Unfogged Mobile

'Sup, remecourt?
Posted by Heebie-Geebie on 06.26.17

In order to preserve 40 comment topic purity on any and all prior discussion, I do hereby ordain and establish this here thread for the discussion of Supreme Court Decisions. Void where prohibited.

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Health Care, Fast & Slow
Posted by Heebie-Geebie on 06.26.17

1. Ugh, the Senate vote. Apo repeatedly says elsewhere that all this hemming and hawing by moderate Republicans is just performance, and that there are currently zero moderate Republicans in the Senate. I think he's probably right, but that a big enough stink would cause them to waver on their re-election.

IMO, the real lesson for Senate Republicans is from the House vote: If the opposition rallies against you, just wait a month and try again. It takes tremendous energy from everyday, non-elected voters to wage these oppositions, and we can't do it over and over again.

So do I think the vote will pass this week? Not necessarily. But I think they'll wear down the activists by doing this month after month until it ceases to command attention, and then it will pass. It might screw up their reconciliation timeline, but since when has blowing through a deadline bothered Congress? They've got a million ways to stall and extend deadlines and do stop-gap measures.

2. One of the trainers at the gym is heading to Peru for one of these Ayahuasca-Shaman led guided weeks to turn yourself inside out and upside down. He's a really interesting candidate - a vet who is pretty straightlaced, but struggles a lot. (In general, I respect him a lot for struggling internally and not burying it in rightward talking points. He's definitely struggling, but is not kidding himself about that point, if you see what I mean.)

If I weren't a parent, I would do something like that in a heartbeat. In general, I am pretty damn risk averse, but that kind of thing just sounds like Disney World to me.

Comments (69)

ATM: How does one approach professional mental health care?
Posted by Heebie-Geebie on 06.25.17

Consul Caius Martius writes:

I've had, for about the last 12 years, periods of what I as layman would call depression. I'm not sure how consistent they've been in frequency or duration. Presently, they're maybe 1-2 weeks long at 1-2 month intervals. The worst I can remember was during college, lasting maybe 5 months; in hindsight, I think that one would qualify as clinical depression. I also procrastinate chronically, causing repeated dropouts and massive underachievement in college.

I've never been in any therapy before, apart from a couple of one-off sessions I attended unwillingly years ago; I know a little about psychology, from one year of study and random reading. From that, I have some prejudice in favor of psychiatry, as opposed to psychology. I've been to one introductory session, with psychologists. I think it went well, and was much easier than I expected.

The proximate cause of this is rage issues (I teach; students sometimes anger me). My manager suggested I go and get help. I think she is sincerely supportive,* but is also bound to protect the organization. I am otherwise good at my work; they've said essentially that they would have fired me already if I wasn't.

I told the psychologists everything above, but didn't mention the suicidal ideation, self-harm, and occasional heavy drinking; because I really wasn't willing to say that up front, and because they didn't ask, but also because I want to hold those facts in reserve in case I need to give someone a persuasive push somewhere down the road.

I pushed for medication; they said that drugs would make an immediate change, but that they didn't want to go that way: what you feel is what you are. I said I didn't like what I feel, and wanted to change it. (Which is true. I am very tired.) They didn't push back, and didn't seem affronted,* and will refer me to a psychiatrist. We agreed to further counseling combined with medication. I would have agreed anyway, tactically, but I did actually see value in the counseling; simply in answering questions I realized things I hadn't noticed before; for instance that (as best I can calculate) my job satisfaction on any given day tracks my mood, rather than vice versa.

I am an expatriate in a non-English speaking country, but there are English-fluent people available (my privilege, I cuddle it like a teddy bear). This is a land of single-payer, so money is unlikely to be an issue. All the therapists will work in hospitals rather than private practice, and I'm guessing will have limited flexibility in scheduling; I don't see these as issues, but that's the picture.

General comments? Advice? Specifically: withholding information? Gaming tests, which I could probably do if I tried? Figuring out drug regimens? Anger? I want to make this work. I didn't expect it, but I left that session with a glimmer of hope, which in retrospect I don't think I've had for years.

*But I can't read people for shit.

Heebie's take: I think medication plus therapy is the way to go, provided that you find a therapist that you don't think is dumb, and that you respect them enough to be basically cooperative and open-minded. I think one of the biggest hurdles is therapist-shopping, because each new appointment takes such a toll of hope/energy/re-hashing unpleasant questions that the idea of doing it 3 times and then picking a therapist is enough to just turn Netflix back on and binge whatever the depressives are binging on these days. (I would not enter it by booking three different appointments. Just book one, and if you are on the fence with the person afterwards, book one more, and trust that the profession has a wide, wide range of people practicing it.)

On withholding information: you are fully entitled to withhold information, especially at the beginning, when the therapist is still earning your trust and respect. Some people might feel comfortable disclosing all information up front, but if you don't, then don't. Same with gaming tests: the tests aren't the therapy, they're shorthand for acquiring information from patients in a systematic way. As long as you engage honestly and sincerely with your therapist when you find one you trust, then I would just do whatever feels most expedient and useful on the tests to get there.

Once you have a therapist that you trust and respect, you are on the hook to engage honestly and sincerely. There's no point in wasting everyone's time. On withholding information: it's okay to wait while you get to know the therapist, and then at a certain point, it would become counterproductive. You are not obligated, but I imagine there'd be a point where your System I and System II grow into conflict about it, and you'd have to sort it out.

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