Is There a Problem in Finding Ongoing Therapeutic Psychiatric Care? Absolutely. But There Are Alternatives.

Is There a Problem in Finding Ongoing Therapeutic Psychiatric Care? Absolutely. But There Are Alternatives.

I have had a psychiatrist for about four years who has been an ideal match for me. Not only did he find the right cocktail of medicine that finally stabilized my bipolar condition, we became friendly and spent a lot of time talking politics. He always had insights and recommendations when I would become depressed or I was caught in a disabling loop of self-recrimination.

However, now he is retiring.

Recently, he sent out a letter with some potential mental healthcare possibilities after his retirement. Trying to replace my skilled psychiatrist led me to understand the massive shortage of psychiatrists that we are facing.

From his list, I chose the psychiatric division of a medical group affiliated with a large hospital network on the North Shore. I was told that I needed to fill out a form that the practice would consider at a weekly meeting. In addition, I could only apply to be seen if I was referred by a physician in the health system. That is because otherwise they would be overwhelmed with applicants. A psychiatrist was interested in my case, so I received an appointment. However, I was informed that it was only for prescribing meds.

I asked about therapy and was told that there was a waiting list of 550 people and when asked if I wanted to be put on the list, I responded to the administrative assistant that, quite honestly, I would die before I got to the top. She apologized and said that they only had seven psychiatrists and that they couldn't meet the demand.

The Association of American Medical Colleges (AAMC) corroborates my experience by describing shortages of psychiatrists around the country:

"Within a few years, the country will be short between 14,280 and 31,109 psychiatrists, and psychologists, social workers, and others will be overextended as well, experts say.

“We have a chronic shortage of psychiatrists, and it’s going to keep growing,” says Saul Levin, MD, CEO and medical director of the American Psychiatric Association. “People can’t get care. It affects their lives, their ability to work, to socialize, or even to get out of bed.”

Not only is there a shortage of psychiatrists -- for a number of reasons including the fact that an estimated 60% of psychiatrists are over the age of 55 and retiring -- the waiting lists for psychiatric care means that those with mental illness cannot have the opportunity to "shop around" for a psychiatrist who meets their needs. If you are lucky enough to find a psychiatrist who accepts insurance (and for seniors that means Medicare, which most psychiatrists don't accept), many individuals need to grab the appointment, whether or not the psychiatrist is someone they are entirely comfortable with.

I know, from personal experience that I needed treatment options. I had a very affable psychiatrist a few years ago who charged me $140 for a once-every-3 months 20-minute medication consultation, cash or credit card only, and no therapy. Such care did not meet my needs.

The good news is that there are alternatives to psychiatrists for talk therapy, including licensed clinical social workers (LCSW's), licensed professional counselors (LCPC's), psychiatric nurse practitioners, and psychologists (PhD or PsyD's licensed). Psychoanalysts are for long-term intensive commitment. They often do not treat more severe mental illnesses and are generally quite expensive.

With some but not all of these potential choices, you are more likely to receive talk therapy than getting an appointment with a psychiatrist who offers it. And you will have more choices to meet your needs for what you want out of therapy.

Some people with mild mental illness choose their primary care physician for meds, but not for talk therapy. But if you choose to go that route, make sure your doctor is familiar with treating mental illness and has a back-up team. 

In all cases, you must be the strongest advocate for yourself and get care when you are not in a crisis to enable you to prevent a crisis.

In short, not only do those with mental health challenges need to find daily ways to diminish their illness's effects, they must navigate a system of mental health providers that is becoming increasingly short-staffed.

However, there is a good possibility that you will successfully find treatment, but do not limit yourself to seeing a psychiatrist as the only alternative.

Mark Karlin is retired, after a long career in advocating against gun violence, as a hospital executive and founder of a progressive website. He graduated from Yale University with an honors degree in English.

The Inner Peace of Coming Out

The Inner Peace of Coming Out

If I tell someone I have bipolar disorder, the last thing I want is pity.

Pity implies that I have some dreaded disease and that I need thoughts and prayers, as if I am stricken with cancer and about to die. I may have a mental disability, but most of the time my relationships with family and friends are now just fine.

Pity creates an unbalanced relationship in which your friends, family members or colleagues regard you as having a weakness that they have to tiptoe around and treat with kid gloves.

As my psychiatrist told me, I was born with severe bipolar disorder and didn't have a chance to reduce its devastating impact until I was diagnosed and the right cocktail of medications established. Even then, he advised me that I was always going to live with the chance of bipolar moods emerging or maybe not. Coming out is an opportunity to free up the isolation chamber of the mind and integrate oneself into society and build a support network that branches out like roots from a tree and can prevent isolation.

We all face the sometimes daunting question of who to reveal our mental illness to and how.

There are many considerations that require different criteria to tell someone that you have a treatable mental condition.

First, there are immediate and extended family members. Your immediate family may already know that you are struggling to live a healthy life and enjoy yourself as much as you can and are supportive. This, unfortunately, is not always the case.  

Your extended family may be shocked or find themselves regarding you as a "different" person, or they may respond with acceptance. You need to take the stigma that they might attach to you as a teaching opportunity.

Then there is the often intimidating question of coming out to friends. If a friend has a visceral negative reaction and starts ghosting you, then they probably weren't a true friend to begin with. They may feel uncomfortable with being around you and distance themselves, as if having a mental illness is a communicable disease. In short they now regard you as a pariah.

However, it is important to remember that empathetic friends, on the other hand, can help you through your struggle. The disorder might not change the relationship at all when you are in remission. They are invaluable. If you have a relapse, they may provide vital support.

How to handle disclosure in regards to work requires careful reflection. If you are looking to be hired for a position, do you want to casually say at the end of the interview, "By the way, at times I have depression, but I am under treatment, and it shouldn't interfere with my job"?

Or do you want to avoid any possibility of not being hired because of possible prejudicial stigma? Each person must come to their own decision. And if you are hired, do you tell your colleagues?

In most cases, reveal yourself when it seems natural. You don't want to blurt out your disorder out of the blue. If you appear at peace with your disorder, you are conveying that it is nothing that should scare other people off. You want to impart that it is a natural part of your life, not a crisis that might cause alarm.

Of course, there are always people from any of these groups who might regard depression as a self-imposed and fabricated state. They believe that you don't really have a mental illness,  asserting that "temporary melancholy" is just a natural way to respond to the world in these troubled times. They might advise you to "shake it off" and get on with life, 

Whatever your decisions about "coming out," do not think of it through the lens of fear.

Consider it an opportunity to exercise some control over your disorder, allowing you to become liberated from the trepidation that you will be "exposed."

As jazz vocalist Gregory Porter sings:

Take me to the afflicted ones
Take me to the lonely ones
That somehow lost their way

Let them hear me say
I am your friend
Come to my table
Rest here in my garden
You will have a pardon

We all merit a "rest in the garden," and coming out may provide a moment of inner peace that we so richly deserve.

Mark Karlin is retired, after a long career in advocating against gun violence, as a hospital executive and founder of a progressive website. He graduated from Yale University with an honors degree in English.

Maybe that's why they are called Camp Counselors?

Maybe that's why they are called Camp Counselors?

Anyone who works with children and adolescents must be attune to their emotional needs. This is especially true for overnight camps. At many camps there are staff members devoted to the mental health of their population.

Back in the 19’s (as my kids like to call it) that wasn’t the case. Do kids have more mental health problems today than they did 25-50 years ago or are they just not swept under the carpet?

I cannot answer that question. What I can tell you is I remember the first person who “saw” me was a camp counselor at a Jewish overnight camp.  In two weeks, she picked up on two problematic behaviors: frequent stomach aches requiring the attention of the nurse and self deprecation as humor.

One Shabbat we took a walk, and she asked me,

“Why do you only make jokes about yourself?”

“Why do you always hold your stomach?”

“Why did you tear up that letter from home?”

She taught me the phrase “low self-esteem” and explained that I had an inaccurate picture of myself. Knowing that my family had drawn the picture, I could see she was unsure of what to do next.

After her next day off, Taryn brought me a journal to write in. “I want you to write five positive thoughts about yourself every day,” she said. “Then you can see yourself as everyone else sees you.”

I honestly don’t remember what happened next - if I wrote in the journal or not. As an adult, I can recognize that while Taryn was well meaning, perhaps she was a bit out of bounds. Today, we’d tell Taryn to bring her concerns about me to someone with more qualifications. I would say the same.

But that doesn’t change my experience: Taryn in identifying that the way I felt about myself was not normal and that the way my family spoke about me was inappropriate, and as I’ve come to understand, abusive, was empowering. She couldn’t take away my pain, but she started my journey of change that began as a little girl and continues every day of my life.

So thank you to all of the camp counselors, social workers, unit heads, assistants, all of you who help kids, “see them,” and do so much. You are the unsung heroes of summer and we appreciate you.

-anonymous is a writer and teacher who has struggled with anxiety, depression and body dysmorphia since the 19’s. 

Don't Get Hobbled by Regret

Obsessive regret, for many people with mental illness, can be toxic and potentially undercuts a tenuous stability during recovery.

Regret emerges in response to recalled destructive memories, but not in a nostalgic sort of way. It focuses negatively on the past instead of the promise of the future. Regret fills the mind with mourning for what could have been different in our lives, particularly what our lives would have been like if we did not have a mental illness. It cannot go well.

Managing a mental disorder requires learning how to walk into the future without being maimed by the unsolicited burden we carry through life. I know this because I am 73 and only diagnosed with bipolar disorder a few years back.  During my vicissitudes of the mood disorder, I had occasional rare opportunities, call them rare moments of fleeting remission, to look back at the egregious mistakes in my life and my squandered opportunities. But I was bewildered, not knowing that mental illness was running through me like a turbulent river.

In the past few years, I now have the knowledge to understand my past behavior. It has awakened a clarity of understanding about what I did and why. However, I am very wary of lapsing into a melancholy or depressive state of regret. I am glad I awakened to my illness slowly because a realization of my hobbled life, if too sudden, could have led to suicide. For some people, the weight of ruminating on what might have been becomes an albatross that can drag them down beneath the raging waters of self-recrimination.

The famous American poet Theodore Roethke resonantly captured this challenge. I have my own interpretation of his words (which for him are about facing aging). I must not allow myself to trigger a precipitous downfall when I am mortified by an awareness of how I have not been in full control of my past life. In his poem "The Wakening," Roethke wrote:

I wake to sleep, and take my waking slow.

I feel my fate in what I cannot fear.

I learn by going where I have to go.

We think by feeling. What is there to know?

I hear my being dance from ear to ear.

I wake to sleep, and take my waking slow.

Regret is only useful to me, given my history of bipolar, if the past can inform the present, resulting in actionable change.

I have many regrets about relationships that I mangled into oblivion.  But I cannot go back years upon years to rebuild them. I was in a cocoon of depression and mania, while my friends, who I often alienated, moved on with their lives. I can ask for forgiveness, but I can't restore the lost time that would have fostered attachments to people like a tree with its root system of support.

Dwelling upon regret can, in itself, just create another regret, not regret for the past but regret in the moment.

Better to walk confidently into the future, with all its possibilities, through the door opening before you.

Mark Karlin is retired, after a long career in advocating against gun violence, as a hospital executive and founder of a progressive website. He graduated from Yale University with an honors degree in English.

The Ripple Effect of Gratitude

The Ripple Effect of Gratitude

I've wrestled with an enduring sense of powerlessness and melancholy throughout my life. Therapy sessions became a familiar backdrop from my middle school years onwards, and I even ventured into the realm of becoming a therapist myself. Personal growth wasn't just a hobby; it was my daily bread - podcasts for breakfast, self-help books for lunch, and peer-reviewed articles for dinner. Yet, amidst this relentless pursuit, a nagging question persisted: Why didn't I feel any better? Despite advocating self-care and healthy habits to others, I struggled to practice what I preached. 

Each new year brought resolutions that fizzled out within a month or two. I pledged to be kinder to myself until the inevitable stumble. I committed to daily gratitude until a lousy day clouded my perspective. I embarked on fitness routines until a missed session derailed my efforts. Invariably, I found solace in the familiar embrace of powerlessness and gloom. This was my narrative, a journey where everything seemed futile, akin to chiseling away at a glacier of troubles.

Yet, amidst this darkness, a glimmer of hope emerged - the practice of gratitude.  While intellectually aware of its scientific benefits like increased positive outlook, decreased levels of depression and anxiety, correlation with better physical health outcomes, and more, I initially dismissed the notion that jotting down three things I'm thankful for each day could alter the trajectory of my life.

 Nevertheless, desperation spurred me to try, and with the support of accountability partners, I embarked on a journey of transformation. Recognizing that my struggle was shared, I enlisted my closest friends in this odyssey of personal development. Thus, on January 22, 2023, our "personal growth group chat" was born. 

Each time I missed a day while my friends remained consistent, I felt the weight of my absence. Yet, delving into their entries reminded me of my commitment and deepened our bond. It was a rare glimpse into the minutiae of their daily life, illuminating the simple joys that often go unnoticed. As someone who cherishes social connection, I felt that this window into their lives brought a sense of closeness I didn't know was missing.

My contributions to the chat initially revolved around the expected - the conventional blessings of family, shelter, and sustenance. But gradually, my perspective shifted. I found myself celebrating the small wonders: the comforting warmth of morning coffee and a stranger's kindness in the rush hour hustle. These authentic expressions of gratitude nurtured mindfulness, anchoring me in the present moment and amplifying my appreciation for life's fleeting pleasures.

With time, my entries evolved from mere sentences to heartfelt paragraphs, each infused with the essence of why a particular moment brought me joy. Reflecting on the more profound significance of these experiences elevated my gratitude to a soulful level, enriching my journey in ways I never imagined. And now, as I reflect on over a year of shared exploration with my friends, I marvel at the profound transformations wrought by a simple practice. In this journey, I've gained more than I could have ever imagined: 

1. I experienced a heightened sense of connection and gratitude within my circle of friends. 

2. Monitoring my daily moods through a free app named How We Feel since embarking on this journey revealed a significant shift (See below image). In January 2023, the majority of my emotions skewed towards low-energy unpleasant feelings, followed by low-energy pleasant feelings, high-energy unpleasant emotions, and high-energy pleasant experiences (Image A). However, after a year and three months, the landscape had transformed. Now, low-energy pleasant emotions topped the chart at 42%, with low-energy and unpleasant emotions following at 29%. High-energy pleasant emotions constituted 19%, while high-energy unpleasant emotions trailed at 10% (Image B). This transformation departs from the presence of powerlessness and sadness that once dominated my emotional landscape.

1. This seemingly small habit cascaded into other positive changes. Collaborating with my friends, we initiated mini-challenges to complement our gratitude practice. From abstaining from late-night eating to limiting social media usage and incorporating exercise, we leveraged our group dynamics to monitor and enhance our progress.

2. Embracing the adage, "If you want to go fast, go alone; if you want to go far, go together," has become a guiding principle in my life. Through firsthand experience, I've witnessed the transformative power of social support. While this wasn't my first attempt at maintaining a gratitude list, it marked the first time I succeeded in sustaining it long-term.

3. At last, my relationship with myself has blossomed. I now have confidence in my ability to keep the promises I make to myself, and I perceive myself through a lens of positivity.

Today, I stand as a testament to the potency of gratitude and the transformative power of tiny habits. This journey, once dismissed as insignificant, has left an indelible mark on my being. Through this post, I express my deep gratitude to my dear friends Shaylee and Tina, whose unwavering support and camaraderie have propelled me towards a brighter tomorrow.

July B. in the middle surrounded by her friends Shaylee and Tina in 2018.

Written By: July Bayasgalan