Soap Box

This is the inevitable post of every recent article, blog, or news commentary where I take a stand against mental illness versus physical illness and rail against the unfair and biased system of separating treatments and systems of health care.

To those who see no difference in the two, I say congratulations on winning the health lottery, because if you had been diagnosed with a mental illness you would see the system for the mess it is.  A recent article (see biology below) in the Huffington Post discusses a study on how patients and doctors relate when discussing their mental health issues. The study found that the more biological based talk was used, the less empathy doctors had. As patients already know, you cannot remove the emotional element of these illnesses and expect good care.  There has been great debate recently with the revision of the DSM-V in the form of dissent as many feel they were cut out of the process by well-meaning yet detached psychiatrists who regulate the system. 

Let’s face it, the very nature of many mental illnesses leaves the afflicted without a voice in their community; many cannot protest so they must rely on advocates who are sometimes shut out of the process because of privacy issues. Most advocates have their hands full with the person in crises. Politicians know and freely admit this fact.  Mental illness funds are often the first cuts made in budgets.  Talk therapy costs more than medication.

What is it exactly that separates mental from physical illness? We can all agree that an illness in the brain is just as devastating as an illness in another organ.  Through technology and imaging we see more clearly that our bodies work better when they are treated as a whole.  So why does it take so many doctors to receive proper care?

To seek help you must first see your primary provider who then sends you to both a psychologist and a psychiatrist who you must ricochet between, often taking months or even years.  This is especially poignant as most people do not seek care until they are already in crises, they are scared and confused and often desperate for relief.

Many newly diagnosed patients are unfamiliar with this system, so beware: both professions can take months to get into; your preference may not be covered by your insurance, or they have cost prohibitive co-pays. This information has been disseminated before but must be reiterated as new patients enter the system every day.

The hierarchy is a matter of degrees:

You may first encounter clinically trained social workers (LCSW), who are 60% of the mental health workforce. They often have a Master’s degree in social work and offer suggestions for treatment but not medication.  They screen you and refer you to a psychologist or psychiatrist. They cost less and are paid less.

Generally, a licensed psychologist (Ph.D) talks with you for 45 minutes weekly or bi-weekly in order to evaluate, diagnose, treat, and study your behavior and mental processes. They are trained in medical, clinical and research environments.  They do not prescribe medications. They typically see eight patients a day and cover roughly 23% of the system.  A psychologist may refer you to a psychiatrist for medication.

There are about 5% psychiatric nurses who offer treatment and assessment and prescribe medication and often have their own practice.

And finally 10% are psychiatrists who are physicians that specialize in psychiatry. They give you an initial diagnosis after one 45 minute visit and prescribe medications. After that you will see them about once every three months for medication adjustments.  They typically see up to 30 patients a day.  There are still a few psychiatrists who are trained and perform both talk and medication therapy, but they are very rare and very expensive, usually upwards of $200+ an hour.

Generally, a licensed psychologist is a Ph.D. (Doctorate of Philosophy) and a psychiatrist is an M.D. (Medical Doctor).  A medical doctor degree costs more to achieve and that is the way they justify compensation, not on their effectiveness.

So we see that even though talk therapy is immensely beneficial to the patient and the system as a whole, we choose as a society to take a more short-sighted path of medications (many unproven and not understood) so we all end up paying more in the long run with inferior results.

A divergent point might also be made towards our health care system itself which has turned into a symptom management only machine which chugs through pharmaceutical laboratories and factories by day and returns with loads of cash by night. A cynical view I know, but nonetheless one shared by many.

Are there really evil corporations plotting to take over the world with their SOMA recipes?  There may be a few, but I like to think most people are conscientious and honest or at least they think they mean well. There is general disdain for our current system with no one person to blame because it is a numbers game; perhaps this is the real evil.  In essence our health care is now literally inhuman(e).

Since economists have been invited into the system by the evil conglomerates to develop algorithms for health care, nearly every subset of our lives have been affected. Cost efficacy is king in our soulless market economy.

In order to deal with the vast amounts of money and devastating diseases within the human population, emotion has been removed.  Health care is a numbers game that rules our world now more than ever.  How much is a life worth, and what are the odds you will make it to a certain age in good health, or not? What if you do become ill?  Well that frequently depends are your income.

So who exactly is to blame?

Let me know what you think.


Biology of mental Illness


Health care


 Social Workers


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