Just a little reminder about the role of Benzo’s…

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pill-man

Yeah, I know rehashing old posts is a bit lame and lazy, but, this one will be timeless for my time working as a psychiatrist:

Read and enjoy, duplicated in full:

http://cantmedicatelife.com/2013/04/10/is-there-really-a-difference-between-benzodiazepine-abusers-and-alcohol-abusers/

“Picture your most annoying noncompliant alcohol dependent patient, why him/her is so difficult to work with, then when you have the image and feelings up front…………..

then picture your most recent “struggling” benzodiazepine patient who is just basically demanding more meds and dismissing any other interventions.

See a difference?  I don’t.

What do noncompliant, substance seeking, insight limited people offer in the office?

always erratic:  never on time, extremely early or more often late, cancel appts late, if they show at all, stories never make sense and either take longer or are abruptly short in session.

inconsistent:  with everything!

intolerant:  never accept any boundaries, and take no responsibility for overt mistakes

usually unemployed or underemployed:  and always complaining about payments until proven otherwise.

focus in the office is always first and last about medication, and quick to want more.

almost always with legal matters:  even if not felonies, then civil matters, or themselves are taking legal action against others, even threatening the provider.

if at all involved in therapy, usually minimally participating, yet with enough psychosocial stressors for two or more people in treatment.

finally, few if any collateral supports of honest validity to their claims and situations.

Do these people ever come in and have a direct, uneventful visit?  Do they ever genuinely seem satisfied with their current course of life?  Do they ever offer the idea of lowering medication dosages?  Do they ever offer ideas of how to improve their lives spontaneously?

How many between visit calls do you get from these patients, especially after they miss or late cancel an appt prior?  And the final jeopardy question, why is it there is always an excuse they claim you should accept WHEN their controlled substance prescription runs out before it is due for refill?

This is why I am tired of the bullshit from benzo seekers.  They are alcohol dependent people who get their drinks from a tablet.  And they are quick to draw you into their convoluted, disrupted, and rationalized world of better living through chemistry, and will never accept there is a ceiling to dosage use.  And from a liability standpoint, you have little ground to stand on to defend prescribing habits unless not only you challenge them repeatedly WHEN they pull stunts and are noncompliant, but document it repeatedly and make a statement of what you will do should the behaviors not cease.

below is my handout at the CMHC I give to people who just hassle me with their lame efforts at making me their dealer du joir:

Image

My advice to providers:  set limits up front once the patient is showing no other interest than just getting a controlled substance that is intended for misuse or abuse.  If/when the patient has a negative outcome and you are seen as a potential villain by the family, show you made a sincere effort to set limits, and document every time you did so.

Not only is the road to hell paved with good intentions, you may become the guardrail that did not keep the reckless vehicle on the pavement.

It is time to make benzos controlled 2 substances, if at the very least to discourage PCPs and other nonpsychiatrists from writing them like pez.  And then being the pez dispensers I recently label XAN-I-DO!!!

Good luck with your treatment efforts!”

Going to be a long Fall season…

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Loads of fun for this next Locum assignment, having an 800 patient load by myself, giving me 20 minute med check time to see patients I have never seen and some without follow up for 6 months, asked to write 12 or more scripts a day for patients not in the office, most are for controlled subs, and oh, now there is a crisis service I have to cover on top of the 22-25 patients scheduled a day all the way to the end of my hours there.  Does this picture sum it up for you?:

screwed in number

Sums it up perfectly for me.  Oh, and their internet service sucks, so, I am truly on my own solely at the hotel, so my work at this blog will be very limited these next 8 weeks.  I will end with this regarding Ray Rice and the Ravens, talk about scapegoating, the team has taken this to a new level, with what was revealed Saturday AM:

http://espn.go.com/espn/otl/story/_/id/11551518/how-ray-rice-scandal-unfolded-baltimore-ravens-roger-goodell-nfl

Just remember this, anonymity is the breeding ground for the antisocial, and just ask Home Depot and late last year Target customers.  Using credit cards is getting quite like pseudo Russian Roulette with your money, eh?

Another 2 months in purgatory, get back to ya on weekends…

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waiting for a job

So, after 7PM last night, on a Friday night mind you, I get my assignment details for the next 2 months, 3 hours away and no clue to what the client wants.  Gee, kinda reminds me of the Elisabeth Shue character in Leaving Las Vegas with Nick Cage 10 years ago or so.  Anyway, the point of this post is simply this, have access to a computer while out of the house, but, doubt I will be doing much posting during the week, so if you are a regular reader, don’t expect much between Mondays thru Thursdays much of the time.  I will check for comments daily, but probably in the evening.  Have a nice Fall, I already am having mine, as in my fall, that is!

elisabeth-shue-as-sera-in-leaving-las-vegas-1995-660x425

(sorry, this was the best picture to make the point above)

Another Black eye for Domestic Violence training and eradication!

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ray rice assault

Not putting up the video, enough is enough!

Wow, after 24 hours of this nonsense, where do we begin to note how fairly much everyone, EVERYONE, has screwed this up and made domestic violence still muddled, and dealing with it first about convenience, not right/wrong!

Let’s list the wrongdoers in this, in no particular order:

1.  Ray Rice:  Zero tolerance for abuse, either as offender or victim.  Remorse by the offender has to be so overt and prevalent, no one could ever say he/she is being insincere or inconsistent the rest of his/her life hereon.  But, as an extension, where were his mother and father in raising him to NEVER hit a woman, unless in self defense.  Forget his peers, they show nothing less than inconsistency and cluelessness overall as a profession.  (and note that offenders are also women, I have seen it first hand in my travels)

2.  Janay Rice:  Marry him just after a couple months from the incident?  Sorry, rule number 1, offenders are likely to reoffend unless they are consistently remorseful and that takes time to reveal, not measured in a couple of months.  What is the mixed message to not only her daughter, but Janays’ family, friends, and the domestic violence victim community she and Ray allegedly are now supporting?

3.  The NFL:  Goodell and company are idiots.  2 game suspension?  And then abruptly suspend indefinitely after the video comes out following week 1 of the season?  Wow, gotta love double jeopardy, and remember that term down the list here.  People think the Commissioner is going to lose his job over this?  This is the NFL folks, even Obama has less power in this country as compared to this league!

4.  The Ravens:  now remember, I am a Ravens fan, so this is a bit personal for me, but, I am more a fan of society and common sense first, so, John Harbaugh who is coach, Steve Bisciotti the owner, Ozzie Newsome the Director of Personnel, and the players, well, let’s assume you all saw this video yesterday for the first time.  This is going to make every one say “wow, this guy Rice is bad news, let’s dump him now!”  Umm, what do you think happened that had Rice in a NJ courtroom facing assault charges back in May?  He pushed her, just slapped her in the face?  We all saw the outside elevator video back in Feb showing him drag her out unconscious.  Something BAD happened inside that elevator, get a clue! This is nothing else but damage control solely by the Ravens.  Glad they lost Sunday, moreso to Flacco and his idiocy, but, karma is a bitch, eh, Ravens Nation!  And I am a fan, but, won’t support poor judgment.  Winning ain’t everything here!

5.  TMZ:  who the hell is this organization releasing a video of this magnitude!?  Even if the property rights to release without permission expired, wonder if the judge for the case in NJ may have something to say about the unauthorized release as the case is NOT closed, as I hear now.  And, the Net in general, what is this now, privacy is now irrelevant in society?  Let me remind humans in civilized cultures, privacy exists to a sizeable degree if you don’t want something aired to the public, unless you wave it by putting it out in the first place by picture, video, post, or comments to the media.  I hope TMZ gets burned big time for this, there has to be a message for accountability!

6.  New Jersey Court:  Umm, they saw this video, count on it.  Another judge who thinks that wives are property, or first offenses are a generic matter, forget the specifics to an incident.  Sometimes once is too much, and the degree of violence needs a degree of consequences.  No jail time for an assault of this magnitude?  Leads to the last one accountable for this mess now…

7.  The public and their pathetic media sources:  Back to #1 per Ray, zero tolerance for abuse.  I have been practicing for over 20 years and see domestic violence and personal assault issues my entire career, and frankly, the lame denials, rationalizations, minimizing and deflecting by others, and sheer ugly projecting at times by the abuser, it all sucks to hear and have to reflect back as absurd and wrong.  What bothers me about this incident yesterday are such:

a.  employers now can fire someone for DV/assault, after the courts ruled and the defendant has accepted his/her sentence and is following it without violation?  Sometimes that is true, but sometimes it may not.  And where is the line for consequences at work drawn, as we are a culture of precedence.

b.  violence may have some shades, but there is a basic black or white here, assault is assault when charged and defined, yet, people still find justification at times, and families sometimes are just so lame in claiming their matters behind closed doors are no one else’s business.  Here’s a fact I have learned in my travels:  when people hit family and the police, fairly much everyone else is fair game to be attacked.  Count on it.

c.  the media has made this so ugly, forget TMZ above for a second.  Who needs to see this video again after 6PM yesterday?  Bet you will see it all week.  Ratings=viewers=money=more poor judgment by TV/paper/Internet.  And back to society, you all watch it to validate the media keep showing it!

d.  supporters of double jeopardy:  the system played this out, and the video was known prior to yesterday, so, why are we  again prosecuting and punishing Ray AND his wife?  And, as I have said earlier, what will happen now, has a precedent been set we can retry people because the original punishment was not satisfactory to the pubic?  Also, what will this do to motivate people to change their violent ways if they see they can be attacked back without just cause?  But, can I get people as a whole to think and change?  Haven’t had a great batting average as a psychiatrist over 20 years now!

(note this is what Janay Rice wrote earlier today as a rebuttal to yesterday’s legitimate circus:

“I woke up this morning feeling like I had a horrible nightmare, feeling like I’m mourning the death of my closest friend,” Janay Rice wrote. “But to have to accept the fact that it’s reality is a nightmare in itself. No one knows the pain that [the] media & unwanted options from the public has caused my family. To make us relive a moment in our lives that we regret every day is a horrible thing. To take something away from the man I love that he has worked his ass of for all his life just to gain ratings is horrific. THIS IS OUR LIFE! What don’t you all get. If your intentions were to hurt us, embarrass us, make us feel alone, take all happiness away, you’ve succeeded on so many levels. Just know we will continue to grow & show the world what real love is! Ravensnation we love you!” )

Note the one group I will NOT mention are the victims of domestic violence who have taken a stand, drawn a line, and note some validation to my chorus of “Zero Tolerance For Abuse, Period!”  They deserve better, and I leave you with this to make sure those who are attentive, responsible, supportive, and insightful remember:

PAY ATTENTION TO THOSE WHO DEFEND AND APOLOGIZE FOR ABUSERS AND ASSAILANTS OF VIOLENCE.  EVEN IF THESE FOLKS ARE NOT VIOLENT THEMSELVES, THOSE WHO DEFEND AND APOLOGIZE FOR SUCH INCIDENTS ARE AT LEAST WILLFULLY IGNORANT, MORESO EASILY MANIPULATED, AND WORST CLOSET OFFENDERS THEMSELVES.

Evil seems to flourish these days, and we have ourselves to blame.

addendum:  nice column overall, read and digest:

http://www.washingtonpost.com/news/act-four/wp/2014/09/09/making-an-example-of-ray-rice-isnt-enough/?hpid=z2

“Knowing this, we should be thinking carefully about what kind of public pressure we want to advocate. In dropping Rice, the Ravens and the NFL have opted for an ostracize-and-isolate model (only after a conspire-to-minimize-and-conceal attempt didn’t work). Overnight, the league ensured that Rice would be persona non grata in the NFL, going as far as to pull his jerseys from their online store. Other retailers quickly followed suit and a local Baltimore pizza shop went as far as launching a Ray Rice jerseyexchange program: free pizza and a $2.70 donation to the House of Ruth for every jersey dropped off. None of this should help us rest easier.

Making an example of someone is far different than setting an example for him.”

Gee, sounds like common sense, that must have been punched out somewhere between Rice’s arrest and his courtroom appearance…

addendum #2:  and this one from Kurtz at Fox News:

http://www.foxnews.com/politics/2014/09/09/tmz-video-packs-punch-ends-pro-footballs-shameful-leniency-for-ray-rice/

“Now for Rice’s enablers. We knew what Rice had done. We saw the woman’s limp body. He had apologized. The team also trotted out Palmer at a news conference, where she apologized (for what? Somehow instigating her own beating?). Yet here’s what Ravens Coach John Harbaugh had to say earlier:

“I stand behind Ray. He’s a heck of a guy. He’s done everything right since. He makes a mistake, all right?”

Geez. A mistake? Failing to pick up the blitz on third and one is a mistake. Not knocking your girlfriend senseless.

Watching Harbaugh duck questions at a news conference last night, and uttering such inanities as “I’m excited about our offense,” was a new low in tone-deafness.

NFL Commissioner Roger Goodell had this to say earlier:

“You know, you have a lot of people voicing their opinions, but I think it’s important to understand that this is a young man who made a terrible mistake. [Rice's actions are] inconsistent with what we’re all about, and we’ve dealt with it in a serious manner, and we’re very confident that this young man understands where he is and what he needs to do going forward.”

In other words, domestic violence just isn’t that important to the National Football League, unless we see the assault on camera.”

However, I do not agree with the author’s opinion about TMZ…

addendum #3 (and last for now Sept 9):

CNN story, I think it does a nice job showing the pros and cons to the role that Janay had during and after the incident:

http://www.cnn.com/2014/09/09/us/ray-rice-nfl-janay-rice/index.html?hpt=hp_t1

“However, The Associated Press reported Tuesday that the news organization has viewed a longer, “higher-quality” video with audio given to it by an anonymous source that shows the couple yelling obscenities at each other in the elevator.

In the video AP viewed, she spits on him, and he punches her, the story said.

“Rice made no attempt to cover up the incident,” the AP reported.”

NOT saying she deserved to be knocked out, but, you don’t spit on people either.  And note I was aware of the incident a few days after it happened, so how much was being withheld, well, I don’t know…

Good thing courts only have a jury of 12, but, where do you house a mob to rule on a public execution anyway these days?  Oh yeah, it’s called the Internet!

Addendum Friday Sept 12:  I can’t believe that Sports Illustrated made the video shot the cover this week, and then just had a 3 page story about it in the front section, part of their Scorecard section to be exact.

After the last 3 days, I stand fully behind what I wrote above on Tuesday.  The dishonest and disingenuous dialogue by so many is pathetic, ignorant, and plain scapegoating BS.  Ray Rice is not the only man to have made a poor judgment to engage in domestic violence, and certainly not the worst example of an incident I have witnessed or been a third party participant in recounting of issues, but, the way the media and the extremist activists are shrieking, now they are attacking fans who wore Rice’s jersey last night at the game?!

I like what Peter Schmuck, a Baltimore Sun sports reported and guest on the lame C4 show on WBAL 1090 here in Baltimore said on that show today, if Roger Goodell really wanted to make amends for his boneheaded handling of the matter over the summer and comments earlier this week, yes, he should donate most if not all of his salary this year, a paltry 44 MILLION dollars, to domestic violence education and programs, and show a sincere and genuine interest to help the public and show the NFL is wanting to be seen as a support to ending/controlling the issue.

But, that ain’t gonna happen, we all know that.  People in positions of power and influence aren’t interested in real change and helping society.  If they did, we would not be in the predicaments at hand in so many areas of this culture.  Obama’s speech Wednesday night shows why we have him as our President, because there is too sizeable a voting block and partisan interests who will defend, apologize, and blatantly lie to make sure his agenda stays in place.

Same with the NFL.  They know that violent players are part of the game, and as long as the gladiator attendance at the stadiums and TVs across the country continue to scream praise and worship for these players, that is where the money is and to be sought.  I don’t fault fans for wearing Rice’s jersey, it might play better if they alter the number or name to show some respect they aren’t wearing it as validating Rice solely, but, come on, any one who wears it “You read that right, many Ravens fans, including many female fans, celebrated Ray Rice by wearing his jersey to the game.

The team offered to accept Ray Rice jerseys in trade at their team stores, and many other Baltimore businesses offered products in trade for turning them in. Still, some fans weren’t interested.

Racquel Bailey, a 23-year-old waitress, told the local Fox station, “There’s two sides to every story. I saw the video. That’s their personal business, and it shouldn’t have affected his career. I don’t agree with domestic violence, but she’s still with him, so obviously it wasn’t that big of a deal. Everyone should just drop it.”

If stupidity were an Olympic event we’d have a medalist right there.”

Another example of why extremists and zealots are only f—-g up America, not finding ways to improve it.  Here is the lame link for the above garbage comment:

http://dailycaller.com/2014/09/12/networks-and-stupid-people-collaborate-to-protect-ray-rice-nfl/

I want to finish this post asking readers simply this:  what are you as observers or direct/indirect participants of ongoing domestic violence in your homes, communities, cities going to do now, that you’ve seen a video?  Going to keep whipping on Ray Rice, or, take a stand on the perpetrators you know of close at hand?  My money is Rice will be the sole victim now, and wait for it, there will be future abusers who will say one of two things from the crap of this week:  “I’ll make sure no one can capture my abuse on any media recording”, or, “why should I make an effort to change my ways when I will be retried and convicted over and over for my past poor choices, I am always going to be labeled evil for my past.”

That is the lesson I learned this week, thank you NFL, Baltimore Ravens, media across the country, the public at large, and perpetrators and victims of domestic violence who won’t make efforts to accept the basic premise of

ZERO TOLERANCE FOR ABUSE/VIOLENCE, PERIOD!

Expect to keep seeing that video through the weekend, more games comin’!

Belated last addendum Sunday Sept 14:  Didn’t want to add something else, but, this link was too good to ignore, after first reading it Friday night and again this AM, AM, I hope readers appreciate the point of view of the victim in DV:

http://www.washingtonpost.com/opinions/he-held-a-gun-to-my-head-i-loved-him/2014/09/12/31fb5720-39c3-11e4-8601-97ba88884ffd_story.html?hpid=z2

Lots to read, this is one of the better paragraphs, to me at least:

“Instead of condemning her [Janay Rice] for loving a troubled man, let’s educate ourselves about the twisted psychology of abusive love, so that we can be there for her if she decides to leave. Firing Roger Goodell and blaming the NFL won’t do Janay Rice, or any other domestic violence victims, any good.

Rather, we should hold abusers — and no one else — responsible for the damage they inflict.”

And, zero tolerance for anyone being abusive or being abused.  Done now.

Maybe if you hear it from someone else, you’ll start to wonder if I am right.

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obamacare lies

I have been saying that Barack Obama is a Manchurian candidate, in this case for the Islamic/Muslim agenda, and everyone keeps rationalizing or minimizing why he won’t call overt Islamic terrorism exactly that, be it the Fort Hood shooting, various foreign incidents, even reports of commentary against America by Islamic/Muslim sources.

What is that?  Sometimes words, or in this case, lack of words, are deeds.  But, No One wants to challenge me in comments, so what does that mean as well?  Silence is validation, or, just dismissing the crack pot?

Well, this link certainly spell out some of the efforts Obama and his ilk cronies across Government agencies and programs have been doing to erode boundaries and expectations by the country.

http://www.foxnews.com/opinion/2014/09/05/president-obama-is-fantastic-success/

“Add it up. Under Obama’s leadership, danger signals are flashing like the neon signs in Las Vegas. The middle class (i.e. consumers) is in shambles. America is at the precipice of disaster from sea to shining sea. And our enemies around the world have lost both respect and a healthy fear of America. The result is chaos and crisis across the globe.

But congratulations are in order for President Obama. He promised “fundamental change” for America. We sure got what he promised.

By his own unique standards, Obama is a fantastic success.”

Hmm, when do responsible and invested Americans finally stand up and scream “STOP”.  Oh, when you are being shot at or bombed, or more insidiously when you are unemployed and without options in your communities?  Why is it human nature only pursues change when life or death issues are front and center?

Not on the screens in front of most of you, eh?

If you want to do temp work in Psychiatry, well, be prepared to be treated like this.

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male prostitute

My dealings with recruiters this past year has basically shown that I am the proverbial “whore” in this line of work, the recruiters are the “pimps”, and the “clients” are the organizations looking for someone to at least fill in the holes in their programs/clinics/hospitals, and boy, you better be ready to be roughed up if you don’t perform as expected!

Three recruiting agencies I strongly advise any physician reader here to NOT work for, hell, don’t even take their calls, if you are considering Locum Tenens work in the coming year or so:

Staff Cares:  greedy and callous

Interims:  incompetent and insensitive

FCS:  clueless and fraudulent

I can name and say those things about the above three because I worked for them, and either the orgs themselves or their clients figuratively screwed me and then left me without any consideration for consequences.

Oh, and this is NOT an overgeneralization, but, most “clients” are looking for temps because the management alone at too many of these places is so inappropriate, that any psychiatrist with half a brain stops working for them as soon as the chaos and incompetence, not only of the administration but often of providers as well, is beyond reproach.

To finish up, this link is NOT a promo for the site providing the info, but, a nice summation of what is expected if you do temp work, hope you read it and ponder the options:

http://www.locumtenens.com/physician-careers/411-of-locum-tenens.aspx

I am going to continue doing temp work, because if what I have dealt with the past couple of years is the basic mentality of most out patient sites at least, there is no way I would work for someone more than a few months.  Feel free to  chime in to agree or dissent, I am interested in discussion!

Leave you with this fairy tale image:

Pretty Prostitute

Hey, at least she was her own boss, had no pimp!

An Impassioned Plea: Please, Please, do NOT vote for any incumbent in office more than 12 years in November!

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purple opening

This is my picture for the PURPLE PARTY, do not vote for any person in state or federal office in November who has been in office for more than 12 years, as I completely believe until random chance proves me wrong otherwise, you are just reelecting narcissistic and antisocial cretins to rule you further.  After what is going on with foreign violence and frank brutality, stupid domestic policies like health care and immigration, and just ongoing disrespect for the constituents per comments and revelations across the country, you owe it at least to future generations to not subject them to this disgusting display of selfishness and self destruction ongoing.

Obama is a Manchurian candidate, you all find out the hard way by the time he leave office in 2017!

Disposable Doctors.

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Dr janitor

This is Dr Jan Itor, or, a doctor who is just a janitor, or, doctor being treated like a janitor.  For readers with a memory, yes, I wrote an earlier post about doctors being treated like janitors, here it is:

http://cantmedicatelife.com/2014/03/21/i-am-not-a-psychiatrist-anymore-just-a-glorified-janitor-cleaning-up-the-messes-of-people/

Well, with this being my 500th post, what have I learned since I began over 21 months ago?  Being a psychiatrist really is a shit job, after this morning where I had to walk out of my new assignment as a locum doc, following the clinic giving the recruiter notice last Friday they wanted to end the assignment just 3 days after I started, for no reason in the letter.  Gotta love being seen as “fixing a hole”, or, “plug a need”, or just plainly “see our patients until we find a perm replacement”.

I wanted to write a lengthy post, being the 500th one, but, after the crap I had to wait through to get to today, I am beyond burnt out, I realize now I work with so many antisocial losers as administrators, colleagues, therapists, and support staff, you have to wonder who really cares about providing patient care anymore at most sites.

Don’t know when I will be writing another post of any real substance soon, so, have a nice rest of summer per the calendar year definition.  Good luck if you are a patient looking for honest and sincere care, I hope you find it. Me, I am just looking for work to provide care the way I was trained for the 3-4 months I will be employed at the next temp job.  Sounds less than invested, but, after all the times I have been screwed by people in my Locum travels these past 4 years, well, it just gets old.

Enjoy…

500

Next, I’ll note what is offensive about Correctional Psychiatry…

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correctional psychiatry

I am finally finished my current assignment west of Baltimore, and the last day was textbook for what goes on in too many Community Mental Health Clinics these days.  Addicts, antisocials, and dissenters to standards of care, that sums up at least 60% of what comes in for alleged mental health care.  But, these antisocials who have perfected how to be irresponsible, impulsive, and immature and make it a psychiatric disorder, well, how many of these folks can a provider see day in and out before it gets annoying and disruptive to the clinic, I just don’t get it!

The last few weeks both in the news and my personal travels have reinforced what I really believe is inherent about antisocial disorder:  there are cultures, religions, and governments that have an entrenched, if not growing element of this sociological nightmare that is truly equally nature and nurture in cause.  I will not spell out specifics, but, I think the attentive and responsible readers know who and what I am talking about.  Here in the US, they claim the stats for real Antisocial Personality Disorder is about 2-4%, but, I think it is now over 5-6% easy, so, above random chance folks.  That means, in my opinion, there are at least 1 out of every 20 in a room who are antisocial, if not even worse, sociopathic.  And there ain’t a damn thing I can do as a psychiatrist to help these folks, not that 95% of them want any help to begin with!

So, getting to this top story in the August issue of Psychiatric Times, another APA hack newsletter at the end of the day by the way, here is the story:

http://www.psychiatrictimes.com/forensic-psychiatry/treatment-persons-mental-illness-prisons-and-jails-untimely-report

In there was a lot of interesting statements, this is one to intrigue and enlighten:

“The first recommendation, foreseen in the Joint Report’s introductory paragraph as well as in how the
data were obtained and presented, was: “Provide appropriate treatment for prison and jail inmates
with serious mental illness.” Even within the discussion of this recommendation, hospitalization is
not mentioned for the seriously and acutely mentally ill, who, were they not incarcerated, would
most certainly be hospitalized. Instead, legislation is proposed to allow involuntary medication, and a
“model law” patterned after the Washington v Harper2 decision is included in the appendix.

The Washington v Harper decision has been generalized to correctional settings, including jails.3
The policy that met constitutional approval in Washington v Harper was a policy specific for the Special
Offender Center, the purpose of which was “to diagnose and treat convicted felons with serious
mental disorders,”2(p214) also referred to as a hospital, not the rest of the Washington State Prison
System and not for non-medical correctional facilities. No mention of these distinctions was made in
the Joint Report. Although the Joint Report has no legal authority whatsoever, it will now most
certainly be relied on to support and expand the practice of involuntary medication in jail and prison
facilities, thereby further reducing the perceived need for and use of mental hospitalization.”

Also was this, “As the practice of involuntary medication in non-medical correctional facilities becomes more widely
institutionalized, any political or clinical motivation for restoring hospitalization will continue to fade.
Policymakers, correctional administrators, and correctional mental health providers will do what
comes naturally: they will justify their actions and, consequently, the newly devolving status quo in
correctional health care.”

My interpretation is this:  yeah, they don’t want these people in the hospital, because that costs the states money, and it is easier to just dump them back on the streets.  But, who is going to provide this “involuntary medication” treatment?  Yeah again, the CMHCs, and what are the antisocials gonna do when they get out and realize they are free to prey again, but, to not overtly violate parole and probation, who they gonna pick on first, dudes?  Providers, because we are now an extension, without being asked mind you, of the courts.  Sure, we will be respected and loved by many from these institutions of corrupted learning.  We feel your pain, folks!

I get it, there are real psychiatrically impaired people in prison for fairly much minor felonies, if not trumped up misdemeanors as the police want these people out of their jurisdiction, because cops are becoming equally antisocial and can’t figure out how to deal with impaired people, well, outside their own personality disordered ways (I’ll deal with the growing antisocial element in the police force in the coming weeks).  But, these sweeping generalizations by politicians and judges, is anyone else sick of this crap besides me?

I want to finish with this though, as probably one of the most offensive things that parallels the earlier post this week how a Muslim woman was offended to read the word “Bacon” on a street sign:

http://www.independent.co.uk/news/people/billy-crystal-leads-robin-williams-emmys-tribute-awards-show-criticised-for-choosing-racist-joke-about-iranian-woman-9690355.html

What is wrong with this religion, are Muslims/Islamists so shallow, vain, and without any ability to be a bit self depreciating for one moment of the day that there is absolutely nothing funny in their religion?  Williams right after the Iranian Woman bit then made a joke about Jews, which to me was equally hilarious, and are Jews demanding a retraction?

No, and you know why I honestly believe is one strong reason people across the world hate Jews?  Because we can laugh at ourselves, because we have the ability to be self depreciating when it is tactful, yet appropriate as well.  And that seems to be a tough trait for a lot of cultures, religions, and political bodies.  Gee, which seems to mirror my opening, and believe me when I say this, antisocials have a tough time honestly laughing at something that makes fun of them.  There’s a test that could trump a polygraph!  Oh, and by the way, I know Madoff is jewish, so don’t go there I am making a claim there are no antisocials in Judaism.  But, as far as Hamas goes, well…

Next post, believe it or not, is number 500.  Have no freakin’ clue what to write about.  Maybe during the weekend?…

Robin-Williams-iran-Getty  ENJOY!

I’ll stick to what I find offensive, starting with the APA.

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APA Newsletter

I still don’t know why they send their biweekly newsletter to me, I am not a member, did not ask for a complimentary copy, and certainly am not interested in their propaganda.  But, I will say this, it has been interesting what they promote and support, and you have to like their “tag line” for the periodical, “THE FIRST AND LAST WORD IN PSYCHIATRY”.  Talk about huge ego and chutzpah at the same time, sheesh!

This issue, the Aug 15 ’14 one, Vol 49 #16, had some interesting articles.  The link is http://www.psychnews.org, I’ll leave it to anyone interested to see if they can peruse the site without having to join.  The cover article, “New White House Drug Policy focuses on science of Addiction”, talks of how this current administration wants to promotes treatment, and end the needless incarceration of addicts.  Yeah, seems to me they don’t want to address ANY legalities to substance abuse, Holder et al are going to focus solely on the “serious high level violent traffickers“.  So, the comic, lighthearted, lower level (based on what?) and non violent, I assume meaning no weapons or people being killed or hospitalized, are free to sell drugs.

With the New York Times promoting the legalization of pot across America ASAP, well, we’ll see how trivial or non complicated this would turn out if it happens.

Moving on, page 28 had an article, “Manual Updates Sleep Disorder Diagnoses”, and in there was this stat:  Some 231 psychiatrists are among the 8,655 members of the American Academy of Sleep Medicine.  That is close to 3% of the total specialists in this field.  So, why are psychiatrists being referred all these insomnia patients when we as a profession aren’t the experts in this field?  I’ll tell you why, because psychiatrists are the most liberal in writing for sleep meds, albeit PCPs/NPs are probably close to equal in frequency at the end of the day.

But, sleep disorders as of this decade are a specialty profession.  So, why the hell am I being asked to diagnose and treat it without the diagnostic procedure access?  Sleep studies are the primary tool here, so, maybe PCPs/NPs/FPs need to remember that trivial fact and look for a diagnosis, not a dump.

There were a couple of other articles that were just lame, the parity issue being touted by the APA as being resolved, the front page had separate articles about alleged progress in New York and California, but come on, the insurance industry is NOT a friend of psychiatry, so who are the APA folks kidding at the end of the day.

I will end with the article on page 31, which I spoke of in an earlier post, “Potential Biomarker for Suicide Vulnerability Identified“, and I just want to point out to readers this PhD guy, Zachary Kaminsky, and keep track of who and how much he is earning for himself and Johns Hopkins in the next couple of years with this “research”, and how it impacts on the military especially.  I sense the facts will not be too motivating for the general public.

As I approach my 500th post for this blog, I will probably write more of what I find offensive in my profession, and maybe some of you might be offended too.  I will end this post with this simple fact, in the past 4 years of working in various aspects of psychiatry, I can say without hesitation I meet VERY FEW psychiatrists who are not guilty of not only medicating without hesitation, but are quick to use polypharmacy of three or more meds within a couple of visits, and diagnose patients with very specific, limiting diagnoses on day 1 that shows one of 2 things:  omnipotence that would make a God envious, or, a narrow vision if not a bit of an arrogance to “know” a person so well from at most a 60 minute visit to be able to tell them exactly what the problem is and what medication is needed.

Oh, and to this day, why I still meet patients who tell me I am the first psychiatrist they have met, some having been to 3 or more prior to seeing me, that asks them to be in therapy.  What the Hell is That!?

Per Paul Harvey, Good Day.

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