Marian (Different Thoughts) pointed me to her interesting commentary on the practice of clients (aka users or consumers or patients) becoming practitioners in the mental health field. I was aware of figures like Dan Fisher, MD, PhD. I believed myself in a position to follow a similar path, though I did not count on becoming much of a public persona. Marian’s blog set me thinking more about the implications of my failure to get accepted by psychiatry residencies, and helped reaffirm my current path. At first, getting rejected felt just like that terrible word I used in the last sentence: failure. As someone who used to be a high achiever, but also someone who suffered a string of nasty losses over the first ten years of this third millenium, that perceived failure and humiliation hurt. And of course, it’s a short journey from hurt to anger.
Since I already carried a burden of hostility toward the system for how medications damaged my life and my body, the rejection propelled me into a belief that I should be an activist from without, rather than a clinician on the inside trying to do a better job. Problem is, I’ve never been an activist before, having mostly done safe (though long and tedious things) like go to medical school and become a surgeon. But at least I like to write, and apparently one can accomplish a lot just by putting ideas on paper. ‘Activism’ doesn’t only mean I have to get out and hit the streets.
What is happening, however, is that I am being pushed into a more extreme position than that from which I started. I’d like to think medications are not all bad. I do believe they have a role in acute situations. It’s just that as chronic treatments, they suck. Side effects and destruction to health build up, and efficacy diminishes. In the end one gets stuck in my position, having a really hard time getting off the drugs because my brain has gotten habituated (read: addicted) to them. Yet, the more I read, the more I wonder how much the benefits outweigh the hazards. While some small number of acutely psychotic people will always need some medication, most likely, I wonder if perhaps the majority of ’patients’ could be treated better with kindness, cognitive techniques, and comprehensive attention to their spiritual and physical health. This is the kind of approach I believe Tom Wootton’s Bipolar Advantage is advocating. Maybe we have enough medications for now. Maybe the whole endeavor (and highly profitable industry) of looking for and marketing new drugs needs to be shelved. These are questions that I can’t answer right now. Not for myself and certainly not for others. But I do see my attitudes becoming more and more opposed to the medical model and psychiatric drugs. This wouldn’t be occurring if I was on my way to becoming a psychiatrist.
My biggest question is: would I have been able to make more difference as a clinician? Would helping dozens, or hundreds, of patients get (what I consider) appropriate treatment be more valuable than writing? The point is mostly moot, of course, since I don’t have a door into the field. On the other hand, I could reapply (to programs that don’t already know me) without being so revealing about my psychiatric history. Yet, all I’ve read since I entered the (badly named) blogosphere convinces me I’m better off not going into the field. Marian makes a persuasive argument about the compromises that one inevitably makes in the course of entering any kind of organization. Plus, if I could bring myself to get my whole story out (I’m still hesitant to reveal the worst of it), it might attract some attention and really increase awareness. It would require a lot of work, and that much effort might be beyond me (not to mention the requisite compelling writing style). It is an idea for the future. For now I am just exploring options, writing my blog, and commenting on the blogs of others.
I never wanted any of this. Although I once had dreams of glory, way back when, more recently my ambition has just been to settle down as a happy worker bee, productive and comfortable. Unfortunately for those modest dreams, however, my past has caught up with me. My only choice seems to be to tell my stories, and comment on the messed-up systems of psychiatric care. That puts me out in public view, and the only way to really be successful is to try to be as visible as possible. So now the question becomes, once again, how successful do I want to be? Especially knowing that the price of success is exiting my comfort zone and losing my anonymity?
Which brings up the whole question of obligation. Having learned medicine formally, a lot of psychiatry informally, and possessing a pretty good understanding of cellular neurophysiology, I certainly can speak with an authoritative voice about the medical implications of modern mental health care. Add to that how I’ve suffered really horrible side effects, and lost a decade of my life to mental illness-related disability (which might not have happened if I’d not been given so many medications), can I justifiably stand by and not speak out? Can I actually, in good conscience, let this go on without trying to make a difference? Painful questions for someone who just wanted life to get easy, now that most of the life-wrecking psychiatric storms have abated.
Forgive me for using this website as a chalkboard for sketching out a future strategy and a guiding philosophy. I am learning a lot from your blogs and your comments, and look forward to a lively and productive conversation.
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mark p.s.2 at http://YourWebsite
“would I have been able to make more difference as a clinician?” The question of your becoming a clinition or not, is for your own person quality of life. The numbers of “mentally ill”, the poor or whatever group will exist without us.
Posted at July 12, 2009 on 8:58am.
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Will at http://willspirit.com
Thank you, Mark. You are right. One of the legacies of my upbringing is what usually gets called ‘codependence’, namely a strong tendency to deny my own needs in favor of other people’s wants, necessities, or demands. Especially after all the hardship I’ve endured these past ten years, it would not really have been fair to my psyche to put myself in such a onerous situation as training to be a psychiatrist. The programs took the decision out of my hands, more or less, but it’s good to remember that I have a duty to myself as well as others. Besides, there are plenty of unhappy, over-stressed psychiatrists out there who may be ineffective just because of their own dissatisfaction with their positions. I would not want to end up like that. Best wishes.
Posted at July 12, 2009 on 9:36am.
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freda at http://YourWebsite
Will, you are so right about the kindness,possibly cognitive techniques and attention to spiritual and physical health being more effective for many people – this requires good staff,well-trained, which seems to be a stumbling-block in some facilities.
Posted at July 12, 2009 on 12:41pm.
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Will at http://willspirit.com
Yes, it is striking how well our culture does when it comes to technological solutions, and yet how infrequently it comes up with good human ones. So we have algorithmically sophisticated and electronically complex imaging machinery, which allows us to recognize subtle changes in delicate brain structures. As another example, development of new drugs often involves computational modeling to propose chemical structures that might match specific proteins on nerve cells, in order to effect just the right changes in just the right neurons. (How well this process actually works in practice is questionable, of course; but it’s a highly complex and informed approach.) Vast sums of money are invested to identify and alter the most miniscule and fleeting brain processes.
At the same time, we provide the lowest pay, and almost zero training, to the staff that work day in and day out with the mentally impaired of all varieties (those with so-called psychiatric diagnoses, developmental disabilities, brain injuries, dementia, etc.). A well-educated staff may be in the background, checking on things occasionally, but those who do most of the hands-on work typically lack much instruction, as you no doubt know better than I do. And yet it is exactly such direct care that really makes the difference in a person’s well-being. No medication or MR scan can substitute for kindness and directed attention.
Does our society really value peace of mind? If so, then more resources would go to the things that truly work to bring comfort to people. Personally, I believe that our civilization places a high premium on control, and less of one on contentment. There seems to be greater distress, in our anticipation at least, involved in things spinning out of our hands than there is in the actual experience of illness.
Perhaps we could tolerate more uncertainty with regards to outcome, in order to expend some resources toward peace in the moment. Not that I think research to prevent or reverse (for example) dementia is unimportant. But we would help more people feel better sooner with even a small shift in priorities toward face-to-face ministry.
I apologize for the long reply to your concise comment and astute observation. I really do like to write about this stuff, and tend to run off at the ‘mouth’!
Posted at July 12, 2009 on 4:31pm.