, including psychopathy, anti-social personality, and others.”

Personality disorders are mental illnesses, to be sure, but psychosis is not necessarily a part of their symptomology.

The report also states that serial killers do not meet the legal requirement for insanity, which is

“Mental illness of such a severe nature that the person cannot distinguish between fantasy and reality, cannot conduct his/her affairs due to psychosis, or is subject to uncontrollable compulsive behavior.” (The People’s Law Dictionary, Gerald and Kathleen Hill, 2002, as incorporated into the Law.com website)

So, it seems, clinically and legally, serial killers are not, on the whole, psychotic.  Consequently, to lump people with mental illnesses that feature psychosis (schizophrenia, for example) in the same group as serial killers is not accurate.

Yet this is exactly what is being done every time someone puts out a prop or dons a costume portraying a “crazy person”.

Part of the reason there is a perception amongst the public that serial killers are psychotic, in my opinion, is because people do not understand the difference between personality disorders and illnesses that feature hallucinations and delusions (like schizophrenia).  Another reason is the very human trait of trying to make sense out of nearly incomprehensible acts of horror, and…

~ We don’t understand why someone would do these horrible things, so it’s easier to just say “they’re crazy”.

~ We want to be able to identify someone who could do these horrible things, in order to arrest them or keep them from committing crimes in the first place.

Additonally, it makes for a more interesting news story or book if the killer did what he did because voices told him to or because he thought he was battling aliens.

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