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Mental disorder

Psychosis Is Like A Bad Trip

PsychosisVonnegutCoverPsychosis is like having a bad trip on drugs but it never ends.  You are no longer in control of your own mind and you may not even know that you are not in your right mind.  You might do some crazy things that hurt others.  It used to might have even sent you to “prison” at an insane asylum.  Lock them up and throw the key away.

The closest I ever got recently was when I was  coming out of back surgery and having an IV for a pain pump.  I know I pushed it too much and time crawled by.  I just wanted it to wear off; but I knew I was “not in my right mind”.  What if I didn’t know and was that way anyway and had no control over my trip.  I apologized to several different people for what I might have said or did at that time.

At a very young age I had visual hallucinations from taking codeine cough srup for my asthma.  I saw orange and green bugs everywhere and they didn’t go away when my mom turned my light on.  When the codeine wore off, the hallucinations went away.  Seeing is believing.

Also this happens when someone like my father has Alzheimer’s or some form of dementia (my dad’s was Parkinson’s)and we have been more aware what that is like with all the coverage the victims and caregivers have been given.  Victims are frequently not themselves and don’t know it.  The frightening thing is that many victims (with our new ability to diagnosis this early) know what is going to happen to them.  Because these people are so hard to care for nursing homes have developed special locked Alzheimer’s units so they can’t get away and get lost not knowing who they are, where they are going, and where they came from.

People with paranoia can get very dangerous ideas.  They often feel that somebody is out to get them.  Voices in their heads tell them to do bad things. They may think that they have a special mission in this world and that they have to fulfill it no matter what they have to do.

When do we take away a person’s personal freedoms?  Why don’t we have places for them to go that recognize that they have special needs and meet them.  Diabetes is more accepted than psychosis.  It can be the person’s own personal hell.  When people are incapacitated because of these changes in their brain where do we put them?  Do we care for them.? There are illnesses of all kinds, some are socially acceptable.  These people get treated and others who do not get socially acceptable diseases are not.  We often allege that people suffering from mental illness want to be that way and that they choose their own path.

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The Decline of Mental Health Services

Mental Health Awareness Ribbon

Mental Health Awareness Ribbon (Photo credit: Wikipedia)

There are at least three causes.  People who direct mental health clinics and recruit personnel are often not mental health professionals.   They often feel their authority is threatened by the mental health professionals they employ.  One problem is that well qualified mental health personnel are professionals  and are often personally held responsible by their professional associations and state or federal laws for making certain decisions that the administrator may not want made.  It is easy to supervise less qualified people who aren’t held  accountable to such high standards and who aren’t also held accountable to professional boards or state licensing bureaus.

Besides being easier to supervise, people especially with Associates Degrees, Bachelor’s Degrees, and Masters degrees, are much cheaper to employ.  Even if a clinic hires M.D.’s and Ph.D.s,  they not be willing to pay them for  years of experience or added certifications.  Such as there is in law, there are specialized branches of service in mental health, notably for children and adolescents. Most clinic administrators must always watch the bottom line.

Last, but probably not least, insurance companies monitor the provision of services for which they are expected to pay.  They can not only say what, if any, kinds of services they will pay for, but also how much and for how long.  Mental health professionals in private practice can not ignore insurance companies and their required paperwork.  Such  people probably can not succeed in business without being certified as approved providers by these companies and depend on their reimbursement.

Who’s running the show here.  How qualified are business managers, accountants, and medical administrators, not psychologists or psychiatrists or qualified social workers, to determine what mental health services a seriously ill child, adolescent, or adult needs?  Sure under this system mental health services are provided but what kind? Do you want a surgeon or a nurse’s aide to operate on you? Do you want the care you get, medical or otherwise, to be chosen only by what it will cost?

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Psychopaths

English: Lansing Correctional Facility

English: Lansing Correctional Facility (Photo credit: Wikipedia)

Prison 2
Prison 2 (Photo credit: planetschwa)

Having almost no or almost no conscience, psychopaths can commit violent crimes often without an ounce of guilt.  They have a high recidivism rate.  Committing the same crimes over and over again until he (or she) is permanently locked up and cut off from society.

As far as mental illnesses go, psychopathy is expensive to treat as incarceration is expensive and is mostly useful as a form of  protection for society and really is not a form of treatment.  They may continue to be violent in prison and may acquire a longer prison term because of this.  Also they usually need to be kept in  expensive high security prisons.  Even when taken out of society, they remain dangerous to others, both other inmates and correctional facility staff.

Because psychopaths having no built in governors on their aggressive drives, talk therapy does not seem to work with them.  Also they could care less about the feelings of others.  It would seem that if some form of treatment could be found that would inhibit their aggressive behavior, it would of a great benefit to society and perhaps even hopefully to psychopaths themselves.

Focusing on rewarding good behavior in adolescents who seem to be destined to be psychopaths with privileges seems to be more effective than punishing bad behavior which often causes an increase in bad behavior..  The theory behind this is partly based on the neuroplasticity of the brain.  Please see this article, (Mis)guided Light by Jenny Price in “On Wisconsin” (Vol. 113, No. 3), the alumni magazine of the University of Wisconsin at Madison.

 

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Therapy is a Craft

A photo of a group conducting psychotherapy.

A photo of a group conducting psychotherapy. (Photo credit: Wikipedia)

As a graduate student, I chose to go to a big name university to study clinical psychology.  What I didn’t know (until I got there and learned what kind of research the psychology professors did) was that they taught that psychotherapy and psychological evaluations were all bunk unless their processes could be broken down into scientifically measurable procedures that could be applied by anyone scientifically trained  and thus measured for outcome.  Yes, I read the recommended books and reports of applicable psychological experiments; but there were areas of clinical work that I didn’t have a clue about how to do them.  When I reached the point in my training where I went for  experiential training in a mental health clinic,  I found out that there were qualities and intuitive behaviors of mental health clinicians that had not been scientifically measured and replicated and therefore could not be proven  effective that were successful.

That was how I learned that psychotherapy was an art and psychotherapists were artists or better yet craftsmen.  It was a privilege to observe these people work their magic.  Scientists were hard put to describe or replicate this magic process.  An interesting article in the current edition of The Psychotherapy Networker  talks about the clinician as a craftsman.  I also realized when in postdoctoral training were I was training medical students that they had to observe my interview of someone behind a one way mirror and then ask me questions about what I did and how I did it.  I did not completely know ahead of time what I would say and do; but if they questioned about how or why I said or did something after the interview, I could usually tell them even if I didn’t know this information ahead of time.

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