Hell

In you are here: Discovering the Magic of the Present Moment, Thich Nhat Hanh writes,

To me, the definition of hell is simple. It is a place where there is no understanding and no compassion. We have all been to hell. . . If there is compassion, then hell ceases to be hell. You can generate this compassion yourself. If you can bring a little compassion to this place, a little bit of understanding, it ceases to be hell.

Then he writes what, to me, is the perfect definition of the psychotherapist's job:

"Your practice consists in generating compassion and understanding and bringing them to hell."

The 24-Hour Experiment: Love Your Body

Yes, that's right. Love your body.

Identify something your body can still do right (and it's doing something or you wouldn't be reading this. Then appreciate it. Tell your body you appreciate it.

Then for 24 hours, treat your body like you would an adored child. Rest it, wash it, dress it, and feed it like you would a precious infant. Play with it. Talk to it.

Bigotry is not a mental illness. . .

Image via Wikipedia

. . . and neither, ladies and gentlemen, is domestic violence.

I had planned on another A.A. blog post today, either about individual members who try to cram their personal God down your throat, or what to do about the ones that want you to stop taking your meds "or you're not really sober."

But then, alas, up pops yet another female apologist for Mel Gibson, and I just couldn't let this one pass. Alicia Sparks is a layperson who writes for PsychCentral, which I usually recommend but am lately having doubts about.

"...think about why Mel Gibson (and anyone else, for that matter) has done these things," she writes.

OK. Here's my theory:

1. He drinks because he is an alcoholic.
2. He abuses women because he hates us. And because he can.
3. He uses intimidation, threats, and physical force to get his way.
4. He's bigoted because, well, because he's a bigot.

Ok, Ms. Sparks. Next?


"The verbal abuse and threats were bad, yes."

"Bad?" Oh, oh. Anybody else here see a minimization coming? Sure enough:

"The physical violence was bad, too (if there was any – there’s now speculation as to whether Gibson actually hit Oksana Grigorieva in the mouth, as she claimed, or if that all plays into the extortion theory)."

The link takes you to a brief Entertainment Section story which refers to photos Ms. Grigorieva has given to the police of herself with damage to the veneers on two teeth. Apparently, "sources familiar with the medical charts, photos and examination notes of Grigorieva's dentist indicate there is no evidence Oksana was struck in the mouth."

Well, no sh*t, Sherlock. How could there be? Unless the dentist got DNA off Mel's fist from between her front teeth, all he can say is whether her injuries are "consistent with" or "not consistent with" being punched in the mouth. What he actually said in a sworn statement was that she showed signs of blunt force trauma, and that he was concerned enough for her safety to offer to shelter her himself.

So first, you have a non-professional blogging on a psychology website. Second, she's citing entertainment pieces as if they were investigative journalism. Third, she's accusing Ms. Grigorieva of extortion, and doing it without the courage to come out and say it directly herself, using the mealy-mouthed "there's been speculation".

OK, just for the sake of argument: I think I'd like to strike out on my own with a child, leave my husband. I think that I will cause myself some extremely painful, potentially permanently disfiguring injuries, and tell him if he doesn't give me money, I'll claim he did it to me. Does that make sense to anybody? And does anybody really think that Grigorieva bruised their daughter herself, to make money??

For what it's worth, the police have opened an investigation into the DV allegations. They have not opened one into the extortion claim.

Sparks is also conveniently ignoring two other little minor details, that being Ms. Grigorieva's description of the alleged incident on tape, followed by a little snappy repartee from Mel, to wit, "You know what? You f**cking deserved it." And then there's the photo of the baby, with bruises.

Details, details. 

Next, Sparks asks,

But even amidst all that, it is possible to eventually set aside the inevitable shock and confusion and anger and evaluate the situation. If indeed Mel Gibson is suffering from untreated mental illness, which would be better: Hoping he seeks (and benefits from) professional help, or writing him off as a lunatic lost cause?

Here, the logic breaks down entirely. But let's try to follow it.
#1. Who's confused? You? Not me. I see a clear case of domestic violence here. Yeah, yeah, I know, innocent until proven guilty and all that, but we are not in a court of law. This is a blog.
#2. If indeed, Mel is mentally ill, what does that have to do with anything? Domestic violence is not a mental illness. It is not even about mental illness. (It is not about anger management either, but that's another rant for another day). No, ladies and gentlemen, domestic violence is about power and control. Period.
#3. Bigotry is not a mental illness, either. Not as it is expressed in racism, anti-semitism, or hatred of women.

I defy Ms. Sparks to find me even one sloppy study that shows that bigots or wife-beaters can be helped with diagnosis and treatment of a mental illness.

Alcoholism, of course, is a disease. However, I would also like to see the study that shows that sobering a guy up will make him quit spewing hate-talk, making anti-semitic movies, and hitting people.

Just one. Even a sloppy one.

#4. Mel, according to friends quoted on MTV's website (yet another shining example of investigative journalism, I know, but there you are), is already in therapy. And he already knows he needs to quit drinking.

So what, exactly, is Sparks' point here? Is she saying he shouldn't be held accountable for what he's done? Does she want us to give him a pass?

#5. Who's writing him off? There's a straw man argument if ever I heard one.

No, going back to the title of her piece, I think what she wants is for us to have compassion for him. So I looked it up. Compassion means "deep awareness of the suffering of another coupled with the wish to relieve it."

Funny thing, that describes exactly how I feel about Ms. Grigorieva. 

Suicide, again

Jolene over at Graceful Agony had a suicidal person Google her blog on the way to trying to find out "the best drugs" to kill herself with.

Jolene's response is thoughtful and on the money, so I'm going to limit myself to putting up a link.

Blue Cross Blue Shield Of Georgia Is Skimping On Mental Health Care, Says Georgia Psychological Association

This story is from last year. I found it when I Googled Blue Cross/Blue Shield tonight looking to download an Outpatient Treatment Report form for a patient. Given the problems I've had recently had getting treatment re-authorized, I also downloaded a 50-page explanation of what Blue Cross/Blue Shield considers "medically necessary". You can read that for yourself here. I found it enlightening.

Because I am on their panel and neither wish to be tossed off it nor to have clients convicted by association, I'm not going to say anything more.

You can read the article for yourself as well:

Blue Cross Blue Shield Of Georgia Is Skimping On Mental Health Care, Says Georgia Psychological Association

Enjoy.

Why I Hate Managed Care in General, and the Medical Model in Particular

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So this arrogant psychiatrist in another state, who has never met nor spoken to my patient, decides in less than 10 minutes on the phone* to deny coverage for depression and ADD because she's made only minor progress in 12 weeks of outpatient psychotherapy ("three months!" quoth he, obviously horrified).

Oh, yeah, and because she's not getting "standard" (read: "cheaper") treatment, to wit, psychotropics.

He actually asked me why I was asking for more sessions! Um, because she's still depressed? still has family issues? Still doesn't know what she wants to do with her life? After all, he says, it's not working, is it?

Yes, it is. It may be slow, but it is working. Her problems have been years in the making and we're not going to turn them around in three months. He seemed astounded by this concept.

He implied more than once that my treatment of her was substandard. She wants a non-drug solution and I'm not forcing the issue, partly because her depression is moderate, therefore not an emergency, and partly because most of it is environmental in origin, not endogenous. As for the ADD, well, it is definitely holding her back, but it's not going to kill her, and I see the decision whether to medicate or try adaptations and accommodations as a personal one. I respect patients' ability to make decisions like that for themselves, and support their right to do so.

And by the way, the standards of care are written by--wait for it--the American Psychiatric Association.

Not to mention, success with medication is hardly guaranteed. I have had dozens of patients who have not responded to medication after medication after medication. Do insurance companies then want to stop paying for any more drugs? No. This is about money, pure and simple, and it pisses me off. This, people, is why we need national health care.

So if your insurance company doesn't want to pay for ongoing psychotherapy, fine. If it doesn't fit within their definition of "medically necessary," fine. I get that, and I have no problem with it. But don't imply that my work is substandard, dude. Do not go there.

*actually, he'd clearly already made up his mind before he even picked up the phone, based on a one-page request form I'd faxed in. I suppose I should have claimed "moderate" progress on the form. Her role functioning has improved because she's learning to structure herself better ("yes, but is her concentration better?" the insurance company care manager wanted to know) and she's made one of the major life decisions she came here to make. But I really feel we're just getting started. "Moderate" to me implies that we're about halfway through. "Major" progress would be close to the end, right?

While I was writing this the care manager called to see if I wanted to appeal. You betcha! And she pointed out that this all happened because I didn't return their calls quickly enough to suit them. I got passed on for this "peer review" thingy (Do you really think he's my peer? Do you think he's got a doctoral degree in psychology and 30 years experience providing psychotherapy?) partly to punish me.

Anyways, if I had, she went on to say, she "might" have given me two more sessions!! to get the client to agree to a med consult.

Makes me want to set my head on fire. 

Mental Housecleaning Time

"What's on Your Mind?" is the prompt for Facebook status updates.

Recently, I've noticed that there's a lot of junk on my mind, much of it unpleasant and worrisome. We unconsciously shovel in junk all day with the news, tv shows, and even the books we read! So after serious consideration (and one of those "last straw" experiences) I'm giving up reading fiction with any form of violence in it.

Which means most of my beloved murder mysteries and thrillers. I used to love, for example, the Dick Francis mysteries because they were all about horse racing. And you know how I feel about horses. But the novel I've just finished involves bad guys abusing horses, and one disturbing mental image in particular stuck with me long after the book was done. And I thought, why would I traumatize myself like that on purpose? Don't we have enough in our real lives to worry about as it is?

Jon Kabat-Zinn suggests that we think of what information we take in the same way we think about our diets: Pay attention to what floats up unbidden in your mind from things you've read, heard on the radio, or seen on tv. Be mindful of what you shovel in during the course of a day. See what you might want to change.