The Mental Health "System"

I am planning to see a psychiatrist to talk to them about my bipolar disorder. I tried to do this once before, in August of 2008, but gave up without managing to actually make an appointment. It's three and a half years later and I'm trying again in a different state.

Here is my experience this time. I started by going to see my regular doctor to get a referral, while I was there I thought I would also get a physical. What happened was that I got an extensive physical, right down to full blood work and an EKG of my heart. The doctor said I didn't need a referral to see a psychiatrist and that I should call the mental health number on the back of my insurance card. The only question he asked was whether I was very depressed at that time, basically whether I was a danger to myself at that precise time, and when I answered that I wasn't he went on with his tests. His reaction was essentially that I shouldn't be bothering him with something that wasn't in his area of responsibility.

To give you an idea of how irresponsible this is I would like to give you some statistics about bipolar disorder. 2.6% of the population (nearly 6 million in the US) have been diagnosed with bipolar disorder, although the actual numbers may be higher because many are not diagnosed (perhaps half are diagnosed). Of those diagnosed 60% attempt suicide and 20% die as a result, that's a mortality rate of 1 in 5 which is higher than that for diabetes (10-15%). A million Americans are going to die from this disease and those with bipolar disorder don't do cries for help, the rate of "success" in suicide for bipolar is about four times higher than for the general population.

However, I am not suicidal, when I started the process I was actually feeling fine. I called up the number for mental health on the back of my insurance card. After pressing button 1 for English, button 3 for finding a doctor, and so on for some time I reached a real live human. They informed me that I could go to a web site and look for doctors, and they told me not to interrupt them while they were giving me information (which I did not need).

I went to the website where I was able to search for providers near me in the area of "Behavioral Health" because clearly what I have is a problem with my behavior rather than a crushing mental illness with which I have coped heroically for twenty years. After searching through a list of 150 providers in the area I was able to narrow down the search to three psychiatrists working in mood disorders. I was able to do this because I know the difference between counselors, clinical psychologists and psychiatrists and know that only psychiatrists can prescribe medication, and also I know that I have a mood disorder rather than an anxiety disorder, or some other problem. I know the difference only because I have experience in the field of social work, if I had been a plumber I would simply have had to guess as to what I needed.

I called the closest person on the list, didn't get a human being, pressed #1 for ...(you get the picture) and left a voice mail which informed me I would get a return call within 48 hours. 36 hours later I was informed that the next available opening was nearly two months away (even though they are "accepting new patients." I said I would try elsewhere. I called the second number, hit #1 for ..., #229 for ..., #3 for... and got a human! I was very excited by this until it turned out that the number was for an inpatient mental hospital at which the psychiatrist worked and the receptionist had no idea how to hook me up with the psychiatrist for other practice, didn't even try, and didn't offer to take a message. I called the third number, hit #1...etc. through three stages and then left a message. It's been three hours now since my message without a return call.

It's almost a certainty that I am going to give up again. I am depressed now, with very dark thoughts going through my head and a strong urge to cry. Grocery shopping was quite hard yesterday and dealing with the plumber is no joke. Two weeks ago I had surging emotions of indescribable beauty. Circumstances seem to have conspired in such a way that the money we would need in order to move out of Texas has been taken away simply so that we can maintain our position, so prospects for the foreseeable future are more of the same.

I think it's important to remember through all of this that I am enormously more qualified to deal with this sort of stuff than most people with a mental illness. I have a degree in psychology. I am much more intelligent than the average person. I am no where near as sick as many people. I am not delusional. I have someone who loves, understands, and supports me. I have many years of experience in dealing with medical and social work systems. Each time I hear a recorded message I despair at what this must be like for someone who really needs help now. This is literally killing people. It's killing them in the worst way possible by demonstrating beyond a shadow of a doubt that even the people who are supposed to care for those who feel alone, abandoned, hated, held in contempt, crushed under a great weight of impersonal misery, don't care if they live or die.

"If you wish to live, press #1 now. For caring, press extension #229. Have you looked for concern from us before? Press #3 now. If this is your first attempt to find help for something that has devastated your life for press #7. We are sorry, we haven't bothered to have a human answer the telephone, leave a complete, lucid, and detailed message and if we find the time in the next couple of days we might call you back. Should we call you back it will be to inform you that we cannot manage to care for you until our schedule is open. Good luck."

Artistic Rollercoaster of Confidence

It's been an interesting week.

A week ago today I put some extra time into playing the mandolin, as I work towards achieving a dream. By the end of the second day I really felt that there was some hope that I was going to be able to play a particular song through from start to finish, although it was going to take time and work. This was important to me because the song is the Battle March Medley, and at times I have called it the greatest piece of music I know. Essentially if I can play my favorite song to a standard where it sounds good I will have reached an important milestone in becoming what I think is a real musician. I was very encouraged.

By day three I was writing about how happy I was that there was sunshine and I was happy.

Day four had me becoming extremely angry at imagined slights.

Day six had me listening to music through the most fabulous invention ever, MP3 and ear buds makes the greatest songs that have ever been produced play inside your head with essentially no physical clue as to the source. In this manner you can hear music as great artists hear it, simple the notes perfectly played inside your mind. Some of the music that I heard was so heart-wrenchingly beautiful that I despaired at ever being able to play anything that could be put in the same category. I was just a duffer, an amateur without much talent, someone whose performance was more like those of a children's play where any applause is the polite reaction to an incompetent trying hard.

Day seven had my mind slightly bruised, like a body after extreme physical exercise. I wanted boring and easy and uninspired. I knew that the previous week had simply been a case of my mental weather, moods like cold and warm fronts passing through the landscape of my consciousness. Even at the time I knew that anything I was feeling was simply temporary, that it too would pass, whether for good or ill.

Today I will pick up the mandolin again, but right now I have no idea if I can actually play it or whether it has all been some sort of sham.

Sunshine.

As I was walking along the sun-baked sandy ground of Elizabeth Myers Park this morning I thought of the words of an old hymn, In the Bleak Midwinter. After a brief muse about how myths happen (the hymn is about Jesus being born in a stable all surrounded by snow and frozen cold, we don't know when Jesus was born but we can be pretty sure it wasn't in feet of snow in Israel) I looked around to see limpid pools of golden sunlight dappling the verdant trees. It was beautiful.

It was beautiful, and I was happy.

No weight on my soul, no worry in my head, no dream unfulfilled.

There must be people who feel like this on a regular basis, that without any particular difficulty they feel good. It is a very nice thing indeed that there are such people.

Now I am going to return to the park with my very spoiled dog, sit under a tree and work a little at learning The Battle March Medley on the mandolin.

Another Year in Surburban Texas.

So another year older, and what have you done? To somewhat plagiarize John Lennon. It's now been two years since Christina and I moved to the northern suburbs of Houston. Therefore I am taking a moment to take stock of the time.

Here is the first post on this blog about living in Houston. It's not very positive, is it? Well, I would say my opinions on the place, and the life I am living in it are not really very different. I am more comfortable in the place, in that I have adjusted to the situation, but the situation is essentially the same. I'm just treading water until the next thing, and I have discovered that it's not up to me to change it.

I tried meeting people, with little success. I tried starting bands, which failed. I joined a band, which I subsequently quit. It's now been a full week since I went anywhere but to a store or the park.

There is a pub that we go to where the people are generally nice to us. None of them I would say I could really call friends, but it's a place where I can have a nice time. It's big ass beer night tonight and I am really looking forward to riding our bikes there.

Life in a gilded cage. It's a hell of a lot better than life in a gutter.

Creeping Miracle

For essentially the same point I am making in a video, watch this.

Around the world life is being transformed at a break-neck pace, and almost universally for the better. On the other hand the majority of people are worried and concerned about the present, pessimistic about the future and nostalgic about the past. I'm not really sure why this is, but I think it must have something to do with taking what we have now for granted, as if we always had it. Therefore I am going to write today about what I consider to be the miracle of our times.

Now, I am not one for the use of the word, "Miracle." I'm a materialist, a naturalist, I think things happen according to fixed laws. However, I think if most people from 100 years ago could experience what life is like now I think they would consider it a miracle.

One hundred years ago, in 1911, life was extraordinarily different for the majority of Americans. At the time there was no minimum age so many, if not most children worked. About one third of children went to elementary school and only one in ten graduated from high school. If you met an American from 100 years ago the chances are that they would be unable to read this post. Life expectancy was around fifty years. A study found that one in five children in inner cities in the USA were malnourished.

What was life like for most people back then? Well, it was mostly a life of drudgery. With electricity just beginning to become available to homes during this century the vast number of labor saving devices that we take for granted were not available. I want you to imagine living without a refrigerator or access to washing machines, or a vacuum cleaner. For women, without safe contraception and with extremely limited opportunities to find work outside of the household, this meant usually sticking with a husband regardless of his qualities, multiple children (average per household around three, with a one third chance that one of your babies would die as an infant) and a life that consisted almost entirely of chores. Hand washing for a family of five, often heating the water with firewood, would take hours of hard physical labor. Cleaning the house would consist of you on your hands and knees with a scrubbing brush and some soap. Grocery shopping would be a daily activity because food wouldn't keep, requiring walking in both directions carrying your bags.

To get an idea of what it would be like back then I suggest thinking of what it would be like for you to recreate for a week the life of the average American from 1911. First of all you cannot read anything, watch tv, check the internet, make a phone call. Secondly, you cannot refrigerate anything, or eat anything that is imported. Third, all chores for the house must be done by hand, and for real verisimilitude anything that requires water should be done out of a bucket. Oh, and by the way, no zippers, or bras. all information that you receive would be simply by word of mouth, what someone told you (as you have no way of checking any information). For entertainment you can eat out once in the week, or go to see a movie, or see a play.

Now, I suggest that there is not one single one of us who will have any intention whatsoever of going through with a plan to see what such a life would be (and still an improvement because of health, low crime, social programs, increased education, mental health, etc..) for a week. Why is this? Why am I so sure that this life has no appeal to any of us? It's because such a life was so obviously markedly worse than the lives we live now. The experience of the average American has so dramatically improved over a hundred years that the average modern American doesn't want to experience how life was for even a day.

Now, why is this a miracle? It is a miracle not just in the ease of our lives. It is a miracle in the transformation of the experience of people (particularly women) from almost entirely uneducated, ignorant, laborers into thinkers, feelers, and dreamers. There are about three times as many people now with undergraduate degrees in the USA as used to graduate from high school. The average person in the USA can now travel to other places for vacations on an annual basis, something that would be the most amazing experience of someone's entire life 100 years ago.

This freedom to learn and experience, to think about our lives and how to improve them has transformed our lives in other ways. Health care so that you don't have to worry that your loved ones might sicken and die at any point, mental health care so that those with depression, labor laws so that you and your children don't have to kill themselves slowly for money, laws and attitudes to stop men beating their wives and children, and on and on and on.

This miracle has happened in the USA, and is still happening. However, the grander miracle is that this is happening around the world. This transformation from a lifetime of ignorant, manual labor to a lifetime of educated freedom has happened to nearly half the world in the last three decades. The rate of change is faster elsewhere than it was for the USA, since the technology has already been invented. In our lifetimes we can expect that the experiences of the "golden age" in the USA, that of the 1950's and 1960's, will be the norm for people around the world.

Why does this matter? Why should we, who have not only the benefit of this miracle but also no realistic expectation that we or anyone we know might have to deal without this miracle, care about this miracle? It matters most importantly because a happy life is one that acknowledges the good things in life, and almost every single moment of every day there is something that is better than it used to be, and for this we should be grateful. It matters because it is so much better to feel good about how things have gone and therefore to be optimistic about the future. It matters because if we acknowledge that this is a transformation miracle in people's lives then we can work to encourage more of these miracles. Happy, optimistic people trying to improve the world produces more happy, optimistic people, and an improved world.

While many of us spend our time bemoaning politicians, corporations, the system, the terrible economy, the instability of our culture, our greed, the vileness of human nature, and the idiocy of those with whom we disagree, these are the things that have produced the greatest change for good in the history of the world.

There is a miracle going on around you, and it is a miracle of great goodness.

Working Towards A Dream

I've talked a lot about the difficulty I have in remaining motivated by something for an extended amount of time. This is of course only with regard to certain things, I am pretty consistently motivated to have naps, read books, be around the woman I love and so on. But things that most people would consider productive I have struggled with generating and maintaining interest. I have considered graduate school, writing novels, grand treks across the world, deep spiritual practice and never really seem to get much farther than the beginning.

However, there is something that I continue to do that is productive, gives some level of self-identification, and is working towards a dream. I play the mandolin and sing. I don't play everyday in alignment with the Cariaga Doctrine (if you play 15 minutes every day you will get better) but I play the mandolin more days that I don't, and I tend to play longer periods of up to an hour and a half.

It is odd that I put so much effort into the process. After all, my total number of songs I am play is perhaps forty. I have played most of these songs hundreds of times, and I am playing them to myself in my own home. As time goes by I work on more and more difficult stuff to play, and that largely consists of trying and failing at something, then trying and failing less badly, until something sort of OK comes out. Learning how to play music is hard work, and often very discouraging. About half the time I put the mandolin down in disgust at my failure.

The reasons I still play are several. I really do love music. I'm one of those awful people who will put on a piece of music and say, "See that, that! That emotion right there is what I am talking about!" while people who like pretty tunes will look at me blankly. The music I play brings images of home back to me, the greenest, thick-bladed grass blowing in the wind. Moss on stone. Something older than cars and telephones and records.

Music is also a lifelong skill. I'll always be able to sing a folk song now that I've learned how. Unless arthritis cripples my hands I expect to always be able to pick out a song or two, and really I expect simply to get better. Getting better at something beautiful is a reward. To be able to play something new, or something better, is always a recognizable achievement. The little pieces matter to me, and this is how you know you are doing something that feels worthwhile.

Then there are the memories. I don't think there is anything more rewarding that people can do than to be part of a team that works together to achieve something that makes life better. I have been very fortunate to be part of teams full of good, kind, funny, interesting people making music good enough to bring joy to others. Being in a band has been very special for me, with people becoming somehow more than friends through the process, more like family.

Finally, there is the dream. If I keep playing, keep trying to get better, still feeling the music, then at some point I believe that I will become someone worthy of being called a musician. I'm not talking about being a star, or being famous, or amazing people with my technical ability. What I mean is that I will be able to play a large group of songs beautifully, as one would think they should be played. I will be able to sit with a group of other musicians and find my way into songs. I will be able to play in the town I live at least weekly. Who is Dan? He sings Irish songs and plays mandolin. I don't know if that is five or ten years away, much depends on my own perception.

The perception of improvement, or adequacy in music is a funny thing. I have played in bands on stages for money. Two of the bands I was in have been (on some memorable occasions) asked to play enough encores so that we had to repeat songs for lack of repertoire. Is this not adequate to be thought of as a musician? Not to me. I am still an amateur, still someone concentrating on curling those fingers to get right there while ignoring the cramping and the pain in my fingertips. There is no-one who can find an error in music with quite the same level of perception as a musician listening to themselves play. I remember with a smile the times that bands I have been in have listened to recordings of ourselves playing. Everyone says how good it sounds, and everyone cringes at a litany of their own mistakes unnoticeable even to others within the band.

The best thing that has happened to me recently, in a string of somewhat difficult moments, was being asked if my old band Sam's Cross would play a friend's wedding in Portland in August. A high point in my process of working towards a dream, a comfortable dream of quiet satisfaction, friendship, and beauty. It all started with a question from a friend, for which I will always be grateful.