But how can you not talk to someone who is hallucinating, for example, and NOT think that their brain is broken... that something's not working correctly.
We must be seeing two very different populations. Also, your statement that "In order to think of what I do as healing, I would need to see the people I work with, and indeed myself, as broken, ill and I don't, not in the sense of illness," appears very hypocritical. Unless you do not take any insurance, do not complete patients' insurance forms, do not provide "ICD-9 diagnosis codes", and do not have a license which identifies you as a "therapist" of some sort, then this statement is completely hypocritical.
Perhaps our two differing viewpoints are more a matter of philosophy. What I see as a medical problem caused by some type of dysfunction in the brain, you may see as, umm, something different. When I think "wounded", I think of wounds "healing". From my medical training, I can only think of a "wound" as a pathophysiologic process whereby the body is trying to heal itself. When that healing attempt causes other problems or is not perfect, that is where you get a "scar".
The health insurance industry would benefit from your view, as then all mental health coverage would cease and they'd "save" money. But, other costs would go through the roof. That is what I hope the presidential candidates start to discuss.
We do indeed see very different populations and I do not in fact accept insurance.
As a psychiatrist, you are grounded in a different tradition and perspective than I am as a psychologist. We view the world we and our patients live in through lenses which sometimes differ radically.
I have a solely outpatient practice and I do not see people with major mental illness. In 35 years of practice, I have not had a patient who hallucinated nor was psychotic except when I briefly worked part-time in an ER.
So my patient population, as I have said before, comes mostly from the group once known as "the worried well" -- people who have problems in living rather than illness. And while I do see my share of borderlines and narcissists, and enjoy working with them in fact, I do not see them as having major mental illness either.
I have been around long enough to know that the folks I see actually are pretty representative of the people who seek help via psychotherapy. They have either tried psych meds, usually SSRIs in the past and found them not especially helpful or they are not interested in medication at all. On those occasions when a patient requests it or I believe it would be useful, I do refer to a psychiatrist. But I choose to refer to one whose philosophy vis a vis when psychotropics are useful and necessary agrees with mine.
It has taken direct advertising by the drug companies to create in people the belief that hardly anyone can handle the ups and downs of daily life without meds, a view I do not share.
Not surprisingly, I do not share the idea that ordinary outpatient psychotherapy should be covered by health insurance, because I do not think that what is being treated is illness. I think that health insurance should cover, with parity, major mental illness.
The current state of affairs in mental health treatment is a sad mix of motives too many of which are about money and not patient welfare.
We can agree to disagree based on our philosophical differences. I can enjoy reading you while recognizing that our views differ.
After reading your description, I think we are actually both on the same page. Most of my pts have been hospitalized in the past, have attempted suicide, and have been disabled at some point by their illness. I agree that most of the pts you describe do not have a major mental illness, and do not require health insurance coverage. While some of my peers may feel that any diagnosis in the DSM should be covered, I think coverage should be limited to major mental illnesses (which are "major"? that's a whole 'nother kettle of fish).
We are also on a similar page about the drug companies.
So, I'll agree to agree.
Thank you.
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