Monthly Archives: July 2013

Looking Back on Ten Years of Talk Therapy

I’ve been in and out of the mental health system for more than ten years now. In that time I’ve had a few run-ins with talk therapy. The results have been varied.

The first form I remember was group sessions a bit after my daughter was born. I hated them to begin with, but after a while I learned to relax and participate, and it helped me to focus on what was important to me, to not try so hard to be perfect (a lesson which I sometimes remember), and to stop and refocus when my brains was starting to spin out. I’m sure I learned more, but that’s what I remember. These sessions were every day for at least a month or two – so very intensive. It took that long to start coming right again, even with both medication and talk therapies combined.

The second time was maybe a year or so later. I got pretty unwell again. So I had two types of therapy this time. One was a course of CBT, which was a flaming disaster. I hated the homework – ‘tell me how you felt today’ charts left me in floods of tears as I looked back on a day that I had survived and realised how bad I had felt through the day, and how often I’d thought of suicide. If I didn’t think about it, I lived through it all right, but thinking about it just made my world dissolve. And anything that required the use of smiley face charts made me feel talked down to. In fact, much of the therapy in that course made me feel talked down to, as though I was not too bright and needed even the bloody obvious explained to me.

The other therapy at this time was a course of counselling offered by a charity in a nearby town. It was partly funded by WINZ, and I think I got six sessions. Working with that guy was pretty good, he helped me to identify thinking patterns that were making my life harder, and helped to change them. It was over too soon.

Two years ago, my partner left me, and my mother had a stroke, within a couple of months of each other. I was given six sessions at the university counsellor, which was essential in trying to sort through both the emotions and the practical problems of becoming a single mother and having an unwell mother. That six sessions was not enough, but it was all I could get under that particular university system. I was referred out to a community organisation that was supposed to pick me up, but they lost my file for several months, and by the time they got their shit together I was only a couple of weeks from moving about 150km from their location. I declined their services.

Early last year I was given a counsellor at the university health clinic. I would see her every two weeks, and just vent. She would sometimes give me ideas on new ways to look at things, and I always felt that I came out of that office a little happier and a little lighter than when I went in.

The most recent talk therapy attempt was my time with the psychologist. She and I just never clicked, and so it turned bad fairly quickly. I didn’t feel like I could trust her, and I didn’t know what I was supposed to get out of those sessions. This most recent experience was pretty awful, in part because I felt I had to be there, that it was supposed to help me get better, and when it didn’t I felt I had failed in some way.

So my experience has been rather varied. I have probably forgotten other experiences I’ve had. But the summary seems to be that counselling-type things go well for me, and the gentle redirection of a counsellor helps me see things in a different light and deal with them differently. This was especially helpful in the high-stress times in my life, when I desperately needed some help in ordering and prioritising my thoughts. On the other hand, formalised therapy and me don’t seem to be friends. CBT was a disaster, going to a psychologist made me even more miserable. I don’t know whether it was just the people I was seeing that I didn’t click well with, or whether I don’t do well in more formal therapy settings. There may be a lot that I can learn from proper therapy programmes, but the truth is that I don’t have the mental energy to pursue yet another expensive course of therapy that might not work. Maybe later.

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Overseas Service

Wandering around the real world today, I came across a poster by one of the local private schools. It was asking for people to ‘sponsor roof tiles’, for the price of ten dollars per tile, for a house that they’re going to build in Mexico for a poor family. I find this all a little misguided.

There are fifteen people heading to Tijuana for this project. They are fundraising to build one house for a poor family over there. The sheer wastefulness of this astounds me. A short bit of research on Expedia gives a total cost for flights at just under $3500 per person. Perhaps they get a good deal from their travel agent, and fly for $3000 each. That’s $45,000.

I’m taking a stab at them being over there for two weeks, and assuming that they’ll share rooms. The cheapest place I could find, this time on Booking.com, comes in at just under $430 per room for two weeks. Say they get it at $400 because of an awesome travel agent. That’s $3200. And that’s for a very, very cheap place.

So these boys are spending tens of thousands of dollars in transport and accommodation. Food hasn’t even been touched on yet. It’s a hugely pricey undertaking already.

There are twelve students and three adults going on this trip. These are wealthy students in their final years of high school. The chances of them having much building experience are fairly slim. So the idea that they’re going over there to build this house unassisted is not a likely one. There will almost certainly be local builders and so on showing them what to do and providing assistance and guidance.

So. What would happen if you sent these local builders the tens of thousands of dollars that these boys are going to spend on this project, as well as the resources to build the one house that they’re already funding? How much more good would it do?

But, you say, this experience will be good for the boys. They’ll learn more about poverty, and more about helping others, and grow as people. Aren’t these worthy aims?

The truth is, there is poverty in their own region. There are homeless shelters, soup kitchens, food banks, all sorts of places needing volunteers. If they want a field trip, they could head down to Christchurch and be hammer hands on the rebuild. Unpaid labour is usually welcome. There is no need to head off across the globe, while ignoring the problems back home.

This project smacks of something that my brain calls the white saviour complex. These boys are travelling to Mexico because they want to make a difference, and the best place to make a difference is to poor suffering people in underdeveloped countries. It has more impact than helping out back home. And there’s a vibe of ‘we need to go help these people because, even given resources, they can’t help themselves. They need us to rescue them’. I find this undertone a bit nasty.

White man has been doing this for centuries: going out and trying to ‘civilise’, ‘educate’, and ‘assist’ people that were once called savages. It’s insulting, and it needs to stop. If you have a needed skill, then by all means, go and help people who don’t have that skill. But just waltzing in to rescue a bunch of foreigners, with no important skills, is not helping. It’s wasteful.

As a final aside, if you sponsored a tile, you name would be inscribed on it in gratitude. WTF, people? What value does that have? A poor family in Mexico will have a bunch of names that mean nothing to them up on the roof that never gets looked at. It’s weird, and pointless.

Cutting Back on Talk Therapy

Sunday’s New Zealand Herald ran a story on cuts to funded talk therapy options.The cuts come from the private sector, with Sovereign Insurance looking to cut expenditure on counselling sessions, and in the public sector, with the Family Court cutting relationship counselling entirely, the Ministry of Social Development tightening up counselling services to the mentally ill on disability allowances, and ACC reviewing the treatment of sexual abuse and assault victims. These moves are all wrong-headed in different ways.

Sovereign’s chief medical officer gave a quote that sums up the problems with line of thinking: “A guy whose wife has just left him might be depressed and struggling to cope but it doesn’t mean he necessarily has to see a counsellor. Anti-depressants like SSRIs (selective serotonin re-uptake inhibitors) are proven to work.” Let’s pull this apart. We have our poor dude, whose wife has just up and left. He’s struggling to cope with the adjustment – hell, it’s not easy – but he *does not* have anything wrong with his brain chemistry. Giving him pills is not an answer, because he does not have clinical depression – he has situational depression. He needs someone to talk to, to learn some coping strategies. If that doesn’t work, and if he keeps getting worse, then you start looking at pharmaceutical options. Before that point, you’re just opening him up to the possibility of side effects, without actually giving him anything that helps.

Recommendations for mild and moderate depression are usually based around two things – self-help (reducing stresses, eating better, exercising more, and so on) and talking therapies. There’s a good reason for this – because *that’s what works*. Throwing drugs at the problem is not a solution, because it simply does not work with people suffering from mild to moderate depression. Sovereign is working off a bad assumption, and they are forcing doctors to prescribe treatments that don’t work, and can do harm.

Counselling is expensive, and many antidepressants are cheap – fluoxetine (Prozac) is three cents per pill, as is citalopram (Celexa). Three to six cents a day seems very attractive when compared to the hundred-plus dollars it costs for each counselling session. So in economic terms, antidepressant therapy seems like the obvious choice. Economic concerns, however, do not equate to good therapeutic choices. This is good for Sovereign’s bottom line, but not so much for their clients. If Sovereign were saying that chemotherapy was too expensive, and that they wouldn’t pay for it for cancer patients, people would be screaming. Chemotherapy, radiotherapy, and surgery are all parts of a treatment plan, and taking one away because it was too expensive is compromising people’s care, and increasing the chance that they will not recover. It’s exactly the same with mental health treatment plans – all options need to be open, and the best one selected for a patient’s needs.

When someone with few resources walks into a doctor’s office with depression, the process is simple. They fill out a questionnaire to ascertain the degree of their depression. If it comes out as mild, they’re told to wait and see – come back in two or three weeks if you’re not getting better. If it’s moderate or severe, the doctor will write a prescription for their favourite SSRI, and tell them to come back in six weeks if it’s not getting better. If the doc is REALLY worried, they’ll refer on to the hospital mental health team. Things like talk therapy are off the table unless you can pay, or find somewhere that does cheap-to-free counselling. It’s a bit of a lottery.

People with health insurance are paying more out of their own (or their employer’s) pocket, with the expectation of better care if they need it. They’re paying to be treated with the best treatment protocol, not the best that the cash-strapped health care system can afford. And the best treatment out there for many people is talk therapy. What are these people paying for if it’s not to be treated better than the public health system can afford? What Sovereign is proposing is simply what you’d get from your GP if you were broke.

Meanwhile, the Family Court is killing off their free relationship counselling services, and replacing them with ‘separation mediation’ sessions. Access to cheap relationship counselling is even spottier than that for solo counselling, and this will cut off one of the last reliable sources. Apparently, the government is less interested in sorting out struggling relationships than they are with making sure that the separation goes smoothly. Tell me again about how they don’t want people on the DPB?

The Ministry of Social Development is making it harder for people on the Disability Allowance for mental health to access counselling. After all they’re just bludgers, leeches on society. Why should the government pay to help them become well? Why don’t they pay for it themselves, after all, people live a life of luxury on the dole.

And finally, ACC is looking at cutting the amount of counselling available for sexual abuse and assault victims from sixteen sessions to as little as four. Four. For people that have already had to relive their personal hell in order to access the counselling, retraumatising themselves in order to get the help they need. Four sessions to try and work through the horror they have been through. Sixteen is often not enough. How the hell do they think four will do?

These issues come from a fundamental misunderstanding of mental illness. People, medications are not magic bullets. They don’t just make everything better. Mental illness is complex, and requires some combination of medication, self-help, and talk therapy to recover. Talk therapy is slow and expensive, and it’s not as sexy as a magic potion that solves everything, but it can be the basis of life-long wellness, as people learn better ways of thinking and dealing with what life throws at them. Taking that option, and those tools, away from people is wrong.

Youth Parliament and Homophobia

Last week, New Zealand held a Youth Parliament, which is a gathering of young people held every three or four years. One young person is selected by each MP to represent them in this mock-parliament, and they go through the motions of parliament. It’s probably a very interesting experience for the people involved, and I think it’s a pretty neat concept.

This year’s parliament had an interesting moment. One young lady elected to make a speech about the equal marriage bill that recently passed into law. In it, she suggests that the New Zealand parliament has gone mad by introducing the legislation, and that gay people are not part of the ‘circle of life’. She has the gall to say that she does not intent to offend, which echoes the problem of sentences that start with ‘I’m not racist, but . . .’. Then she slips in a slippery slope argument, and finally sums up with the claim that “This fight is not one for equality and not one for rights”.

This speech was evidently offensive to many of her peers, which included at least one openly gay person. A decent proportion (reports say possibly over a third) of the people in attendance walked out.

I was deeply saddened that a young person could cling to such antiquated ideas, and I was proud of her colleagues for not sitting and silently accepting what she said. Those kids are the people I want leading us into the future – people who stand up to bigotry.

I’ve had it put to me that what this girl said was not homophobic, and that it was simply stating her belief. To that I say, her belief is homophobic. She explicitly states that this is not about equality or rights. I would argue that this means she does not believe that gay people deserve equality, nor do they have rights, or at least not the right to have their relationships recognised by the state in the way that heterosexual relationships are. She excludes them from the ‘circle of life’, a statement which may be technically true, in that homosexual couples cannot reproduce without some outside assistance, but its implications cut deeper, suggesting that gay people are not part of the natural world, and that they deserve to be excluded.

Fifty years from now, we’re going to look back on this girl, and on people like her, and shake our heads. They’re like the people who protested equal rights for black people in America in the middle of last century. They’re on the wrong side of history.

Rape Analogies

I heard the argument a wee while back that rape victims should be doing more to prevent being raped. That people do things to prevent themselves being robbed – locking your doors, keeping valuables out of sight, and so on. Why shouldn’t potential rape victims take precautions?

The thing is, most rapes are committed by people you know. So the analogy is wrong. It’s like saying that to stop yourself being robbed, you should never invite friends over, never have a drink with them. You should keep all your nice stuff locked in a basement where no-one can ever see it. You shouldn’t show off your vintage record collection or let people watch the game on your 50″ tv. And that if you do, well, then you did kind of tempt them to steal your stuff by letting them see it all.

More than 80% of rapes are by someone the victim knows. Perhaps the next suggestion to prevent rape will be to just not know people.

 

Passing on

Watching an old man pass his last hours on earth. His family drawn in from homes miles away to be with him, to be with each other as he goes. Laughter and tears and memories shared.

Death is not pretty, it takes very few gently, but it is not all unkind. Hours pass, wavering between peace and agitation, before peace finally falls forever.

Texas and Abortion

On Thursday, Texas Governor Rick Perry signed a bill into law that massively restricted abortion access in the state. The bill means that many women will have to travel hundreds of miles for terminations.

Christians and other anti-abortionists have celebrated this move, seeing the roadblocks that it throws up as saving many babies. But the reality for the women of Texas is not the joyous saving of beloved children’s lives.

The horrors of septic abortion wards are a thing of the past in America, but if abortion laws continue to be tightened, then they could make a return. If a woman is desperate enough, she will do anything, even risk her health or life, in order to end a pregnancy. Freely available abortions simply make the process safe for these women. Thus, the bill’s catch-cry of ‘more safety for women’ rings hollow. Laws like this do not add to the safety of an already medically safe procedure. They make massively unsafe procedures more likely.

If a woman chooses to keep the child, there are further nasty scenarios that can arise. A common cry in the early years of the feminist abortion wars was ‘Every child a wanted child’. The consequences of an unwanted child can be pretty awful. If the mother never gets past the problem of not wanting the child, then eventually that child is going to know. The awful feeling of growing up knowing you’re unwanted is not something that any child should have to bear. And I would surmise (although I have no statistics to back this up) that unwanted children probably have higher rates of neglect and abuse.

If a woman is choosing an abortion because of her financial situation, then forcing her to keep the child brings a new set of problems. Poverty is a major burden to bear, and when you’re only just getting by, a baby is going to make things so much more difficult. The working poor woman has to find some way to have the baby cared for while she works, or she has to rely on the state for support. And relying on the state for support is not a choice anyone really wants to make, especially in the US where many states’ safety nets are painfully threadbare.

There are many other reasons why women choose abortion, and many different sets of consequences for these women if that choice is taken away from them. None of this is new, none of it hasn’t been said before, and it’s sad that it still has to be said. But it does have to be said, and said again, until those in power listen and understand.