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Tag Archives: mental health

Coffee, Tea or Pee?

pup

There are lots of monumental problems in the world, but for the moment let’s ignore them. Let’s instead focus on the latest unpleasantness to occur on airlines: dogs. It seems that while we’ve been losing legroom, meals, snacks, magazines, and dignity, pups have taken to the friendly skies. The rise of the cabin canine (versus the baggage hold hound) is due to the (relatively) new loophole of “emotional support” animal. If your dog (or pig, monkey, or cat) is designated as giving you emotional support he/she must be treated like an assistance animal. Passengers and crew are not pleased by this trend and for good reason.

Allergies to animals are far more prevalent than peanut allergies. Being trapped in the sealed can with a dog is the worst nightmare for many people. Uncontrollable itching, hives and difficulty breathing are now part of the trip for many. There is no limit on the size of the animal when its owner has a prescription. It is conceivable that Marmaduke would be sprawled on top of the passenger next to you (riding for free!) These animals pose a threat to trained service animals. Unlike a Seeing Eye dog, an emotional support animal’s only qualification is that the owner likes having him/her around. Seeing Eye dogs can be trapped in a small space with butt smelling, barking, peeing and perhaps biting dogs. An airplane can quickly and unexpectedly become a place from which people need to flee. It’s horrifying to consider what would happen in an emergency with a pet and a trained assistant dog on board.

There is no doubt that people feel better with their animals. There are people with robust mental health who benefit greatly from the demands and love of an animal. There are also very few people who aabsolutely must travel on an airplane; save for the crew who it must be said are legally entitled to carry a dog on the beverage cart. If we are a bit too timid to impose restrictions upon where people may bring their comfort pets perhaps we could at least take the issue a little more seriously.

Currently all one needs is a letter from a health care professional and WHAM, the entire terrain changes. With one letter, from someone who may or may not be treating me for an actual disorder, I can force my landlord to allow Fido in, I can walk into any bar, restaurant or hospital with Fluffy and I can sit next to you at the opera with my potbelly pig. None of these animals have been screened, trained or licensed. The first step is to legitimize the “prescription” writing process. More than one mental health provider must sign-off and at least one of them must be treating the patient. Having your cousin the dermatologist sign the form should not be sufficient. Comfort animals must be certified to obtain the same privileges as assistance animals. They need to have a clean bill of health, be trained in how to act around people and other animals and be certified.

It’s hard to imagine that anyone who legitimately needs to be holding their pet at all times would actually balk (or should we say; bark) at such guidelines.

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Posted by on November 16, 2013 in Travel, Well-Being

 

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A Mental Health Crisis

illness

Once again extensive and lengthy mental health issues are revealed after a heinous crime. Once again we are left wondering how can this happen? How can anyone living in today’s over-exposed world manage to evade authorities and/or medical attention? How can a person with repeated exhibitions of mental illness have access to weapons? These discoveries of warning signs and bells usually crop up during the first 24 hours of investigation. This speed suggests that the perpetrator’s mental health status was pretty well known. How does this happen?

How do police listen to a man talk about hearing voices and microwave vibrations and not have him hospitalized? How does someone retain his military security clearance after violent and erratic behavior? How does someone with a well-known history of mental imbalance own and keep a gun? It’s actually quite simple. We don’t want to get involved. We see examples of this aversion every single day. When you use a restroom and discover there is no toilet paper, it’s because at least one person before you did not tell management. We don’t want to get involved in even the most benign situations let alone one that might be complicated. And nothing is quite as complicated as mental illness. We are equally consumed with fears of offending someone behaving questionably as we are for our own safety.

We are woefully under equipped both personally and on a larger infrastructure level to deal with mental illness. If you work with someone who exhibits troubling behavior you might screw up your courage and go to personnel. Then what? A competent personnel officer may talk with the employee in question about services and counseling. Then what? Does the veil then lift from the employee’s eyes? Do they trot off to up until that moment an unknown resource known as counseling and become cured? Only in a Lifetime movie. What if it’s your next-door neighbor, the guy in the diner, or the woman on your bus? How do you alert anyone? Who do you tell?

When a person’s behavior becomes impossible to ignore, the police are often called. The police may or may not be well versed in the signs of mental illness. The police usually have some leeway as to whom they can have transported to an emergency room. Then what? If a person in distress makes it to the emergency room they are held for less than two days. If they are not a danger to themselves or others (which is determined by the patient saying the words; I am a danger to myself and others) they are released.

Over the years we’ve become more comfortable with the concept of mental illness. We bandy around terms like post-partum depression, P.T.S.D., eating disorders, O.C.D., etcetera. Many people are comfortable taking psychotropic medication and/or sedatives. But mental illness is far more vast and varied. There’s a whole lotta real estate in between social anxiety and paranoid schizophrenia and most of us are a bit vague about it all. Compounding the confusion is the fact that mental disease can be scary for spectators. Of course in our most rational moments we know that it is far scarier to ignore erratic behavior. But we can hardly be blamed for listening to our own little voice inside saying; “run the other way!”

In a world in which people often assume that someone else will take care of something, mental illness is mysterious and scary and our mental health infrastructure is flimsy at best it is no wonder that we have what we do on our hands. We’ve heard people (including politicians) say that guns don’t belong in the hands of the mentally ill. We’ve never heard what that means. Surely not all mental illnesses are considered in this classification. What has been spelled out is that “people with mental illnesses” will be identified as those who have sought help. This is a ludicrous and meaningless classification as it’s a deterrent to people to seek help, and we don’t really have many options for those seeking help. And that is the issue.

We’ve shrouded mental health issues for which there isn’t a kicky acronym or a medication to be peddled, in a thick cloud of secrecy and shame. We’ve manifested that sentiment in the abysmal mental health system with which we’ve settled. It’s great that you can get a flu shot and blood pressure check while picking up some cat litter. But what of prevention and detection of diseases that could affect public safety? How much devastation does it take before we face this issue? How many lives must be destroyed until we can say; we have a mental health crisis in this country?

 
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Posted by on September 18, 2013 in Cultural Critique, Well-Being

 

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Crime Of The Mind

Edgar Allan Poe

In New York City a man has been convicted of conspiring to kidnap and could be sentenced to life imprisonment. He did not in fact kidnap or hurt anyone, but did type extensively about his desire to do so. It is conceivable that this 28-year old man could spend the rest of his life in prison for having creepy thoughts. This in a land in which people who’ve been convicted of actual crimes serve their time and are released. What in the world does it mean for thoughts to be illegal?

Was the fact that this man a N.Y. police officer too emotionally charged for the jury? Was the jury swayed by the graphic nature of the defendant’s writing? Was the fact that the writing occurred in cyberspace perceived as more threatening than a handwritten journal? Was it that the defendant engaged with other typists in these fantastical plans? Something must have clouded the jury’s vision to render such a verdict. Is there reason to be concerned about the judgement of this police officer? Absolutely, but that’s a personnel issue, no? Were the messages so convincing that the jury was concerned about imminent danger? Perhaps, but that is why probation, monitoring and court mandated treatment were invented.

By equating thought with action we set a dangerous precedent. What does this mean for all crime writers for example? What does it mean for anyone who’s ever put pen to paper (or fingers to keyboard)? And what of those who engage with the dangerous writing? Are book clubs or theatre audiences aiding and abetting these dark thinkers? While no one will ever confuse Sweeney Todd with the contents of a chat room, the overarching premise is the same. The fact that the chatting, posting, emailing and texting wasn’t particularly well written or the least bit musically engaging doesn’t mean it wasn’t an exercise in creative writing. Creative writing by a man of questionable mental health of course.

But questionable mental health is not a crime. Do we want people with questionable mental health to be carrying a gun and be charged with protecting people? No. Do we want real and meaningful treatment for those who are not entirely well and who harbor violent thoughts? Without a doubt. Imprisoning (for any length of time) because of mentally illness is a black eye for us all. It is an ugly bruise of a reminder of how inept and misguided we are in matters of mental health.

 
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Posted by on March 13, 2013 in Cultural Critique, Well-Being

 

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Having Vision

Lucy

“Background checks!” “Assault rifle ban!” “Mental Health Registry.” I can’t be the only person completely flummoxed by the latter of these gun control cries. There’s been plenty of chatter and innuendo but little if any real explanation as to what in the world is actually meant by a mental health registry. How will illness be identified and categorized? Is the inclusion of a mental health codicil simply a way of saying ‘a registry of people who have exhibited violent behavior in the past and had treatment.’? If so, that is quite the branding overreach. People who commit violent acts are by definition violent. People who harm strangers are not of sound mind. But neither are people who commit white-collar crimes.

Mental health and violence are only linked in terms of a one-way relationship: people who commit violent acts=unwell. But the vast majority of people who are unwell do not commit violence (to others anyway.) A glance through the Diagnostic and Statistical Manual of Mental Disorders IV (DSM) will (takes quite some time but) will result in concluding there is simply no single mental disorder commensurate with violence towards others. If we were to analyze mass murderers we may see similarities. They might have social phobias or a narcissistic personality, they may even have hallucinations. Those are three distinct disorders that are also symptoms of several other disorders. What of people with substance-related disorders? They very well may have induced psychotic disorder, or not. And all psychosis is not the same. Psychotic episodes rarely result in shooting up a pharmacy.

So what do we really mean when we talk about a mental health registry? Even if we scrape away the Pollyanna delusion that the majority of unwell people seek and obtain good mental health care, we are still left scratching our heads. Are we saying that mental health professionals need report when a patient vocalizes intended harm? That already is the case, so if that’s what we mean we should just stop talking about this. Will mental health professionals be asked to expand the reporting paradigm to include those patients they suspect will do harm? Even if that type of Ouija board, tea leaf reading were possible, we’d still be left with a tiny population of people who are on a path of violence and are actively seeking help. In this magical scenario where therapists with any and every kind of training and credentials can see into the future and place someone on a registry; what exactly is the goal? Perhaps (in this lollipop and unicorn made for T.V. scenario) a violence prone person will be prevented from buying a new gun. Fabulous, great. Does it prevent him or her from accessing their mother’s stockpile? Does it stop them from using the guns they already own?

Focusing on the mentally ill is very much needed in this country. People are suffering and need care. Those in a fragile state shouldn’t be expected to do battle with insurance companies or general practitioners. We need to stop whispering when we speak of mental health issues. There is nothing shameful about needing help; but there is much shame to be shared in turning our backs. It shouldn’t be challenging to find good help, it shouldn’t be financially out of reach either. The path towards help shouldn’t be so opaque that people have to ask, “where do I find a therapist.” Professionally staffed mental health clinics, offering consistent and continuing care should be as ubiquitous as LensCrafters. There is no shame in needing help; most everyone needs glasses at some point.

 
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Posted by on February 9, 2013 in Cultural Critique, Well-Being

 

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Dealing Prescription Drugs

Pill

Drug abuse has existed since the dawn of time (or at least since the first person ground a leaf into powder.) Just about any substance can be misused or abused. Many drugs lend themselves to misuse/abuse due to their mood altering effects. However in recent years antibiotics have become misused as well. As a culture we are not entirely comfortable with discussing prescription or over-the-counter (OTC) drug abuse. We know what drug abusers (a.k.a. junkies) look like; we’ve seen them in movies and magazine features. Surely the (pill taking) carpooling mom next door can’t be abusing drugs; look at her! Those honor students doing homework in the media room can’t be abusing A.D.H.D. medication; look at how well they’re doing! What adds a heavy opaque veil to the detection is that these drugs come from doctors. Doctors know a thing or two about the human body and what is good for us, no? In theory, yes.

Detecting drug abuse during a 3-5 minute office visit is not easy. There are those who live with people day in and day out and still have no knowledge of drug misuse/abuse. This is by no means to suggest that doctors shouldn’t prevent and detect misuse/abuse. Quite the contrary. We need to incentivize the doctors to limit prescription writing (kind of the way drug companies give incentives to write the prescriptions.) Primary doctors need to spend time asking pointed and probing questions and not merely relying upon questionnaires to make diagnoses for mood altering drugs. Doctors must know the signs of dependency and always err on the side of lower dosage. Doctors know the signs of mental illness and should be on alert for signs of self-medicating behavior. Doctors should refer patients to a mental health practitioner if there are any doubts about stability. The mental health practitioner and referring doctor must decide in concert what medication (if any) is best for the patient.

Pharmacies are already set up to detect prescription abuse. But there are gaps and it’s not considered abuse to fill legitimate prescriptions. We need to start with source (or ‘dealer’ as he/she is known on the street.) Doctors are not looking to get people ‘hooked’, not consciously anyway. For the most part they want their patients to be healthy and happy. They certainly don’t want to see their patients in pain, physical or psychic. Pain medication is tricky business and that’s why there are specialists and pain clinics. Managing pain and pain amelioration can’t happen in a 3-5 minute general practitioner’s office visit. General practice is not the place for treating a cognitive, behavioral or mood issue either. Psychologists and psychiatrists are trained to diagnose learning disorders, and behavior and mood disorders. Relying on general practitioners to treat all aspects of the human condition is quaint and ridiculously. No one person can possibly be up to date on all the medical developments of the 21st century.

We’ve become rather blasé about medicine; ironically as it’s become space age in its sophistication. But we are wrong to do so. Often times, dangerously wrong. Drugs are drugs; whether they come in a childproof bottle or a tiny ziploc bag. They can be life saving or ending, and should be treated as such.

 
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Posted by on February 3, 2013 in Cultural Critique, Well-Being

 

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