Category Archives: psychiatry

Laws Cause Crime

The government thrives on crisis.  If it doesn’t have one, it will create one, in order to justify wasting more money and grabbing more power.  The “opioid crisis” is a case in point.  To suggest this is a manufactured crisis invites challenge, because I am a lone voice against a deluge of government, media, institutional, industry, and public claimants who insist the “crisis” is real and in need of drastic counter-crisis interventions.

As I recently trudged the forty hours of propaganda training necessary to renew my medical license, I noted a new requirement by the state of Georgia to undergo three hours of training in opioids.  In studying the materials, I also learned about Prescription Drug Monitoring Programs (PDMPs), which are “state-operated databases that collect data on dispensed medications.  They periodically send reports to law enforcement, regulators, and licensing agencies, as part of an effort to control diversion of medication by prescribers, pharmacies, and organized criminals.”

Let’s be clear, here.  The histrionic references to the “opioid epidemic,” this “public health emergency,” and its fatalities usually involve heroin, which is increasingly adulterated with fentanyl.  Heroin is absolutely illegal in the US, so no doctor can prescribe it.  Fentanyl is used in surgery and exists as a patch, and is not injectable.  Most fentanyl is obtained illegally, and some sources say it is coming from China.

So the database to track prescribers and users of controlled substances sounds more like a government control strategy than any genuine attempt to protect users from overdoses.

Meanwhile, as I stewed over the “gotcha game” of putting doctors in the firing line of this artificial crisis—damned if you do and damned if you don’t–I received a notice requiring me to show up in court for federal jury duty.  Unlike jury duty for local court (which I did a month ago), there is a dress code for the feds.  Women must wear a dress or pants suit.  So I hauled out my one dress—a fall dress—and washed most of the musty smell out of it.  Already I was plotting ways to get myself disqualified without going to jail.

I have long protested the almost rabid encroachment of the federal government on individuals, most vividly embodied in drug laws.  I retired over the virtual mandate to prescribe, with psychiatrists marginalized into “medication managers,” and psychotherapy turfed to less expensive psychologists and social workers.

Meanwhile, drug laws as part of the patriarchal government control and revenue machine has a long history.

Wars have been fought over opiates.   Although their medicinal powers have been known for at least 6000 years, in the Middle East, Roman, and Greek civilizations, and Asia, the practice of smoking opium was brought to China in the 1600s by European traders.  By 1729, there was so much addiction that China outlawed it because it made opium smokers unfit for work or the military.  However, the British used slaves in India to grow the opium poppy and to smuggle the drug into China.  Presumably, the Chinese were willing to buy the opium with gold, and gold was leaving the country.  This led to the Opium Wars, which the British won, and through the Treaty of Nanjing and subsequent ones, forced China open to trade with the Western World.

My Goodman and Gillman’s The Pharmacological Basis of Therapeutics claims that “opioids have been the mainstay of pain treatment for thousands of years, and remain so today.” Opiates and opioids are highly addictive, and tolerance to their euphoric effects builds faster than to physical effects, such as respiratory depression.  This can lead to fatal overdoses, as the user takes more and more drug to reach euphoric levels.  When combined with other drugs that depress the respiratory center, like benzodiazepines (such as Valium, Ativan, or Xanax), or alcohol, the risk for fatal overdose is magnified.

The Harrison Narcotics Act of 1914 put the federal government in control of every aspect of the opiate and coca supply-and-distribution chain, as well as insuring taxing power over them.  There are strong arguments that it was a racial discrimination tool.  It was claimed that cocaine was improving Southern blacks’ gun marksmanship and causing them to rape white women.  Chinese immigrants were seducing white women with opium.  Later, the Marijuana Tax Act of 1937 was used to control the Mexican immigrants who had used marijuana as part of their culture for centuries.  US citizens, who had used “cannabis” in their tonics, did not know it was the same substance as the Mexicans’ “marihuana.”

Fast forward to 1970, when the Controlled Substances Act (Richard Nixon), instituted a schedule for approved substances.  Both heroin and marijuana were assigned to Schedule I status: no medical benefit and absolutely illegal.

The Drug Enforcement Administration was created as a sub-agency under the Department of Justice on July 1, 1973 to enforce the Controlled Substances Act, among other things.

The “War on Drugs,” begun by President Nixon in 1971, was vigorously pursued by President Ronald Reagan, who took office in 1981.  For-profit prisons began emerging after 1980 to accommodate the massive incarcerations that resulted.  Reagan’s Anti-Drug Abuse Act of 1986 dramatically increased the number of incarcerations and length of sentences for drug-related convictions.  As of 2008, 90.7 percent of federal prisoners were incarcerated for non-violent offenses.  At present, the US has the highest rate of incarceration in the world, 724/100,000 people, compared with Russia in second place, with 581/100,000 doing time in prisons, jails, on probation or parole.  The US has 25% of the entire world’s incarcerated population, with black men comprising almost half.

Laws cause crime, according to me, and drug laws are especially guilty of creating the criminal element that is filling the prisons.  So last week, when the federal judge read the indictments against the young, black, male defendant, who was charged with conspiracy to distribute cocaine, methamphetamine, and marijuana, I knew I could not be impartial.  The judge listed all the members of the federal prosecution team, the local narcotics squad, and the members of the Georgia Bureau of Investigation team who had participated in this gang bang (my take) on this one guy and his lone, white, female attorney.  When the judge asked if anyone had any issues with the federal government, my hand shot up.

I was handed the microphone, stated my name, and said I retired over drug laws.  The judge asked if I could consider the facts of the case as they applied to the laws.  I said the laws themselves are criminal, and, to my mind, the federal government is on trial, here.  It is guilty of practicing medicine, and the defendant is innocent. (That’s how I remember it, anyway.)

“At least she’s honest,” the judge said.  At that point all the lawyers agreed that I would not be a good juror.  I was dismissed and did not get arrested on the way out.

Now, we have the ongoing “opioid crisis,” a new twist on an old theme, once again designed to control through fiat and insider collusion, people’s rights to self-governance.  The institutional powers-that-be have ganged up to push misleading propaganda on the public.  First, the officially prescribed “cure” for this crisis is more money, and more government and institutional control, specifically for “medication-assisted treatment.”

The misrepresentation in reporting shows in its superficiality, with slants calculated to confuse the facts.  First, in reporting numbers of fatal overdoses, heroin is included with other opioids, including prescription pain medications.  Heroin exists in its own category, because no doctor can prescribe it, so there is no legal way to obtain it.  Doctors are being targeted for over-prescribing opioid pain killers, so there’s the push to put more controls on prescribing MDs.

Another flaw in the reported statistics is that “overdoses” are not broken down to determine how many drugs may have contributed to the death.  Accidental overdoses of all medications are increasing, primarily because people are taking too many different medications—not all psychotropics– with cumulative side effects, including respiratory depression.

“Medication-assisted treatment,” is—no matter what they claim—substituting one pill for another, and yet another plank in the pill-pushing platform of the “health-care industry.”  The three drugs approved for treating “opioid use disorder” by the FDA include methadone (an opioid agonist) and buprenorphine (an opioid agonist-antagonist) —both opioids themselves—and naltrexone (an opioid antagonist). Now, “providers” need special licenses and special training to prescribe buprenorphine.

The psychiatric establishment is pushing for more funding for more “addiction specialists” and more legislation to curb this dangerous trend.    FDA Commissioner Scott Gottlieb is pushing for more funding for more treatment and insurance coverage.  They brag about how all the professional and government organizations have joined in “partnership” with drug companies to find ever more effective strategies for treatment.

Never mind that an internet search leads to addicts who extol the highs they experience from buprenorphine.  Addicts are happy with methadone, too, and can fairly easily switch dependencies, especially if they add other drugs.  The high from buprenorphine isn’t as good as with heroin, they claim, but it can be enhanced with benzos like Valium.  The withdrawal is easier than with heroin, but it lasts longer.  Nausea and vomiting are problems.

Never mind that most substance abuse treatment is notoriously ineffective, with most studies following patients for a year or less.  The mainstay of treatment since 1935 has been the non-pharmacological approach of Alcoholics Anonymous and its spin-offs, like Narcotics Anonymous (NA) and Cocaine Anonymous (CA).

So where’s the crisis? It is claimed Prohibition gave rise to organized crime, because the best way to raise the price of anything is to put controls on it.  Do laws cause crime?  With all the lawyers practicing medicine in Congress and in the Supreme Court, I have to wonder if they do.

 

 

 

 

Emotional Honesty

My father insisted that men were rational, women emotional, and therefore, women were irrational and inferior to men.  He liked to prove his point by provoking his wife and daughters into a rage, at which time he would sit back and smirk. I learned from his example that emotional expression showed weakness and inferiority, so hid or denied my emotions until I finally realized he was wrong.  Over time, I discovered that much of the maturation process involves un-learning beliefs and attitudes picked up almost by osmosis from early conditioning.

My father was not a bad guy, and he was probably rather typical of his generation.  Untold generations of men and women throughout history have believed and perpetrated the idea that intellect is superior to and at odds with emotion, yet this is fallacy.  The way the brain is wired, all sensory input travels through the pain (thalamus) and emotional (limbic) centers before reaching the frontal cortex, where intellectuality resides.  This implies that even the most intellectual and rational thinking is influenced by emotion.  What we choose to focus on, our interests, our skills, are all based on intent or desire, and their emotional significance to us.

Emotion gets a bad rap because it is associated with lack of control, as in the emotions of anger or fear.  But denial of emotion makes a person particularly susceptible to being manipulated by it, a major tactic used by advertisers and propagandists.  Targeting people’s insecurities, such as feelings of inadequacy or vulnerability, makes them more suggestible and more likely to buy the product or agenda being promoted.

The artificial split between emotion and reason is culturally created at an early age, when children are told what they “should” or “shouldn’t” feel.  The words “should” and “feel” do not go together.  Feelings are.  While it may be improper to act on certain feelings, to deny their existence only leads to repression, distortion, and dishonesty.   If allowed to run their course, emotions generally evolve into something else.

The greatest value of psychotherapy is that it helps people find words for their feelings.  A diary or journal can serve the same purpose.  The words help bridge the gap between emotions and intellect, by making the feelings conscious and less threatening.

Ideally, emotion and intellect work together to guide thinking and behavior, but for this to happen, emotional honesty is crucial.  Some experts claim addiction is a disease of lying.  A more fundamental explanation is based on the Freudian model describing the stages of psychosexual development.  In the anal stage, which occurs around two years old, the child begins to learn self-control, symbolized by potty training.  Here power-struggles with the parent can begin, as the child learns boundaries and the meaning of the word “no.”  This phase is thus termed the “terrible twos” because of the child’s resistance to new structure and boundaries.  Successful mastery of this phase allows the child to develop healthy attitudes towards authority.  If this phase is not successfully negotiated, the child may develop life-long issues with authority.  In an alcoholic or addict, this shows in the see-saw between overly controlled versus out-of-control behavior, as internalized authority struggles with the inner child in a contest for power over the will.

This is why one of the maxims of addiction recovery emphasizes changing the concept of “power over” to “power to,” in which the individual harmonizes the opposing forces to achieve balance.

There’s a mistaken belief that emotional honesty must be rude, crude, or uncivil.  I’ve had people insist that people want you to lie to them.  Some believe in telling people what they think  the other person wants to hear.  I disagree and claim that tactful honesty is actually a sign of respect.

This is another benefit of psychotherapy or of journaling.  Having the words for feelings provides a broader range of tools for communication, and allows for reasonable expression of emotion in a rational manner.

 

 

Masochists, Martyrs, and Victims

I’ve been going through old files of articles and clippings, trying to simplify my life.  While younger people talk about productivity and greed, I look at the yellowed and dusty results of having produced and saved too much that has nowhere to go, except the trash.  The exercise is gratifying and humbling, because I used to know and care about many more things than I do now.  There are remnants of lost causes, one of which was my career.

I re-read ‘The Masochistic Personality,” by Stuart S. Asch, a psychiatrist who claims a difference between the sexual masochist and the personality type.  The former gets his kicks by being dominated and abused by a certain type of person.  The personality type is not specifically sexual but courts disappointment or humiliation.  The term is derived from Leopold von Sacher-Masoch, a 19th century Austrian novelist who wrote about sexual gratification from self-inflicted pain.  Some psychiatrists believe self-mutilation is also one of the traits.

The article focuses on the personality type, which has been dropped from the official list of psychiatric diagnoses, the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), although the term retains historical and descriptive usefulness.  Asch says masochists desperately seek approval and love.  The masochist is strongly self-critical, having introjected an abusing authority figure who approves of self-punishment for forbidden sexual or aggressive thoughts or behavior.  Masochists will abase themselves repeatedly or in ever more humiliating gestures to obtain the approval or extract guilt from the unloving, rejecting love object.  They tend to blame fate for their repeated failures.

Asch mentions animals, who apparently develop more intense bonds to an adult that inflicts pain in early life.  Indeed, in human beings, there seems to be a pattern of stronger attachment to an abusing parent.  Genetic theories have contributed.

Asch doesn’t discuss sadism, with that term ascribed to the Marquis de Sade, who wrote in the 18th century about people who experienced sexual pleasure by inflicting pain on others.  Sigmund Freud attributed this to fear of castration, which leads the sadist to act out his fear on others.  In my view, masochists and sadists need each other, and each carries traits of the other, like two sides of a coin.  The metal that binds them together is blame.

The coin of blame buys religions, lawyers, governments, soldiers and toys. Everything from religion to law to parenting holds self-sacrifice as a noble standard, in the name of loyalty, duty, or spiritual progress.  Society at large reinforces the sado-masochistic power struggles that have become the “norm” for Western beliefs.  To falter brings guilt and, often, punishment. The ominous “they” are blamed for universal problems that “we” feed into without acknowledging “our” contributions.

I read with the distance of time and recuperation from the world of medicine.  There is such rigid judgmentalism built into the discipline that patients become guilty just by being patients.  I can already hear the screams of protest from my former “colleagues,” who are masochists for putting up with this arbitrary system of classification known as the DSM-V  and who collude with such an inhumane approach in the name of scientific objectivity.

Moreover, psychiatry as a discipline errs by not addressing the generalized ills built into the national psyche.  For psychiatrists as a group to diagnose and presume to treat the individual effects of PTSD (Post-Traumatic Stress Disorder), for instance, without addressing the causes of PTSD—primarily war–is abhorrent.  To attempt or pretend to treat symptoms of substance abuse or attention-deficit hyperactivity disorder (ADHD), or even depression, without delving into society’s contribution to the problems is, to me, an abdication of responsibility that puts the profession to shame.

What does this have to do with masochism?  Maybe nothing, except that by taking such a narrow view, the institution of medicine begs to be punished, as though it knows it’s wrong but will continue unchecked until something or someone puts a stop to it.

The victim role is the hardest to give up.  It’s easy to blame someone else when things don’t work out.  The masochist holds grudges and denies his role in his own trajectory.  He will find or create a controlling sadist to manage his life for him.  Power struggles ensue, with each blaming the other when things go wrong. Unfortunately, healthier choices are overlooked in this struggle, one that erodes self-respect and mutual trust.

Drug use going up?  Suicide rates rising?  All manner of psychiatric and physical illnesses swelling like a pregnancy?  Violence increasing?  Fear and anger seeking catalysts to ignite them into something cataclysmic and definitive?  Look for someone and possibly many people or groups to blame.

A retrospective analysis of “The Masochistic Personality” reveals more about psychiatry’s limitations than its strengths in understanding human nature.  Perhaps psychiatry’s move from early, descriptive interpretations to the codified DSM, its increasing reliance on medications, technology, and “scientific,” measurable results, under the pretext of objectivity, renders it less human and compassionate, and thus less relevant to real life.

From the beginning of my studies, I noted the preoccupation with pathology.  What a difference from astrology, which shows the dynamic interplay of strengths, weaknesses, and how perception often determines the difference.  Oriental belief in qi gives a similar picture of dynamic patterns, with a concentration on health maintenance.

In contrast, the Western love affair with trouble, under the guise of reason, logic, sequential, and binary thinking, that shows in its approach to medicine, is like putting blinders on to see only a narrow range of information and to deny everything outside the limited field.

No one else attempts to diagnose society at large, but I see unsettling correlations between Freud’s anal stage of psychosexual development and the current sado-masochistic world we live in.  Have Americans been unable to mature beyond the “terrible twos,” the age at which Freud claimed toddlers learn sphincter control and appropriate use of power?  Successful negotiation of this stage leads to good boundaries, healthy respect for self and others, and the ability to tolerate a degree of frustration. Shame and doubt mark those who fail at this task.  They are prone to power struggles with internal and external authority figures throughout life.

A culture carries its own karma.  I don’t understand the blame game.  I don’t blame anyone or anything for what we have created, because blame only perpetuates the problem, at the expense of solving the problem.  Not to avoid the problem but to understand that anyone could have created it, and everyone can learn from it – this is the challenge.

 

 

Drugs, Drugs, and More Drugs

The pharmaceutical industry in the United States has hoodwinked the public into believing its snake oils are worth the money you pay.  The government, “health care industry,” and insurance companies are happy to comply, and maybe some of them even believe their hype.

This does not stop them from jacking up the prices of necessary medications, like insulin for diabetes.  According to the New York Times, Martin Shkreli set a new record for Wall Street greed when he acquired the rights to Daraprim, a life-saving anti-parasitic drug, in 2015 and hiked the price from $13.50 to $750 a pill overnight.

The NYT says the Trump administration “went ballistic” when Pfizer increased prices a few weeks ago.  This has deterred Pfizer, along with Merck, Roche, and Novartis from raising prices, for now.

But not to worry, if you have stock in a pharmaceutical company, because the FDA and its sympathizers are on your side.  Only worry if your insurance company doesn’t cover the cost of your medications.

You might profit from buying stock in the companies whose drugs the FDA, the “health care industry,” and the insurance companies are pushing, such as the over-the-counter naloxone that is one of four medications promoted for “opioid use disorder.”  In terms of reputation, this “opioid crisis” has spread far and wide, to the highest government offices, academia, psychiatry, newspapers, magazines, television, the internet, the courts, and dinner-table talk.  Its funding has been greatly enhanced by the promoters of public disinformation, yet relevant facts are few.  All the stories have the monotonous flavor of canned worms, opened, sampled and regurgitated for yet another meal.

We are told about opioid-related deaths, the evil drug company that promoted its opioid drug as non-addictive, the lazy or greedy doctors who over-prescribe narcotics, and the glories of “medication-assisted treatment,” or MAT.  Somehow, heroin comes up in all these stories, yet most people should know heroin is nowhere legal in the United States, not even by prescription.  We are rarely told that this magical MAT consists of four drugs, two of which are opiates themselves, or that the federal government has added special training and licensing requirements for administration of its approved protocol. We are not told that “treatment” does not mean “cure.”  No, “cure” would imply eventual freedom from all drugs, a notion that doesn’t serve Wall Street profits.

So let me give you one example of how this scam works.  I hesitate to call it a “conspiracy” (wink, wink), because of the paranoia such a word implies.  I’d rather call it a “consortium” of interrelated interests, all of which stand to profit by exaggerating the problem and presenting expensive but ineffective solutions.

We are told opioid-related deaths have skyrocketed this century, and Oxycontin (oxycodone) is the precipitating culprit.  OxyContin is produced by Purdue Pharma, which indeed does have a shady background.  In 1952, three brothers—Arthur, Raymond, and Mortimer Sackler–all psychiatrists from Queens, New York, purchased Purdue Frederick Company.  Arthur was reputed to be brilliant in psychiatric research and pharmaceutical advertising.  Working for Roche, he found enough uses for Valium (diazepam) to make it the first drug to hit the $100 million mark in revenue.  He also “positioned” Librium (chlordiazepoxide) for Roche.  Valium and Librium are members of the “benzodiazepine” class of drugs, a class that includes Xanax (alprazolam), Ativan (lorazepam), Klonopin (clonazepam), and others.  Alternatively, oxycodone is a semi-synthetic opioid from thebaine, an opioid alkaloid in the Persian poppy.  It was developed in 1919 in Germany.

In December, 1995 the US Food and Drug Administration (FDA) approved Purdue’s OxyContin (oxycodone), to treat pain.  It hit the market in 1996. Direct-to-consumer (DTC) advertising of drugs was approved by the FDA in 1997.  Purdue marketed the drug to doctors and the public as a non-addictive treatment for pain.  It reached $45 million in sales the first year, and $1.1 billion by 2000.  By 2000, it was becoming evident that OxyContin was, indeed, addictive, but the FDA still approved a larger, 160-milligram pill for those with high tolerance.

In 2007, in US vs. Purdue Frederick Company, Inc., Purdue pleaded guilty to intent to mislead doctors and patients about the addictive properties of OxyContin.  It paid $600 million in fines, among the largest settlements for pharmaceutical companies in US history.

By 2010, revenues had hit $3.1 billion, or 30 percent of the painkiller market.  Purdue remains a privately held company, in the hands of the Sackler descendants.  It is being served with multiple lawsuits from different states for its role in contributing to the “opioid epidemic.”  According to The Week, Kentucky is one of the worst-hit states.  It has filed twelve claims against Purdue, for false advertising, Medicaid fraud, unjust enrichment, and punitive damages, among others.  The Week also says there was a four-fold increase in prescription painkillers supplied to pharmacies and MD offices between 1999 and 2010.

Meanwhile, The Guardian reported in 2017 that the US constitutes 80 percent of opioid pill production but has only five percent of the world’s population.  It claims the pharmaceutical companies made false claims of an “epidemic of pain,” in the 1990s, and the federal agencies went along.  Pharmaceutical lobbyists got Congress to loosen restraints, and doctors were often reprimanded for not supplying enough.  “Regulators became facilitators,” as the FDA approved one opioid pill after another.

How does this relate to heroin, a known street drug, one might ask.  It’s a good question, for which there are no easy answers.  The idea that prescription painkiller pills are “gateway” drugs to heroin use has been mentioned.  One source notes that heroin is less expensive on the street than OxyContin, which can cost $1/milligram, or $80 for an 80-mg pill.  A more significant problem with heroin, we are told, is that it is increasingly laced with fentanyl, another opiate that is up to 5000 times stronger than heroin.  Synthetic fentanyl is being smuggled in from China.  Heroin is coming from Mexico, some say.  Fact is, there are few facts available in this gigantic obfuscation of facts that characterizes sensationalism.

So we don’t exactly know how prescription pain-killers are related to heroin/fentanyl deaths.

Death from opioids usually comes from respiratory depression.  In other words, people who overdose pass out and stop breathing.  Many other drugs cause respiratory depression, too, and a mixture can have cumulative effects.  It is common for people with chronic pain to take both a narcotic (opioid) and a muscle relaxant/sedative of the benzodiazepine class mentioned above.  The benzodiazepines also cause respiratory depression, as does alcohol.   Too, it’s not clear how many of these opioid-related deaths are complicated by other substances.  One psychiatric journal mentioned that a third of opioid deaths were complicated by benzodiazepines.  It’s probably safe to say that hard-core street addicts could be taking many drugs at any given time.

But our “medication-assisted treatment” bypasses all these inconvenient details.  It does include a drug, naloxone, which reverses the effects of opioids and can save lives in a primary opioid emergency.  It has been around over 45 years and is well known in emergency rooms for its life-saving effects.  Since this crisis began, police and ambulance drivers have had to use it on numerous occasions.  Now, the US Surgeon General Jerome Adams, MD, MPH, has encouraged over-the-counter preparations of naloxone for those with opioid use disorder and their loved ones.  FDA head Scott Gottlieb is also advocating expanded access to treatment, Medicaid funding, and other systemic changes to pay for the problem.

Manufacturers of OTC naloxone have jumped to increase prices accordingly.  Narcan intranasal (Adapt Pharma Inc.) retails for $135/dose, more than double its price a few years ago.  Kaleo’s Evzio auto-injector now retails for $4,500, more than 6.5 times its $690 average price in 2014.

What’s not clear about this scenario is how a passed-out opioid over-doser who has stopped breathing will be able to administer the naloxone.  Irreversible brain damage occurs mere minutes after a person stops breathing.  The life-saving medication requires someone alert, quick to recognize the problem, and to administer the antidote.

With all the calls for funding, research, and treatment, no one is admitting that substance use treatment is notoriously ineffective.  FDA head Gottlieb and others are begrudgingly accepting the idea that cure may not be practical, and long-term maintenance must be considered.  So the magic bullet, the aforementioned MAT, or “medication-assisted treatment,” is not a cure.  It is designed to convert illegal opioid use to legal opioid use for perhaps a lifetime.  Of course this will require funding for treatment, for the treating facilities, support staff, the researchers, and for the prescriptions.

Who benefits from this crisis?  Well, the National Institute of Health has earmarked $1.1 billion to develop “scientific solutions,” backed by a $1.3 trillion omnibus package passed by Congress, according to Psychiatric News.

US President Donald Trump has declared the “opioid crisis” a public health emergency.  We have the White House Opioid Commission looking for ways to fund and treat the problem, including such issues as insurance coverage.  It recommends funding for no less than eight professional organizations.

The four approved medications in MAT are naloxone, mentioned above, naltrexone, and opioids buprenorphine and methadone, in case you want to buy stock in the companies.  Insurance company stock will most likely benefit, too.

The common denominator in this “emergency” is the use of more drugs to treat the drug problem in the drug-crazed culture we have created.

How Do You Define Crazy?

What is “addiction”?  What causes it?  There’s a lot of attention given, lately, to various forms of “addiction,” but definitions of it and its clues about its causes are rare.  The American Psychiatric Association (APA), the primary lobbying organization for the professional mental disorder labelers, claims it is a “brain disease” that is “complex” and characterized by “compulsive substance use despite harmful consequences.”  The official platform, published on line, says there are a number of effective treatments, and that people can recover.

The APA also asserts there are “changes in brain wiring” as a result of addiction, and that “brain imaging studies show alterations in judgment, decision making, learning, memory, and behavioral control.”

The psychiatric establishment, including the National Institute for Drug Abuse, states brain changes in the brain stem, cerebral cortex and limbic system cause addiction.

So that’s our answer, in a nutshell.  Satisfied?

I’m not.  In fact, it’s embarrassing to admit I’m associated with such pretenders, because this propaganda campaign is nothing more than pandering to a group of people who probably know more about addiction than the “experts” do.  First, “addiction” per se is not listed among the growing list of “mental disorders” in the latest bible of psychiatric diagnosis, the Diagnostic and Statistical Manual of Mental Disorders, version V.  (DSM-V).  We have “substance use disorder,” and specific diagnoses related to the type of substance (mis)used, such as “opiate use disorder.”  We do have “internet addiction,” a new, DSM-V, excuse to seek funding for treatment.  But my rant here is not about addiction or the “opioid epidemic,” or even the marketing blitz that characterizes modern strategy for creating and perpetuating insanity.  It’s about terminology and the ocean of irrelevance that is pawned off as information to an under-informed, misinformed, and gullible public.

I first heard the term “brain disease” from members of the National Alliance for the Mentally Ill (NAMI), a lobbying group that prides itself on its family-associated organization, lobbying efforts for “mental health parity,” and its disassociation from mental health professionals.  NAMI has especially wanted to “de-stigmatize” mental illness by insisting it’s a “brain disease,” caused by a “chemical imbalance” in the brain, thus equivalent to physical diseases, even though there is little physical evidence for such conditions.

The psychiatric establishment, assisted by the pharmaceutical companies, the government, and to some extent, the insurance companies, has jumped on this opportunity to legitimize (and fund) research and treatment for a variety of mental disorders, and the list keeps growing.  Since the first DSM was published in 1952, the number of official mental disorders has steadily expanded, apparently to accommodate the tide of new medications flooding the market.  Homosexuality, formerly listed, has been expunged since 1987, but we have added problems you didn’t know were disorders, such as ‘social anxiety,” “adult attention-deficit hyperactivity disorder,” and “hypoactive sexual desire disorder.”  Insomnia is now an official psychiatric disorder, maybe thanks to the efforts of researchers and pharmaceutical companies that want to study and profit from it.

Lately, we are told the national suicide rate has gone up.  Army suicides are up, and there’s a question about whether some of the opioid-related deaths were intentional suicides.  We have the controversy over what used to be called “physician-assisted suicide,” which is no longer a politically or socially correct term, because it stigmatizes those who get a physician to help them die.  This is now called “medical aid in dying.”  Who remembers when Jack Kevorkian, a pathologist, went to prison in 1999 for helping patients die, convicted of second-degree murder?

Psychiatric terminology is tossed around with the same carelessness of standard epithets but carries the unsubstantiated veneer of insider knowledge.  Who hasn’t heard the president called a “narcissist?”  Look in the DSM-V to find out that “narcissistic personality disorder” could probably fit many people, depending on how one interprets the list of vague criteria, such as grandiosity or lack of empathy.  There are no “brain imaging studies” that prove it, and there’s no treatment.

To say the APA is misrepresenting itself, psychiatry, the mentally ill, and is flooding the public with irrelevance seems like a drastic claim, but here are the “facts.”  In its bid to align itself with “medical science,” such as it is, psychiatry likes to talk about “evidence-based” findings, but the evidence for most of its claims is based on subjective screening tools, such as Beck’s or Hamilton’s Depression scales, which depend on the patient or observer to assess symptoms or signs believed to contribute to clinical depression.

Also, the APA’s claim that “brain imaging studies” have identified specific areas of malfunction related to various mental disorders, is simply not true, but they keep trying, and the “psychiatric industry” is hot to obtain more funding for more research into the various potentialities of such tools as functional MRI and PET scans.

It is true that people under the influence of certain drugs and alcohol show more or less activity in certain brain areas, and autopsies of those with significant alcoholism, for instance, have brain changes consistent with long-term damage.

A great deal has been made over neurotransmitters, in order to justify the “chemical imbalance” hypothesis.  The class of antidepressants termed “serotonin-selective reuptake inhibitors” or “SSRIs”, led by the introduction of Prozac (fluoxetine) in 1989, quickly followed by copycats Zoloft (sertraline), Paxil (paroxetine), and others, spawned a new wave of psychiatric drugs that targeted specific brain chemicals (neurotransmitters).  Do they work?  There is increasing evidence that they don’t work for long, especially in children, and they may do more harm than good.  Approval by the FDA of direct-to-consumer (DTC) advertising in 1997 may have contributed to the upsurge in use of psychiatric as well as a host of other medications, and to the misperception that there’s a pill for every ill.

The “opioid epidemic,” deserves particular note, because it has been deemed by the Powers-That-Be as a “public health crisis,” deserving of broad-scale funding, research, special treatment protocols, legislation, and lawsuits against the pharmaceutical companies deemed most responsible for creating the problem.

Here, the psychiatric establishment–along with the government and media–has gone out of its way to misrepresent and inflate the problem, as well as its preferred solution, which is to hook people forever on different opiates.  The Need-To-Be-Needed crowd indirectly admits it has no cure, yet, but more funding will provide for better access to “care,” and for more research, such that maybe someday we will know enough to cut people loose from their psychiatric problems.

 

 

 

 

 

Symbols and Psychiatry

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Corn snake, kco051316

Ten years ago this month, I had just retired my medical and DEA licenses, in search of better ways to inspire people regarding the mind and its potential.  A long-time student of symbolism, I write daily in my journal and regularly include references to astrology, mythology, religion, dreams, and other symbolic languages.  These universal concepts fall loosely into Swiss psychiatrist Carl Jung’s idea of a “collective unconscious” and of “archetypes.”  As most people probably know, Jung was a protege of Sigmund Freud, father of modern psychiatry, whose The Interpretation of Dreams, published in 1900, rocked the scientific world and initiated the field of psychiatry and psychoanalysis.

The following excerpts from my November, 2007 diary show how I play around with symbolism to help develop a deeper appreciation for everyday life.

ON PREDICTIONS AND FREE WILL

Tuesday, November 20, 2007 – I believe if the student fails, the teacher fails more, because the teacher is paid to teach.  The student (ideally), pays to learn.  This is why I’ve never believed in tenure and probably why I don’t believe in marriage or other chains on the future.  As an astrologer, I don’t believe in predictions either, but astrologers as a group would disown me for saying this.  They thrive on making predictions, and people expect them to do it, but no one can say that predictions are consistent with free will.

You have to be a free thinker to understand how limiting predictions are.

This moment, as I sit in my recliner on this beautiful sunny day, overlooking vast expanses of marsh and blue sky, I have access to all time, depending on my focus.  It can come as dream, memory, fantasy, association, feeling, impression, dimly or readily perceived.  A book once read is forever a part of my experience, because I have invested the personal effort to make it so.  A book once written is part of everyone’s experience, whether direct or indirect, as knowledge brought through on the verbal place is “thicker” and more physical than the more ethereal realm of imagination.  How can I know before I read a book how it will change my life?

PENELOPE AND UNDOING

Thursday, November 22, 2007 – I’m approaching my multiple goals in piecemeal fashion.  When everything seems to be at beginning stages, as now, or beyond my capabilities, I feel frustrated and at odds with myself.  Re-doing things makes me feel like Penelope, Odysseus’ wife in The Odyssey of Homer, who undid her father-in-law’s shroud every evening to avoid having to marry any of the moochers who invaded her home as soon as Odysseus stayed gone too long.

I used to think Penelope was a sap, but undoing is a matter of perception, and if you enjoy the weaving and undoing for its own sake, it is no longer a waste of time.  Here we have the clash of the results-oriented and the process-oriented approach.  Also apparent is the stated vs. actual purpose.  Penelope stated she wanted a shroud.  She actually wanted to stall for time, so the actual purpose was met.

She lived in a time when women were possessions, and we have that subversive belief still, although no one admits it.  Marriage is a testament to the people-ownership concept.  While presumably it’s a mutual ownership, no one expects men to be as faithful as women, although this is a generalization and less true than in the past.  In the great sexual shuffling of today, men and women seem equally unfaithful.

Probably few perceive the ownership attitude as clearly as I, the target of so many who want to own by any means available.  Insurance companies, government, bankers, stockbrokers, businessmen, acquaintances, friends, family, partners–all want an advantage and will look for or create excuses to cross the line of equality, move in and take over.

Am I bitter and cynical?  Yes.  I don’t like feeling this way, knowing it only hurts me to have this attitude.  Like it or not, I am a herald, of sorts, meaning I search restlessly for higher and more comfortable ground, especially mentally.  Those who would control will seek first to control the mind.

I can’t control my own mind, nor do I want to.  I like its free ranging ability and thrive on the little lessons obtained from every facet of my life.

How would I know about undoing if I did not live it, feel the emotions associated, know the practice from mythology and the term from psychiatry?

Unraveling a sweater – which I’ve already done once with this one because I didn’t like the stitch – brings many facets into play.

How would someone else handle it?  Who knows?  Most people would not attempt to knit a sweater at all, I suspect, and this is my contention with “most people.”

Nor will “most people” appreciate the value of the process as a means of showing how to solve problems, because this is my real purpose.  Rather than start over, I can adapt mid-sweater and potentially turn a mistake into a success.

SNAKES IN THE GARDEN OF EDEN

Monday, November 26, 2007 – I’ve retired my medical license to become a New Age Profit . . . er . . . Prophet, for the Spirit of Capitalism.

I cut my fangs on Telluride politics and other stories from the Serpents of the Modern Caduceus.  What if there were two serpents in the Garden of Eden, and they ran the interlopers out, better to rest in peace without getting trampled?  Then they can bask in the sun of the Garden, eating of their favorite fruit, the apples from the Tree of Knowledge of Good and Evil.

Now that Adam and Even have departed in search of something better, the wise snakes may rest assured the tree won’t be cut down to build a house, to hold squealing brats who like to torture snakes for fun.  Minimal risk of getting eaten for supper or skinned for belts and purses.  Why, now that God has expelled these demons from Heaven, the snakes are ecstatic.

Unfortunately, the Garden of Eden isn’t quite as lively as when the humans were around.  They provided entertainment, if only by making God mad.  We snakes can make God mad without even trying.  All we had to do was show him how dumb his latest invention was, and he threw them out and has been moping around ever since, feeling guilty about over-reacting.  Now, look at the mess man has made of his lives.

All we said was “Wise up.”  We didn’t say do it the hard way.  No.  That was Adam’s choice, to do it the hard way.

We snakes wise up the easy way.  When our skins get too small, we shed them and slither on out to greater dimensions of girth and wisdom.

Yes, snakes are hated and feared, because we are so smart.  We see life from the ground up, and we know where our support and strength lie.  Our raw intelligence knows its own turf and doesn’t seek to intrude on that of others.  Snakes don’t go looking for trouble, unless it’s entertaining trouble that enhances our wisdom and gets a potential threat redirected into other dimensions, like hell on earth.

Crazies ‘R’ Us

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One of my alter-egos, Kookie the Shrink, with New-Age, eco-friendly, portable, non-pharmaceutical, public domain feel-good idea that hasn’t been invented yet.

Everyone knows psychiatrists are crazy.  Just ask my deceased mother, who claimed psychiatrists enter the profession to solve their own problems.  Fact is, I only began having problems in medical school.  My problems got worse after psychiatry residency, when I started practicing psychiatry in a “health care industry” so saturated with sanctimonious hypocrisy that I was astounded.  No one seemed to notice or care that externally imposed rules and expectations were making a mockery of the principles I was taught in training.  While everyone in the “health care industry” claims to be acting in the patients’ and public’s best interest, the so-called “healers” have become passive tools in a tidal wave of co-dependency that cripples to control and calls it “care.”

While “health care” professionals across the board have succumbed to this debilitating delusion, I feel particularly betrayed by the leadership in my own chosen specialty, because psychiatrists should know better.  I believe the psychiatric establishment has abdicated its philosophical foundations.  Instead of promoting mental health and self-reliance, it is busy kissing up to the profiteers in government, pharmaceutical and insurance industries, and seeking ever new ways to bind patients and the public to its mind-numbing agenda.

Two concurrent trends show how the psychiatric establishment–which depends on pharmaceutical advertising for its numerous professional publications—is desperately seeking relevance in a drug-pushing world.

The first trend, toward “medication-assisted treatment” for “opioid use disorder,” has been heavily embraced by the psychiatric establishment and the mainstream media.  The Friday, August 11, 2017 issue of USA Today claims “Opioids to be declared a national emergency.”  Here, we learn that President Donald Trump “’is drawing documents now’ to officially label the crisis as a national emergency.”  Such a designation would trigger specific tools for federal and state governments, including grants from the Public Health Emergencies Fund, a suspension of some of the patient privacy provisions of the Health Insurance Portability and Accountability Act (HIPAA) of 1996, and waive Medicaid restrictions on federal funding for mental health hospital admissions.

The second trend is the ongoing fight by the American Psychiatric Association (APA) and its state-level affiliates to stop the push by psychologists for prescription privileges.  This is an ongoing turf battle, with bills for psychologist prescribing introduced in multiple state legislatures every year.

The common denominator in these trends is that they are turf battles over drugs.  They have nothing to do with caring for patients, mental health, or the mind’s intrinsic self-healing potential.  The professional contestants, however, all claim they have patients’ best interests in mind.

Contributing factors abound.  In psychiatry, the shift from psychotherapy to medication management has been particularly devastating to professional self-esteem.  Psychiatry, now more than ever, seeks to align with the “scientific” foundations of medicine. Meanwhile, insurance and government have delegated “talk therapy” to less expensive psychologists and social workers.  What used to be 45-minute psychiatric consultations have become 15-minute “med checks.” Freud has been replaced by Prozac.

This follows a general cultural trend toward quick-fix solutions, with pills becoming the treatment of choice in all specialties except surgery.  The rise in illegal drug use can’t compare with the explosion of drugs for medical conditions, vaccines, and pseudo-conditions.  Over-medication is a major cause of accidents, drug interactions, and overdoses.  Unintentional injuries from falls and overdoses from prescription and illegal drugs are now the fourth leading cause of death in the US, according to one study.  Another study cites medical error the third leading cause in hospitalized patients.

The “opioid crisis” is attributed in part to Purdue Pharma’s misrepresenting OxyContin in 1997, when it was introduced, as having low abuse potential.  That same year, the FDA approved direct-to-consumer advertising. Pharmaceutical DTC advertising took off at the turn of the century.

That prescription painkillers fall in a different category from heroin—which cannot be prescribed in the US—bears mention, but they are linked by their black market affiliation.  OxyContin’s introduction on the market, and its aggressive marketing campaign to specialists and family practitioners brought Purdue Pharma $45 million in sales the first year.  That increased to $3.1 billion by 2010, or 30 percent of the prescription painkiller market.  In 2007, Purdue pleaded guilty in a federal lawsuit claiming it intended to mislead doctors and patients about its addictive properties.  It paid $600 million in fines.  The state of Kentucky, the state most ravaged by prescription painkiller and heroin use, has made 12 claims against Purdue, including false advertising, Medicaid fraud, unjust enrichment, and punitive damages.  OxyContin costs up to $1/mg on the street, or up to $80 for an 80 mg tablet.

Other reports say fentanyl, a prescription opioid that can be synthesized by drug traffickers, dramatically increases the risk of fatal overdoses.  Its deadliest component, carfentanil, is five thousand times stronger than heroin.  Add this to the fact that multiple common drugs and alcohol also depress the respiratory center, with a cumulative effect.  Benzodiazepines, like Xanax, are often taken along with opiates.

The “opioid crisis,” is now being traced to pharmaceutical companies and to the FDA, according to The Guardian’s latest report.  (www.theguardian.com/commentisfree/2017/aug/13/dont-blame-addicts-for-americas-opoid-crisis-real-culprits)

The collusion between the psychiatric community and the pharmaceutical industry to push drugs on a gullible public smacks of a cronyism that few seem to recognize.  The FDA-approved “medication-assisted” treatment for opioid use disorder contains two opioids—methadone and buprenorphine—which are also abused.  However, the psychiatric establishment, which has sub-specialties in addiction, has a piss-poor success record with addiction treatment and virtually ignores Alcoholics Anonymous and its spin-offs, like Narcotics Anonymous.  These are peer run, free, and have a better track record than the “experts” can claim, despite their education and degrees.  The APA also ignores non-pharmaceutical treatments like acupuncture, which even the NIH has admitted has utility in chronic pain.  Auricular acupuncture for substance abuse has a long and under-appreciated track record.

Where does psychiatric officialdom stand on the mental health advantages of low-stress lifestyles, nutrition, physical therapy, and exercise?  Ask, and let me know what you find out.

Crazies ‘R’ Us indeed.  The psychiatrists need to get off the drugs and learn to use their minds to heal themselves first.

 

Opiates: Crisis du Jour

Opiate abuse is the crisis du jour in the medical and psychiatric world.  I’ve seen reference to it in the psychiatric journals, in the New York Times, and in the Summer, 2017 issue of Utne magazine.  There are Continuing Medical Education credits available for it.

Do I believe opiate abuse is a new problem, or that it has suddenly grown into the gigantic epidemic the “authorities” claim?  I know there is a push for funding for substance abuse treatment.  Other than that, I believe the “crisis” is fueled by enablers who need to be needed.

First, the literature I read makes no distinction between heroin, which is an absolutely illegal drug in the US, and the other opiates.  There’s a vague claim that the heroin is coming in from Mexico, but I wonder if it’s coming home with troops from Afghanistan, too.  No one has asked that question.

The legal-with-a-prescription opiates are presumed to be used for pain, and apparently there is a growing trend to abuse prescription opiates.  Doctors who prescribe too many of them fall under the DEA’s watchful eye, so I wonder how many doctors are willing to risk their licenses to support an abuse habit.  There are pain clinics sprouting up around the country, specialty clinics in which opiate use is standard.  These are carefully monitored by the DEA, as are pharmacy records that show which docs are prescribing controlled substances.

A large number and variety of substance abuse treatment methods and facilities exist, but effectiveness over the long term is poor.  Most studies into substance abuse treatment only follow patients for a year.  Long term studies are rare.  Alcoholics Anonymous (AA) and its spin-offs, like Narcotics Anonymous and Cocaine Anonymous—with their reliance on the 12-Step Program—have remained the standard since 1935.  These are free programs, peer supported, in which names and paperwork are not required.

My questions about this new “crisis” stems from my cynicism about our current drug-centered world.  The difference between “good” drugs and “bad” drugs is only a matter of legality, according to me.  Drug laws confuse the issue and create problems that needn’t exist.  Even the Psychiatric Times is beginning to take a fresh look at substances such as marijuana, looking to explore its potentially therapeutic effects.  There was a recent article suggesting hallucinogens like LSD and psilocybin might deserve more attention as therapeutic agents, under controlled conditions.

Unintentional injury from accidents and drug overdoses, according to one Continuing Medical Education (CME) course I took, is now in the top five causes of death.  The course didn’t distinguish how the overdoses occurred, but my experience tells me a surprisingly large number of people take ten or more medications, don’t know what they are taking, how to take them, or what they are for.  They don’t know about side effects, and their doctors don’t explain.  They take them “when I feel like I need them.”  or don’t take them at all if they can’t afford the cost.

Direct-to-consumer advertising by pharmaceutical companies has grown exponentially since it was approved by the FDA in 1997.  Pharma spent less than $800 million/year on advertising in 1996, but by 2000, that sum grew to $2.5 billion.  Of that, 20 percent was for psychiatric medications, and these constituted 10 percent of the top 100 selling drugs.

Obviously, there is a great demand for “feel-good” drugs, either over the counter or under the counter, and I have to wonder why.  From what I’ve seen, none of these drugs satisfies the long-term cravings of those who have lost their way.  The psychiatric drugs, like antidepressants, are not proving themselves over time, so there is a constant turnover of medications used to treat depression.  Yet advertising, the “health care industry,” and the world at large seems to believe there is a quick fix to problems, lifestyle problems, relationship problems, financial problems, employment problems, health problems, loneliness problems, and all the problems people’s fantasies tell them should respond to drugs.

As long as people put faith in solutions outside themselves, they will be disappointed, I believe.  Maybe a pill can help, temporarily, but there is no pill for financial problems, unless you’re selling it on the street.

That, in summary, may be the underlying impetus behind the “opiate crisis.”

July, 2007 Retrospective

bksangelldrug2005

Ten years ago this month, I was working in a public mental health outpatient clinic, preparing to retire my medical and DEA licenses the following month.  These journal notes give a profile of my reasoning at the time.

GOSSIP AND SECRETS

Sunday, July 1, 2007 – I have been victimized by gossip more than once.  I tell patients therapy wouldn’t be necessary if not for gossip.

I remember excluding myself from cliques – the lunchroom crowd at Duke, composed of several girls in my dorm, and the group in medical school who gathered at lunch – because I didn’t like the mean-spirited gossip and chit-chat that characterized the gatherings.  I couldn’t sit with them without judging and seeing sides of them they couldn’t be proud of.

So I have been naive about gossip’s power.  In a culture built on hearsay, I am an odd duck, indeed.

Of course, my way is better, because it’s more practical.  I like forming my own opinions and always wonder what the gossiper’s agenda is.  I agree with Anne Scott, my history professor at Duke, who insisted on primary sources.  I believe in getting my information from the individual in question.  What he or she doesn’t tell or show me is none of my business.

In theory.  When people are plotting behind my back, it becomes my business, because I end up being the victim of their gossip.  I have been blindsided too often by those I trusted too much.

FREEDOM

Monday, July 2, 2007 – My unconventionality surprises me more than anyone.  Rather, I’m surprised to be growing so confident in it.   Perhaps I always knew it was there – that I was “different” – but it was unexpressed until revealed by the contrasts with the groupthink.  I live what others profess to believe, yet I am castigated for it by those who claim the beliefs most strongly.

No one attacks me directly, but they use triangulation, hurting things and people close to me, such that no one is safe.  I believe at some point the winds will shift, and I won’t stand so alone.  I will not actually lead, except in ideas and methods, as I feel I am already doing when opportunities arise.  After the fact, everyone wants to claim credit.  I don’t care who or how many people get credit, because everyone who takes a stand on her own behalf deserves credit for it.  I do for myself what I hope others will do for themselves, in commitment to self-reliance and freedom from bondage.

A PATIENT-CHURNING, PRESCRIPTION-WRITING MACHINE

Tuesday, July 3, 2007 – The more I work as a patient-churning, prescription writing machine, the more I hate it.  If they want to hire me to do staff development, groups, lectures, or anything that doesn’t involve writing prescriptions, we can spin it as education, and I won’t need a license.  I think these drugs are overrated and/or do more harm than good.  I spend all my time reducing meds and warning about side effects.

ON DRUG REPS

Wednesday, July 11, 2007 – Drug reps were lurking in the halls again today.

I’m reducing people’s meds, and they are grateful.  These folks seem healthier than the system.  Politically manufactured diseases justify churning tax dollars.

As psychiatrists like Dr. W (who plans to be a stay-at-home mom) and me (who plans to be a stay-at-home survivor) leave the system, the exploiters wring their hands in agony, wondering how they can perpetuate the illusions when the docs won’t cooperate.

ON THE HEALTH SNARE RACKET

Friday, July 13, 2007 – I undermine the system with every patient.  A hip replacement?  I ask.  Surgeons like to cut, and they have overhead to pay.  You need a hip replacement?  If you lost weight and restored some flexibility to your joints, your hip pain may not be so bad.  You’re thinking about replacing something living with something dead.  A living hip joint is infinitely more capable of regenerating itself than a plastic substitute.  Do you know how bacteria-infested hospitals are?  And bone surgery is the most invasive of all.  Microbes can hide and fester best in bones.

Your drug rep says you need to up your Cymbalta from 20 mg to 60 mg because that’s the standard starting dose?  But you feel better on 20 mg, and you’re super sensitive to meds?  Your drug rep wants to sell drugs.  Listen to your body.

Turn off the television to alleviate depression.  Dance for exercise.  Journal for self-discovery.  Reduce meds.  People treat side effects with more meds.

The whole world is crazy, so if you’re crazy, you’re normal.

bumpdocchoice0717

FOOD

Thursday, July 19, 2007 – In the check-out line at the grocery store, the man in front of me, an elderly black man, had several chicken pot pies and orange juice in a plastic container.  I think about the cost of all that packaging.

Several patients have gained significant weight, so I’ve begun to talk with them about diet.  They spend lots of money on food at restaurants like Applebee’s, but don’t get takeout boxes.  I’m watching what people buy in grocery stores.  People are using food stamps for things like bottled water and soft drinks.

One patient told me her food stamps go farther since she started eating more vegetables.  She weighs close to 300 pounds.

PFIZER REPS AND DRUG CULTURE

Wednesday, July 25, 2007 – The Pfizer reps were blocking the halls yesterday, flirting with the head nurse, who was laughing and flirting back. As I squeezed past her to collect my next patient, she loudly mentioned that the other doctor was late.  She couldn’t much stop me, could she, considering I was generating money.  And no, I will not sign my name for samples of those poisons.

Fortunately for me, my patients all showed up, and I had a blast with them while avoiding Pfizer at every turn.

They even brought lunch.  There must have been 20 boxes of pizza in the break room, and everyone but me gravitated to the food.  I heard the other doctor’s voice, so the Pfizer rep had his fish.

I was too busy seeing patients until 12:30 p.m., so they knew not to stop me

I have said over and over the drug reps shouldn’t be allowed to hang out in the back.  It’s unprofessional.  But this is the way business is conducted these days, in these “public-private partnerships.”

The drug culture?  Here’s what I think of the drug culture.  Grow it, just like you do food.  If you can’t grow it, you don’t need it.  Tobacco, corn for ethanol, marijuana.

Here’s an idea.  Individuals should be allowed to have private ethanol plants, formerly known as stills, to fuel their personal energy needs.  Whatever they sell, they can pay taxes on, if they must.

Same with tobacco.

Individuals could grow corn for their energy needs and sell designer corn liquor by the side of the road.  This would give farmers more value for their ethanol and save taxpayers from the middlemen.

Why, if investment bankers and oil companies can get government mandates and subsidies to force commercial ethanol plants, individuals should have equal status under the law.  Corporations don’t vote.  Individuals do.  Corporations vote behind the scenes, with money and favors, but the public pays the taxes and other costs for the fat cats’ deals.

THE TRUTH ABOUT THE DRUG COMPANIES, MARCIA ANGELL, MD, 2004, 2005

Friday, July 27, 2007 – I’m on the last chapter of The Truth about the Drug Companies:  How they deceive us and what to do about it, by Marcia Angell, MD.  I read about how the Food and Drug Administration (FDA) basically works for the pharmaceutical companies.  Far from protecting the public, the FDA protects snake oils, since approved drugs are not required to show superiority over current drugs, only over placebo.

Monday, July 30, 2007 – Dr. Angell castigates drug companies and FDA throughout the book but at the end, she recommends more legislation and more money for the FDA.  Of course she’s part of the establishment and can’t rock the boat too much and expect to be published.  A Boston Yankee, liberal Harvard elitist in an ivory tower, she depends on government for funding so is ultimately a GoverCorp slave.

And, she doesn’t mention insurance.  How does insurance, which costs more for giving less, get away with being so transparent?  Like with cellophane, you don’t recognize the costs until you’ve been shrink-wrapped and can’t breathe.

Tuesday, July 31, 2007 – So Dr. Angell is sadly naive about government and Medicare, either that or she chose to focus on one problem at a time.

Not I.  The FDA, for instance.  Waste of money.  Have the drug companies market directly to patients, starting with FDA employees, and pay them to participate in clinical trials. This could constitute true consumer marketing, drug company accountability, earning opportunities for all, and publicly supported large scale scientific research.  Capitalism in a nutshell.  They already do it in third world countries, under the pretext of giving free medications and vaccines to the poor.

Secrecy is the problem, and regulations make secrecy necessary to survive.  The more rules, the less anyone knows about cooperation.  Communication plummets, except by hearsay, and this further tangles networks.

Perhaps the FDA should focus only on safety and leave the efficacy to market-based consumer trials.  Abolishing drug laws would give taxpayers direct access to drugs of choice, and MDs could assume advisory and educational support but not have to play middleman in the government’s war on taxpayers.

 

 

 

 

 

Memories, June, 2007

 

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Above:  The Department of Human Resources (DHR) building in Columbus, GA

In June, 2007, I was finishing a short term psychiatry contract in the public health system in Columbus, GA.  Columbus is one of Georgia’s largest cities, on the Alabama border, and home to Fort Benning, one of Georgia’s largest military bases.

In August, 2007, I would attempt to retire from psychiatry, by letting both Georgia medical licenses and federal DEA licenses expire.  The stress was literally ruining my health.  Seeing patients was my favorite part, but the system itself was so dysfunctional that I risked everything if I missed a call.

BUILDING DESIGN

Saturday, June 2, 2007 – I fantasize about taking a sledgehammer to the walls at work.  It’s a maze, inefficient, unnecessarily confusing, and downright dangerous, with too many blind alleys, locked doors, and long, narrow halls.  Everything is so disconnected from everything else that the entire organization functions like a mindless blob of quivering protoplasm.  Individual effort dies in situ, never achieving enough momentum to spread beyond the 12’ X 12’ walls of the private offices.

These offices all have the  latest electronic equipment and programs, though, upgraded too often to be useful.  But they have zero reference books, so I bring my own.   I had to retrieve my own DSM-IV from the 500-foot walk to my other office, because the computer only takes diagnosis numbers rather than words.  I have not memorized diagnosis codes and never intend to.   Of course, the intake office does not have a DSM-IV.

HEAVEN

Saturday, June 2, 2007 – Anybody ever consider that heaven is not having to pay taxes?

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WASTE OF TREES

Sunday, June 3, 2007 – Columbus is full of railroad tracks.  As I negotiated 15th Street and around a tangle of other streets, I went under a RR trestle where Norfolk-Southern cars filled with fresh wood chips, piled high, smelled the air of pine.

How sad for those trees, I thought.  Their chopped chips are probably going to make junk mail, paperwork, and packaging.  This while their fellows are burning in a hundred square miles of uncontained forest fire in southeast Georgia.

CURRENT EVENTS

Thursday, June 7, 2007 – I’m becoming bored with current events.  I’ve had fun on the internet message boards, but the columnists remain uninspired – from my perspective – and I battle basic assumptions, like the belief that competition is good.  So, I approach it with the cavalier feather stroke of playfulness.  I balance discussions about nuclear proliferation in Iran with questions about paranoid counter threat tactics by the US.  How much are taxpayers paying for nuclear proliferation under our noses at home?

Lah de dah  . . .

Another world, another opportunity to blow it up, or not, depending on your reference point.  Worlds split off from each other, I believe, and those who believe in nuclear holocaust may well travel along a world chain of events toward that outcome.

Moi?  I’ll let that car pass on by, to avoid being swept up in that drive chain.  I see myself as an illusion-popper, clarifying ambiguities, flipping coins, turning phrases, bringing a sense of hopefulness through flexible thinking and clever (to me) juxtapositions.

Slowly, I see others becoming more confident, more outspoken, more imaginative.  Less victims, more involved, responsive, and reflective.

GONNADOS

Friday, June 8, 2007 – The world is overrun with “gonnados” who expect others to pay huge up-front costs for questionable future rewards.  There was an online Washington Post column extolling the new president of Arizona State University, for his grand vision of developing better communications between Americans.  President Crow starts by firing 20 of 23 deans on the faculty.  This communicates clearly to me.

Next, he creates lots of programs – a biodiversity center, for one – in order to make Arizona State a bigger place, competitive with Harvard and the like.

Another empire builder, think I.  I post my view that he’s another “ivory tower elitist with more theories than sense, standing on a soapbox bought with other people’s money.”  Another megalo-maniacal world changer, think I.  Yawn.

He talks about “stovepipe” mentality, but if he has replaced most of the deans, he’s just creating a different stovepipe for those he’s indebted to, or who share his agenda.

PRESCRIPTION SNAFUS

Thursday, June 14, 2007—I discovered yesterday that writing a prescription for something like Geodon doesn’t necessarily mean the patient will get Geodon.  Yesterday’s patient got four days’ worth of samples because that’s all the pharmacy had, so by the time I saw her, she hadn’t taken it for over three weeks.  By then both she and I decided she didn’t need it.

I’m beginning to wonder if these meds work at all.  As Seth* says, your beliefs determine your reality.  Those who improve give the pills the credit, but I’m not so sure. Antidepressants like Prozac “change your brain chemistry,” they say, but so does any life experience, and the fact of going to the doctor may change it even more.  Perhaps pills are merely transitional objects, tools to link mind with body, as valid for relieving suffering as faith.

I wonder how many people would take antidepressants and the like if they were over the counter.  To hold the claim of potency to the measuring stick of free market capitalism would be an experiment worth trying.

SIMPLICITY

Saturday, June 16, 2007 – Everything has always seemed so simple and obvious to me, issues of right and wrong, justice, fairness.  As I have come to know myself, I’ve shed projections from others, thanking psychiatry for teaching about projections and projective identification.  Psychiatry supplies the words to describe confused feelings.  People’s lack of clarity leads them to assume way too much and act accordingly.

I grew up believing I was potentially a brutally violent person, in need of rigid self-control, yet I’ve learned the opposite is true.  My childhood question, “Why can’t people just love each other?” remains as valid today as ever, and I’ve yet to learn the answer.  My nature has been to look for things to like, and I can usually find something, especially if I’m in a situation not easy to leave.

I’ve always felt safe and protected, though, not only by parents – although they certainly helped – but by life.  Not flamboyantly psychic, I suppose, I’m merely supersensitive emotionally, although there is no objective standard to measure this.  I don’t even believe I’m supersensitive, merely more aware than others, and more trusting of my perceptions.

FOR THE LOVE OF GOD

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Sunday, June 17, 2007 – My desire for solitude stems from a wish to know myself apart from others’ projections and judgments.  I suppose even as a child I was trying to reconcile what I felt with what adults said, and with what I saw.  Basic truths boil down to one truth:  God is love, and I want to do god proud, I will aspire to demonstrate her love in every thought, word, and deed.

It sounds sappy, inconsistent with my tendency to scream things like “Back off, asshole!” to the gas guzzling red truck tail-gaters with mag wheels and attitudes.  This is innately loving, I figure, because if I didn’t yell or otherwise show him where his rights end and mine begin, how would he learn?  If he already knew, he wouldn’t be tailgating.  And just because he’s behaving like an asshole now, it’s not necessarily a character trait, especially if he backs off or passes.  The loving hand of God therefore works through me to teach such testosterone-poisoned creatures how to grow in grace, in terms they can understand.

I’ve found taking my foot off the gas works, too, if yelling doesn’t, and I’ve allowed many such a creature to rush ahead to a destiny too frenzied for me.

DEMOCRACY IN AMERICA, ALEXIS DE TOCQUEVILLE, 1835 AND 1840

Monday, June 18, 2007 – de Tocqueville cites the lawyer class in America as the equivalent of the aristocracy, and the jury as the means by which every citizen sits in judgment over every other.  It strikes me that we do have a society that looks to laws to solve social problems, and perhaps the preponderance of lawyers in government has distorted our national perspective.

DRUG LAWS

Thursday, June 21, 2007 – I flip flop from thinking the drugs I prescribe are dangerous to thinking they are useless, validating Seth’s* assertion that the belief determines the effectiveness.  I really do believe drug laws create an artificial mystique about their effects.  Everyone would claim this is doctor turf, the license to prescribe, but I contend that this is a front for the government and pharma to falsely inflate the price, as well as presumed benefits and risks.

 

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*Seth is the channeled entity who spoke through medium/author Jane Roberts.  There are several books in the Seth series.