Why is it when people make poor choices, they are so outraged by the consequences?

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Irresponsibility is not excusable, Poor choice does not give a free pass to no pain, sadness is just 2 aspirin away from relief, William Martens and his supporting the psychopath

You have to read this link and then ponder, what the hell were voters thinking when they put their trust and management in the hands of addicts and blatant profiteers?:

http://www.washingtonpost.com/opinions/charles-lane-colorados-marijuana-experiment-has-a-bitter-aftertaste/2014/10/23/3fb7b34c-5a2d-11e4-bd61-346aee66ba29_story.html?hpid=z3

This is my favorite part of the article:

“Optimistic projections assumed users of medical marijuana, legal in the state since 2000, would switch to recreational marijuana, to avoid the hassle and cost of seeing a doctor. Instead, the number of red cards hasincreased slightly because medical pot is far more lightly taxed, and hence roughly 40 percent cheaper, than recreational. For heavy users, that adds up. LoDo distributes advertisements for $55 red-card consultations at theCanna Health Clinic; “pay less in taxes,” they urge.

In economic parlance, this is known as “regulatory arbitrage.” The failure to have anticipated it makes the continuation of medical pot “the biggest challenge” for the new system, according to Sam Kamin, a professor at the University of Denver law school.

Meanwhile, millions in marijuana revenue may be refunded anyway, under Colorado’s unique constitutional provision that requires the government to give back money when state revenue growth exceeds the rate of inflation plus population growth. 

No one knows exactly what to do about that or many other issues that have cropped up — such as the persistence of the untaxed black market or how to measure the impairment of pot-using motorists.

Colorado could eliminate the medical-recreational distinction. If the latter is available, why keep the former? But then people would have to admit that the vast majority of “medical” usage is, and always was, recreational. The likes of Canna Health Clinic would be put out of business, too.”

And there it is, how much of recreational pot use is being manipulated as “medical need”.  Frankly, I find this exercise in just promoting extremes to be so pathetic and irresponsible, but, isn’t that what addicts want, the population to be uninvested and inattentive, so the abuse can go unhindered?

I’ll write more about this and other poor choices for this post, but just to get it started, wanted to note the Pot Lobby is not interested in doing what is right and just, but what is quick and easy, and oh, if people get hurt, what is it the guy says to  Peter Parker in the first “Spiderman” movie, when he won’t pay Parker for winning the wrestling match after Parker tells him he needs the money?

“I forgot the part where that is my problem”

Wow, how prophetic!

Addendums to follow…

Addendum #1, October 25:  Let’s start with the loser who commented here yesterday, who must be an addict and was so outraged by my link to the dopers masquerading as medically in need stoners.  Well, is it so surprising to people who are wary that being stoned has no consequences?  Of course not, but, the Addict Lobby, forget just the Pot Lobby for a minute, rationalize, minimize, deny, and project their poor choices to no end, and that isn’t just about illicits either, no, the nicotine and caffeine crowd have their problems too.

How many providers out there are more than annoyed with the people coming in who are smoking two packs a day, or drinking a pot or more of coffee or perhaps living at Starbucks all day and then bitching to no end how they can’t sleep.  Umm, here’s your reality check to such nicotine/caffeine addicts, you train your body to get that nicotine fix every 30 minutes or less, and expect to sleep six straight hours, or, think that consuming 1000 mg or more of caffeine well into the evening will not impede on sleep, sorry to use this poor adage, but WAKE UP!

But, getting back to the addicts of more consequential matters, people who are on benzos, stimulants, and opiates by your less than attentive physicians, how dare you come in and complain not only you are still struggling, but you want even more of the substances that are enhancing your dysfunction.  And to the lame providers who just upping the ante of more meds, more dosages, and more drug interactions, please look up Iatrogenic illness, please.  Because you are textbook examples of the definition when you have your patients on Xanax, Adderall, and your opiate du jour.  Plus, opiates and stimulants are just Speed Balling, and we all know how well that goes for street addicts.

When you are on substances of dependency, even if not abusing or misusing, learn what tolerance and withdrawal mean.  It might lessen some of your struggles, and perhaps end some of them as well.

Oh, and Steve, don’t waste my time with any further comments, we get it you are basically subconsciously killing yourself either by directly abusing or supporting substance abuse, so have a moment of sobriety or distance from enabling and as Obi Wan told the guy in the Cantino scene early in the movie “Attack of the Clones”, go home and rethink your life!

Addendum #2 October 25:  Man, you read some really lame crap in both psychiatric and the general press, but these two, boy…

 

First this article by William Martens MD, in this month’s Psych Times, but, is being reprinted after first appearing in 2006, because, it is “…one of the best read articles.”  Really, do you believe this, that clinicians want to read how, per the conclusion by the author, “It is extremely important to recognize  hidden suffering, loneliness, and lack of self esteem as risk factors for violent, criminal behavior in psychopaths.”  And yet, where are all these experts and defenders of the lack of care for these psychopaths?  Telling us to work with these people, and then when one walks into the office and shoots to death a clinician, then what, we are to chastise the psychiatrist forced to shoot the psychopath, when instead he did not invite him to sit and share his loneliness and lack of self esteem???

Am I the only psychiatrist out here in the real world honestly asking, “What the hell is going on here with colleagues telling us to be more sensitive to psychopaths!?”  Another example of poor choices, this time by providers, and then acting so outraged and stunned when the reality of the situation plays out because too many of us foolishly listen to this crap.

Well, here is a link about Dr Marten’s book, and then the Psych Times article as best I can link:

http://www.sociopathworld.com/2013/04/hidden-suffering-of-psychopath.html

http://http://www.psychiatrictimes.com/psychotic-affective-disorders/hidden-suffering-psychopath

And then I read in last week’s THE WEEK magazine about this idiot psychologist advising people in emotional pain just take an aspirin for relief and treatment:

http://www.telegraph.co.uk/science/science-news/11118600/How-to-get-over-a-broken-heart-take-two-aspirin-and-stop-talking.html

You can’t make this crap up, really;  “It was once thought that only time could mend a broken heart, but now scientists think popping a couple of aspirin might be the best way to get over a break-up.

Psychology Professor Water Mischel, of Columbia University, believes that the psychological pain of ending a relationship is similar to physical pain, and should be treated like any other injury.

He also believes that discussing feelings with friends will only increase depression and advises keeping brooding to a minimum.

“When we speak about rejection experiences in terms of physical pain, it is not just a metaphor – the broken heart and emotional pain really do hurt in a physical way,” he said.

“When you look at a picture of the one who broke your heart, you experience a pain in a similar area of the brain which is activated when you burn your arm.

“‘Take two aspirins and call me in the morning’ would be a cold-hearted response to a friend’s late-night report of fresh heartbreak, but it has a solid basis in the research.” “

Fascinating it is noted by a psychologist.  Again, people making bad choices, and then watch and listen to the outrage when it is called on for the sheer lunacy of what is being espoused as gospel.

I’d laugh, but this is honest belief by the above providers here.

 

Stay tuned for Tomorrow the 26th, more to relate, or rant, or just rail…

Addendum #3(and last), October 26:  Last, getting back to general psychiatric care issues, I really do not understand, as of what we know the past 2 or more decades at least, why people come into the office and bemoan their struggles when they have to accept the statistical outcomes of choice to:

leave high school early

stay in conflictual, hostile, and downright abusive relations, not just marital

pursue disability for very treatable problems of depression, anxiety, and PTSD

deny the need to make change, irregardless of issues.

And one more issue, that is very gray and instinctively right and appropriate to be involved, those who are 24/7 caregivers to elderly family members or long term developmentally disordered young, and yet refuse making a more concerted effort to get others to be a support not only to the infirmed, but to the primary caregiver who is getting burnt out.

I fully understand and respect that making changes and getting out of the hole these above matters create is a long term effort, and those coming in who show some insight and judgment to pursue change are often not the struggle for me as a provider.  But, those who present these issues and then not only are annoyed I don’t have the magic pill, but get more annoyed, irritable, if not downright angry when I ask what they are doing to impact on improvement by considering different choices and actions is just absurd to observe.

I think I get it, people are dealt a poor hand sometimes and have a great struggle to progress positively, but, to dismiss the foundations to make healthy and enduring change for the better, how do you help that?  Are some people this clueless to think there are drugs to improve life?  That taking a pill is going to magically educate, empower, and stimulate responsible and effective behaviors and goals??  That there are easy answers to difficult problems???

Again, as I have written before, if I had a drug that improved insight and judgment, we as mental health care providers would be out of work.  And, that drug ain’t bein’ found soon, I can fairly guarantee that.  So, to end this post where it really belongs, in the laps of many therapists out there, you meet with patients who have made poor choices and can’t get on track, why the hell do you send them to doctors for quick fixes that seems to be a major factor to why they are entrenched in misery and pain?

Gee, maybe because too many therapists out there are making equally poor choices as well, so how can you as patients turn to support from those who can’t even handle the job responsibilities?  Think about that when you go to providers out there who claim to know how to care and support.  And then ask you to go on meds, as your life is simply a biological imbalance

And now, the rant is over.

 

(again, sorry the sign is late)

When “a picture is worth a thousand words” becomes “a picture is worth many endless turds”.

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Better living through chemistry and the lie, Big Pharma ads sell the wrong message

 

This picture is run in many psych periodicals of late, and when you look at it, doesn’t it just offend the hell out of anyone who reads into the intent!?

The patient is uneasy and distant, the clinician is intruding and looking either suspicious or at least not outwardly supportive, and who the hell is this chemist in the back of the room???

Better living through chemistry, eh?  Nah, not to me.  “Patient inspired” is the logo for the company, well, as long as the patient don’t expire, keep on selling them drugs, folks.  Here is the better picture for the message, you decide:

 

It is what it is these days, “Mother’s little helper” redux from the Stones, and boy, we still don’t get it, do we?

Another lame post as copying one from earlier.

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mirror mirror on the wall the infinity will never fall

 

I have always been fascinated by mirror to mirror image, as close to infinity you will ever be able to grasp tangibly.  Anyway, this post I wrote a while ago is still fitting, so you can read and digest.

http://cantmedicatelife.com/2014/02/22/time-to-put-the-money-where-the-mouth-is-state-run-mental-health-clinics-and-do-what-will-maximize-cost-the-way-mental-health-care-is-done-these-days/

The post as written:

The title of this picture is “a bitter pill to swallow”, and that is not only fitting, but the metaphor of what mental health care has been simplified and trivialized into these past 10 years.  Let’s have a brutal and candid moment of honesty and reality folks, patients aren’t interested in expending the time, money, and energy to truly problem solve their mental health issues and needs any more.  No, they want and demand the quick fix, the simple solution, the easy out.  And I say give it to them!

So, I advise every state in this country that runs mental health clinics to let go of 50% of the therapists at the state clinics by the end of the year and just have psychiatrists treat about 80% of the patients alone, and allow the doctors to provide some amount of therapy along with the predominate medication management visits that go on now for at least 50% of the billable care provided anyway.

Why do I suggest this today?  Come on, we all know that the majority of therapists aren’t providing real psychotherapy at Community Mental Health Clinics these days, no, they are just holding hands, writing treatment plans, and trying to be psychiatrists without the training nor expertise.  What happened yesterday to motivate this post?

First, the patient who has enough psychosocial crap going on that could keep the patient busy for at least every week visits for honest and dedicated therapy care, if not even 2 a week attendance, but after not showing up for a therapy visit for almost 4 months, the patient shows up for a visit and just after 15 freakin’ minutes in the office, the therapist is at my door asking me to change the meds I started 10 DAMN DAYS AGO!!!  Yeah, thanks for that effort, COLLEAGUE!

Then, about 2 hours later, a patient who is a bit complicated with probably both mood and psychotic issues, comes in after a therapy visit just prior to meeting with me, and tells me what meds the patient needs as the therapist spent much of the therapy visit discussing the meds this patient needs to think about changing to in order to be stable.  Yeah, that homelessness and lack of support in the community will really dissipate quickly with a med change.  At least the patient admitted it was ridiculous for the therapist to be suggesting medication changes without any specifics nor knowledge of side effects or risks in changing the current meds.

THIS IS WHAT IS GOING ON IN THERAPY OFFICES THESE DAYS AT LEAST 50% OF THE FREAKIN’ TIME, BOTH IN CMHC AND EVEN IN PRIVATE PRACTICE OFFICES THESE DAYS, PEOPLE!  Therapists by in large aren’t interested in providing appropriate therapy interventions, they have bought and sold the biochemical model, and if the patient is in any way difficult or not invested, then the therapists want the patient drugged and out the door.

So, to all those bureaucracies out there trying to save money and maximize health care interventions, unload those non MD staff as much as able, and let those who are invested and trained to provide care the way it is intended to be the providers.  And this is not sarcasm or a joke, this is what mental health care is today.

To all those “therapists” out there who want to collect a pay check and do the least you can do, don’t let the door hit you on the ass when you are escorted out.  Frankly, if some of these patients could get appropriate legal representation, suing some providers would reinforce the message to administrations out there who want to avoid the publicity in the first place!

And when the quick fix fails, as it will as many psychiatrists will do just 15 minute med checks onwards anyway, maybe some of these joker asshole MDs will also face some malpractice consequences as well.  Hey, time to touch the stove, folks.

Me, I am ready to provide the compliment of care I was trained to do in residency.  This god damn compartmentalization by insurers and administrators and false equivalent non psychiatrists, well, good luck with your agendas as currently in place!

Oh, there will be more about this matter in days to come, COUNT ON IT!!!

 

So there you have it, nothing new, but well said in my opinion.

Oh yeah, that is my opinion.  Kinda like that mirror at the top…

A painful read, but, a necessary one too.

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Death is part of life, Euthanasia has its place in America

 

You won’t be very comfortable after reading this link, but, it reminded me of one of my most painful moments as a resident, first the link:

http://www.cnn.com/2014/10/07/opinion/maynard-assisted-suicide-cancer-dignity/index.html?iid=article_sidebar

In there was this from the author, Ms Maynard:

“I would not tell anyone else that he or she should choose death with dignity. My question is: Who has the right to tell me that I don’t deserve this choice? That I deserve to suffer for weeks or months in tremendous amounts of physical and emotional pain? Why should anyone have the right to make that choice for me?”

Without going into detail again, as I think I wrote about the situation in a post last year, I faced an older woman, about in her late 60s, and she was dying of metastatic breast cancer, having been hospitalized for severe pain and complications of chronic opiate use.  She wanted staff to give her a lethal dose of meds so she could die, as she believed if she took her own life it would have consequences of her afterlife options.  The physicians who admitted her wanted me to psychiatrically hospitalize her as “she is crazy and suicidal”.  Well, at the end of the consult, I felt she was exhausted and wanted to end life on her terms, with her family around her and at home.  I said “No” to admitting her to a psych unit, and advised she be discharged home once medically acceptable.

The physician did not take well to my consult eval and recommendations (yeah, the one time you’ll read PC commentary here!), but thank god the attending psychiatrist over me supported me and was quite unusually very heated at the nursing station in telling the physician “transfer the patient to another colleague and get out of my face”, agreeing with me we as doctors can’t save everyone and certainly can’t avoid their deaths, especially not on our terms sometimes.

I found out a couple weeks later the patient was discharged a day or two after I saw her and died at home about a week later, and between the lines it was inferred she had “assistance”.  Good for her.

That is why the paragraph above from the link hit home for me this morning.  Who the hell are we as doctors to supersede other people’s choices when it is obvious that life has been spent, that quality of life is not going to be what others would accept if in those shoes of the terminally ill?  One thing the woman I spent an hour and a half with in that hospital room 22 years ago said to me that still comes back to be heard to this day is simply this:

“Why can’t people accept that fact that I want to die, that I have lived, and I don’t want to end my last days in a cold, sterile place like this!?”

I don’t know about afterlife options, I have my theories and hopes, but one I will throw out is this:  if there is an afterlife we all share that is for those who did more good than bad, I bet the woman above is there and well received and supported by her peers.

I just hope there is a separate place for those who are more bad than good, and their peers deserve each other for a despicable eternity.  Why we can’t get some validation this plays out to give some pause and reflection while alive, well, I guess your spirituality has to give you that hope and faith.

I’ll end with my favorite picture found on the web:

Not a NEW story, yet the media continues to report it as such???

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heroin on the rise thanks to Prescription opiates, Middle aged heroin user

Today’s story:

http://www.foxnews.com/health/2014/10/03/us-heroin-deaths-double-in-link-to-prescription-painkillers-says-cdc/?intcmp=obnetwork

Again, why aren’t we going after doctors who are playing a role in this mess?

Addicts are not a primary responsibility for psychiatry, much less mental health in general.

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Addiction is not a mental health matter

 

Perhaps this post is as repetitious as one can get, but, here are to me five simple reasons why psychiatry, and mental health in general, should not, will not, and never consider in the future to be primary providers to addicts:

1.  Treatment for addiction requires frequency of visits more than once a week, preferably at least 2-3 times a week, and no one will reimburse mental health care providers appropriately for that level of care.  So, sorry, I am not willing nor able to take a vow of poverty.  Nor should any responsible provider who knows better!

2.  Medication is an adjunct to treatment when addiction is involved, and anyone who is a clinician tells you otherwise, that meds are the primary intervention, is a liar, or an incredibly poorly trained provider.  Plus, what a disservice to the principles of recovery!

3.  ANY prescription that has a risk for dependency, much less frank addiction/abuse, is and always will be contraindicated for care.  They should always be used as a last resort, and strong boundaries in place if offered and accepted.  Any provider who does not know this should not be working with addicts.  PERIOD, and end of point.

4.  Commitment to care by the person with addiction is essential and not much room for negotiation should be accepted nor tolerated.  Patients who no show, who do not follow prescription terms to the letter, and who minimize or deny the role of addiction to treatment needs has to be redirected or released.  And what is the usual level of behavior by addicts in health care in general, mental health more specifically?  There is room for changes to the treatment plan, but based on need and unforeseen complications or consequences of issues/responses to care, not what is easy, convenient, or popular.  When the patient is claiming he/she knows better for the provider to do, the alliance is most likely lost.

5.  Finally, the antisocial comorbidity with patients who have profound addiction issues is a sizeable contraindication to treatment boundaries, and once identified as a legitimate matter, needs to be addressed and more often referred out.  Remember the simple stat:  80% of antisocials abuse or are addicted to substances of abuse/dependency, and even those who are not primarily antisocial inherit antisocial traits while abusing/dependent, so, how does that fit into the contract with a mental health care provider?

So, if these 5 points have merit, why do mental health care facilities accept and tolerate a disorder that does not fit the confines of the specialty?  I’ll tell you my three conclusions:

Fear, avoidance, and clueless hope.  Fear primarily from Administrators as saying “NO” to addicts leads often to addicts finding ways to access enablers and codependents to badger providers and thus try to make the clinics look bad to the public; avoidance as both administrators and clinicians who lack skills to handle addicts simply dump this on others who are put into positions they can’t say no to patients as a general rule; and, clueless hope as there are people in the health care system who think EVERYONE can be helped, if not saved.  Hence why so many in the health care field are politically liberals, progressives, and Democrats.  And in the political mindset, are inherently crafty to avoid accountability WHEN the crap of addict consequences hits that giant fan in the room.

Hey, just my opinion, but, can you really dismiss not only my 20 plus years as a psychiatrist, but my additional 20 years as a family member, community citizen, and observer of carnage throughout the system of America as to what addiction does to those who won’t set limits?

Feel free to talk among yourselves…

Last night’s post was out of line, but, so are the offenders I raged about!

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Benzos can cause dementia?, Providers writing controlled substances are a danger to society, Xanax is a drug from Hell

What I wrote last night was my gut outrage after a day of seeing patients who thought not only being on large dosages of benzos was not a problem, but, to literally glorify the prior psychiatrist who wrote these absurd and offensive Rxs was just too over the top for me to hear more than once yesterday!

So, when I woke up this morning (Thursday), I went to my tablet and trashed it.  But, I am writing this post tonight to say in perhaps more responsible and professional ways simply these two things:

1.  Patients who want to be on frankly dependent causing dosages of Xanax, Klonopin, Ativan, and even Valium still these days, are fools, addicts, and many just characterological disrupters.  Maybe they can ignore responsible providers like me who call them on these disgusting Rxs, but, WHEN they crash and burn from the consequences, well, don’t bitch and moan to the likes of me!

Like this story?:

http://psychcentral.com/blog/archives/2014/09/29/benzodiazepines-alzheimers-disease/

To me, a stupid story line, benzos cause cognitive disruptions even before getting older to be labeled demented, but, I’ll use it to scare the crap out of anyone who is even remotely listening!

2.  To all you providers out there who write for benzos, and stimulants as well, like pez and thinking they will “ease their pain” and get them out of your offices, well, I look forward to as many of you caught by the growing PDMPs out there in states who are trying to stop this bullshit.  Or, creating patients with profound morbidity and mortality events that have litigious outcomes which hopefully shorten your reckless and stupid careers.  Oh, and if you think you can start these Rxs and then dump them on other providers and think you are immune to consequences, note this from at least this provider:  Once I come across a pattern you are being a drug dealer or careless idiot provider, I will report you to the state I am practicing in at the time.  Even if I can get just one of you off the street, I will be eternally happy.

And maybe when you all see that there are legitimate consequences for writing scripts that cause harm, then the idiocy will at least be less pervasive.  And I will repeat one thing from last night:  if you can’t run and hide, I hope you retire or die, as some of you will NEVER figure it out!

To non provider readers, this site will hopefully educate you what is coming in your state soon, if not already in place:

http://www.deadiversion.usdoj.gov/faq/rx_monitor.htm

in my state of Maryland, the local site:

http://adaa.dhmh.maryland.gov/PDMP/SitePages/Home.aspx

Let’s finish with an image to humor and enlighten those of you who think being addicted to Xanax is no big deal:

Gee, this woman 10 years ago was just 50 years old and employed and a mother to 3, but, those years of 6-10mg a day of Xanax really took their toll, eh???

Just a picture I got off the Net, but, it could be someone you know as a patient or perhaps a close family member or friend?  THINK ABOUT IT!!!