A sad post at the waning of the year and an angry one as well. The typo above is intentional.
First off, Health and Hospitals will close all detox units routing them now to ERs. Reason: Census.
Census is an excuse, not a reason. Mental health does not operate on an efficiencies of scale basis. Individuals with mental health problems isolate. They avoid crowd situations. They avoid public transit. And most certainly, they avoid ERs. Upon walking into the ER, the fug of stress wallops you in the face like a lead-filled sock. ERs offer sensory overload. ERs offend sensory overload. Stressed, overburdened nurses who triage promptly, only to abandon patients to a poorly lit cavern, where they can be terrified by the talking heads on the big-screen TV's. Homeless people camp there, hoping for free food and temporary shelter. People coming down from alcohol or many drugs enter altered states, become aggressive, or get naked so as to parade their privates. The ER is the antithesis to a safe place, where fragile people take tentative steps toward establishing a trusting relationship into a thoughtful, respectful, reciprocal relationship who offers them more than what can be found among the lees of their bottle or the dregs of their syringes, who can leave a better legacy than Hep C or HIV. The ER is the antithesis to boundaried relations. The patients coming to the detox units are frequent flyers, known to the staff. Perhaps, the detox unit is the most meaningful institutional relationship known to this person. Of course, we as psychologists wish them to take the next step, to abstinence, in our time. Which is not theirs.
And now, what is offered. More crowded ERs, with no concomitant increase in staff. Putting detoxing patients in with emotionally disturbed ones is disrespectful to both. Ah, but it will offer economies of scale. And more Libby Zion's. You remember her. She went to the ER, high as a kite. An inconvenience to the staff. She died when the tranquilizers she received interacted with the drugs she took prior to coming for help. A corpse in the ER is even more inconvenient. And then a triple inconvenience: her father was a newsreporter. A black eye for the hospital which still claims to be #1 in New York.
There will be more Libby Zions. More people arrested for inappropriate aggressive behavior in the ER. Less people going for psychotherapy.
I say less people going for psychotherapy as just because someone is intoxicated does not mean they are penniless. But psychologists have priced themselves out of reach. More and more, group practices opt for out of network practice. An initial assessment is $350. Regular weekly sessions cost between $250 to $300. Reader, can you afford this? I cannot. I work three jobs. I work on contracts. My contractors have not raised their fees in 10 years. I work with the government. The government hasn't raised medical professionals fees in over 20 years. I compensate by working harder. Reader: I suffer. I have panic attacks nightly. I receive no respect from my contractors. All believe they know how to do my job better than I, despite a lack of education, supervision, publications, or licensure. I am their toilet bowl, and they will not flush.
And what do professional organizations do about this? Psychology cares not. There is an insurance committee which assures us they are looking out for our interests. Really? Who is "our." It is not me. Professional organizations are all for going after acute situations, disasters. Not so much for the long-time, enduring relational work. Splashy outbursts, then nothing. Psychologists went to Las Vegas. But what of the people who suffer trauma two years afterwards? Where were the professional protests against the closing of detoxes? Where were the professional protests against the implementation of STRIVE and the implementation of sound, empirical praxis. Psychologists know how to fill out paperwork. They are just as capable of filling out proposals to be funded by the city.
I was involved in many volunteer efforts after 9/11. I worked with Cantor Fitzgerald and was horrified that instead of letting their workers reunite with their families, they made they stay and work around the clock. This is not trauma relief. It is selfish. It is kneejerk. I was placed there so management could claim they valued their workers, and keep working them to exhaustion. I worked on the pier of professionals created by Judy Nathan and observed that the only people going to mental health were other mental health professionals. The people swamped were the lawyers and the accountants.I worked on a panel offered by Channel 13 to get the traumatized to reach out. The only people who reached out were the drunks, fearful and wanting detox. I worked with firefighters at a special mental health pavilion set up by Coney Island Hospital. Firefighters only came because they were mandated to by their supervisors. They didn't want to see us, let alone talk to us. Coney Island set up a special 9/11 victims psychotherapy about a year afterwards. I was one of the specialists who they were supposed to be referred. Few came and the special unit fell into oblivion.
And yet, the trauma of 9/11 persists. Ordinary people, ordinary students, ordinary professionals--priced out of the talking cure. Doing as I do, just holding themselves together.
Worse, professional organizations fail to heal the world, because it interferes with their bottom line. And they actively spread evil words of those who try to heal the world, who try to inform others of alternative visions. The head of the insurance committee of a professional organization that I am leaving publically called for me to be censured, claiming I was endangering their non-profit status by offering an information session on New York State's Single Payer Insurance proposal last winter. And he was only sorry that he pressed "reply to all, " not "reply.' And leadership did nothing. He apologized. Case over. Not for me. I hold grudges. I never forget and I rarely forgive. It is not admirable. Little Tree knows that. Little Tree probably wonders why I still do not think of the children in the pediatric oncology unit, instead of my petty little problems. I am weary of negotiating "scholarship" prices. I am weary of being shamed by psychologists for not being whom they think I should be, or of not being in their income bracket. I am weary of being told that my modest income is a symptom.
That is the mentality I am dealing with. Players of a zero sum game.
I am not rich. I work very hard. I am exhausted. I am a decent psychologist. I am tired of professional organizations conflating worth with net income. Freud never owned a home. Nor did Ferenczi (his wife did). Neither traveled first class rail. Modest men, living comfortably modest lives. As do I. Modest psychologists can only offer psychotherapy to others, but cannot get help for themselves.
Open your doors to the poor. Obtain a teacher. Find a friend. Do not become overly familiar with the government. Do not despair of retribution. I hold to Pirkei Avot as my ring of power against the encroaching darkness.
And ally myself with the music makers to empower the light. Music and musicians do more to heal the world than all the psychologists in various New York State professional organizations. And the do not feel it is shameful to endure modest, comfortable lives.