Behavioral Health

[Recidiva]

Agreed.


Fortunately, the agency for which I work has what I consider the "correct" philosophy in terms of facilitating appropriate behavior (as opposed to controlling inappropriate behavior). I wouldn't work for them otherwise.

That is a huge relief. It's good news to see this happening anywhere. And thank you for being a part of it

 

[JAMESBJOHNSON]

IMPRESSIVE

When you use the word 'NORMAL' what do you mean?

 

[amicus]

Would, 'normative', be a better term or are you going to argue there are no normal behavioral patterns applying to humans?

Amicus...

 

[impressive]

IMPRESSIVE

When you use the word 'NORMAL' what do you mean?

Normal varies from person to person.

The process of adjusting to change, especially (for example) the change involved in one's life when it is touched by disability, is normalizing it -- making it your new normal.

Thus, my normal is very, very different than yours. Normal for me is diapering my 14-year-old son, shaving his pubic hair so I don't have to clean smooshed shit out of it, feeding him by g-tube four times a day, and dealing with having strangers in my house around the clock due to his personal care & medical needs.

Would that be normal to you?

 

[JAMESBJOHNSON]

AMICUS

Normal definitely applies to humans, but its a statistical concept. The 'normal' range for anything is one standard deviation (above & below) the statistical mean. And it applies to specific traits NOT aggregate behavior.

 

[JAMESBJOHNSON]

IMPRESSIVE

Behavior can be typical for an individual but it cannot be normal for an individual.

 

[damppanties]

IMPRESSIVE

Behavior can be typical for an individual but it cannot be normal for an individual.

If you have a point, I'd like to see you come out and say it.

 

[impressive]

IMPRESSIVE

Behavior can be typical for an individual but it cannot be normal for an individual.

Whatever you say, JAMESBJOHNSON. I'm sure it all seems very ... typical ... for you.

 

[JAMESBJOHNSON]

IMPRESSIVE

When you use terms incorrectly you make yourself look ignorant to people who know what the terms really mean. If I'm not mistaken your original point was asserting that non-degreed people should get respect for their competence.

In graduate school the faculty will climb up your ass when you talk nonsense.

 

[impressive]

IMPRESSIVE

When you use terms incorrectly you make yourself look ignorant to people who know what the terms really mean. If I'm not mistaken your original point was asserting that non-degreed people should get respect for their competence.

In graduate school the faculty will climb up your ass when you talk nonsense.

Well, see, there's the rub. I don't give a flying fart about impressing grad school faculty. The people who are important to me -- the ones who MATTER -- are those kids who are struggling to make a life in this world. I'd gladly wager all the credentials those faculty members possess that those kids couldn't care less about the semantics of behavioral psychology.

If you wanna spend your time arguing terminology, knock yourself out, scooter. I'll be over here -- making a difference.

 

[lisa123414]

I'll be over here -- making a difference.

And you are, and will, make a difference. As the mom of four special needs kids (I am not looking for sympathy here – anyone with half a brain would envy me my kids, they are the best) I probably have the same level of life training as you have, Imp, but I do not have your skills. The thing these kids need most of all, is advocacy.

The people who did my kids the most good, and helped me set them on the path of survival, were those who were empathic. They always gave my kids and me hope and the will to keep on. I did run into a few Ph.D.s and medical doctors, along with school administrators with masters degrees in education, and teachers with BS degrees in teaching, that did make us feel like a few of the 10,000 pieces of shit.

You will do the world so much good. Although you may not have wanted to take this job, THANK YOU!, from all the families that need you.

 

[impressive]

 

[Belegon]

And you are, and will, make a difference. As the mom of four special needs kids (I am not looking for sympathy here – anyone with half a brain would envy me my kids, they are the best) I probably have the same level of life training as you have, Imp, but I do not have your skills. The thing these kids need most of all, is advocacy.

The people who did my kids the most good, and helped me set them on the path of survival, were those who were empathic. They always gave my kids and me hope and the will to keep on. I did run into a few Ph.D.s and medical doctors, along with school administrators with masters degrees in education, and teachers with BS degrees in teaching, that did make us feel like a few of the 10,000 pieces of shit.

You will do the world so much good. Although you may not have wanted to take this job, THANK YOU!, from all the families that need you.

Keep on keeping on, Lisa...

 

[amicus]

ET AL

I love the anecdotal drool.

My graduate program consisted of 60 hours of psychology coursework and 60 hours of rehabilitation coursework, 2 practicums, a thesis, and a 16 week internship. I did my thesis on the genetics of alcoholism. My rehab coursework included head & spinal cord injuries, addictions, several clinical courses, and several testing & measurement courses and statistics. I also took a comprehensive final exam: 5 essay questions taken from EVERYTHING I learned in the entire program.

I've evaluated 1000s of people. Whatever was brought in the door. People with epilepsy, people with drug rotted brains, alzheimers, Korsakoff's Psychosis, senile dementia, plus all the other stuff. People often drove up, opened the door, put their foot against their partner's ass, and pushed them out of the car. Shove the bitch out of the car. I've found people dead outside. I cant number all the nasty, violent drunks I had to take down.

One man called me from God Knows Where and announced he ate a bottle of meds. Then he collapsed on the floor, wherever he was. A drunk called me and said he had a gun and was gonna blow his brains out. A woman came in with a live grenade. Guns, knives, etc.

When youve evaluated 10,000 pieces of shit, you get the idea people are not mysterious or interesting. Mostly theyre stupid and losers....like a few of the posters here.

~~~

Taking your words at face value, JamesB, that is to say I accept them as an accurate reflection of your thoughts, leaves me with a small statement and perhaps a generalized question.

Having the opportunity as a print media reporter for many years, I was fortunate enough to go behind the scenes and learn something of the somber picture you portray about mental health care and facilities and the men and women who administer care to them.

Not just hospitals and care facilities, but mental care, disabled care, geriatric care and perhaps worst of all an intimate look at behind the scenes police and forensic work; sobering is to mild a word, the stark reality of it stopped me in my intellectual tracks as to how one might deal with the spectrum in a nominal way.

I don't dismiss those who post here as merely anecdotal, many have been dealt a harsh hand in life and are struggling to survive and overcome and I have empathy for that.

I do have abstract concern for heath care providers and even administrators and agencies that coordinate and maintain service as best they can.

I am also aware of the accumulative debilitating fatigue that turns medical professionals to drugs and other harmful behaviors just to survive another shift, another day, another week.

Any input on that rather ambiguous inquiry?

Amicus...

 

[lisa123414]

Keep on keeping on, Lisa...

Thanks to the support of people like Imp, we do better than keeping on. We thrive, we contribute. Thanks!

 

[Recidiva]

Thanks to the support of people like Imp, we do better than keeping on. We thrive, we contribute. Thanks!

I have learned the hard way, but I have learned. And that's of infinitely more value than deciding. Wonderful to see other people making positive gains and choices.

 

[jomar]

Mostly from my viewpoint, particularly dealing with the autism end of the spectrum...all the rules that apply to "normal" people (social pressures, peer pressure, discipline) are exactly the wrong thing to apply to an autistic kid.

So the stuff that works on normal kids will make an autistic child completely implode.

It's a bit like general practitioners versus a specialist. Yes, cutting down on salt and cholesterol and the like seem like a good idea. But not if you're a cardiologist and your patient has low blood pressure.

Many "common sense" psych tenets or child behavior or even people behavior tenets are the equivalent of throwing water on a grease fire.

Thanks. I like the specialist idea. Mental health professionals should know their limits and stay within them.

In the OP Imp mentioned inadequately trained workers and I see that in my community. The local mental health center is getting out of the business of mental health care so lots of businesses are springing up to cover services (e.g., community assist programs, 1:1 services). Some of these are hiring folks who mean well, but don't have much of a clinical clue, not to mention barely a vague understanding of all the state/federal regulations. Pretty scary.

 

[Recidiva]

Thanks. I like the specialist idea. Mental health professionals should know their limits and stay within them.

In the OP Imp mentioned inadequately trained workers and I see that in my community. The local mental health center is getting out of the business of mental health care so lots of businesses are springing up to cover services (e.g., community assist programs, 1:1 services). Some of these are hiring folks who mean well, but don't have much of a clinical clue, not to mention barely a vague understanding of all the state/federal regulations. Pretty scary.

Part of my expectations of "good services" reflect my attitude now toward "mental health."

I expect things to be messed up. I still work toward fixing them, but I realize the responsibility is mine, and not that of the practitioner. Unfortunately often in my experience, the practitioners I've encountered mean well, but are educated about all the probabilities of normal, and not the realities of the exceptions. And people much more likely based on the normal paradigm, want to blame the person for not responding to "normal" treatment. It works on everyone else!

I have migraines, which for the majority of my early life, were blamed on me, my attitude, my stress levels, my diet, my this, my that...when it's a disease that nobody knows how to fix, and that's the reality. I've forgiven people for misunderstanding and blame, forgiven myself for misunderstanding and blame, acknowledged it's just really damned hard, and go from there. I've discovered ways to mitigate, if not cure.

I get why it's this way. It used to be that I wanted to strangle them (and myself). Now I understand the challenges involved on both sides, and I try to bridge that gap if at all possible, forgive them if I can't.

The fact is...it's not simple, it's not easy, a working system is very difficult to build and maintain.

 

[JAMESBJOHNSON]

AMICUS

My problem is with the anecdotal discounts.

Psychotherapy is not a process of doing an enema then filling the patient's ass with fresh sunshine. But it's exactly what some of these mouth-breathers expect.

I left mental health work when the marketers took over the business. That is, keep people sick until they exhaust their insurance/medicaid benefits, then toss them out. I mean, I've had it put that way to me by management, "Four sessions only! Then toss his ass out!"

But until the money is gone the facility schmoozes and indulges and winks on all the bullshit people bring with them. Hug them. Pat their heads. Hand out gold stars. Therapists are emotional whores. The hugs and stars end when your money is gone.

It's not about healing people, anymore. If youre exhausting benefits you dont need qualified, experienced clinicians. You need bodies.

 

[Recidiva]

AMICUS

My problem is with the anecdotal discounts.

Psychotherapy is not a process of doing an enema then filling the patient's ass with fresh sunshine. But it's exactly what some of these mouth-breathers expect.

I left mental health work when the marketers took over the business. That is, keep people sick until they exhaust their insurance/medicaid benefits, then toss them out. I mean, I've had it put that way to me by management, "Four sessions only! Then toss his ass out!"

But until the money is gone the facility schmoozes and indulges and winks on all the bullshit people bring with them. Hug them. Pat their heads. Hand out gold stars. Therapists are emotional whores. The hugs and stars end when your money is gone.

It's not about healing people, anymore. If youre exhausting benefits you dont need qualified, experienced clinicians. You need bodies.

Can you explain to me why I shouldn't simply dismiss you as someone who experienced burnout so severe that the only thing available on the subject is the stench of smoldering rubber?

The benefit to actually caring about the people involved in the field is that you continue to care, because the people are in your life daily. They're not just a sample in a profile that you can minimize, discard and then light on fire, having only ash to show for it, and assuming ash is the nature of all things.

 

[JAMESBJOHNSON]

RECIDIVA

Youve dismissed me already, so why post a rhetorical question? Trying to influence your thinking seems like a fool's errand to me.

Caring. The most egregious harm I ever did, I did feeling intense care for the person. I allowed my "care" to totally fuck his life. So Care Bears dont impress me anymore. You can kill with kindness. I learned the lesson the hard way.

What matters is competence and skill. You dont have to care to do good.

 

[Recidiva]

RECIDIVA

Youve dismissed me already, so why post a rhetorical question? Trying to influence your thinking seems like a fool's errand to me.

Caring. The most egregious harm I ever did, I did feeling intense care for the person. I allowed my "care" to totally fuck his life. So Care Bears dont impress me anymore. You can kill with kindness. I learned the lesson the hard way.

What matters is competence and skill. You dont have to care to do good.

I'd considered whether asking you was a trap, but really, it's not. I'm genuinely curious because it's of interest to understand where you're coming from compared to assuming I already know.

My assessment of "burnout" doesn't assume you were anything that required dismissal. My assessment of burnout comes from the idea that what you just described happened, happened.

I'm not a care bear either. But care is one of the tools required. Competence and skill include the judicious use of care, and also the anesthetic dispassion of knowing when you need to cut like a surgeon and not be distracted from a goal.

The fact is that you will make misjudgments, misapprehensions and through attempting to influence other people, change their course. That's the nature of attempting to heal.

The difference mainly between you and me is not the care, it's how it's used.

The second difference is you accept full responsibilities for total outcomes, and give yourself little credit for the attempt to make the difference, which is the key required in avoiding burnout. Healing requires humility, before the person you try to heal, and the fact that the healing is their choice. It's not yours to teach. It's theirs to learn.

This is all my opinion, and not anything engraved in stone. It's just the practical result of caring. You can't save everyone. Some people are rigged to lose, and playing at all is a losing game. Still play, and learn from the loss.

There are several tools on the belt here, caring is a powerful one, but it's not the only one.

 

[mismused]

delete

 

[xssve]

In fact Mr. Johnson is mostly correct, the American system has become extremely coarse grained in many way, particualry when it comes to money - not at all certain it's any better anywhere else, but the sad truth is that the primary goal of any bureaucracy is to perpetuate itself and health care bureaucracies are no different - it was only a couple of months ago a hospital left a parapalegic literally lying in the gutter - because his insurance ran out.

Granted these are bureacratic decisions, representing group behavior - onthe individual, acentric level, you'll find people devoted to simply doing the best job they can, even individual administrators, but wholistically, 99% of what goes on in this country is marketing of some form or another.

Off topic here, but I do believe it's closely related to our culturally inherited class bias - it tends to promote wealth as the primary measure of excellence, displacing the notion of excellence itself, and this I think is tied in with the anal retentive attitudes that have been mentioned, i.e. agonistic stimulus, withholding as punishment, etc.

This of course, is going to increase the incidence of mental health problems, including the incidence of outright anti-social behaviors, perception of inequality etc., and the flip side of our worship of affluence are our uncommonly high crime rates, which tend to skyrocket during recessions: test scores start to fall about 3 years after the onset of a recession, and the crime rate starts climbing soon after - the juvenile murder rate in the late Eighties brke the previous record, set during the Great Depression, but dropped precipitously by the early Ninties.

A significant factor in these "anti-social" tendencies in the median group is simply rational expectations: children and adolescents aren't dumb, they're inexperienced, and they what limited experience they do have tends to be proportionally exaggerated in importance, a primacy effect of sorts. If you obsever early on that life is a struggle, you tend to adapt to that expectation - i.e., the individual will adapt their behavior to the situation they expect they'll be required to deal with, like R Richards and his shiv - by the early to mid Twenties, you the individualtion phase is mostly over, and you tend to accumulate enough experience to realize it's not always a kill or be killed situation, and that finer grained behaviors can offer more satisfying rewards.

It's a situation every generation has to deal with, as economies do tend to cycle, and there is a socially deracinated generation that emerges out of every iteration of the cycle, as well as local self contained economies where this dynamic is more or less perpetual, how this is expressed and dealt with is fairly unique in every iteration, massive civil/political unrest in the Sixties was met with what amounts to an agaonistic, military response - but significantly, it split into a genuine social movement in its own right on one end, even while shedding off your ordinary forms of turpitude and extralegal behaviors on the other.

Perhaps some kind of lesson there, the young are very creative, but often inhibited by fear of being unable to compete in an indifferent world, while I'm not a therapist, I have had some success in simply ignoring the behavioral element, and concentrating on occupational areas - everybody has something they're good at, they just aren't always able to find it, once they do, it tends to initiate a self reinforcing cycle that provides some resitance against peer pressure, etc.

Agonistic/anhedonic stimulus works in the short run, but most effective when used as a tool to redirect behavior into positively self reinforcing channels - i.e., to get their attention, while personal growth and self confidence do the heavy lifting in terms of behavioral modification.

i.e., if agonistic/anhedonic stimulus is used just to "keep people in their place", the feudal model, then eventual reaction formation is predictable.

 

[jomar]

Part of my expectations of "good services" reflect my attitude now toward "mental health."

I expect things to be messed up. I still work toward fixing them, but I realize the responsibility is mine, and not that of the practitioner. Unfortunately often in my experience, the practitioners I've encountered mean well, but are educated about all the probabilities of normal, and not the realities of the exceptions. And people much more likely based on the normal paradigm, want to blame the person for not responding to "normal" treatment. It works on everyone else!

I have migraines, which for the majority of my early life, were blamed on me, my attitude, my stress levels, my diet, my this, my that...when it's a disease that nobody knows how to fix, and that's the reality. I've forgiven people for misunderstanding and blame, forgiven myself for misunderstanding and blame, acknowledged it's just really damned hard, and go from there. I've discovered ways to mitigate, if not cure.

I get why it's this way. It used to be that I wanted to strangle them (and myself). Now I understand the challenges involved on both sides, and I try to bridge that gap if at all possible, forgive them if I can't.

The fact is...it's not simple, it's not easy, a working system is very difficult to build and maintain.

I sincerely wish you (and others here) all the best in your continuing efforts.