Tommy Bryan on World War I

My Mom's Dad had three war stories.

In the first, he is marching toward the front when his squad passes through an olive grove. He claims that he'd always loved olives and so began picking them from trees near the road, carrying them in his helmet and eating them on the march. Which apparently made him quite sick.

In the second, he is in the trenches, watching the little aeroplanes go over, thinking that was the place to ride out the war--safe home at base every night. So he applied to be a pilot, but was not accepted. I am glad, in retrospect, because while I certainly would have wished him out of the trenches, the death rate for fighter pilots in those days was staggering.

He did manage to transfer into a supply/transportation battalion and would spend the rest of the war driving food and ammunition back and forth from the front. He might not be at home base safe every night, but he would be most nights. In this, his third war story, he is driving toward the front and is close enough that he can hear the guns. His truck slides into a ditch, sort of accidentally on purpose, and he spins the wheels "trying" to get out until he is well and truly stuck there. He is happily sitting cantilevered into the ditch, eating a sandwich, when along comes a French tanker who insists on pulling him out.

He would giggle at this point, that funny hee-hee laugh of his, and tell us that no sooner did the tanker pull him out than he promptly slid back into the ditch. Again, the Frenchman, cursing, hooks up the chains and pulls him back out. Again, my grandfather, making a big show of his incompetence, slides into the ditch. The Frenchman throws up his hands in Gallic disgust and rolls on. My grandfather ends the story by telling us that was as close to the front as he ever intended to get.

I do not think my grandfather was a coward: Quite the contrary. He never spoke of his experiences other than this. You just could not get him to. My grandmother, however, once said that he came back from the war with his health ruined, and that it was years before he got it back. You don't ruin your health sitting in a ditch eating a sandwich and giggling. So I always believed that he suffered, as infantry did in that war, horribly, and was lucky to return home alive. And that it was a combination of modesty and discomfort with painful topics that kept him to his three-funny-story repertoire.

As an adult, and later as a mental health professional, I found this pattern pretty common. Vets tend to talk to vets, and to demur with everybody else.

My father in law never said much about his World War II Navy service, either, but I watched him light up when he met my cousin who'd also served. They spent the whole time during that family gathering comparing notes on their experiences. On another occasion, we took my father-in-law to a movie about the Pacific war. I don't remember which one. But again, I remember how he perched on the edge of his seat, eyes riveted to the screen, excitedly whispering to us, "That's where we were. . . yes, it was just like that!" and so forth during various invasions and sea battles throughout the movie. And then not one word in the car on the way home, nor did he ever mention it again.

Vets are pretty sure we won't get it. They may be right, but we have to be willing to try. We owe them that, and so much more.

Disturbed patient, disturbing therapy by St. Cloud psychologist | StarTribune.com

Somebody on Twitter alerted me to this story. Briefly, a therapist got over-involved with two of her clients and was disciplined for it. The problem, at least as it is framed by the local newspaper, is that she has poor boundaries and poorer reality testing: As they so cutely put it, she believed the client's delusions more than the client did.

The line between a memory and a delusion is a fine one, especially in Dissociative Identity Disorder (DID). DID occurs in people who have suffered especially severe and often bizarre, but quite real, abuses while at the same time there is an unreal quality to the disorder itself. Real memories, in other words, quite commonly exist side-by-side with unrealistic beliefs in DID.

Therapists are not, and cannot be, in the business of validating clients' memories. However, when a client questions her/his own memories, we can encourage reality-testing by the client. In doing so we must not forget that perpetrators of abuse quite naturally go to great lengths to hide what they are doing, so that validating a specific memory may simply not be possible. We also need to caution clients against attempts to validate that may be dangerous, such as directly confronting perpetrators.

Sometimes the only validation available is indirect: We are working on a dysfunctional behavior in therapy, a memory surfaces, and the behavior “spontaneously” clears up. Other examples of indirect validation that come to mind include addicted and sexually-acting-out siblings (possible co-victims) and an arrest of a relative for a related crime. None of these things proves the validity of a specific memory, but it does lend credence to the client’s family portrait.

It is a myth, by the way, that a person has to remember in order to heal. Or that survivors have to remember more: To quote the late Ann D. McAllister, Ph.D., "What [they] already remember is more than enough." Digging for additional memories runs the risk of (a) producing "memories" that aren't, and (b) completely unraveling the client's ability to function in the present.

Since disbelieving real abuse can be as harmful as becoming part of a delusional system, the therapist serves the client best by focusing on current functioning. The focus of treatment becomes teaching the client to manage flashbacks, switching between alters, emotions, appropriate boundaries, insomnia, self-harm, addictions, self-image, etc. And the key phrase here is “teaching the client to manage,” not managing it for the client. Treatment for DID is emotionally intense, and it’s not going to happen without a degree of dependency developing. But throughout the therapy, the therapist maintains the boundaries of the working relationship and encourages the client’s independence.

National Novel Writing Month

National Novel Writing Month

I thought this looked like fun. Quite naturally, mine will be about a murder in a psychology practice.

9/11 still killing

I get my news on the internet these days, and as I was browsing blogs with my morning coffee in my hand today, I found this. "This" is an epic Fail on the part of this entire country to appropriately care for 9/11's first responders and the residents and workers in the immediate neighborhood.

But as if "this" wasn't bad enough, I looked up the law proposed to remedy it, and that was worse. "That" includes Congressional findings on the aftermath of 9/11. A few high points:

• On average, a New York City firefighter who responded has lost 12 years of lung function.
• Nearby buildings are, as far as anyone knows, still contaminated with "caustic" dust, to which workers and children are still being exposed daily
• All told, a half million people were exposed
• Nearly a third of the firefighters were still sick five years later, and 65% of them are scraping by on less than $15,000 a year because they can't work.
  
• Many lost their health insurance, Workers Comp has been jerking them around, and a lot of folk are going broke paying for their own care--or going without and dying.

And guess what? There's a lot of posttraumatic stress! Well, duh.

Go read the bill, please. And if it shocks you like it does me, contact your legislators and ask 'em to vote for it.

For my part, I will treat--absolutely free of charge--one person who can demonstrate to my satisfaction (a) that hir psychological problems stem from their presence at or near the Twin Towers on 9/11, and (b) that s/he does not have the financial resources &/or insurance to afford treatment on hir own. I'm on Main Street in Woodstock, GA.

Call me: 770-924-1818, extension 307.

It's the least I can do.

A few facts

This will break your heart:

22,000 people between the ages of 25-64 die every year due to poor health care provision/ lack of health care.

Between the time Mr. Wilson yelled, "You lie!" and the time you and I go to bed tonight, 60 people will have died for lack of care. Could be my son, or your grandmother.

For some more statistics along these lines, visit Prof Susurro's blog.

Silly Season

I wish that the President could simply have declared that the Silly Season was over, as of last night.

/sigh/

At the first commercial break, however, some PAC or other ran an ad with a woman actress telling how Canadian health care denied her life-saving treatment, and she had to come to the US for top-of-the-line care. It ended with a tag-line to the effect that no government should come between us and our doctors.

There are three lies in this:

#1. We are not replicating the Canadian system, thank you very much. The public option as currently proposed is not government-run healthcare, but a single-payer model.

This would, by the way, save a metric shit-ton of money. Unless you are in health care yourself, you have no idea how much time and money we fritter away verifying benefits for a dozen of different insurance plans every day, applying for pre-authorizations, recording pre-auths in the billing software, getting re-authorizations every few weeks, billing, re-billing, going to different websites to bill different payors, printing hard copies of all these transactions, paying for electronic billing services' monthly charges plus transaction fees, tracking payments, filing appeals, entering different insurance company discounts in each policy-holder's books, applying to be on panels, renewing memberships on panels, submitting to audits by insurance companies of our books and clinical charts, billing patients for the portion insurance does not cover, and explaining patients' benefits (or lack thereof) to them. We spend on staff, training, computers, printers, storage systems, phones, software, paper, postage, and space (a portion of our overhead expenses such as rent, utilities, tenant's insurance) for this work in addition to the time away from patients and continuing education. And after all that, we write off thousands of dollars in uncollectible fees when it turns out that the insurance companies won't pay for what their policies and pre-auths indicated that they would and the patients don't have the resources.

But I digress.

#2. We do not have the best care in the world, as the ad claims. We spend more than other industrialized countries, for some of the worst results in the Western world. Higher infant mortality rates, for example, than anybody in Western Europe--or Canada, for that matter.

#3. The current system does not give you and your doctor complete control of medical decisions, people. Ask anybody who's ever been denied coverage by their private-pay, nonsocialist, for-profit insurance company for the medication their doctor prescribed, or a treatment their doctor recommended. Ask anybody whose private-pay, nonsocialist, for-profit insurance company dithered about pre-authorization until a critical treatment window was missed. Ask anybody who's gone bankrupt paying for their own treatment because their wonderful nonsocialist, private-pay, for-profit insurance company refused.

Heck, some of you have never even met your primary care physician. Our current system is so expensive to the practitioner and pays so poorly that they all use so-called "physician extenders" now. You see a nurse-practitioner or a physician's assistant. Not that there's anything wrong with them, but let's don't pretend we have direct relationships with our physicians under the current system, ok?

And the ad conveniently forgets that up until Congress made it illegal, it was our citizens organizing bus trips over the border to Canada to get affordable medications. It also conveniently overlooks the recent 'health tourism' trend, in which U.S. citizens go abroad for affordable surgeries.

No, I'm afraid the silly season is far from over.

GlaxoSmithKline used ghostwriting to promote Paxil - The Boston Globe

Just a quick note, as, if I had any sense at all, I should already be in the car on the way to the office, not sitting here in my jammies blogging.

In a new article in the on-line version of the paper today, The Boston Globe adds GSK to the list of pharma con artists.

GlaxoSmithKline used ghostwriting to promote Paxil - The Boston Globe

The fact that five ghost-written articles were placed in at least two prestigious professional medical journals is significant. When you perform a literature search on a medication, you would typically get a handful of review articles. If five out of that handful are bogus, that is going to significantly slant your view of the medication. Add to that the fact that most physicians do not do lit searches but rely on articles handed to them by the reps, and you have trouble.

In and of itself this is no indictment of the drug. But it does mean that your physician may not have had all the facts when she prescribed this medication for you.

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