Saturday, December 7, 2013

A Social Commentary Comment

 Brace yourself.  Social Commentary is coming.

As a society, we take less time now for some things than we used to even twenty years ago.
For example, remember psychoanalysis?

When I was a kid, everyone who went to a psychiatrist was in psychoanalysis.

Or, if it wasn't Freudian analysis, it was Jungian analysis.

Empirical studies now suggest that psychoanalysis, while not exactly a sham, was little more than an interesting  experience.  Painful and somewhat elucidating, maybe, but ineffective for dealing with seriously inconvenient symptoms of mental illness.

Back in the day, if psychoanalysis didn't work and you had inconvenient symptoms, like clinical depression, the next step was electrolysis.

No, that's wrong.  What was it?  Oh, right: electro-shock therapy.

Electro-shock therapy actually yielded results, the worst of which was significant loss of short-term memory; the best of which was a veritable rebooting of the addled brain, a fresh start, clear of recollection and the vagaries of mood...relief that was by and large temporary.

If electro-shock therapy didn't do the trick, then a lobotomy was still an option.  Better a bottle in front of me than a frontal lobotomy.

Being gay or transgendered was considered an illness even as recently as when I was in high school. Adverse conditioning was considered a valid approach to curing it.

To recap, even in the relatively brief framework of my lifetime, psychiatry has been at once high-highfalutin' and medieval.

Nowadays, no one is in psychoanalysis--which is too bad, because it was an interesting subjective experience, if little else.  But today, the idea of spending 50 minutes lying on a couch and free associating, while a psychiatrist sits outside your field of vision (lest he distract you from stumbling toward your next epiphany) taking notes (so he can later look up the symbolism of your dream imagery in his dream translation dictionary) seems pretty patently absurd.

Why?  Because a psychiatrist gets paid way more for one 50-minute hour than an MSW.  Today, hardly anyone who can still hold their head upright talks to a psychiatrist for more than twenty minutes...certainly not five times a week! (Did I not mention that one saw one's psychoanalyst five times a week?  Can you imagine?!)

When my friend's child had mental health issues, that child saw a psychiatrist for twenty minutes.   Sometimes a resident psychiatrist-in-training would practice asking questions for that 20-minute appointment.   The child was nice.  The parent was nice.  The professionals were nice.  Medicine was dispensed.

At one point, it was thought that the child might benefit from talking to an MSW who specialized in kids with these issues.  The MSW was always late and exhibited disturbing symptoms of OCD.   Eventually, the parent became annoyed with the MSW for always being late, (did she not know this was a grave breach of trust?); and for scolding her child for playing with the wrong toy in the wrong way at the wrong time.  The last straw was when the MSW got down on her hands and knees to scrub the water that the child had accidentally spilled on the carpet (half a tiny Dixie cup), scrubbing and scrubbing while trying to maintain the thread of discussion despite her evident rage.

Had the child's therapist and psychiatrist consulted with one another about the child?  Did one process inform the other? The parent saw no evidence of this.

As the child grew older, the parent he saw the same congenial and bright psychiatrist for many years, and yet he did not know the child particularly well at all.

And YET, the child was lucky to have even this much access to mental health care--because clearly, as evidenced by the notorious acts of troubled souls who do not have access to mental health care, (who languish on waiting lists for years), even a twice-annual twenty-minute encounter with a psychiatrist is a class privilege.

Many others don't have access to the medication they need; which, for those of us more fortunate, is procured by an un-elucidating practice of taking medication after medication, in various dosages, until the primary symptoms are alleviated and the side effects are not intolerable.

Another area in which society today takes a similarly prescriptive approach is education.

We are all so busy, most of us are working full or part-time while also managing families and households; when our kids say that school is fine, we're inclined to need to believe them.  We may not know that our kid is struggling with learning, or focusing, or bullying, or a developing sense of alienation.

We are probably all a bit laissez-faire, (a nice word for benignly neglectful), in the area of homework supervision.   How many of us know what our child's homework is?  How many of us sit down with our child as they do their homework?

I do.  Sometimes.

I have been a a pro-active parent and a passive (laissez-faire) parent.  I prefer and default to the later, but circumstances usually insist that I become the former.  I do, and then I slip, and then I do again.

My kid goes to a very good public school.  But I think that one person, however amazing a teacher he or she is, can't effectively teach 21 kids.

I have found, when I've volunteered in my son's school, that I am needed.  Maybe I am only needed for twenty minutes, but for those twenty minutes I am there for kids who need me.

I wish I could do it every day--go and volunteer in Josh's school--but I can't.  I have my freelance work to do.  I have other stuff to do.

And YET...

And yet, when I was doing it, I had the feeling that there was nothing more important that I could possibly have done with my time.  Nothing else was as important.

Still, life today doesn't accommodate that kind of altruism.  Or maybe it's just me.  Is it me?   I know lots of moms who volunteer at their kids' schools.  But it's like a lot of things along those lines: Volunteering at the food pantry, volunteering to feed the homeless, volunteering to read to kids with cancer....

When you become involved, you risk arriving at the conclusion that the need is endless.  We all have to come to terms with that fact in our own way.

Public education is, perhaps surprisingly, like that.  The ongoing need is so great, it's daunting.  The need is built into the structure of the thing.  One teacher, 21 kids.  It doesn't work.  The kids are all different; some of them are painfully disadvantaged in any number of ways:  by a dysfunctional home life, by poverty, by aptitude, by ADHD, by autism....

The teachers are young and bright and strong.  I am amazed by their ability to discuss the specific details and issues attendant to each of the learners in their charge.

The endless salvo of standardized tests, which grade not only the child, but the school, and the school district, and the state, and the country... We are competing against South Korea and Vietnam and China on these tests.  Poland has risen among the ranks, a potential usurper.

Even children who don't test well--who very specifically do not test well, but who will be judged by their performance on these tests--are encouraged to take them, because the worst thing that could happen--the WORST THING--would be for the school to have to factor in a 0.

The school psychologist, maybe, tells you this.

Your child's psychiatrist, when you mention anxiety, lights up.  They're doing a study on anxiety.  Would your kid like to participate?  Oh, but then you couldn't have the medication.

Here he pauses, and you know that he is measuring not only his own words but your reception of what he has just said, and what he might say next.   In his calculus, you are too sophisticated not to realize that he is no longer sounding like your own child's best advocate.

It is easy not to be a child's best advocate when you don't really know that child.

This is how I would tie all of this together.  I would say that in today's society we are losing insight.  Yes, psychoanalysis as a practice was self-indulgent, maybe, and not particularly effective for dealing with obsessive compulsive disorder, schizophrenia, clinical depression, bipolar disorder, etc.

And YET, the pendulum has swung too far in the other direction.  Today, it is possible for a child to receive what is considered to be very good mental health care--and nonetheless, somehow, INSIGHT, that old chestnut, that once gold standard of psychology, is missing from practice.

Caveat:  As ever, a good MSW is admirably capable of navigating your average neurotic through the rocky shoals of life.

Back to social commentary:  My point is that where mental health requires a marriage of insight and medication, we find that the two have been amicably divorced for some time, and that they share joint custody over the dominion, in a scenario whereby the one leaves us at a certain meeting point, and the other picks us up, and the two of them don't really talk like they used to.  And of course, being estranged, why would they?

And so, we live in a time when the very structure of our educational system is still essentially broken, because one person cannot effectively teach 21 children.  And the schools try to address this by fiddling with the pedagogy in wildly imaginative ways, reinventing the wheel to be bigger or smaller (but always more or less round) every few years.  And the government tries to address it by imposing these ridiculous tests, which is a very quick way of getting a very superficial impression of how our broken system compares to other countries' broken systems.

And we, at home, are tired, because our computers allow us to do so much more than anyone ever used to have to do.  We are eager to be diverted by a hundred diversions, like making supper and shopping for groceries and doing the laundry and cleaning the house and ferrying kids to games.  Or maybe we have a second job, in which case, God help us.

What if we had twice as many teachers?

What if the talk-therapists and the prescribe-doctors were required to work together as part of an integrated program oriented around a healthy marriage of insight and science?

What if we all pursued insight again--not with crazy navel-gazing indulgence--but just enough to shed light on what's broken?

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