Friday, October 30, 2009

Let Them Eat Cake? No! Let Them Make Tea!!

I work with people (adults and children) who have chronic complex PTSD and dissociative disorders, many of whom self-injure, and many if not most of whom have suicidal ideation, and some of whom are actively suicidal. Meaning that sometimes they act on their thoughts.

When I, as their clinician, think they are a danger to themselves or others, part of a safety plan we've put together includes going for an evaluation at a hospital or crisis center. I don't just send people to the ER on a whim, because that would be, well, idiotic, would it not? Generally, I try to speak with someone there to express my concerns, and my familiarity with my patients' patterns. If they listen to me.

Lately, that hasn't been so much the case. And I am discovering many of my colleagues are having similar experiences. Seems like, more and more, people who should be inpatient are not being admitted, whether it's because of having poor insurance with poor benefits, or I'm not sure what.

It is often very hard for people who are a danger to themselves or others to admit that. So the act of actually going to an ER and saying, yes, I have been having those thoughts, and yes, I am afraid I will act on them, is really quite a step forward, clinically-speaking. For someone to respond to that admission in a trivializing way, as in the "Oh, it's not so bad, why don't you just go home and make a cup of tea" (which actually just happened, I kid you not) gatekeeper incident, is completely unacceptable.

Obama, who is quite ready to spend on physical infrastructure (roads, bridges, etc.) needs to spend money on shoring up our social infrastructure -- mental health and child welfare, doing it from the bottom up, not from the top down. More services, not fewer. More services for the most endangered.

Are we hypnotized, as a nation, by some weird gender-biased kinda frame? Bridges and roads are visible, strong, real and manly and tough? Minds are invisible, weak, fickle, unreal, not truly existent, thus unworthy of making a top priority?


Dave von Ebers said...

I think most people would be shocked to learn that suicide is the fourth leading cause of death among Americans between the ages of 18 and 65, and the 11th leading cause of death over all. Some one in this country dies by suicide every sixteen minutes. Yet, of all our major health problems, this is the one we are not allowed to talk about.

And by the way, as for the gender issue … men are four times more likely than women to commit suicide. So, maybe we should tell the insurance companies and the government that the Viagra and phallic-shaped buildings are the least of our problems.

No Blood for Hubris said...

I would guess that more women try, and more men succeed.

democommie said...

No Blood For Hubris:

I would say that it's more likely that women realize that emotions are NOT who they are. When a man is stripped of his property, freedom, standing in the community, etc.,--what he considers his "worth"--and he has to own his feelings it's often too much for him to deal with (I'm talking about men who aren't being hounded to death because they are teh GAY).

I've been a pretty openly emotional guy for most of my life and been called all sorts of things because of it. However, I quit thinking that "ending it all" was a viable option a long, long time ago. I had a mini-breakdown back in 1983 and spent a lot of time talking to a great counsellor over the next two years. My then employer (and very good friend) did not understand what I was going through and had a hard time cutting me slack, some days. A few years later he had HIS mini-breakdown and spent a lot of time talking to me AND a great counsellor.

One day when we were having a conversation over dinner he said, (I'm paraphrasing, here) "I never realized what a hard time you were having, until this happened to me. I wish I had your ability to feel your emotions in the present.". He does now and is a better person for it.

Dave von Ebers said...

NBFH: Turns out, you’re exactly right statistically speaking. Women are more likely to attempt suicide than men, but more men actually die by suicide.

Of course, I don’t mean to suggest that we should be more concerned about men’s mental health issues. Rather, I mean to suggest that men should be more honest about their mental health issues. Kinda like what Demos says.

What I really should have said, though, was thanks for fighting the good fight. I have no doubt you have helped a lot of people through some very rough times. And for that, I’m truly grateful.