My post this week is a random gathering of my observations on the “NAMI Basics” course I’m enrolled in and how my experience with US style medicine as a rush to medicate/operate is confirming what I’ve observed from abroad before moving here.
The NAMI Basics course is a bit of a surprise in that it questions the use of medication more than I would have thought. What is troubling is the emphasis on early intervention in the teen years, which sounds like a good idea, but really means bringing in a swat team of doctors, psychologists, etc. and elevating what could be a one-off situation into something more sinister and chronic. This is one version of the hammer approach to problem solving that I discuss in more detail in this post.
My more pressing concern these past few months has been my own health, not Chris’s. Without getting too specific about the details, I moved to Florida from Europe, proud of the fact that at my age I was on no prescription drugs and taking only baby aspirin to prevent blood clots. I’ve had atrial fibrillation on and off for many years, but I’ve lived with it and never consulted a doctor about it. It hasn’t impeded my life so far. Exercise doesn’t leave me breathless. I’m not saying that A-fib never requires some form of attention, but the devil’s in the details.
In November, I went for my first physical here in Florida and it was like setting off a five alarm fire judging from the response to the taking of my pulse. (This was the first time that my A-fib had been “caught” in real time.) The panicked look on the medical assistant’s face was the first tip-off that A-fib was not okay. (I had always heard that it might be scary, but not life threatening.) The doctor arrived. He pooh poohed the baby aspirin, gave me free samples for an expensive anti-coagulant and set me up for an appointment with a cardiologist. “But,” I protested, “I’ve always had A-fib to some extent or another. I’ve lived with it.”
Fast forward to today. The two heart drugs tried so far have not stopped my A-fib, and I’m no longer feeling quite as perky as before because of the side effects. Furthermore, the medical reaction to my condition had added stress. The cardiologist is sending me to an electrophysiologist and there is talk of surgical intervention (ablation). To gain some reassurance that my concerns about unnecessary intervention are well founded, I’m listening to a Youtube doctor from the UK who takes a much more laid back, non-surgical, non-drug view of atrial fibrillation. I am trying a variety of ways to normalize the heartbeat (heart rate is down already) and plan to discuss my preferred approach with the specialist. I’ll shut up and not question the need for the prescribed anti-coagulant if the specialist will backpedal on the need for the surgery.
I now find myself in the position that people under psychiatric care are in: being encouraged to accept stronger intervention that perhaps can be best managed by holistic means outside of a doctor’s office.
After Chris’s psychiatric appointment was cancelled due to the doctor’s no show (see previous post) I marched up to the receptionist and demanded a new appointment –not two months from now, or even a month from now, but NOW!
Chris got an appointment for the following week. I accompanied him to the appointment as the doctor had encouraged him the first and only time he saw him to bring along his mother the next time. I came armed with the results of the neurofeedback brain mapping, hoping to get the doctor to request the insurance company to cover twenty sessions of neurofeedback.
Dr Jesus de N. was an avuncular man in his late fifties with (unsurprisingly) a Spanish accent. His friendly demeanor couldn’t warm up his office however, which had all the charm of an interrogation room. Three wooden chairs facing the desk, no artwork or personal momentos on display. I got the distinct vibe that the doctor didn’t occupy the space for very long and it was probably a shared arrangement. I waited while the doctor asked Chris to update him. Chris wandered all over the map, none of his utterings were connected to any point that I could discern. Now I know how logical Chris can be most of the time, but the doctor wouldn’t have a clue that the rambling person in front of him was fully capable of clarity. My interjecting to try to bring reason and linearity to the update and request a letter to the insurance company just made me look, well, illogical and rambling (schizophrenic). Like mother, like son, the doctor may have been thinking.
The doctor brought up the subject of meds and asked Chris where he was with his Abilify. In classic Chris fashion my son intuited that the doctor must want him to go back on the drug. It was hard to tell what Chris was saying but he seemed to be simultaneously telling the doctor that he was no longer on Abilify while teetering on the point of telling the doctor that he would be willing to go back on it! (He hates to disappoint.) I immediately jumped in and laid that one to rest. “Chris is off Abilify, has been off it since September, and he and I agree he’s doing just fine. He has no intention of going back on it.” (Remember, this is the doctor who suggested to Chris at his first appointment that he consider taking Abilify in long term injectable form.)
“So, what’s the purpose of this visit? We only have fifteen minutes,” said the doctor, not unkindly. “If Chris isn’t on meds then there’s no point is my seeing him. Our clinic can provide talk therapy if he wants it.”
If finally dawned on me. This wasn’t a fifty-five minute appointment. It was a fifteen minute med check. Why hadn’t Chris told me this after his first appointment? I wondered. For months I had been under the impression that Chris had spent an hour with the guy.
Our fifteen minutes was up. On our way home, Chris and I high fived each other on the outcome.
Today’s vignette is not about the way letting go of psychiatry is supposed to work. Let me explain. Normally when people write about how they ended their relationship with psychiatry, they talk about how they made a conscious decision to just stop going to their appointments, maybe because they felt they no longer needed them or perhaps because they didn’t feel they were serving any useful function.
Chris has seen Jesus de N. (his psychiatrist) ONCE since we moved to Florida in August. Today he attempted a third try only to be told that the doctor had a problem with his car and would be late. Chris was prepared to wait until the doctor got there, but was told that he’d have to make a new appointment because the doctor would not be arriving any time soon. (This was the second time in a row that the doctor has cancelled.)
So, the question is, does Chris actually have a psychiatrist? I think not. He has a psychiatrist on paper, someone whose office he can phone to get a referral, someone who can satisfy our insurance company to continue to cover him, but this person is not someone he actually sees. He is free to do what he wants, unencumbered by psychiatry. This is brilliant! I’m surprised that more people who want to escape psychiatry’s clutches aren’t praising the system here in the United States. (Dr. Stern, Chris’s psychiatrist in Switzerland used to phone him if he missed an appointment or was late. She rescheduled any missed appointments for the same week. Not the case here. Here, it’s like the psychiatrist doesn’t think he needs to see his patients.)
Hallelujah brothers and sisters. Free at last!
On Friday, Chris and I met with the director of the brainwave center to go over the results of the testing. To cut to the chase there is clear evidence of a brain trauma. According to the report we received, “Frontal, temporal motor strip and parietal dysregulation are consistent with his symptoms. These areas participate in the executive, default, and salience networks, which have been implicated with schizophrenia. The frontal lobes are involved in executive functioning, abstract thinking, expressive language, sequential planning, mood control and social skills. The temporal lobes are involved in auditory information processing, short-term memory, receptive language on the left and face recognition on the right.”
Evidence of a brain trauma in the left frontal lobe was surprising news to the director as both Chris and I had assured him that he has no history of a trauma.
“Oh, I guess I forgot to mention that when I was about age 30 I used to bang my head on the wall on occasion, and also, I got hit by a car when I was 24 and landed on the side of my head though my arm cushioned the fall.”
I was both dumbfounded by the news and totally embarrassed that we had failed to report any of this in our previous interviews. I did know of the car accident, but this was the first time I learned that he had hit his head in the accident. (His father took him right away to a nearby clinic and he was pronounced okay.) As for deliberately banging his head on a wall, well, how stupid is that?
The point is there is clear evidence of a head trauma as shown by the spectral analysis and topographic mapping. Chris’s alpha, beta, and high beta powers looked very good to the director.
Recommended treatment: Direct neurofeedback x 20 sessions with left frontal and motor strip emphasis.