I have been involved with Mental Health as a patient for the last twenty five years. In this time I have noticed some glaring problems I would like to bring to your attention. First is the stupid questions. There are any number of stupid questions that might come up and it is a little mystifying as you have doctorates and the whole system is set up so only smart people can get doctorates. So why the stupid questions and comments? Your smart enough to know better. The most glaring of the stupid questions are: how many, how much and how often, in regards to alcohol, drugs and gambling. At first this might sound a little innocuous; they just want to know how much your drinking, why not just tell them? The problem is they are not satisfied with vague answers; they need to know the exact number and they need to know exactly what. If you went out drinking last weekend and you were mixing your drinks they see a detailed drink by drink account of the night. And its not just last weekend; you can be telling them about something that happened to you thirty years ago, something you think actually matters and all of a sudden they need to know how many drinks you had that day.
“I don’t know how many drinks.”
“Why don’t you know?”
“It’s a trivial detail I cant remember.”
“It’s not trivia at all”
“How could you get more trivial? And why do you need to know?”
“We need to understand your condition.”
The public system doesn’t deal with addictions. If they did they would fill the hospitals with addicts and there wouldn’t be any room for the crazy people. But in the private system three quarters of the patients are addicts, they primarily deal with addicts. But they don’t require anything like the detail of the public system. They need a general idea of how much you have been drinking recently so they know what they are dealing with while they detox you, after that quantity doesn’t come up again. But in the public system that’s all they want to talk about: how many, how much, how often?
I smoke a little bit of marijuana, they ask.
“How much marijuana do you smoke?”
“A little bit from time to time.”
“How much?”
“A little bit from time to time.”
“How much?”
“A little bit from time to time.”
“How much?”
“Look; I’m not giving you any other answer, you’ll just have to make do with a little bit from time to time!”
At one point I found my self smoking on a daily basis.
“How much marijuana are you smoking?”
“Me and a friend go halves on a quarter of a ounce and it lasts us a fortnight.”
Confused look
“How much is that?”
“I just gave you a through detailed answer, what do you want from me!”
“How many cones?”
“I don’t know how many cones! Cones come in different sizes, how finely you mull up the buds makes a difference, then there is tobacco to be considered, how many cones is meaningless. I just gave you a through detailed answer, but you don’t know what it means, what is the point of asking the question if you don’t understand the answer!”
The insistence you need to know these details in order to understand my condition is simply absurd. You don’t need to know exactly how many drinks I had on July the 15th 1994 in order to understand my condition. Even if you did; sorry I can’t give you the answer, I just don’t have the details you want. Your just going to have to try and understand me without those trivial details! You are working hard to get details you just don’t need and all you end up with is a frustrated, angry patient on your hands. Your creating a rod for your own back. This problem is easy to fix; just stop doing it. It is a pointless exercise that serves no purpose and does nothing but create unnecessary hostility. Just stop doing it!
Here’s another example of a stupid question.
“You need to take into account I’m smart.”
“How smart?”
“I just told you I’m smart, I know your smart because you have a doctorate, why would a smart person ask another smart person such a stupid question?”
“It’s not a stupid question.”
“How am I meant to answer it? If I told you my IQ would you believe me? You ask me a question I can’t answer, how could a question be more stupid! I just told you; in order to understand my condition you have to take into account I’m smart. You have clearly decided my claim to being smart is a manic delusion. I’m telling you, as long as you maintain that my claim to being smart is a manic delusion you won’t be able to understand my condition!”
The next one I want to look at is a lie. It is simple, easy, convenient and useful. But non the less a lie and a harmful one.
“We have tested your brain chemistry.”
“No you haven’t.”
“Yes we have.”
“No you haven’t.”
“How do you know we haven’t?”
“Because the brain doesn’t excrete anything into the blood stream you can measure. It’s called the blood brain barrier. You can’t test my brain chemistry without taking my brain out and dissecting it!”
Guilty silence.
“Why do you keep treating me like an idiot! I told you I’m smart, then you insult me with a lie like that! Did you really think I was so stupid I was going to fall for that one! I realise that lie may be use full with your stupid patients, but please, use some intelligence. This is me your dealing with, not the idiot your clearly thinking of, please; stop treating me like an idiot!”
You wouldn’t be aloud to give a patient a placebo and claim it as Valium. You wouldn’t be aloud to give a patient one medication and claim it’s another. You have to give the patient reliable information about their medication. It should be the same with tests. You shouldn’t be aloud to claim you have made tests you haven’t made. You should not be aloud to claim you have got results you haven’t got. The patient needs to be given reliable information so they can make decisions about their treatment. I’ll repeat that one. The patient needs to be given reliable information so they can make decisions about their treatment. Oh no, you say, were the ones with the qualifications, we make the decisions, the patients do what they’re told. We are completely justified in telling any lie we feel necessary in order to get the patient to comply with our prescription. But then what happens? OK, were finished here, off with you, get your scripts from a GP in future. The patient has to go to the GP and ask for the medication they want. The patient has to manage their own medication. It is inevitable, unless you put the patient in permanent instructional care, that they have to make decisions about their treatment.
Another one I want to look at is post traumatic stress disorder. I was first told I had an undiagnosed psychotic condition. Then this was up graded to schizoaffective disorder. I was happy with this because I thought it sounded funny. After all, it could be worse, I could have schizodeffective disorder. Then I did The Steps and all of a sudden I had in front of me what had driven me insane. I fell into an insane rage, beat the living shit out of a bush in my parents back yard and screamed like blue murder at two o’clock in the morning. I didn’t sleep that night and managed to convince Mental Health to let me into hospital the next day. There I told them what was going on for me. I was told “we don’t deal with that sort of thing.” I didn’t have schizoaffective disorder I had post traumatic stress disorder. I repeatedly went to the doctors with this and I was repeatedly told “no you don’t have post traumatic stress disorder.” But I thought I had such a good case for PTSD. Eventually I asked “what makes you think I don’t have PTSD?” I was told “we don’t have the resources to treat PTSD.” I don’t have PTSD because it’s inconvenient, you’ve got to be fucking kidding me!
There are three main causes of madness: those who are born with it, those for whom it is caused by drugs and those who were driven insane by unpleasant experiences. The first is easy, those born with it are easy to identify, heaps of other people in their family have similar conditions. Treatment is easy, it doesn’t come as a surprise to them and when it happens and then they know how to deal with it. They’ve seen it all before in other family members. The treatment of drug induced problems is easy to apply, ineffective, but easy to apply. You have to convince them to stop using the substance. Then there’s PTSD; if some one rocks up to Mental Health showing signs of PTSD, they simply make a different diagnosis. If, conveniently, they are using some substances, stick them in with the druggies. In this regard Mental Heath is guilty of systemic misdiagnosis. It is an appalling bad state of affairs that desperately needs fixing. Acknowledge the trauma and admit you can’t fix it. Mental Health doesn’t provide counselling for PTSD, but Medicare will provide ten sessions with a councillor per year. This information needs to be provided to patients
Then there is the Mental Health application of Cognitive Behavioural Therapy, it works like this.
“Doctor I have a problem.”
“Oh that’s not a problem.”
“Isn’t it?”
“No.”
“I guess it isn’t.”
“Great you’re cured.”
Let me give you more tangible example.
“My parents wouldn’t let me do year eleven and twelve and bullied me into doing a chefs apprenticeship instead. I couldn’t get a chefs apprenticeship and had to settle on a baking apprenticeship. I hated it, but my parents wouldn’t let me quit and go back to school. I’m an intelligent creative person. But my parents wouldn’t let me get an education and made me do really stupid boring jobs for abusive employers that I wasn’t any good at.”
“There’s nothing unusual about that. It’s just some parents really believe in trades. There’s nothing unusual about that at all.”
How utterly invalidating and offensive! This is absolutely appallingly bad therapy. A better approach might be.
“Yes, some bad things have happened to you and this might have contributed to your problems. But we can’t go back in time and fix that. It would be better if you didn’t dwell on it. Rather, try to put it behind you and concentrate on how to make the best of what you have today.”
But this involves Mental Health doing two things it doesn’t want to do: 1 acknowledge the trauma, 2 admit powerlessness.
Right, now I’m really going for the jugular. There is something Mental Health needs to do early in a patents treatment; admit you don’t really know what your doing. Diagnosis is an essential part of treatment. But while we like to think were scientific, diagnosis is largely supposition. The modern medications have provided a huge improvement to the standard of living of people with psychiatric conditions. Things were very grim for psychiatric patents before these medications came along. But the application of the medications is largely guess work. We can’t really be sure what effect the medications will have on you. They effect different people differently. For these reasons you need to take an active role in your recovery. Ask questions, do research, talk with other psychiatric patients, seek out support groups. We don’t have all the answers, we can’t do it all for you. You need to apply your self to your recovery.
In summery: drop the how much, how many, how often and other stupid questions. Apply intelligent discretion to your methods. Be honest. Acknowledge trauma. Confess your limitations. Encourage patients to take an active role in their recovery. Provide patients with information about the availability of counselling. These changes require you make some adjustments. But not adjustments that will cost a lot of money. Just some changes to the kind of language you use. These changes will provide better outcomes for your patients and make your job much less stressful. They will improve things for everyone involved.
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