Tag Archives: psychiatry

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

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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.

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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.

 

 

 

 

 

 

 

Involuntary Manslaughter?

Twenty-year-old Michelle Carter was convicted last week of “involuntary manslaughter” for encouraging the suicide of her friend Conrad Roy III, in July, 2014. While I’m not surprised by the outcome, I’ve always wondered if anyone should be held responsible for another person’s actions, up to and including suicide and murder.

The law says they should.  Psychiatrists, in particular, can be held liable if their patients–present or past–kill themselves or anyone else.  A mere hint of “suicidal ideation” in an emergency room is enough to get someone committed to psychiatric hospitalization, at least for an observation period of up to 72 hours.

That homeless people, alcoholics, drug addicts, and those escaping the law or outside enemies use this ploy to obtain “three hots and a cot” on cold or stormy winter nights is common knowledge in the medical world.  There are also the drug seekers, who hope to receive controlled substances to alleviate their pain.  While others want to blame the patients, I look to the crazy-making system itself. Those who learn to “work the system” are only doing what they believe is necessary for survival.

The professional’s challenge and dilemma is always to determine intent to act. Psychiatric evaluation is meant to assess the seriousness and immediacy of the threat.  It includes questions about access to weapons, past attempts, serious stressors (like medical diagnoses, relationship breakups, financial crises, for instance), level of intoxication (if any), mental stability (such as psychosis) and other possible contributing factors to the person’s distress.

In most cases, a 24-hour hospitalization is enough to alleviate the symptoms and allow a person to be discharged safely.  By morning, most people have changed their minds, at least until the next time.  Those who are truly suicidal can remain in the hospital for weeks, months, or even years, although this is becoming rarer. Psychiatric hospitals are so crowded that there’s constant pressure to discharge as soon as possible, or at least as soon as insurance coverage ends.

Bottom line is potential suicidality is taken very seriously in the medical and psychiatric world, and each case is different.  Although it is an ethical no-no for psychiatrists to diagnose or analyze people they have not personally examined, I deduce from news reports that there were a number of factors playing into the Carter case, including the un-examined belief that anyone can prevent anyone from doing what they intend to do.

News sources say Mr. Roy had attempted suicide four times in the past.  Ms. Carter met him in 2012, had emotional and mental problems of her own, and needed to be needed.  She fancied herself a helper, and up until the last two weeks of his life, she tried to convince him not to kill himself.  Then she suddenly changed tack and began encouraging him to act on his threats.  She even ordered him back into the carbon-monoxide filled vehicle when he became scared and got out.  Most of this was done long-distance, say the reports.

Witnesses for the prosecution claimed her motive was attention, as she was communicating various moves in this two-year dance to a variety of other people. It’s not clear whether anyone intervened or tried to break up this dangerously destructive dynamic.  Was this so-called need for attention a desperate cry for help by Ms. Carter herself?  Apparently Ms. Carter at one point encouraged Mr. Roy to seek professional help, but did she consult anyone herself about this problem? Chronically suicidal people can be exhausting, even for professionals, when they begin to manipulate for sympathy, attention, or to control the relationship.  At what point does the helper give up and say (or think), “Quit talking about it and just do it.”?

I don’t mean to excuse Ms. Carter for her actions.  She apparently gave a lot of bad advice over a long period of time, and she was way out of her depth.  Who can ascribe motive? For all anyone knows, Mr. Roy may have killed himself sooner if not for Ms. Carter’s friendship.  I happen to believe suicide is a personal choice.  I don’t recommend it, but I also believe we all choose our time to die, on some level.  We only differ in how we do it.

The Power of Life

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May 28, 2017—The following thoughts give an overview of my reasons for skepticism about Western, allopathic medicine and the paradigm it represents.  I claim the overriding belief in external agents for healing or symptomatic relief ignores the basic dignity of the individuals in question and the “vitality” that keeps us going.

The body is a marvelous homeostatic instrument, for which health is the natural state.  This understanding pervades Oriental medicine, which is based on the concept of “qi” (“chi”) or life force.

I’m an amateur student of Oriental medicine so can only describe it in general, simplified terms.  Essentially, it holds that there is a continuum between spiritual, mental, emotional, and physical levels.  Problems begin as spiritual.  If not resolved at that level, the problems become increasingly “dense” until they show up in the physical body.

In Chinese medicine, the idea of qi underlies and informs the entire system.  This sets Oriental medicine at odds with the Western, mechanistic viewpoint we Occidentals take for granted.  With the advent of the industrial age, the “scientific method,” and the requirement for “objectively verifiable” evidence, we’ve come to rely on instrumentation and a cause-and-effect sequence for assessment and treatment of any given condition.  The body is treated as though it’s a machine, with the resident human being largely a passive recipient of the diagnoses and treatments decided by the technician/physicians who administer them.

While the official stance of “science” receives almost religious devotion and some legitimate respect, it is exceedingly limited in what it can do.  “Science,” which relies on measurable “proof” has yet to prove that life exists.  Nor has it located the “mind,” although most believe the “mind” is in the brain.  The scientific method relies on studies that theorize causes, then set up conditions that limit variables to one, to determine whether there’s a significant correlation between cause and effect.

My unorthodox approach to life, health, and medicine stems from a fundamental belief in the power of the life force.  I call it “vitality,” but others may refer to “qi,” “quality of life” or use any number of terms to describe this battery that keeps us going.

Whether individuals survive physical death, and if so, in what capacity, is a question no one can answer, although religions and philosophers of all persuasions have tried.  What is life, anyway?  Is it a candle flame that can be extinguished?  Is it an essence, like “qi” that joins the “qi” of the cosmos, to be re-born in another place and time?

I won’t try to answer these questions but raise them simply to note that a belief in life beyond death strongly influences how I live mine.  Certainly others wrestle with the question, especially as they get older and wonder what lies ahead.

I became a psychiatrist partly to help make philosophy practical, but the profession—and Western medicine as a whole–is going in the opposite direction.

“How so?” a reasonable person may ask.  The most obvious answer is that it devalues the most basic principles that keep us healthy or make us sick.  Western medicine systematically undermines the individual’s faith in his or her own body’s self-correcting mechanisms.  It pits mind against body, which is deemed untrustworthy, a thing to be feared, unreliable.

The intangibles that formerly distinguished psychiatry from other medical specialties, the “quality of life” issues—now take a back seat to “evidence-based medicine” and the vain attempt of psychiatrists to align with the more “scientific” practitioners.

The antidepressant Prozac (fluoxetine) was introduced in 1989, two years before I graduated from medical school.  This began the separation of psychotherapy and other “talk therapy” from “medical management” of emotional problems.  While other antidepressants, anti-psychotics, anti-anxiety agents, and mood stabilizers had been on the market for decades, Prozac began the trend toward a raft of new, patented, drugs that could treat symptoms while ignoring the larger life pattern that led to the problems.  “Talk therapy” was shifted to psychologists and social workers, with the move heavily supported by government and insurance reimbursement criteria.

Since that time, the avalanche of patented drugs, technologies, diagnostic tests, and other interventions has made the “health care industry” one of the most profitable sectors in the United States.  Costs for the individual have skyrocketed, such that few can afford medical help without insurance.  Now, the government has made insurance mandatory.  No one seems to recognize that insurance does not equal health care.  In fact, insurance impedes, rations, and delays health care, and it raises the price for everyone.

Medical care costs twice as much in the US as anywhere else.  Medications are significantly more expensive.  A continuing medical education article I read says medical error is now the third leading cause of death in the US, after cardiovascular events and cancer.

That medicine and psychiatry seem obsessed with finding or creating problems already puts patients at a disadvantage, in a defensive position.  Psychiatrists don’t get reimbursed for “no diagnosis.” They must find or invent a diagnosis, a label, to justify the time they spend.

No wonder Oriental medicine has such appeal for me.  Here, diagnosis is based on patterns of disharmony within the body and mind.  The hands-on approach is individualized and personal.  The patients and the practitioners are partners, with the belief in the treatment’s effectiveness–“the placebo effect” in Western terms—a desirable component.  In short, it respects the dignity of the vital forces that medicine presumes to reinforce.

I hear people say that “health care is a right.”  We also have a right to refuse health care, especially when it’s forced on us by hostile, predatory forces.  We have the right to eat nutritious foods, life a balanced life, and keep stress levels low.  We have the right to maintain our vitality and health they best way we know and to choose who and what to trust for help when we need it.

 

I Couldn’t Make This Up: 2007

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Ten years ago this month I was working a short-term contract as a psychiatrist in a public mental health outpatient clinic.  At I was considering allowing my medical and DEA licenses to expire, simply because I felt like a hypocrite.  I entered psychiatry to set people free, not to enslave them to diagnoses and drugs, government and insurance, for the rest of their lives.

DEPRESSED ECONOMY

Sunday, April 1, 2007 – Driving around Columbus, GA shows how depressed the economy is.  It smacks of military people borrowing against an uncertain future. Independent businesses are so rare as to be non-existent. Otherwise, Columbus is clunking along on pawn and title pawn shops, government buildings, banks, insurance companies, and a variety of businesses dedicated to selling and maintaining vehicles and vehicle parts.  There is so much run down and empty commercial space – and the place looks generally devoid of life – that the only activity shows at the multiple traffic lights, where large trucks, vans, SUV’s and old clunkers congregate as if at a business meeting.

PET FOOD SCARE

Tuesday, April 3, 2007 – The pet food scare widens, and it appears the economic hit is on China’s wheat gluten.  I’m more convinced than ever that the thugs at DHS, CIA, FDA, CDC, or DEA are behind it, and they all answer to Bush and Cheney, the sadomasochistic side show in the world-wide butt fuck.

I believe the goons at DHS have made their point.  Melamine is a plastic, used in McDonalds’ forks, hahahaha, and the latest bullet in the war on pets, but the repercussions in the plastics industry should be interesting.  I’ve wondered about the buildup of plastic breakdown products in the environment, and the toxins they release.  Animals would be the most susceptible, of course.

No one has proved the wheat gluten is the cause.  No one has even proved what the toxic agent is.  The “scientists” are disagreeing with each other, thus to obscure the real issue (in my view) that this was inside sabotage by someone who had access to aminopterin, which was proven in the DHS-funded lab at Cornell, created for the purpose of protecting US tax revenues from foreign threats.

The media arm of the Police State blithely ignores the obvious, so eager is it to cozy up to the perpetrators.  I’ve noticed AP is particularly reprehensible along these lines.  No wonder it hides behind its image.  It took some research to discover where their corporate offices are.

FEAR

Wednesday, April 4, 2007 – The vague cloud of fear that hovers over me surrounds the planet, I suspect, and I am less afraid than most.  Unseen enemies are those who are reacting to their own fears, and I have to dance lightly to stay out of their way.  I try not to take insults personally, even if they are meant that way.  I get strong reactions from people, as on the ESLR message board, when I assess the state of the “economy.”  I don’t pander to the Wall Street-generated hype meant to reassure people of economic growth, despite evidence.  It’s a pack of lies and deserves to be so-called, because people aren’t as gullible as they once were, especially as they feel the “economic growth” like a cancer in their personal lives.

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Corn, Cochran, GA Supposedly 80% of corn sold in the United States is already genetically modified. It’s too late to label GM products.

CORN AND ETHANOL

Wednesday, April 4, 2007 – How much time does it take to grow an acre of corn, convert it to ethanol and burn it?  Has anyone calculated the cost of energy, soil depletion, and water for the process?

The environmental groups are quiet on this one, and so are the Agriculture Department, the economists, farmers, American Solar Energy Society, and scientists.  Isn’t anyone even curious?  Congress hasn’t asked, Bush certainly doesn’t want to know, and once again, I am the lone voice asking questions that should have been asked a long time ago, before the legislation, before the factories were built, before the farmers were seduced into following this government-created fad.

COLUMBUS, GA NOISE POLLUTION:  LOCUM TENENS ASSIGNMENT

Wednesday, April 4, 2007 – The noise makes constant assaults on my senses, and I’m afraid  I will explode from repressed fury.  The airplanes have been droning–along with machines, traffic, and sirens–but mostly constant airplanes since I got home to the camper, exhausted from a relentless day, seeking a little peace, not to be had here, where the very earth is vibrating from the din.

I, for one, will be glad if I live to see the world run out of oil.

Now, the train.  The trucks on the highways.  The last airplane is gone, finally.  Was air traffic stacked up over the airport?  The train whistle is constant.  Everybody is in a dizzy tizzy today, all except the one bird I hear twittering, and my cat, who is as serene as a placid pool, asleep.

That train has been whistling for five minutes.  Motorcycles, more trucks.  If I were home and could do it, I’d let out a primal scream by now, so furious am I.  A horn.  another motorcycle.  I can still hear the train.  More traffic.

I turn on music and dance awhile, as I encourage patients to do.  It helps my attitude a little.

Train still blowing the whistle – seven minutes or so.  Constant.

The work turns me into a zombie prescription writing machine.  In W’s office, where I work on the adult side, the computer is also loud, so I listen to that all day and wonder if that contributes to my headaches.  Or maybe it’s the coffee they have there, the creamer, the stress.

I just got up and closed the windows.  It helps a little, but my head is vibrating still.  I can feel it like a saw grinding though my skull.

I turn on the fan, now that the windows are closed.  I can still hear the traffic noise outside, even though the fan is only two feet away from my head and has its own noise.

How loud must it get before people wake up?  Now I know why people go deaf.  Not that it would protect anyone here, because the vibrations penetrate all walls, all protections.  You can hear it over the music, over the fan, over the air conditioning.  It rattles the ground, shakes the camper.  I might as well be in the center of a war, except this is a war on nerves, as in the nerve of them.  There is no defense against sound, except to leave or bury my head in  . . . what?  The earth transmits it, too.

You get what you focus on, says Seth, but how can I think of anything else?

Winston Smith, in George Orwell’s classic novel, 1984, had a horror of rats gnawing his face, so those who would convert him used rats in cages over his face, as I recall.  For me, relentless machine noise is the torture I most fear, but I am already being tortured, and my head hurts, and I think I will have a stroke or heart attack, and soon, if I don’t escape this hell hole in a healthier way.

 

USPS REORGANIZATION

Friday, April 13, 2007 – I discovered Richard Nixon re-organized the Postal Service in 1971, giving it over to a Board of Governors, and removing the Postmaster General from the Cabinet.  You don’t hear much about the Postmaster General or the Board of Governors, but the USPS affects every area of our lives.

Who exactly owns the USPS, which is so heavily saturated with garbage mail it can’t deliver a first class letter without losing it in the junk?  Why am I subsidizing these assaults on my money, attention, and all the trees on the planet?  I pay yet again for the destruction to the environment.  And these government goons are blaming taxpayers for global warming?  They are burning resources just as fast as they can get away with it, and their solution is to do more of the same?

Not at my expense, folks,  Use your own money to play stupid, because I don’t run my life that way.  Double rates on all sneaky mail (that is, all mail with rates they don’t want you to know).  How’s about publish ALL the rates everyone has to pay, like the slick paper flyers and unwanted medical journals, CME offerings, school and university solicitations, magazines, newspapers, non-profits, campaigners, sales pitches, fundraisers.  If they didn’t spend so much money on self-congratulatory propaganda, perhaps they could afford to do some good.  What exactly is pre-sorted first class?

MONEY MANAGEMENT

Saturday, April 14, 2007 – Money management is about keeping my money.  The more money I keep, the more money I save.

 

 

 

 

 

The More Things Change . . .

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Above:  The professional literature in Psychiatry remains funded primarily by pharmaceutical companies.  I get up to eight Psychiatry periodicals every month, all containing about 50% advertising, most of it by Pharma.  This junk enjoys a privileged postage rate, because it is “educational.”

April 12, 2017–Reading old journal entries helps me focus blogs and show the trend of my thinking over time.  In April, 2007, ten years ago this month, I was considering allowing my medical and DEA licenses to expire, because I felt used by a medical system that causes more disease and suffering than it alleviates.  As a psychiatrist, I was under a virtual mandate to prescribe drugs that promised more help than they delivered.  Not only that, but the system itself was so dysfunctional that it put everyone at risk.

ON MEDICINE AND PSYCHIATRY
Wednesday, April 18, 2007 – If I can get out of the business of medicine, I can enjoy the fun of medicine, when it’s done right.

It starts with honesty.  We have created a sado-masochistic society that feeds failure and punishes success.  In today’s climate, the individual doesn’t matter.  “Equality” means bringing everyone down to the lowest common denominator, statistically speaking, to save the “economy” from the individuals who take more than they give.

Our society has rendered them so dysfunctional that they are incapable of doing anything useful and resentful of those who expect them to make an honest living.
What kind of psychiatrist would I be if I didn’t point out the insanity of that?  I believe the individual matters, if only to herself.  I matter enough to stand my ground in the face of society’s power struggles and to comment on the process.

The US psyche is caught up in the emotional two-year-old anal stage of psycho-sexual development, the “terrible twos,” the year of potty training, the age in which life-long issues related to power and power struggles emerge.  The “self” vs. “not-self.”
As we play with the shit we have created, we are evolving, hopefully, toward a greater understanding of what it means to be free.  Demonizing and drugging the individual mind and spirit is society’s game, not mine.  I have evolved beyond the anal stage.  I quit.  Get ahead by slowing down.  Take time to smell the roses before you pave them over.

This patient-churning prescription writing machine throws the government credentials—the medical licenses—into the compost bin.  Thus relieved of the paper shield, I step from in front of the DEA’s guns to show them aiming at my back, to control invisibly every aspect of the prescription game.

They need me more than I need them, but only because they believe in drug laws.  If there were no drug laws, we wouldn’t need the DEA, but doctors would still have jobs.

“Doctor,” a word my absentee bosses don’t know, is derived from the Latin “docere” meaning “to teach.”  A doctor is fundamentally a teacher about health.  That’s what I do – teach people about health, especially mental health.

You know what I tell my patients?

“It really is them,” I say.  “They are the crazy ones.  Don’t put your life on hold waiting for the government.  You’ll grow old and die waiting.  Live it up while you still can.  Dance in the living room.  Turn off the television, for your sanity’s sake.  Shut off the mind and noise pollution so you can hear yourself think, and you’ll get back in touch with your common sense.”

ADHD (ATTENTION DEFICIT HYPERACTIVITY DISORDER)

Tuesday, April 3, 2007 – I enjoyed working with kids and parents yesterday.  I gave practical advice and supported them in their efforts.  A little six-year-old hugged me on the way out.

These aren’t bad kids.  In fact, I think many who are branded with ADHD are brighter and more creative than the rest, with skills and interests that reach beyond the classroom.  A 12-year-old girl who is about to fail sixth grade for the second time daydreams and draws during class.  Likes violin and reading Japanese books in English.

I reassure them school really is boring, and teachers are busy pleasing absentee bosses.  Moms nod vigorously, and the kids stare at me as if they are shocked I would express such heresy.

CME ON ADULT ADHD

Tuesday, April 3, 2007 – I read a Continuing Medical Education article on ADHD (Attention Deficit Hyperactivity Disorder).  Bottom line is there’s nothing new, except the diagnosis of adult ADHD.

Do you think anyone would consider causes pills won’t treat, like multi-sensory fatigue from the environment?  Machine noise from traffic and power tools, airplanes, blowers, coffee grinders, speakers in coffee shops, grocery stores, hardware stores, banks, blaring “I Died and Went to Hell” music and advertising at top volume?  The screeching, attention-starved voices from the halls of hell?  Who can attend to anything with all that noise?

No.

Think they might consider that the same drugs are used by drug addicts and schools to treat the same symptoms, but it’s okay if you have the correct diagnosis?

No.

Think the lack of physical education in the schools, or the fact that kids with too much energy are punished by depriving them of play time might contribute to their hyperactivity?

No.

It’s all in the brain chemistry, you know.  Hit ‘em up with a little Adderall or Ritalin and we’ll let ‘em come back to school.  Never mind that they have been suspended the last X days and are even further behind.  They shouldn’t have acted out.

The other two psychiatrists here, Child & Adolescent psychiatrists, indulge me in my one-to-two minutes of tirade.  Each says separately, unfortunately, the kids who come here need to be on meds.  Doctors have adapted to being prescription writing machines, drones in the endless grind of patient-churning status quo.  They see the hypocrisy, but they learn quickly to keep quiet, to show in behavior the repressed anger generated by power abuses.

Learned helplessness vies with identification with the aggressor, but do you think psychiatrists make the connection between abstract understanding and the evidence in front of them?

No.

Why learn psychiatry if nobody cares?  You could get a computer to write prescriptions faster and more legibly.

The inertia is as cloying as clear gelatin.  Perhaps this is the egg; the yolk, the planet, the albumin the atmosphere, with humans poised at the interface, possibly growing and possibly getting big enough to crack the shell.

 

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