In this morning’s New York Times magazine, former journalist Lori Gottlieb wrote a feature titled The Branding Cure, My so-called career as a therapist, about the dying practice of psychotherapy. As a newly minted psychotherapist, she sat in her empty office awaiting patients to flock to her door for her help. They neither flocked nor walked. They stayed away in droves.
In an effort to find out why, Gottlieb discovered that according to Dr. Katherine C. Nordal in a 2010 American Psychological Association paper titled “Where Has all the Psychotherapy Gone? that psychotherapy as we know it – or at least I know it as 50 to 60 minute face-to-face sessions with a caring and knowledgeable psychiatrist or psychologist – is quickly becoming archaic.
Meanwhile, as “managed care” has declined dramatically, “pharmaceutical companies spent $4.2 billion on direct to consumer advertising and $7.2 billion on promotion to physicians, nearly twice what they spent on research and development,” Gottlieb reported from Nordal’s paper. Increasingly more and more patients are receiving medication only – 57.8% in 2007 or 30% more than 10 years before.
I find that shocking and sad, but I know it’s true.
Having lost my only kidney (yes, I was born with one) to carelessly monitored Lithium Carbonate back in the 1970s and 1980s – iatrogenic acute endstage kidney failure – I know that unmonitored medication can be perilous.
Nordal admits at the outset that “while medication is an appropriate part of a treatment plan for many mental health disorders, psychotherapy has been documented as the preferred treatment for many common psychological disorders.” I have learned that medication PLUS psychotherapy is the best route, but that is my experience. My psychiatric experience started in the 1960s, its dark ages with precious few pharmaceutical choices.
I want to stay hard and close to my subject, Coming Out Crazy, but there are times when I long to digress.
And if the truth be known, craziness is a wild and woolly subject. We’re all crazy at times in our lives. Being a bit crazy is quite liberating, I think. So I hope you’ll understand if I share some of the strategies that keep me sane.
“My exit strategy”…
We’re spacing out our appointments. Seeing each other monthly. This is all part of my “exit strategy” from my psychiatric psychotherapy.
Dr. Bob and I began seeing each other in 1990. That’s 22 years of life-changing therapy.
This past February he spent six weeks at Addis Ababa University teaching psychiatric residents through an exchange program with the University of Toronto. Initially I was concerned about him being so far away for so long.
I was meeting with my psychologist Kim Watson and working on recovery from my eating disorder. So I was not working entirely without a net.
When Dr. Bob returned he couldn’t believe the change in me…
“You’ve done it,” he said during our first session on March 29. “You’ve been working very hard.”
That was when I began for the first time in my life to entertain the idea of what until now was unthinkable for me.
I’ve steered far away from. It scares me.
Here’s how it was explained to me at the Eating Disorders Outpatient program I just completed. And remember, an eating disorder is a psychiatric illness.
For a minimum of two years, I was told, I could not go back to see my social worker, dietician or any of the practitioners who helped me begin eating normally for the first time in my life.
A follow-up might be possible, but now I have a psychologist to help me.
I suspect psychiatrists work in similar ways. I don’t know…
Once you say good bye. Once you receive your psychiatric “seal of approval.” Once you have your psychotherapeutic “walking papers.” Once you leave, is that it?
Do you venture off into the world on your trembling feet, vulnerable, alone? Independent? Do you never see your therapist again? Or at least for a minimum of two years? That never seemed to be the case with Dr. Bob. It seemed he would always be there for me.
He’s an unusual psychiatrist…
“A very, very, very difficult child,” I’ve been told time and again all my life. “There was something wrong with you.”
You hear that long enough and often enough and you begin to believe it, Dr. Bob reflected this week.
His orientation to psychotherapy is eclectic. We talk. I sit facing him and he sits behind his desk facing me. There’s a couch in his office, but I doubt anyone uses it. And an intriguing piece of art that says, I need you which I’ve written about here.
It’s been a while. And a struggle. But I am definitely on the mend.
Happy 2012. I have resolved not to make any resolutions, other than to be more empathetic with Marty, my husband, who has a completely different temperament than I do.
My mind works faster than my left forefinger, so writing this blog is not easy for me. Living with me is not easy either, but we’re doing much better. Couples therapy is wondrous if you find the right therapist and, happily, we did through my eating disorders program.
Today’s big news?
My cast comes off today ~ I hope.
In the meantime, to make life easier for Saint Marty, I had all my hair cut off. Every little bit helps. I love it and when both my hands are working, I’ll send you a picture.
Since we last spoke, I was on Day 31 of my Eating Disorder Treatment Program.
By the way, yesterday, somehow, it was accidentally posted, unfinished!
I’m so sorry…
Now it’s here, camera ready, as they used to say in those by-gone days of print.
It began as a comment, but was so long, I decided to post about it.
So, thank you, “Phillips and Kane,” for your inspiration.
As I’ve known hoarders in my day ~ and I confess, I am one, with certain things…
You struck a chord….
Don’t you think almost all of our behaviours are as a result of some sort of “trauma” in our lives? Almost?
It began as a comment, but was so long, I decided to post about it.
Thank you for the inspiration.
It struck a chord.
Also, I’ve had personal experience with hoarding and hoarders.
Don’t you think almost all of our behaviours are as a result of some sort of “trauma” in our lives. We’re attempting to fill a void inside of us because we don’t feel good enough.
Perhaps that traumatic event or events were in vitro. Or in our infancy. In some long forgotten or “blocked” or “repressed” event? Depending upon one’s levels of sensitivity, traumatic events can happen all the time. Little psychic bumps and bruises along the way.
Through my 51 years of psycho therapy, Dr. Phillips, I’ve learned that seminar event that triggered my psychotic/manic episodes happened when I was raped in a mental hospital by an orderly in 1962. I was 14. And I repressed that memory. This was long before Post Traumatic Stress Disorder was created. That memory came back to me in 1976, when I was 28 years old.
Yesterday, in my Leadership in Society class, the second last class of the term, my students discussed change.
Our discussion was based on an assignment I had given them. A written assignment. But their real ideas and feelings tend to come out in live conversation. When they engage.
Disatisfaction with the status quo…
They’re pretty unhappy at the campus where I teach. It’s small. Formerly an insurance building. Never meant to be a college campus.
That’s what they want to change. Transform it. Give it some spirit. Some sense of community. They have no place, other than a cavernous cafeteria in the basement, to gather in the flesh. Together. Face to Face. Not just online.
Copeland, WRAP’s founder, has a dramatic recovery story beginning with her mother, Kate, who was taken at age 37 to a mental institution in the late 1940s.
She was diagnosed as incurably insane. Her doctors told her family to forget about this once vibrant and accomplished woman — she would never get well.
Doctors were wrong…
Kate began improving. Her mood swings became less severe. Several hospital personnel took a special interest in her, encouraging her to talk.
They listened to her and for the first time in her life, Kate felt emotionally supported. With the help of one psychiatrist, she started what was probably the first-ever patient support group called the Mental Health Fellowship.
She was able to organized her fellow patients and disrupt the program. So much so, that she was discharged after eight years. She reclaimed her life and lived actively and well until she died of a stroke at age 82.