Health Care Alternatives and Reality – Series – Pt. 5

 

The Myth of Mental Illness

The above is the title of an important book by Thomas Szasz. Mental illness still dominates a significant portion of our health care system and it still has major conceptual problems. Of course, as a clinical psychologist, I was schooled in it. I actually came to love Carl Jung’s work a lot more than Sigmund Freud’s but his work still dominates.

Alternative Realities

And so we again return to where we live on the cusp. Over the decades I found nonphysical problems related to mental and cognitive issues to be far removed from “illness” and often nuanced. And when we move away from the dominant model, we find suitable alternatives. Unfortunately the insurance industry dominates the field and therefore may dictate treatment or at least what it is called. What it is called will often influence what is done. Substantial reform is needed.

Some of the Issues

When my wife and I personally confronted issues for remarried families (aka stepfamilies) we learned important lessons. An important initial lesson was that the process is a matter of adjustment, not psychopathology. Certainly there were some people with substantial disturbance from other causes but we learned to begin with our model of adjustment. The  couple was focused on initially. Too often the mother or stepmother was put in therapy as if they were the problem although they may have shown the greatest distress initially. And we were resistant to putting children in therapy because adjusting to a new family was not pathological in almost all cases. Because of our approach we could structure an information system and found that generally the family could take over adjustment and handle their own future after very few sessions. See our book Stepfamilies: Professionals and Stepcouples in Partnership by Mala S. Burt, M.S.W. and Roger B. Burt, Ph.D.

Another major issue is what is termed post traumatic distress disorder or PTSD. The military is wrestling with removing the word disorder because it proves to be a bar to veterans getting help with their adjustment. Does anyone really believe that someone should go to war and kill people daily or risk being killed daily while suffering stress and not need to cope with management and an enduring reaction. I shared my perception with some friends who were veterans and found them in tears when I suggested they were not “sick” although there were still issues decades after their war experience. 

Enduring and Broad Issues

Those are just two examples of the reality of a world far more nuanced than what is described as mental illness. We can go on between things like personality diversity, numerous personal management needs as we pass through stages of our life. When I first came into the field the predominant viewpoint was that our development was finished in early adulthood. Absurd.

Management of life experience continues throughout life and it would be best if we approached our lives in that fashion. Take an area of life experience and we see that there is change, stress and adaptation. It would help if we defined a type of insurance that was appropriate and took these issues out of the hands of insurance companies focused exclusively on profit.

Life on the Cusp

Yes, here is that cusp again. Each of us is different with a raft of different experiences. We work for stability and commonality and often success. But it would help if we understood the richness of our diversity in the sense that much of the issues are not pathological and that our views from the cusp feed creativity, diversity and innovation. And life can be difficult, even jarring. From time to time we need to seek expertise and guidance but we generally do not need to cast it all into psychopathology. There are problems out there with profound biological origins where the person needs substantive help but very often management and guidance are what is needed.

Gaia’s Majesty-Mission Called: Women in Power by Roger B. Burt

Roger B. Burt’s Amazon home page

Creating Characters and Plots by Roger B. Burt

Stepfamilies: Professionals and Stepcouples in Partnership

Whatever Happened to Community Mental Health by Roger B. Burt

Pie in the Sky

 

How do you think seniors are doing?

We Have Work To Do

Even if the actualization of a thought is distant or unlikely, there are times when some things have to be said.

Here is today’s dream.

The Elder Tsunami

The “advanced” economies of the world are facing the rapid aging of their populations which means a growing burden on the societies as a whole. The birth rate is often low and getting lower which means less familial and societal support for the elderly. Who will take care of them as they age and become frail? Family is often distant or members few in number. 

Time was that we lived in close family groups. No more. Instead we are fragmented. We need a realistic national dialogue about solutions. Perhaps, as the neocon obstruction dissipates we may see improved governmental programs, but it seems no matter what, it will be insufficient or impossibly expensive. And I must add that Paul Mason’s book Postcapitalism, that directs our attention the future, is making my blood run cold. It is a complex and dense book but each area he touches on is being validated by current events. But the true import of the coming changes in the world economic system is not being recognized publicly—yet.

https://www.amazon.com/Postcapitalism-Guide-Future-Paul-Mason-ebook/dp/B011I42XQ0/ref=sr_1_1?s=books&ie=UTF8&qid=1464014949&sr=1-1&keywords=postcapitalism+paul+mason     (get this from Amazon page for WordPress)

Certainly there are ideas out there to mitigate the coming trials. One alternative is social.

Societal Commitment

The Elderly for Each Other

I’m impressed by the progress that Habitat for Humanity has made nationally. There can be other forms of programs with societal support. The most likely source for the elderly is each other. Retirement is reached and then often there are healthy years before the inevitable decline. When I was working on my doctorate at Duke they finished a study which described a two year major decline before death that was common. Prior to that time, before the final decline the recently retired elderly could become more of a formalized volunteer force. It already happens somewhere, sometimes, but could be expanded.

The Elderly for the Young

In later years, having a cause is also useful. One cause I would recommend is making the commitment to support the efforts of a younger generation. The future for the elderly dims but there is reason to support younger generations. I don’t mean to say that these things don’t happen. What is at issue is the societal institutionalization of an ethos where we as elderly focus more strongly on our collective wellbeing whether that is for the elderly or for the ones who will remain. We have not been doing this well.

System Efficiency and Personal Management

And then there is the matter of health. Another thing we must do is to finally create a less expensive and more efficient health care system. Currently we have a very haphazard system which is expensive. Each of us experiences it on a regular basis. And included in these changes for the health care system needs to be a change of viewpoint by the elderly. Many have been trained over the decades to assume that the medical personnel will define what must be done and they adopt a passive stance. It is time to change that societal viewpoint so that we take the highest form of responsibility for our own care informationally and by action.

In Summary

In short, I would like to see a societal change in which the elderly, as they go through the later stages of life, work more closely together for mutual benefit. Secondly we should see to it that there is more organized societal support for the generations coming up. It is clear Millenials have felt overlooked and that needs to change. And the third item is long overdue reform of the health care system.

I know the response in many quarters will be that these goals are unrealistic or are already being undertaken. My response is we have not done enough and can do much more effectively.

I can dream can’t I?  Are you dreaming?

Gaia’s Majesty-Mission Called: Women in Power by Roger B. Burt

Roger B. Burt’s Amazon home page

Creating Characters and Plots by Roger B. Burt

Stepfamilies: Professionals and Stepcouples in Partnership

Whatever Happened to Community Mental Health by Roger B. Burt

Health Care Alternatives and Reality – Series – Pt. 4

Our Ailing Health Care System

Where to Begin!

Since this is a post, not the required book, I’ll keep it short. 

We are a nation in crisis currently and not the least of the crises is our health care system. The enduring battle to reduce if not cripple government has taken its toll. We are the only developed country without an advanced health care system for all its citizens. And even what we have is under attack. Our system is inefficient and costly. Even if you are well off and well insured you immediately see problems.

And now that the government is under continuing attack we may see the collapse of small hospitals in rural areas. It would make the system even worse.

Seeing Problems First Hand

A few years ago I began to suffer mysterious and ephemeral problems and began a search for a cause. It turned out that I had Lyme Disease which had been poorly studied and is now epidemic. That was a major indicator of medical shortsightedness in itself. But then the problems became more obvious. I saw three separate physicians and each ordered a blood test (which we now know was virtually useless). When the results came in I found they were all the same tests. What a waste.

In France the public carries a data card and all results go on it. If we had such an efficient system the second physician would have had the results and there would not have been a second or third set of tests.

Floundering Over the Years

I am now considered to be a chronic Lyme Disease sufferer. It has been ten years since I believe I contracted the illness and I’m in my fourth return of the disease. This time my treatment will be more protracted. I can’t fault the medical people who have tried to help but the research has been abysmal and denial has been widespread. The stories of problems are endless.

Each of us has our own stories of problems, failures and inefficiencies. And the mental health field is no different. In a later post I’ll focus on one notable issue I became centrally involved in.

Failure on the Horizon

Many of us are looking at health care systems around us failing or on the verge of failing. As noted above, poorer, rural areas are particularly vulnerable in present circumstances. If those hospitals close, the effects will be devastating and the consequence will echo down the generations.

And currently we see areas which are very vulnerable and I saw a very specific area decades ago and it has not gotten any better. When I went to work in the impoverished area in the inner city of Baltimore our young staff learned quickly that the greater threat to “mental health” was poverty because of the depression and anxiety. But our seniors held fast to their desire for centralized systems rife with long term therapy and medications which served our people in the inner city poorly. I’ll leave it there for now. The sad tales go on and on.

But There Is Hope

Suddenly we are seeing an uprising in America. Our young are proclaiming “Enough Is Enough” and women are proclaiming “Me Too” in regard to sexual harassment and at the same time we are seeing a reenergized civil right movement. Now we can see the distinct possibility of vision and attention to the realities for our future. And health care is an essential part.

Gaia’s Majesty-Mission Called: Women in Power by Roger B. Burt

Roger B. Burt’s Amazon home page

Creating Characters and Plots by Roger B. Burt

Stepfamilies: Professionals and Stepcouples in Partnership

Whatever Happened to Community Mental Health by Roger B. Burt

A Time of National Reformation

Understanding the Need for Change

Do you believe we are facing major change or just major disorder?

It has not yet been described as such, but it would seem we are on the verge of a national reformation. We appear to be suffering conflicts with no solutions immediately on the horizon. It is often dismissed as political but we have to suspect we are dealing with more fundamental issues.

The reaction to recent mass shootings is just one indicator of a national crisis. We are looking at demographic change looming large even as a major party seems to be in the process of collapsing. Now is a time for us to do a multilevel reevaluation on many fronts.

Public Safety and Guns

At the forefront is the issue of needed changes regarding our rules about guns. That means what type of guns should be permissible for possession outside of the military and what rules there need to be related to possession in general.

With all the discussion I have not once heard a meaningful discussion regarding the second amendment. The amendment was about the maintenance of a militia in a newborn country that did not have a standing functional army. Somehow it has become transformed into something else entirely.

In broad strokes we need to address matters of public safety as they relate to gun possession and related restrictions. That means we will also have to address ideological issues as they relate to the wellbeing and the future of our country.

Personal Dysfunction in a Society

But for me as a psychologist, I see another set of issues related to what we call mental health. It is brought up regarding guns and has sets of problems of their own. As noted, we originally applied the disease model as a way to remove issues of personal functioning from the belief in demonic possession. Our emotional and cognitive functionality did not belong in the religious arena but using the medical model has serious problems in its own right.

Many of the shooters in recent massacres were victimized by family history, distorted religious zealotry and probably sexual identity confusion among many other issues. But the question of how we address public safety leads us into a complex arena. And in that regard the disease model offers little clarify. It is supposed to instruct us about the nature of the problem, what procedures to use to deal with it and what medication is indicated if any. In fact, we must separate “mental illness” from the issue of gun management. They are related but there are many other issues involved.

Designing a Helping System

Our health care system is often dysfunctional, especially when corporate profit guides response.  The physical health system and the mental health systems need serious attention and redevelopment.

In the larger picture we need to go back to fundamentals and design the model of how to relate to what are currently called mental health issues. They may be biochemical, stress related, developmental, chemically induced and so forth. Then we need to deal with how to respond and what help to offer. A long overlooked reassessment would take considerable time and even then will prove difficult when it comes to public safety. The issue will always be how to make functional help available and how systems can be designed to serve the sufferer and the public.

Reexamining Fundamentals

It would seem, at this time of what I believe will be national reformation, we should be reexamining fundamentals on many fronts. And my special interest is in reforming and completely revising the use of the outdated model of mental illness. How to respond to dysfunction and distress in human life is complex and that includes our response to drug addiction and abuse. Prevention is related to availability and utilization of services. When we tell people they are “sick” it may turn them away from the guidance and help they need. We attached the D to PTSD and turned it into a disorder when it is, in fact ,a predictable stress reaction among other things. It goes beyond a reaction to the experience of war and now we can see effects on our school children because of the recent shootings. The D proves to be a barrier to help and understanding. We can throw money at these issues but it would seem best to begin by reevaluating our approaches. 

How many of these issues have you experienced personally?

Gaia’s Majesty-Mission Called: Women in Power by Roger B. Burt

Roger B. Burt’s Amazon home page

Creating Characters and Plots by Roger B. Burt

Stepfamilies: Professionals and Stepcouples in Partnership

Whatever Happened to Community Mental Health by Roger B. Burt

Orlando! The Meaning and Impact of Mental Illness IV

 

Dealing with Life

Each of us can be placed on dimensions of a set of behaviors and processes. When there is mental illness is a matter of dispute and fashion. When mental illness is defined, too often it is a function of funding and professional achievement. That sounds obscure, but think about it for a moment.

When community mental health blossomed, we learned, at least in inner city poverty, that poverty is stressful (seriously?) if not just plain overwhelming. The social workers were closest to the truth and saw our intervention as “case management”. People get depressed and anxious when they are overwhelmed and when we helped them manage their difficult lives they became less anxious and less depressed. In a poverty environment it is appropriate to be deeply concerned or even terrified regarding the future of your children.

The senior professionals above us wanted the grant money, the status and wanted to perpetuate the establishment. The young staff saw things very differently.

Guidance and Management

Through all my professional experiences I have come to see humans as functioning on a series of dimensions which instructs our personal development, defines, guides or disrupts our functioning. Stress exists and causes serious functional problems. Somewhere in there are biologically based issues and without a doubt most of us need guidance from time to time. And some people benefit from exploration of the self which they may find in some form of what is called insight therapy.

Sorting Out Reality 

Overall, I would like to see us dismiss the concept of mental illness entirely. We can focus on problems associated with biochemical processes when essential and detach severe reactions caused by trauma. It would take time to reformulate the field but we certainly could become more effective and husband our resources. Problem solving and management are basic parts of all human endeavors. What do you think would happen if we started to diagnose corporations or political candidates? I doubt there would be much approval by the objects of such activities.

What happened at Orlando was a terrible tragedy but also opened a door where we find the opportunity for reevaluation on a variety of fronts. I know I’m crying out in the wilderness because there is a huge investment of various kinds in maintaining the status quo. But I can dreams can’t I? There might be a world where we are honest with ourselves, where we can be more efficient and effective and accept our complexity and variety of potentials.

Gaia’s Majesty-Mission Called: Women in Power by Roger B. Burt

Roger B. Burt’s Amazon home page

Creating Characters and Plots by Roger B. Burt

Stepfamilies: Professionals and Stepcouples in Partnership

Whatever Happened to Community Mental Health by Roger B. Burt

Diagnosis and the Real World

Under what diagnoses do you suffer? (Curious question isn’t it?)

Let’s Begin Here

Two definitions come to mind at once as we look at this post. Psychiatry is defined as: “the study and treatment of mental illness, emotional disturbance, and abnormal behavior.” Psychology has a variety of definition but I prefer: the study of human and animal behavior. The numerous other definitions suggest we aren’t actually sure what psychology is and I share that position. in fact, there is even a philosophical element which suits me just fine.

In Clinical Psychology

When we move on to the clinical area we quickly brush up against mental illness and as a student we quickly learn that diagnoses are generally expected. But how does mental illness fit with the broader definition of the study of human behavior. It seems like it must be a subcategory. What I found was that it is a restless subcategory and won’t keep its mouth shut.

Or at least it becomes a problem when we visit that devise place called the real world. And, of course, I believe in the cusp of reality which means I have questions. Are you hearing the pounding of philosophy at the door?

Then There Is Diagnosis

Freud defined a great deal of what is psychiatry and we entered a world of illness which required treatment and so there must be a diagnosis. The whole process was to be applauded because it moved emotionally disturbed people out of intervention for possession by demons  generally under the oversight of the church. They were in better, more compassionate, hands then. But not all of mental health people were devoted to Freud’s teachings. And that included Carl Jung who took us out into the world at large in a variety of ways. I won’t try to explore him. Take a look yourself.

What’s the Point?

It seems we are lost in a forest of exploration. There are those who believe in specific diagnoses for mental illness and in some case it yields helpful intervention. But there are others of us who believe it is far more complex than that. Sometimes diagnoses lead us down narrow corridors and sometimes it is more effective to shy away from an illness model and take the path to looking for functional factors and something I will call life management.

In This Age

Isn’t it interesting that as we rush forward into the future we are still mired in definitions and differing camps of adherents when it comes to what we call health care. At least we have latched onto prevention and a variety of preventive procedures. Those continue to need exploration and so do our responses to things happening to us that deserve attention.

That’s enough of the meshing of philosophical exploration with the real world. In future posts I’ll move deeper into the world of what we call mental illness and alternative forms of response which includes what I call self management.

What are your biggest concerns about health care?

Gaia’s Majesty-Mission Called: Women in Power by Roger B. Burt

Roger B. Burt’s Amazon home page

Creating Characters and Plots by Roger B. Burt

Stepfamilies: Professionals and Stepcouples in Partnership

Whatever Happened to Community Mental Health by Roger B. Burt

Orlando! The Meaning and Impact of Mental Illness III

 In the Private Sphere

The story is long and detailed and over the years I saw so many dysfunctions related to how the mental health field was constructed. In private practice later I had to confront the insurance industry. In the end they were successful in virtually destroying much of the “mental health” field. They required ever more serious diagnoses if they were to grant payment. Often my decisions as a doctoral level psychologist were at the mercy of someone with a two year general college degree.

Stepfamilies at Risk

In work with stepfamilies we recognized that they weren’t pathological but were stressed family units in flux. Families in deep crisis were coming into our practice and we learned that it was essential to stabilize the stepcouple. Insurance would pay for therapy for the stepmother (to them it seemed women were usually the focus if not the origin of the problem), or they would pay for therapy for a child. We saw the need to stabilize the couple and when they were out of crisis the children realized this was their new family and went from crisis to return to their friends and schoolwork. Using a couple’s focused episodic model we were able to stabilize these families in an average of just seven sessions. They weren’t pathological. They were suffering stress from a major life change and needed management help.

The insurance companies were willing to waste money on individual therapy for women and children if we would declare them “sick” enough but weren’t interested in functional work. Their number one goal was obstruction in the interest of profit.

Corporate Dysfunction

People in the field have to face inappropriate “mental health” and diagnosis problems along with a health care industry which is not highly functional. 

And so we come back to the myriad of issues in something like the attack in Orlando. A political system failed to help protect the citizens and we cannot know what the course of the perpetrator was. He probably began with much less serious concerns or impulses and moved on to an ever deepening and more complex crisis. If we had detailed information all along the way we would seen a series of effects and crises that would not lend themselves to a firm diagnosis. And therein lies the problem. We need a wholesale revision of our thinking, description and approach not to mention the system for availability of help for our citizens and dealing with corporate obstruction in the interest of profit.

Coping Versus Disease

As I’ve said before, emotional and cognitive disturbances were moved over to medicine so that we could remove the influence of the church. We no longer believe in demonic possession although at times it is tempting to believe there are demons in human affairs such as in this election.

It was good to remove the demons from our thinking but defining our mental and emotional variations as illnesses was also a mistake. Over time I’ve seen the fads and the missteps. When I was in graduate school I saw not one child who was termed autistic. I had heard they existed but never saw one. Now we have an “epidemic”.  And now we learn it may be related to the use of chemicals which find they way into our food. That makes it an environmental issue and not a mental health issue at all. We have a lot of sorting out to do.

To be continued.

Gaia’s Majesty-Mission Called: Women in Power by Roger B. Burt

Roger B. Burt’s Amazon home page

Creating Characters and Plots by Roger B. Burt

Stepfamilies: Professionals and Stepcouples in Partnership

Whatever Happened to Community Mental Health by Roger B. Burt