Docsplainin' -- it's what I do

Docsplainin'--it's what I do.
After all, I'm a doc, aren't I?

Friday, August 1, 2014

Crass Commercialism

I'll have to apologize in advance, but I'm still gonna do it.

Hard as it is, I've made the decision to monetize the blog. I've put the ads only at the bottom, so most of you should never be bothered by them. I've blocked those annoying animated ads. I've blocked weight loss products. And anything to do with any of the various F0x "News" commercial enterprises is, of course, fox-blocked.

As other as-yet unforeseen obnoxious items pop up, I'll block them on an as-we-go basis.

But a girl's gotta make a living somehow.   

Thursday, July 31, 2014

I Don't Want To Be a Responsible Adult Any More

Digital Photography School put up an article the other day on using photography for personal growth. The woman who wrote it, Catherine Just, was struggling with being a new mom, and found herself taking a photo every day of the part of the process that was the most frustrating to her. In her case, it was not being able to get the little sprat to take his naps. She wound up with some emotionally stunning iPhone pics of herself and the bébé sleeping together. She said the photos -- and her attitude -- changed in about a month of doing this.

I had been wanting to document Mr. Wood's last year? journey? something, and struggling for a way to do it that captured our emotions but was respectful of his desire for privacy. For example, I wanted to go with him to the barber shop when he got his head shaved the other day (his hair and beard are falling out from the chemo), but he would have none of it. The notion of a daily photo of something that frustrated me really clicked, because that wouldn't necessarily be about him at all, but I still spent two or three days trying to figure out what the theme needed to be.

And finally, a light dawned. I'd been noticing a lot of nights, when it's time to go to bed and I discover I haven't cleaned up the kitchen yet and I'm already tired and my legs are already giving out, that I've been surveying the wreckage and saying to myself, "I'm tired of being a responsible adult." I want to go to bed, let my mother do it. And so it dawned on me that the most frustrating part right now is not about him or even necessarily the cancer itself at all, but about my physical inability to rise to meet the occasion, the limitations that post-polio sequelae put on my ability to care for him. Which does indeed frustrate the $#!% out of me.

And too that phrase encapsulates so much more about what's happening to us and our reactions to it. I find myself wistfully recalling times when we didn't know what we know now -- some times as recently as this spring, other times from the beginning of our relationship -- and wanting that innocence back. Not our youth or our health, even, just that sense that not only is today not threatened, but that there's always a tomorrow. I have even cracked to a high-school friend who asked if there was anything she could do, "Take me back to my childhood and leave me there." I don't want to be a responsible adult any more.

But I digress.

This morning what hit me first was the instructions on top of our dog's food storage container. I left them there for the pet sitter, in case of another medical emergency like the one we had two weeks ago, but they seemed this morning, at 6 a.m., to be a demand on me -- "Feed TWICE daily," the stickers shouted. And it's on me to do it because Mr. Wood's fatigue is so bad that he can't reliably be counted upon to be out of bed before noon, and the animals can't wait. (Sometimes he doesn't get up all day. When he got out of the hospital, he slept 28 hours straight!) So I have been, for quite some time now, getting up 20 minutes early every day to take care of the animals before I leave for work.

I took a photo of it this morning, my first for this project.

Something bugging you? Give it a try!

Wednesday, July 30, 2014

Actually now I'm remembering why I quit reading the paper in the first place

In Sunday's paper there was also a response by "Dear Abby" to a potential sexual assault victim that nearly made me blow my obstreperal lobe. The writer explained that she walks her dog in a park close to her house where a park employee is creeping her out with his staring. She would hate to have to stop walking there. Abby advises her that she's probably worried about nothing, and should ask other women if he creeps them out, too. Gee, she (Abby) sure would hate to see the poor guy lose his job if the writer were to make a complaint. Which, by the way, the writer never even mentioned. She had responded to the staring by being more deferential (smiling, saying "hi") and was looking for a more aggressive response -- how, perhaps, to confront the guy.

Seriously, woman? 

In the first place, this park is close to Dog Walker's home. Perpetrators are known to place themselves in jobs, hobbies, and volunteer positions that give them access to victims. There was a guy around here some years back who worked for a car wash, enabling him to copy the keys of women in the neighborhood, you know, for easy entry into their handily nearby homes at a later date. Where he had followed them after detailing their cars.

In the second place, living in a rape culture as we do, women are taught practically from the cradle not to make a scene. When I first started out doing rape crisis, I was amazed to learn that self-defense instructors had to make their students practice screaming. The women didn't want to do it. Couldn't do it. Our instructor told us that, among other things, women would not cross the street to avoid someone whose demeanor concerned them, would not go into a public place to avoid someone they believed was following them, would not even confront someone who touched them inappropriately -- all for fear of making a scene. Mind you, it doesn't make it a woman's fault when she gets raped: My point is that we are forbidden in this culture to act to protect ourselves, and Abby's perpetuating this with her response to Dog Walker. We are taught not to listen to our gut, not to make a stink when something's rotten in Denmark. The last thing we as women should be doing is blowing off each other's instincts that there's something just wrong about a guy.

In the third place, I purely do hate to see that the "Poor, Pitiful Rapist" syndrome (he's lonely, he's frustrated, he can't control himself, he's sick, he's crazy, blah, blah) is still alive and well. Of course this guy's not a proven rapist, but all the same, what's with all this concern about him?? This is not about him. This is about Dog Walker feeling threatened. He might be mute, Abby writes, or not speak English (although what this has to do with staring is beyond me*). Children stare because they don't know any better. But when someone or something higher up the food chain (be it a man or a leopard) stares at someone or something lower down (be it woman or mountain goat), it's a threat that's recognized across all species and so it has been for millennia. Yet just in case she might hurt his feelings or threaten his job or some such, Dog Walker's not supposed to say anything?

No, no, no, no, no -- a thousand times no, Abby. This man's right to creep women out -- for any reason, harmless or otherwise -- does not trump Dog Walker's right to feel safe in public spaces. You should have told her absolutely to quit walking her dog there, or at the very least to give this dude a very wide berth and never be out when or where there's not large crowds around. And even then. What's to stop him from following her to find out where she lives?

And further, Abby, you should have given her permission to tell anybody she damn well pleases about this guy, although I stress that she is not obligated to do so. She can tell park personnel office, security, other women, whoever she wants. It's her story: She can put up a billboard if she wants to. She doesn't have to check with other women in the park first. If it turns out that it's only that he's mentally ill or intellectually handicapped, fine. Administration can put him in a position or on a shift where so many demands aren't placed upon his limited interpersonal skills. If he's some creep who was never backgrounded before he was hired, then better they know about it and deal with it now than later.

*in fact, it strikes me now that that's even a bit ableist or racist

Tuesday, July 29, 2014

Renouncing Psychology

Deutsch: Phrenologie
Deutsch: Phrenologie (Photo credit: Wikipedia)
Well, maybe not quite yet. 

It did get your attention, though, didn't it? 

And it's true, I do have a beef with psychology. My introduction to psychology was accidental, a story many of you have heard. I wandered into a psych prof's office when I was getting signed up for a business degree, and the rest, as they say, was history. 

But these were academics. I got introduced to clinical psychology through Ann McAllister and Stuart Strenger, Ph.D.s who practiced together in Buckhead back in the '70s. They were wonderful clinicians and even better human beings, and I wanted to be like them when I grew up. 

Twenty years later, I was surrounded by so many psychologists whom I could not even like, never mind respect, that I began to wish I'd never let my counseling license go. I no longer wished to identify with the arrogance, callousness, unscientific thinking, unprofessional behavior, and outright greed that I was encountering on a daily basis. The profession, however, I still loved. I was proud of the science of psychology. 

Psychology was already changing, however, and I can't say I like the direction it has taken. So while I am not quite ready to disavow it, I do have a beef. 

Once upon a time, the scientists in psychology were all rat-runners. The psychotherapists were all theorists. And their theories generally took into account the whole human being. Psychotherapy was an emotional, intellectual, psychological -- dare I say it? -- even spiritual journey that the therapist and patient/client took together. 

And then, along came Skinner. That was the start of our slippery slope. 

Don't get me wrong: Behaviorism is a damn good theory, and behavioral therapies have some great applications. But what happened next was that, coincidentally with our long-standing desire to be taken seriously as doctors came the push to be included in insurance reimbursement, to be classed as healthcare providers. And that, my dears, was the beginning of the end as far as I'm concerned. 

 The number of mental illnesses we can diagnosis (and of course this is psychiatry's fault, not psychology's, but it stems from the same sources and we've been on board with it from the git-go) has multiplied astronomically from what it was 50 years ago. Everything's abnormal now, treatable, and most importantly from the point of view of many practitioners, reimbursable. 

The twin drives to be taken seriously and be paid as doctors has spawned the evidence-based practice movement, a child of the devil if ever there was one. Ironically, perhaps, it is also the part of the science of psychology with which I most identified in the early days. Why would we waste people's time and money, and offer false hope, for silly woo-woo therapies that don't work? Let's study what does! Sounds great, right? But somehow, in the process, we have reduced diagnosis and treatment if not to the level of the petri dish then to something scarily close to it.

Therapies are manualized. Follow this cookbook recipe with every client you have with this diagnosis, and they'll get better. It's pigeonholing clients, and reducing professionals to technicians. Everything, even assessment, is by the numbers. The person's humanity is out the window, all their experiences and dreams and complexity reduced to three symptoms from group A, two from group B, for a duration of not less than two years, and not due to some other specified disorder or circumstance listed in Appendix C.

Worse, the therapies don't work. Or they only work in the lab. One I got all excited about last year after a workshop turned out to be this sort of dud. Thirty percent of the potential participants in the big study its proponents were trumpeting were weeded out before the study ever started. They had more than one problem, or they were on medication, or whatever variation in their circumstances that normal human beings coming into clinician's offices every day exhibit. So at best, I'm thinking as I'm reading this, the new treatment works with 70% of people with this diagnosis, right?

Not so fast, Virginia. No fewer than 50% of the folk enrolled in the study dropped out! So now, if the new treatment helped every single one of the completers (which, of course, it didn't), we're talking about a therapy that is effective for 35% of the folk for whom a clinician might consider it. Thirty-five percent.

And yet this has now become the only approved therapy for this disorder.

I kid thee not. It works for maybe 35% of the population with this disorder, but if I don't deploy it with every one of them who walks through my front door, I will not be treating my people according to the standard of care, once this gets written into the standards, which it will. Mark my words.

Ironically, chasing the money has led us to fly directly in the face of the best and latest science, offering "treatments" that are absolutely proven not to work for "disorders" that are pretty much proven by now not to exist because they are lucrative. Jumping on the weight-loss bandwagon, as psychology has over the past year or two, is perhaps the best example.

I'm done.

I want to go back to sitting with my clients. And no, they're not patients. They're not sick! I want to go back to being with my clients, not sitting there trying to look attentive while running algorithms in my head or jumping ahead to what I'm supposed to say next according to the treatment protocol. I want to go back to the day when the therapeutic relationship was the primary healing factor, when my own best tool was my self, not a checklist with lines and boxes and graphs to complete to tell me what's the matter with the person. I want to go back to the day when my care was caring, not steps I followed in a manual, to a time when good therapeutic technique mattered, yes, but when there was an art to it.

Is that too much to ask?

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Sunday, July 27, 2014

Oh, no. That is SO wrong!

I'm reading the Sunday paper this morning and I'm all like, wha-a-at??

It seems that transcripts of some of Carson McCullers' sessions with her therapist are being released to researchers, and everybody's all excited about how this will give them more insight into her life and art. Well, not everybody. I'm certainly not.

I'll give the therapist a pass on terminating the therapy relationship so they could have a personal relationship. This was the '50s, after all, and things were different then. In fact, they were so different that she might actually have been a bit ahead of her time in that regard. Most people back then didn't bother terminating one relationship before beginning another. I remember when I was just a young sprat of a therapist reading about one famous, leading psychologist who was therapist to a young woman, then her professor (presumably he mentored her into grad school), then her clinical supervisor -- and then her husband! Not sure when, exactly, they became lovers, but good grief. That's like a perfect trifecta of "dual" relationships.

But McCullers' therapist/partner lived until 2013. By which time it should have been glaringly obvious to her that those transcripts should have been destroyed -- back in the 60s, not to put too fine a point on it.

And the university that inherited and is releasing them bears some responsibility here, too, even though the actual custodians are likely academics in literature, not psychiatrists. They should have quietly destroyed them as soon as they realized what they had.  

Thursday, July 24, 2014

Opinionated Much?

Just when I get worried that I've been too opinionated, an angel gives me a quote like this:
"Nothing is more conducive to peace of mind than not having any opinions at all." --Georg Christoph Lichtenberg
I have no idea who Georg is (will Google him later) but I do thank him. 

Wednesday, July 23, 2014

Draw, Podna!

Or not.

Some of you may know we have a new gun law here in Georgia. Basically, it says you can carry a gun anywhere, with or without a permit, concealed or 'open carry'. And of course, as you have read in the news, some folk have been exercising that right -- resulting in at least one arrest, but I digress.

The topic came up among colleagues recently, who are all bestirred about exactly what the law says about our ability to prohibit guns in our offices, and several have expressed the felt need for legal consultation before doing anything. There was also some discussion about what to do if a client doesn't like it.

Here's my take on it.

I have always expressly forbidden weapons of any kind, legal or otherwise, permitted or not. No pepper spray, no nunchucks, no knives, no throwing stars, no guns, no clubs. This is a clearly stated, up-front policy: New clients sign a form stating that they have read and understood this. So new clients who do not wish to abide by this policy can go find another therapist. Easy peasy. But I've never had a problem with it. Everybody's reaction, from day one some thirty-three years ago, has always been, "Ok, cool, no problem." Even my gang-banger, whose posse used to stand guard downstairs during his sessions.

I don't anticipate that any of my existing clients will have a problem with it either, if only because (a) they've already agreed to my policy, and (b) because there's no political struggle for them to win here, no point for them to make. After all, I'm a good ol' girl myself, with a gun and a carry permit of my own, and I don't bring my gun to the office! Also, it's not a policy in isolation of other operating procedures I have in place -- all of which I follow as well. I expect 24 hours' notice of cancellations, for example, and in return I let you know the minute I know I'm not going to be able to be there for your appointment. If you no-show, I charge you; if I double-book, the next one is on the house. You can't show up drunk and expect to get a session, but then again, I don't show up drunk to work with you, either.  

There was also a flurry of worry about how to terminate appropriately with a client who violated the policy. Again, I am not concerned about that, because if a client brings a gun into my office or repeatedly shows up drunk, doesn't pay their bill, whatever -- they have already clearly stated by their behaviors that they do not respect me or the terms of our contract. They are in breach of contract and I'm no longer obligated, not to find them another therapist, and not to see them three more times to wind up their treatment. And that is not abandonment, because they knew in advance of the fact that such behavior would terminate our work together. Therefore, by doing so, they are in effect leaving the therapy, same as if they'd walked in the door and said, "I quit." I'm not going to schedule my usual three termination sessions in such a case, knowing they're going to bring in a gun and endanger me, my coworkers, and our other clients in that manner. Now that would be unethical.

I would, because it is a therapeutic issue, a profound statement about how they feel about me/their mother and about their therapy, attempt to analyze it at the time that it occurs. But if we couldn't resolve the issue, then we would be at an impasse which would make any future therapeutic progress impossible anyway. 

Again, this is not about the gun, but about the process. If a client could not come to treatment sober, I would not refer them to another therapist because it would undermine the basic message I wish to send, which is that you can't do outpatient therapy while you are using. You need inpatient first, then come to therapy. Nor would I schedule three termination sessions in such a case, without some assurance that the person would be able to show up clean and sober for same. To do so would send the message that I don't really mean what I say -- that it's ok to show up drunk when I say it's ok. Same points could be made in the case of nonpayment.

So I will continue to forbid weapons -- all weapons, but especially guns because of the irrevocable lethality. The only exception is on-duty cops, who are required by the Job to carry, as has always been the case in my practice. By my reading of the law, it is legal for me to do so as a private person on private property which I have control of by means of my lease of the space. You think I can't? You can take it up with my attorney.

But it's my rule, and it stands.