Posted by Racer on February 24, 2004, at 22:32:21
Thank you for your responses to questions asked here. I was especially impressed by your thoughts about therapist self-disclosure, that's a lot to chew on and I'm gnawing at it a good deal right now.
My question has to do with my own mistrust of the care I'm currently receiving. Alack and alas, I'm long-fingered, I guess you'd say, and feel as if I need to give you some background on how I came to be so mistrustful. I've been uninsured for the past decade, working mostly for underfunded non-profit organizations, putting in 60-80 hour weeks, but with very low income for it and no insurance. (Yeah, I know, I'm a nun at heart, but they've got this religious discrimination going on: they only take Catholics! <<attempted lighthearted joke there.) As a result, I've had a few absolutely dreadful experiences with the health care system, especially the mental health care available to the uninsured in my area.
(The bad experiences range from the idiotic: a PA refusing to do a fasting blood glucose test ordered by the MD, because she "didn't believe in hypoglycemia as a diagnosis;" to the absolutely unbelievably cruel: a doctor who not only tried to make me take three separate drugs to control the side effects of an anti-depressant that not only didn't work, but also made me physically sick, and threatening me with a dx of BPD if I didn't take them. Add my own native fears of practically everything, and you get a major mix of trust issues, right? In that sense, I'm normal, right?)
My current situation revolves around a very well conceived and well intentioned coalition of non-profits providing a wide range of services, from medications and therapy to practical matters like driving clients to appointments with other agencies, hand holding at places like the DMV, etc. Of the clients seen there, I'm in the highest functioning range by virue of an uncomplicated diagnosis of Major Unipolar Depression. In that sense, I'm not a squeaky wheel. In theory, there is a case manager who makes sure that I'm getting adequate care, but in practice I've got a pdoc who prescribes drugs and doesn't want to know my emotional experiences, and a therapist who can't deal with the medication related issues. All of which could be fine, except that I'm in a crisis condition, the case manager doesn't even return my calls, and my current crisis absolutely *is* a combination of the drugs and the therapy. Whether the medication is the cause or the effect isn't really the point: the point is how they interact to treat all of me.
Since I've worked in non-profits for well over a decade, I really and truly know the stresses of that environment. I know that these are well intentioned individuals who believe in personal sacrifice to better the world around them. Since I've worked in non-profit management and administration (WHILE also being chief IT person AND lead instructor AND head of curriculum development), I also know that some of these people really are doing the best they can, and more. (It is hard to keep that in mind, though, because my therapist just got promoted out of clinical practice, to take an administrative position within the same agency. Adds enormously to my anxiety and fears and hopeless feelings.)
After all that, here's the question I have for you: Starting from the arguable standpoint that medication and therapy together are the best solution for some people, how much separation between the two do you think is possible while still providing the best outcome for a patient?
Thank you again for your time, and for your thoughtful comments.
poster:Racer
thread:317359
URL: http://www.dr-bob.org/babble/psycho/20040218/msgs/317359.html