A NOTE TO ALL MY LOYAL FOLLOWERS:

Please excuse the fact that yesterday's notice about my message titled " A BRIEF INTERMISSION" should not have included part of an older blog, just as another old post should not have been sent to you Saturday.  Both were sent in error by blogspot.

Can't begin to understand how such an error occured.  Can only express my regret and look forward to your following my blogs just as soon as I return to writing in a few weeks.

Again, my apology.

Yours,
Linda

A BRIEF INTERMISSION ...

Announcement:

A PSYCHOTHERAPIST'S JOURNEY will not be posted for a few weeks.

I am in a race for time, readying my second book (a "BLOOK" - commonly referred to these days as a compilation of blogs in book form) for publication.

I wish you, my loyal followers, as well as any who may have just discovered this site, good health and successful productivity until I return.  Please know that I send my warmest regards and heart-felt gratitude for your loyalty.

In the meanwhile, do visit or re-visit my website at http://www.applemanshapiro.com/ to learn more about my work as a psychotherapist/addictions counselor/life coach and oral historian.  You may also order a copy of my memoir FOUR ROOMS, UPSTAIRS directly from my site, with no charge for shipping.  Many thanks.

Yours,

Linda

DRUG THERAPY PAYS. TALK THERAPY COSTS and is often being tossed.

                                        

The choice facing psychiatrists and mental health professionals is on its way to creating a nation with an increase in mental health problems and leaving us little faith in our entire system of health care.


When I first began treating patients in the early 1980’s, I thought that talk therapy was the best way to go.  Then, as I became a more seasoned therapist, it became clear that psychiatric medications were often very helpful (if not necessary) when given in small doses for those with difficulty reacting to current life stressors and particularly for those suffering from major depressive disorder, on-going panic attacks, bi-polar disorder, and the like.  I began working with psychiatrists and psychopharmacologists whom I knew had reputations for never over-medicating, and have since then offered this combination of talk therapy along with medication, when medication is indicated.


Fortunately, I am not alone in the psychiatric and therapeutic community.  Most of us agree that the combination of both therapy and medication is the preferred path to well-being.


Drug therapy alone – though a quick, expedient fix – is never, in my opinion, the best treatment.  I am particularly disturbed by the fact that family physicians have at their disposal samples of heavily advertised anti-depressants, which they hand out too easily and too often.  Drugs have different properties and different side effects.  Not following a patient weekly to note objective changes and/or effects is doing them a great disservice.


In order to allow patients to lead stable, productive lives, treating some patients with talk therapy alone is often sufficient.  Other times, medication coupled with having an on-going therapeutic relationship with a qualified professional is optimal.


Perhaps, having said that, you will better understand my reaction to Gardiner Harris’s March 5th article in the New York Times.  The title, in fact, should give it away: TALK THERAPY DOESN’T PAY, SO PSYCHIATRY TURNS INSTEAD TO DRUG THERAPY.


Harris focuses in particular on one psychiatrist’s confessions of only prescribing medication after a brief consult with a patient and no longer offering talk therapy.  This is all in contrast to his training at one of Chicago’s prestigious medical schools where upon graduating he started a psychotherapy (talk therapy) practice in 1972.


Until the last few years, in fact, he treated roughly 50 patients a week, some even twice a week. As the article reports: “Now, like many of his peers, he treats 1,200 people in mostly 15 minute visits for prescription adjustments that are sometimes months apart … often not even able to recall the names of his patients, when before he knew their inner most lives.  Then his goal was to help his patients become happy and fulfilled; now it is just to keep them functioning.”


That was definitely the line that made my anger soar.


We all have choices to make.  Psychotherapists as well as patients.  Yet, the article (with its many statistics) made me believe that we are, indeed, turning into a nation where even when people are being helped, the goal is to help them to be merely functional.


Think of all the CEO’s who expect workers to perform at peak levels.  Yet, it’s common practice to fire workers for not meeting company standards, because all they are doing is “functioning.” Functioning means showing up on time, staying the entire day, but remaining only on the surface of full productivity and never realizing their full potential.


We all know of such stories.   We also know that decisions made by health insurance companies and the government are ones that are made in large part due to ignorance and ill-advised priorities, all of which put our health at risk.   On the one hand, psychiatrists are being convinced – such as the one cited in the Times – to change priorities.   Clearly, listening to patients talk about their problems, developing a trusting relationship with them and helping them to process their options is no longer sustaining his practice financially.  He, like many others, is choosing to simply medicate.  Worse still, psychiatric hospitals that once offered patient’s months of talk therapy now discharge them within days, with prescriptions for medications in hand.  This is shoddy medicine and speaks to the heart of the matter: quality of treatment versus ignorance and greed.


I don’t wish to spend time judging doctors who choose not to take financial losses and opt only to prescribe.  Each of us has to live with the life style of our choice.  The professional decisions we make throughout our lives also have to resonate with what is important to us.  Yet, the great majority of we therapists who continue to offer talk therapy are not psychiatrists.  We cannot, therefore, medicate, and in continuing to see patients, many of us do so at a cost.   For those of our patients who have no coverage, we allow them to pay whatever they can.   For others, we offer a sliding scale and hope that those who pay in full will help cover our costs.  When it doesn't, we end up compromising too much of our income, and our financial burden then becomes a real stress in our lives.  As I see it, there’s something very wrong with this picture.


Those in government who are making public policy as well those in the health care industry who dictate the number of allowable visits do so, more often than not, with no understanding of the dangers involved in ceasing treatment.


Unnecessarily long hours are spent by providers attempting to justify, for instance, why someone who has expressed suicidal thoughts is at high risk.  What they refuse to accept is that if therapy is discontinued due to lack of coverage they (the insurance companies) will be paying much more money for repeat hospitalizations.  But none of that seems to matter.  Theirs is a business first and foremost.  For those of us needing to deal with their representatives, it is apparent that most seem to have little understanding of psychiatric disorders.  They are spokespersons (gate keepers) for a business.  The business just happens to be  “health care.”



As providers we believe that psychotherapy is a microcosm of all human relationships.  The inability to navigate and understand relationship issues and the effects of early life trauma is - through a relationship of trust - explored and, when most successful, resolved during talk therapy treatment.


Talking and processing life events is instrumental in helping people to heal and to develop new ways of behaving, developing better coping skills and gaining an awareness (if not total insight) of how their behavior effects others and how others effect them.   Without that, no amount of pill taking will allow people to alter their expectations, understand how best to improve the quality of their life or their work.  We will, instead, become a nation of robots whose wiring may be somewhat less taut, less liable to explode, but we will certainly not be better able to live richer, fuller, happier lives.


What will it take, I wonder, for those in positions to change the system, to make the mental and physical health of our people once again a top priority?


Yours,
Linda

*Visit my website at http://www.applemanshapiro.com/ to learn more about my psychotherapy practice, my work as an addictions counselor and oral historian and my book, FOUR ROOMS, UPSTAIRS, which may be purchased directly from the site with no fee for mailing.

THE AFTER-EFFECTS OF TRAUMA: PERSONAL AND GLOBAL

There are traumas and there are TRAUMAS!  None is ever pleasant nor easy to overcome – but when everything one owns and everyone one loves is threatened by a natural disaster such as the earthquake/tsunami which occurred and continues to impact on the lives of everyone in Japan – there are no words to describe the devastation, no meaningful expressions of sympathy for those lost, missing, or dead.  With homes and businesses destroyed and after shocks continuing to rumble and tumble the insides and outsides of all that was familiar one moment and gone the next, how is anyone to cope?


So many of us throughout the world have been viewing what happened almost from the moment the quake occurred.  With other recent natural disasters, along with acts of terrorism, such images remain forever in our heads, leaving us more conscious of our own vulnerabilities.  For those of you such as myself, with relatives or friends in Japan now, the nightmare is even greater.


My dearest nephew Marc, along with his wife Shari, their youngest son Drew (and many members of Shari’s family) left the States Wednesday for a long planned vacation to Japan.  And though they arrived in Tokyo just prior to the quake and afterwards did e-mail to say that they felt relatively safe, I am more than merely eager for them to return home. 

As of this writing, we do not know exactly when that will be possible.


For them, the experience will, no doubt, be life-altering.  For the entire country of Japan and its citizens, though, this experience will be a trauma from which it will be nearly impossible to recover.  Being safe one moment and then having the floor beneath them shake and the building or home they were in sway with sounds of impending doom, had to have been nothing short of utterly terrifying.   Then, too, there is the threat now of waiting to learn if any or some parts of the country have been exposed to what indeed may turn out to be the world’s worst nuclear disaster.  That in itself may not only be threatening but immobilizing.


Since the 911 terrorist attack and natural disasters such as Katrina, we here in the States have all felt less smug about what is in our power, less certain of anything we think is in our control, and certainly less confident in the future of the world as we know it.


On the positive side, such catastrophes often bring out the best in people.  Average citizens are already working to send aid and scientific experts are offering to help figure out exactly what happened as well as how best to control what is happening and what might happen again.  Physicians and numbers of health care providers are also volunteering to assist.  Not least of all, leaders of nations, 50 including the United States, have offered to extend help to Japan. 

However, in the words of an American reporter living in Tokyo for many years, this is Japan’s moment for transparency in its actions.  Acknowledging their need and willingness to accept help, to disclose ALL that they know to all of their citizens is of the utmost importance, if their people are to have any trust in their government and any hope for survival.


Such disclosure is akin to an individual’s acknowledgment of pain and willingness to seek help rather than keeping his life’s struggle a secret.  Just as with a dysfunctional family, secrets only breed dis-ease and confusion, if not mental illness.  So, too, with nations!  Japan, therefore, has the opportunity - if not the responsibility – to report honestly to its people and to the world.  Making decisions based on the most sophisticated knowledge they can receive from any countries willing to offer their expertise and assistance at this perilous time is obviously essential.  In the end, it will be more than beneficial.  It is the honorable way to save themselves and show the world they are capable of doing what is both expedient and noble.


For the most part, however, no one else can truly experience the after-effects of another person’s (or another nation's) response to a traumatizing event.   Each of us has different resources to draw upon when tragedy strikes.  Some of us have few, if any.  And although our sorrow remains always and forever our own, no matter how rich or poor we are or whatever part of the world we may live in, that sorrow can be made easier to bear when others offer us their help. 

Obviously, there are differences between personal traumas and global ones.  The nature of how they affect our psyche and our soma can be equally devastating, but they are different, nonetheless.


As a survivor of a personal trauma – namely my mother’s bouts with mental illness and its effect on each member of our family – what’s happening now in Japan reminds me of a chapter in my memoir FOUR ROOMS, UPSTAIRS, in which I wrote about my mother's suffering the after-effects of being a child in war-torn Russia during WWI.


“The turmoil of mother’s internal world was later hidden behind what appeared to be a stubborn reluctance and lack of desire to see more, to visit new places. Early imprinting, which had adhered trauma to change, had also kept her wary of travel, even when she could do so in comfort years later.  Staying with what was familiar, she remained confined, a prisoner in her four rooms, living in a tiny slit of space she assumed to be her only choice ….. venturing out was not an option.  There was no going beyond where fear had paralyzed her and memory still held her in its grip. ….. Reminders of the sadness that filled our four rooms haunted me for years.  Shadows from [Mother’s] past darkened the present, as the constant fear from living with real or imagined danger fed a growing anxiety.  Even when life was relatively calm, it still felt as though a storm was looming.”

I wrote those words because my mother’s traumatic memories created traumas of my own.


Now, in this surreal time when Japan’s toll on human life is staggering and the country’s infra-structure may indeed be forever altered, I can only hope and pray that all who are in various states of shock – trapped, injured, or separated from their loved ones – will survive and WILL be offered the possibility for healing, re-building, and re-creating , not just themselves but their nation.


Yours,
Linda


*Visit my website at http://www.applemanshapiro.com/ to learn more about my psychotherapy practice, my work as an addictions counselor and oral historian and my book, which may be ordered directly from the site with no fee for mailing.

THE MEDIA HAS MOST ASSUREDLY RAISED OUR TOLERANCE FOR INSANITY and VIOLENCE

Acts of insanity and violence saturate our TV screens, the radio, and the internet.  This constant exposure to a wide range of abuse has raised our level of tolerance and, in so doing, brings us closer to a state of apathy and acceptance of aberrant, uncivilized behavior.

In the midst of wars and unbearably painful scenes of humanity on the run in so many countries, our lives are now barraged with the antics of Charlie Sheen.  People can’t get enough, hear enough, see enough of this sick and dangerous man.  Interviewers seem too intimidated to confront him.  Photographers find him everywhere and plaster their findings wherever and whenever they are allowed to do so. 

Yet, Reality TV has blurred the distinction for many of us between what is acceptable and what is simply scandalous.  For those who have become addicted to following his every move and can’t stop themselves from watching him, talking about him and tweeting, it says as much about them as it does of Sheen himself.

No one has stated this phenomenon better than writer Anna Holmes (creator of the website Jezebel) in the NY Times op-ed, Friday, March 4th.

 The title of her piece, “THE DISPOSABLE WOMAN,” tells it like it is!  She recounts Sheen’s self abuses and makes clear that “his abuse of women is barely broached.”  Citing Piers Morgan’s CNN interview with Sheen, Holmes notes that “inertia is not for lack of evidence.”  Each of Sheen's "incidents" was reported nationwide:  his 1990 “accidental shooting” of his then fiancée, the suing by a college student struck after not accepting his sexual advances, a sex film actress claiming to have been thrown to the floor during a fight, a restraining order issued against him by a previous wife, Denise Richards, who claimed he threatened to kill her, and his 3rd wife who called 911, stating that he held a knife to her throat (to which he pleaded guilty and was put on probation).  All of these were made public. 

More recently, we recall the scandal in NYC when another actress who appears in sex films locked herself in a bathroom after Sheen went into a violent rage.  Again, though a criminal complaint was registered, no arrest was made.  And last, but certainly not least, his former wife and mother of his twin sons, alleged that “he had claimed to cut her head off, put it in a box and send it to her Mom.”  Do we see him remanded for a psychiatric evaluation or behind bars?  No.  We find him constantly gaining the attention of hoards of people who see him getting away with offensive and sick behavior.  His money can and often does buy him, not simply freedom, but more fame.

The tragedy is that no one is helping Mr. Sheen. We see his addictive behavior. We are subjected to his manic gibberish while he’s allowed to side-step his treatment failures.  And we know that any other citizen – someone neither famous nor wealthy – would have long been sentenced by the courts or even silenced.

Holmes writes that “a woman’s active embrace of the FAME MONSTER or participation in the sex industry implies that she compromises her right not to be assaulted, let alone humiliated, insulted or degraded; it’s part of the deal.  The promise of a modern Cinderella ending – attention, fame, the love and savings account of a rich man – is always the assumed goal.”  She further states that the “objectification and abuse … is not only an accepted occupational hazard for certain women, but something that men like Mr. Sheen have earned the right to indulge in. ….. These assumptions – about women, about powerful men, about bad behavior – have roots that go way back but find endorsement in today’s unscripted TV CULTURE.  The overall conclusion is that, for many, Mr. Sheen’s real-life, round the clock, recorded outbursts and the sexist narratives devised by reality television producers, in which women are routinely portrayed as backstabbing floozies, and dreadful behavior by males is explained away as a side effect of unbridled passion or too much pilsner.”

Worse, still, “they make assault and abasement seem commonplace, acceptable behavior, tolerated by women and encouraged in men.”

As a psychotherapist/addictions counselor, I have treated one too many abused women – ordinary, self-respecting women who were neither actresses nor famous – and, who, even after receiving orders of protection, were raped or assaulted in unimaginably torturous ways while their “perpetrators” got a slap on the wrist, probation, or a minimal amount of time spent in jail.  Many women in 21st century America – not only in third world countries – are victims of abuse every day.  Those who are their abusers – whether  mentally ill and/or addicted to one drug or many drugs never get the media attention that Sheen gets and therein lies the rub.

We have a society in which many rich and famous men such as Sheen go untreated for obvious psychiatric disorders and are allowed – if not encouraged – to continue to see women as disposable.

As far as I’m concerned, Sheen should never have been given the opportunity for air-time.  Attention should be given to all men who are found guilty by giving each and every one a psychiatric evaluation, a treatment plan and when, necessary, a jail sentence.  The women should be given the therapy needed to move beyond the trauma they have endured and we, as a society, should not allow the Sheens of the world to walk our streets, to have custody of any children, or to have the pleasure of any woman’s company until they have received sufficient mental health care and are abstinent from all drugs.

Once we afford them the luxury of a public forum and the publicity fit for presidents and kings, we’ve lost the right to call ourselves anything but enablers and abettors of criminal acts, especially against women!

Responses?

Yours,
Linda