The Forensic Psychology conference I attended yesterday certainly made an impression on me. In instructing psychologists how to go about setting up a consulting practice, the issue of social media arose. Attorneys who may like to utilize your services will, of course, look at your on-line presence. They will scrutinize the optics--are you leaving little on-line bread crumbs which may serve as sources of potential bias, and, thus, eliminate you from their consideration.
Hummmmmm. What is my on-line presence like? If you google my name, Rate my Prof will show up. There you will find that some students enjoy me, others find me somewhat less repellent than an unfed anaconda. Some of my articles turn up--on PTSD, on Child Psych, on Sandor Ferenczi. It will be easy to discover that I'm not a fan of pharmaceuticals in the treatment and cure of mental disorders. If they read this blog, they will soon discover that I am ambivalent about aging and ambivalent about the curative effects of psychotherapy, especially as practiced by the men in New York, who seem to need their fragile egos cosseted and caressed in order to serve up the smallest turd-pearl of insight. In fact, I'm not even too sure that since I didn't sufficiently cosset and caress their egos, that they even listened to my problems. Even the ones I respected needed as great deal of buttressing in order to feel safe with me. Notice the similarly between "buttress" and "buttrest." Might as well be the same word.
But, (haha) I do believe in the curative power of human interactions, especially when one person is centered, listens, and hears the other, who is emotionally amok and distressed. With minimum and short-term pharmaceuticals, at time. Being heard is a great gift, one not forgotten, though it be most rare. And it is less likely to happen in the short spurts of time accorded to the therapist in NYC clinics. They do not wish their patients to be cured--census. The money is in pharmaceuticals and polypharmaceuticals. Aren't those psychiatric nurse practictioners, who constitute the bulk of dispensing professionals in the hospital ashamed. Symptom--medication. Don't they notice--though they dose out Ambien, Lunesta, Sonata--every week the patient comes back--still not sleeping. Yet, they still dose out the drugs. They run through the gamut of antidepressents--amitripyline to Zoloft--yet, they are still depressed. So they add a supplementary drug, or an anti-psychotic. They magnify symptoms--ruminations are racing thoughts, so they can add a mood-stabilizer, in addition to the alphabetary of benzodiapines: ativan through xanax. . These patients can't tolerate any ache, so they go to the Pain Managment Clinic, where they get opioids. Doesn't anyone look at what these patients are on? Then, their health deteriorates with these long-term drugs--diabetes, heart problems--more drugs. What ever happened to "Pain is an important signal. It needs to be listened to." Now it's "pain is an inconvenience which needs to be immediately and completely eliminated."
If you're depressed, its a signal to change your life. Of course you're depressed if all you do is stay in your apartment and watch television. What would you like to do in the next week that you don't feel able to do now? How can you get there. What do you want in the long-run and how can you get there? What ever happened to "Good, better, best, never let it rest, until the good is the better and the better is the best." Not to mention some of the other tropes my mother used to tell me, such as, "The more you do, the more you can do." Finally, "Which is better, to be last among the sages or first among the fools?" The better choice is: "To be last among the sages, because if you are first among the fools, what can you learn from them?" You can have an alliance and still emphasize healthy life-style choices. When I was a baby psychologist, my supervisors used to decline writing letters for disability, stating, "Psychotherapy is about doing more." Applying for disability (which is appropriate for some) implies that they will never be able to tolerate any level of stress, so that sitting in the apartment watching television and not hearing the voices is as high a level as can be expected--which is fine, for some patients, who are seriously and persistently mentally ill. But that is not the average patient who comes in to the psychotherapy clinic. N.B. My ophthmalogist initially tinkered with the idea of specializing in psychiatry. He remembers his supervisor saying, "It is always encouraging for a patient to know that no matter how deep the rut you're in, you can always get yourself out."
So--yes--short term pharmaceutical adjuncts can help take the edge off and propel patients into mental health, with the aid of a therapeutic relationship(s). But neither is a lifetime arrangement. When I was learning Child Psych, the supervisor discouraged long-term treatment--children need to be in the company of normal children's activities--Scouts, Pop Warner, Little League, Soccer, Boys/Girls Clubs, etc. They don't need a therapist.