 
Dr. Gonzo

A series of loosely related essays on equality, visibility, and modern mental health  
or  
How the Mental Health System Drove Me Crazy

### by Deb Hoag

### SMASHWORDS EDITION

Published by Unlikely Books  
http://www.unlikelystories.org/unlikely_books/

A series of loosely related essays on equality, visibility, and modern mental health, or, How the Mental Health System Drove Me Crazy © 2010-2012 Deb Hoag

Author's Request for the Electronic Edition

Scintillating prose, like bread alone, is sometimes not enough for a writer, much less a publisher, to live on. The grim reality is, we all need a little cash from time to time to keep body and soul together. Even with day jobs. Although I would love to be able to write purely for the accolades and sense of satisfaction that comes from putting 'the end' on a simply mahvelous piece of fiction, ultimately, printers need feeding too. Laurels are nice, but rough on the palate and generally too much fiber for me. Therefore, it becomes necessary for me to entreat you to honor my beloved publisher's request that you pay—cash money—for this book. Honestly, you'll get your money's worth. Incredible but true, you may actually find that it scratches the itch that more mainstream manuscripts cannot. Simple fact: our books have more fingers than other books. Because of this, and a plethora of other benefits as well, we simply urge you: be honest, be fair, and God, please be affluent enough to cross our palms with silver. Ours is not a simple life. Ordinary, neither. Knowledge, good karma and possibly a spare set of kidneys could be yours, but only if you buy this book first.

Author's Note

The characters in _Dr. Gonzo_ are fictionalized representations of events that have occurred in a lengthy and varied practice over several decades, dressed up in party clothes, including the doctor, herself. Please note that while I share many of the good doctor's opinions, I have, to date, never been Tased in the practice of psychotherapy. One never knows, however, about the future.

Without my good friends and co-conspirators Jonathan Penton, Adam Lowe, Bill Highsmith, Donna Snyder and Tom Bradley, I'd still be writing, but couldn't imagine having nearly so much fun doing it. I'd also like to acknowledge the fabulous crew at Flash Fiction Online and all the crazy writing fanatics at Hatrack River for the experience, the crits and the band-aids as needed.

As always, this book is dedicated to my fabulous husband Chuck, whose encouragement, grace under fire and sense of humor make it all doable. Plus, he put up with a boatload of really loud John Mellencamp to get me through this.

Damn! another book my kids won't be allowed to read till they're thirty!

Chapter One: the Doctor is In

Or

How I developed a guerrilla attitude

in a therapeutic setting

Introductions

Tap, tap, tap with the pen, and waiting to hear footsteps down the hall. That last-minute check, do I need to pee? Can't leave once the client gets here, so peeing is important. Don't want to be stuck for an hour while the pressure builds up, like a panicked kid stuck on a church pew between a sanctimonious mother and stern father. Should I turn the thermostat up, down? Is that gas building in my stomach? Horrible, to be inside a small room and get gas, watching the client's face for signs he or she smells it, not acceptable to simply say "excuse me, mind if I fart?"

_Tabula Rasa_ , blank slate. Freud wasn't the proponent of tabula rasa that people think he was. He saw patients in his home. He knew them socially. According to at least one patient, he knew them Biblically as well. He ate herring with them and shared his beloved schnapps, a little alcohol to lubricate the dream machine.

There are several different meanings to the phrase _tabula rasa_ and the term is employed in a number of different fields; the meaning I refer to here is the one that is used to justify the cool distant cut-off between therapist and patient. A therapist who is a blank slate to the client thereby becomes a screen on which the patient's beliefs about self and others are projected, allowing the therapist greater insight into the inner mechanisms of the patient's psyche. This works great with patients who have a borderline personality disorder (BPD), by the way. In fact, it works so great that you don't really need to maintain a blank slate at all, because: A) patients with Borderline Personality Disorder find out everything about you anyway, and B) even when someone with BPD knows everything there is to know about you, they project like hell regardless.

The client's getting closer as I flip through my available game-faces, so to speak. Matron, patron, therapist, geek. Advisor, counselor, fix-it chick, chief.

So many things to think of, so many things to do before the client comes stepping softly down the hall, stomping down, sashaying down. Where the hell is the schnapps when I need some?

More tapping as I wait, and then he comes, secret center of my world for a little while, for a short while, for that brief slice of my life, a single hour, like a drop of crystal that shimmers and drops from the branch. The most precious thing I have in life is my time. It's all mine, and all I really have to give. What's money except the physical manifestation of time I have given away? Isn't that the crux of slavery, of school, of taxes—having our time forcibly taken from us?

Tap, tap, tap and I wait, as preoccupied with my bodily fluids and gasses and processes as any anal-retentive, excrescence-obsessed, certifiable lunatic. _Flatulence, let me have none_ , I pray to the God of Disgusting Body Functions. With each client I accept, I am forced further and further into a childlike state of my own making, the lofty doctor who plays in the mud. I went to school with people who were in love with the idea of being a doctor and all that the position implied—nobility, wisdom, culture, wealth. Now they spend eight hours a day—eight forty-five minute hours a day—with people they never would have willingly let take out their trash in any other circumstance. Does the irony strike them? Do they become humble, more kindly, more Christlike in their practice? Or do they bury the dichotomy in dreams of social climbing and pretend it doesn't exist?

My fingers drum madly as I contemplate the frozen faces of colleagues past, nostrils pinched in distaste at the undergrad students rushing through the hallways. Do they sit and mimic compassion now as a stinking bundle of insanity sits on their tasteful furniture and talks shit? Talks shit about shit, while they try not to hear and pretend to listen. I had a co-worker who kept a couch cover especially for schizophrenic company, slipping it clean over her furniture before the most offensive clients came in, and then peeling it off immediately following the session to be washed, so that no putrid, crazy ass-cheeks could contaminate her lovely wing-back sofa.

There is a timid sound at my door, knuckles brushing softly on the wood, and I call 'come in.' The door opens slowly—just a few inches—enough to admit the face of this morning's patient. His eyes are serious, frightened that the Holy Roman Doctor is going to find fault, is going to reject, humiliate, crush him for his failures. He's been to counselors before, plenty. But the PhD throws him.

I stop tapping. I smile. I say, "come in and make yourself comfortable. I need to step out for just a minute."

He shuffles in, cautious, in case this is a trick, and gingerly sits on the edge of the chair facing mine. I stand and smooth my trousers, then make for the door. I have to piss like a racehorse, and I sprint down the hallway for the john.

Behind me, I can feel the questions rising up like proverbial crows, flapping around the client's head. " _Is it me? Is it me? Is it me?_ "

Reality Is . . . Equality

I am a firm believer in equality. Talk to any crazy person for more than two seconds and the theme of the better/worse merry-go-round will emerge. It was the subject of my dissertation, although, disappointingly, the results were inconclusive. I got screwed by my advisor, my dissertation 'chair,' although not literally. Put it all in the hands of my assigned authority figure, counting on him to care one-tenth as much as I did. One of my last great personal hurrahs in the greater-lesser dance.

Equality is the principle of being equal. I used to divide everyone I met into two groups: better and worse. So do most other crazy people. It was a distinction around which my life centered, and which resulted in the intestinal elevator drop more than once, when my ranking system turned out to be flawed on this occasion or that. Is there anything worse than to be an arrogant, self-serving, supercilious bitch and find out that the person you thought was beneath contempt—and treated accordingly—had been given power over you? Worse yet, and more confusing, was when the fuck-head in question didn't twist the knife. Worse because it was incomprehensible to me at the time that someone would just be kind, or forgiving because it was the right thing to do. I lived and breathed fear of retaliation, of revenge anticipated but infrequently delivered. I can honestly state that I have rarely run in to anyone who was more of a bitch than I. Good for me, I suppose, not so much for anyone I came in contact with and determined was out to harm me, with my pathetic, flawed, paranoid, angry, demented malevolent psyche.

The funny thing was, when I quit drinking, and doing cocaine, and smoking pot and hashish and taking speed, it was presented to me that I needed to go around and apologize for all that shit. I've come to highly recommend apologizing as a tool to maintain a clear conscience, but at the time, was just getting used to the idea that a conscience was a desirable accoutrement; apologizing was about as high on my list as puking in public.

Which is okay—doing the right thing, even though you don't feel like doing it, builds character, character-building currently being a skill that is greatly underrated in this culture to my way of thinking. I advocate if for people on a pretty regular basis, and they sometimes pay good money to hear me suggest it. Mostly, they just look at me funny and then go see if someone else has the magic pill that will make life's difficulties go away without having to _do_ anything.

Equality. The equalness of two different things, people, objects. Equality, that calm resolve that blankets the knowing equalicist, the comfort of knowing that the arrogance of others has no meaning, the discomfort that comes with asskissery by fools who haven't figured it out yet.

When I think about equality, about the long process to achieve it, believe it, live it, I think, _why?_ Why is it so important to believe that we are all equal? Not equally intelligent, equally educated, equally financed, but equally important and precious and deserving of respect and care.

Because it's the only way to explain everything.

When I rank and prod and poke to determine someone's value by some arbitrary standard, the possibility that it will blow up in my face is nearer a certainty. Whether I is depending on someone else to know the answers to questions I have bothered to apply myself to, or stomping on someone's neck to maneuver myself a little higher up the life-choking ladder of success.

We're a nation of rankers, a community of let-the-specialist-do-it and let's-rip-out-their-eyeballs-and-skull-fuck-them-to-death-if-they-screw-up armchair quarterbacks in every field from automobile manufacture to spleenectomies. We're a holy congregation who sings the eternal songs of 'I need it more than you' and 'judge me by my insides and I'll judge you by your outsides.' And mea culpa, momma, I've sung the same refrain.

A long time ago, a dear friend who hated my guts told me: "True humility is being your right size—neither bigger nor smaller than you really are." In _Don Juan, a Yaqui Way of Knowledge_ , the don of black-dog dreams says that a true warrior is humble, and that being humble does not mean bowing before others, but in not letting others bow before you. When we live anything else, we live a lie. And for some reason, regardless of what we would like to believe, we seem to have been constructed so the truth will literally burst out of us, or burst us, if we try to stuff it down, ignore it, or stomp it to death.

Truth outs itself. Invariably.

So, here I am, in my nice little office, with my slightly fetid client/patient/customer/partner-in-wellness/co-conspirator in the pretense that I have no flaws, pretending I don't pee, don't get gas, get cold, get hot, don't do _anything_ human, while he anticipates me telling him that a quick tune-up to his self-esteem will relieve him of night-terrors, hallucinations, mania, depression, hemorrhoids and that horrible smell, obviously directly related to poor self-image.

I once wrote a piece of fiction that started out in a homeless shelter, and the first character to be described was the director of the shelter. A reader immediately fired off an angry email, telling me how fucked up I was to write about things I obviously didn't know anything about. I admired her spirit, but was left wondering where she got the idea that I was immune to homelessness and poverty. Was it because I had access to a computer and Internet to post the story? Does my current fortune or misfortune extend like a magical umbrella to negate any past or future experiences that contradict the now? It hurt my feelings, and I wanted to find her and show her my wounds and demand acknowledgement of how _I've_ suffered, baby! To demonstrate my superior psychic sores and get a foothold for my heel, once again, on someone else's neck. I ended up not responding at all, except with a nagging sense of shame that even in suffering, I have a drive to be the best.

Shadows on the Wall

I return to my client, who has apparently spent his time frozen to the edge of the sofa. On the walls of my office, I have a mixture of photos and quirky art that I find compelling for one reason or another. A print of William Kurelek's _Maze._ A rather mind-boggling shot of Tom Cruise and Thomas Szasz in a casual embrace. Freud's famous white-bearded pose, cigar in hand. A few others. I see my new patient's eyes flick away from me, scanning the walls, passing over Freud, skittering across a placard that simply reads: _What if God Were One of Us?_ His eyes catch on a photograph that used to be quite well-known, although it's been racing towards obscurity in the last decade or so: Hunter Thompson and Oscar Acosta, posed at a casino table in 1971, a reproduction of the photograph that graced the back cover of Thompson's seminal work, _Fear and Loathing in Las Vegas._

He glances back at me. "Family?"

"It's Hunter Thompson and one of his buddies."

A line appears on his forehead. "Who's that?"

Without thinking, I say, "He's the original get-into-it-up-to-your-elbows guy."

The perplexed crease is still there. Is there a character more completely erased from the cultural conscience than Hunter Thompson? More completely erased by the pitiful self-caricature he created of himself in later life?

"He was a writer who took on the whole idea of objective journalism," I continued. "He embraced his own subjective response to the events around him, and instead of writing about them from a distance, he did his best to immerse himself in the events and people he wrote about."

"Huh," said my new patient. "He was like a columnist, right?"

The Catch-22 of Mental Health

In order to get paid for mental health services from the big trough, one has to demonstrate that there is a need for treatment. We could all use a little change, as Smash Mouth says, but to have someone else pick up the tab _,_ you have to be _ill_. With something that responds to treatment. Preferably, from the viewpoint of the treater, something easy. Which is why the big government-funded mental health initiatives don't cover personality disorders, those dysfunctional, entrenched, deeply ingrained ways of acting and being that are learned at an early age and clung to throughout a lifespan. Because those suckers are _hard!_

So, first of all, mental health issues have to be disorders in order to facilitate payment. For a way of functioning to be considered a disorder, it has to be separated from normal human experience as something _abnormal_.

In order for treatment to be funded, the disorder has to be treatable. There has to be some justification for the treatment—it has to have some ability to improve the condition of the person being treated.

The effects of treatment must be measurable in some way. The easiest way, of course, is to ask the person being treated if they are getting better. As long as they are getting better, and there is still some improvement to be made, treatment can go on.

You start with people who have problems, who don't meet that mythical high school standard for 'normal' behavior, or even thoughts. These problems are turned into disorders, so the government will pay to have them fixed. People with problems are people, but people with disorders are sick. Important point, in terms of keeping the money flowing. We're not helping 'normal people' with problems; we're helping 'sick people' with diseases. And just to make sure the gravy train doesn't get pulled over prematurely, build in some rewards so the 'sick' people will have an investment not to give us away by acting too 'normal.'

According to the Surgeon General, twenty percent of all Americans are affected by a mental health disability at any given time, and mental disorders are the second leading cause of disability overall.

When you stop having 'problems' and start having a qualifying diagnosis for your 'disorder,' you can also qualify for disability status, cash assistance, food stamps and their electronic equivalent, and free medical/mental health care, as well as enough pills to choke a horse. Are we saints? Anyone would think twice about turning away free money when it's offered.

And if you complain, report, publicly chastise, criticize or rebuke the providers of those mental health services, wouldn't you worry that you might find yourself without benefits next time the disability wheel goes around?

There's another factor that constricts the response of therapists to this out-of-control spiral of useless treatment. _The experts keep telling us it works_. Some of us are more comfortable with numbers than others, but really, if a guy with a degree that cost ten times what yours does, with connections in DC and a list of publications longer than your arm, tells you that s/he has research proving _unequivocally_ that such-and-such a method works every time if you just do it _right—_ how quick are you going to be to call him a liar? If it means you'll be seen as a bad egg, a difficult employee, a defiler at the alter of public service? What if it means you could lose your job, your livelihood, your means of supporting your family? What if you're not sure you're right? After all, s/he's the big shooter—you're just another peon. Getting peed on, by the way.

And we've all been extensively trained not to show any of this to our clients, anyway. Tabula rasa. Like that Kurt Vonnegut line: so it goes. It's the morals of the front-liners that allow the profiteers to function without any morals at all.

A Curious Case

I had a case once, a man who had murdered a child. His girlfriend's child, not his own. Not offspringacide, just a run-of-the-mill child killer. Accidentally, on purpose, who knows? He, the girlfriend and the victim, no one else. But he had 'paid his debt' to society and was now a semi-free man, as long as he didn't violate his parole or kill any more kids. He was a small guy, with a squinchy face and bad teeth, and I liked him. He was intelligent, interesting, demonstrated a lot of humility for a child-killer, supported new group members in their slow and thready reintroduction to society.

I liked him in spite of his murderous past. I rather liked the person he had come to be, although I would not have chosen to sacrifice a child to arrange it so. But the women! He lived in a small town. Everyone knew what had happened, knew horrific details of the crime and what he had done with the body afterward to try and conceal his guilt. Women loved him. I saw him out in public once in a while, and there was always some sparkling, pretty woman hanging on his every word. He babysat for his neighbor, for Christ's sake, a young single mother with three kids.

This was more puzzling to me than the murder. I could understand the frustration, the drugs, the rage that would drive someone to kill. I could not understand the pretty young women that skated the rickety ice of seeing if he would do it again.

How much time is the life of a little girl worth? According to the federal court system, twelve years. Twelve years to wash the blood from his hands and send him on his way. And I was chosen to be the one who guided him back into being a fit member of society, his guardian, his conscience, his cerebral babysitter, so to speak. The watchwoman of his murder-free future.

But his little corner of society thought he was well enough to invite him into their homes, to introduce to their kids, to drink with and dance with and make merry sunshine on their backs with. It became the psychology of those women that was intriguing to me, and the better I got to know the man, the case and the anomalous behavior of the women around him, the more I looked for an explanation below the surface. I read back through the history of the legal case. He had been out in the sticks with the mother, they had been doing meth for days, and apparently the kid fell out of the pickup (their story) or was beaten to death for misbehaving (the prosecutor's story). The mother was also well-known in the community, and my client occasionally told me that he had bumped into her somewhere, but he wanted nothing to do with her.

It's pretty standard that family members of crime victims threaten, spy on, attempt revenge on the perpetrators once they are out of prison. Except for this guy. These folks shook his hand, lent him a TV when he didn't have one. What the hell? You killed my granddaughter, have a television? None of it made sense. Not the girls, not the family, not his ex-girlfriend or his attitude toward her.

Unless she was the one who had done the killing. Crazy mother, noble boyfriend? Was it noble? Did he take the heat for her crime? Did he donate twelve years of his life as a love-offering to a murderer?

Who knows? She never confessed; he never said. People who knew them both seemed to know something more than we outsiders, with our law and rules and evidence and procedure. Did it matter? Not to the outside imposers of justice and punishment, that's for sure. The record was made, justice—or injustice—was imposed, the dirty, rotten murderer was punished, and the TV was the only prize he got. Every goddamn person in the community knew the real story. Me? I watched, and observed, and talked about those private things that concern a man released from prison after twelve years. And I wondered. But I'd never ask his ex to watch my kids.

Crime and Passion

I spend a lot of time pondering weird questions. Here's one of my favorites: how far would I go, given the correct circumstances? I've treated murderers, serial rapists, child abusers, patraciders and matraciders, alcoholics and prostitutes and drug addicts and sodomizers and thieves and cheaters and lions and tigers and bears, oh my! Everyone on Arlo Guthrie's group W bench, plus the entire cast of _The Wizard of Oz_ , basically. Before sobering up, I'd drunk oceans of whiskey, snorted enough cocaine to deviate a dozen septums, been angry enough to kill and failed only through lack of skill and dedication, I've raged and hit and threatened and aimed and missed. What would I not have done, if the circumstances were right?

It's the tiny secret I keep in my pocket, Thomsoneque in the way it plays out every day, guaranteeing that I will never keep a distance in the most real sense of the word; every time I meet with a new client, in the back of my head, I think: _There but for the grace of God . . ._

An irony I don't always share; I talk with colleagues every day who look at their kinky, rageful, antisocial clients and think, "what the hell made them do that?" or "S/he's an animal. No human being could have done that." But we do. Human beings do. We do all the time. I see the shrink who looks down his or her nose at the rapist, the child molester, the wife-beater, and says, 'not me' like a mantra. The same person then goes home to read their spouse's diary, humiliate their children—'for their own good,' who passes by the poor man and clutches wealth and superiority in his or her hands with sweaty greed. Those people are all me, in different incarnations, bubbled universes only too close at hand should I decide to drink again.

The difference between the child abuser and the arrogant, distant father, the belittling mother? A matter of degrees, and ease of measurement. That's all. When I was younger, I had a friend who lived in an affluent neighborhood, right down the street from a well-known psychologist. Her own TV show, the whole shebang. She had pretty blond hair, wit, and was a Jackie Kennedy-style fashionista with good pearls and practical pumps. She had two sons, teenagers who were destructive, unsupervised sociopaths, with an ingrained sense of superiority, the compassion of sibling alligators and the morals of George W. Bush.

It was a damn good thing she had tabula rasa in the clutch, because it was very obvious that if you knew the products of her tender, loving care, any sane person would flee her office like it was a burning building. Lucky her, she didn't work with sane people. Vulnerable people looked at the nice house, the TV show, the good shoes—the _stuff_ , and flocked around her like hungry birds around a feeder.

On good days, I look at who the person is, what they are, not what they have, and what has sprouted up in their fertile fields. If I don't want what they have emotionally, relationally, spiritually, whether it's respect or a clear conscience, I don't do what they do, or what they tell me to do. I didn't go to the bar to learn how to live sober, or to the crack house to learn how to become a fit member of society. I don't go to the arrogant to learn humility, nor to the liar to learn honesty.

Do things like honesty and humility matter? Hell yes, they do. They may be the only things that do matter, and God knows I suck at most of them. But tabula rasa, the insistence that pretense is more important than reality; that a degree gives me the right to teach you how to run your life when my own is falling apart and I can't keep hold of my ass with both hands—that's the elemental error of our society and our consciousness.

Shall We Dance?

I look at my client, perched tentatively on the edge of the sofa, eying my wall art uneasily, meandering hesitantly through the debris of his past, picking out bits and pieces that don't hurt to talk about; that he considers adequate grist for the therapeutic mill. Is he still wondering if it was something he had done that drove me out of the room for that brief bathroom sprint. I'd like to tell him, "nothing to do with you, it's just the damn water pills I take," but I'm constrained by my training. Kidney function in the therapist is definitely on the List of Prohibited Topics that we all keep, laminated and hidden, in our big, sturdy therapy desks. Your therapist doesn't have a big, chunky desk? Watch out, s/he's probably lost the damn list, too. If you've absolutely, completely lost the ability to stick to topics not on the list, you're not a therapist, you're a social worker. Social workers do all kinds of messy, hands-on, codependent mucky stuff that psychologists and psychiatrists sneer at.

My client's smiling sweetly, shyly, almost as tentative as his buttocks on the pleather. His verbal gush has trickled to a halt, and he waits for me to make some pronouncement on the state of his mental health. A psychoanalyst would have said nothing, spent the whole hour if necessary, waiting for the client to spit something out. A whole year of uncommunicative hours, if need be. But in the days of managed care, no one wants to see pages of progress notes that simply say, "client did not speak." They want to see results, damn it. Interaction, behavioral modification, cognitive interventions, role playing— _something_. Maybe all of the above. At once. While standing on your head and practicing yoga. Stuff that can be measured, calibrated, compared and contrasted to last week's measurements, calibrations, comparisons and contrasts.

What's a Degree Worth, Anyhow?

I grew up in a suburb of Detroit, a working, middle-class neighborhood where nearly everyone's mom stayed home and everyone's dad worked at the auto plants and drank beer and bowled. College wasn't really something anyone thought about much. In my high school, the expectation was: get pregnant before graduation, get married, have a couple of kids, bowl, drink beer. Talk loud and wear tight pants. Have an affair or two, get a perm and fake nails, divorce the starter husband for good alimony and settle down with the biker of your dreams. As you can see, not much time for a degree in there. Hard to pencil in between the fornicating and the bars.

Plus, everyone knew all about college grads, those stuck up sons-of-bitches. They were the snotty guys at the plant that told the real men what to do, couldn't hold their liquor and were afraid to fight with their fists. They fucked up everything they touched, had never worked a day of honest labor in their lives, and wore pocket protectors while being pussy-whipped by their wives and girlfriends, who banged the plant guys whenever they wanted some real dick.

Worked for me. Except that I was so ass-backward I just couldn't make the leap to the alimonial gravy train. Instead, I worked at every shit job there was in greater Detroit, including a chlorine factory, unloading fifty-pound bags of flour from a bakery truck, innumerable gas stations and telemarketing companies. And got knocked around nearly every weekend. Wah-hoo!

How does a woman get to be thirty years old, with an IQ in the upper one percentile, and with nothing to show for it but a hand-me-down bowling ball, two kids and a fiesta platter of bruises? It takes a lot of work and a lot of whiskey, believe me. Quitters and tee-totalers need not apply.

By the time I was thirty-two, life had changed without my permission. Husband number one had come near enough to killing me that even I noticed. He was gone. I had stumbled accidentally and without looking into a job that became the repository for every last crumb of my ego, and then, after nearly eight years on the job, the boss and owner had pulled the rug out from under me by telling me that if I didn't quit drinking (especially at work), he was going to shit-can me faster than Jesus could say, "Shut up, Judas."

A few months later, a trembly, dewy-eyed sober alcoholic, still reeling from being whacked over the head with enforced recovery, I heard someone say that they had gone back to school to become an alcohol counselor. And my future was set. No question, no hesitation, no careful considering. The only thing that kept me from applying to a university that day was that I had no idea where any of them were located.

Details.

You know the great thing about institutions of higher learning? They involve little to no heavy lifting. In high school, I had slunk around, stoned on my ass, trying to avoid notice and clutching my neuroses like kids clutch their iPods. Teachers, more often then not, were the sources of public humiliation, contempt and sly, disturbing passes that no one would believe you about even if you tried tell someone.

In college, the teachers weren't teachers, they were professors. In college, professors were not supposed to make you feel stupid. It was like they had all gone en mass to some sensitive, new-age professor training, where they had been taught that everyone's opinion is valid, and nobody should have to struggle with failing anything. The entire time I was in school, I think I saw two people fail, only because they had gone completely off their rockers and done something so stupid and ridiculous that a whole tribe of sensitive, new-age professors couldn't find a way to make it all right.

Of course, you were obligated to pretend that the professors also made sense and had valid opinions, which some of the teenage first-timers stumbled over. Me, I was so happy to be there, and so delighted that there was no manual labor involved, I'd agree with just about anything.

Tabula Rasa? Does it involve fifty-pound bags of flour in any way? No? Hell, yes, I'll agree to that! I'll take it home and dance with it, if you want me to!

I took a lot of stuff home to dance with that probably shouldn't have been allowed in the house. This is my chance to kick it back out.

Tenderness

Whenever I get the urge to put my self on a pedestal by dropping someone else into the pit, I think of my husband, and the urge goes back into the backseat where it belongs. I fell in love with a wonderful man. Tenderhearted and kind, all the stuff I'm not. He has his moments, but mostly, after twelve years, I'm still hoping he'll rub off on me by proximity and some day I'll just wake up and be a nearly as a good a person as he is.

When we first met, I was still new to school, to my new calling, and while I had a core-deep conviction that this was what I was supposed to be doing with my life, I still had about zero connection with other human beings except to screw or borrow money from. This beautiful man has a rare gift. When crazy people are around him, they're better. Did he go to school to learn how to do that? Does it require a special license? Shots, perhaps, or inoculations? A magnetic field? For a while, I considered it could be pheromones. I used to follow him around and listen to him talk to people, watch how he was with them, trying to figure out what it was.

You know what? He's equal.

Like me, he came by his understanding of how life really works the hard way; with him, when all the evil and the anger and the self-centeredness and the violence and burned their way through his life, what was left was a man with an endless capacity to bring love and compassion to those who need it most. In Detroit, we called people who lived on the streets and ate out of garbage cans 'dumpster divers.' I think of my husband as a dumpster diver of human beings. Sort of like Christ's 'I will make you fishers of men' thing, but with more fire. Kind of like John the Baptist, but with swearing. It's the swearing that keeps me convinced I live with a regular human being.

It goes like this. When you talk down to somebody, you either push the child button, or the resistance button. When you talk up to somebody with either attitude, you either push the hypocrite button or the denial button. Chuck bypasses the buttons altogether. He goes straight to the heart, by treating anyone he talks to with love and courtesy and his full attention. And for whatever period of time they interact, nothing is more important or interesting than that interaction. There was no hint of enabling, or pity or ass-kissing. Psychotic people would freely discuss their hallucinations; scared people would realize they had choices; angry people would calm down.

I don't mean to give the idea that this is a bunch of dialectic mumbo-jumbo. This isn't a formula, or a posture, or anything constructed and conscious. He believes he's equal, simple as that. When he talks to someone who needs money, if he's got some, he shares. If it's someone who has no place to sleep, I'll bet you fifty bucks that person will be making an appearance on our couch. Lots of people make appearances on our couch, thanks to Chuck. I just check the fridge and feed everybody.

And he doesn't do it with a goal in mind. If you offered him reward, a medal, public accolades, he'd just shake his head and laugh. It's just what he does, because when the bad burned away, this is what it left.

It takes a tender heart to be a conduit for the magic. The God magic, the sense of oneness with all. A vulnerable heart, an open heart. Chuck has the magic in spades, and spreads it around. People with the magic are few and far between, and we should be building monuments to them, except part of the magic is that they would laugh and look puzzled and scratch their heads and tell us to knock it off. It's that 'we're all in this together' magic. The 'you're important enough to listen to' magic. And most important of all, 'you're important enough to tell the truth to' magic. The _¡Ai caramba!_ of interpersonal interaction. The truth. And a shitload of patience.

Fantasies of Freud

In my office, along with the more formal photograph, I have a 'Tickle Me Freud' doll, pink and plush, with a suit-coat and spectacles. It's an older Freud, with a bald head and a white, fuzzy beard. When you squeeze his little bare foot, he shakes and quivers and explodes with giggles. Sort of like a 'Tickle Me Elmo' doll but more . . . well, more Freudian.

My dissertation chair—that jerk, had a 'Freud Action Figure' on a shelf in his office. Still in the original packaging. One of my many resentments against him, aside from the fact that he clearly thought I was an idiot, was that he seemed to have no appreciation for what a unique culture collision a miniature, movable plastic Freud was. I admit, I lusted after Freud-the-action-figure, which he had found in Canada, a place I am unlikely to wander into by accident. It's not that Canada is not charming; it is. I've lived in close proximity to Canada for a large portion of my life. But it's like the guest child in your house that never quite becomes family. Eventually, you get tired of having to be polite and not being able to walk around the living room in your underwear; it's time to get the kid the hell out of the house and be comfortable.

How many dreams has the Dream-King swum through in his evolution from mild-mannered doctor to miniature plastic warrior and plush Elmoid? He's impossible to avoid in mental health circles, even if you're a leftover sphincter-gazing specialist from the west coast. The ultimate authority figure in our field. The nice thing about authority figures is that when they're right, you don't have to figure it out for yourself; when they're wrong, hey, it's not your fault!

As time has gone by, Freud's iconography has changed in our consciousness. From stern and scary, all-knowing diver into the murky animal unconscious that we all dread bringing to light, to drug addict and fearful denier of the abuse suffered by women in his society; and finally the emerging picture of a vigorous youth (now that I'm old), who snorted cocaine and fucked his wife's sister under the marital roof, spearhead proponent of a nihilist philosophy of hedonistic justification and acceptance of our animal instincts.

Did Freud convince his charming little wife that boinking her sister was inevitable, somehow? That the primal male desire to plow whatever fleshy furrows revealed themselves was not only natural, but right? Or did the three of them shoot enough cocaine to engage in intimately perverted threesomes—validated by the good doctor's immense intellect and vivacious nihilism?

Do Freudians dream of slutty, moist couches and thick, phallic pens? Of violated notebooks whose pristine white paper has been dappled with spermazoic, inky words so that it will never be pure again? Or maybe, we dream of the salty slide of kippered herring down the greedy throat, the sugary burn of schnapps sliding into the belly like good sex, leaving the cognitive-behaviorists, the rational-emotives, to dream their box-like black and white dreams? Will our nocturnal imaginings be filled with furry handcuffs, sleek whips and the chastisement that changes nothing but the degree of lubrication.

I tuck the thought away, and lower my eyes to look at my client, patient, partner. I am not entirely sure how much time has passed as I contemplated 'Tickle Me Freud' on the shelf and pondered Freud's iconic position in our culture, but long enough, I think, to make me appear judicious in the application of my comments to his dreary attempts to dredge something that will entertain me from his dreams. "So," I respond finally, flicking one last glance at Freud, feeling the patient's submissive, even masochistic placing of confidence in my hands, "how _did that make you feel?"_

The Truth and a Shitload of Patience

Did you know there was a movement out of California in the '70s that used a technique called 'sphincter gazing?' And yes, it was exactly what it sounds like. Everybody would strip down and form a daisy chain of spread cheeks and inquiring eyes. Based on the theory that once you had looked another human being in the asshole, you'd never be intimidated by them again. And, conversely, that once someone had gazed on your holy dark tunnel, you would never again be able to pretend you were superior in any way to your spiritual spelunker.

Simple, ugly, elegant. A reduction of every misguided mental health effort into a stunningly succinct common denominator. It's really rather brilliant. Sphincter gazing. Maybe it should be a course offered in school. Mandatory in school—for the teachers, not the students. Maybe that's where all the university professors should go to get suddenly sensitized. "Why, Dr. Bob, you're so attractively sensitive now—What happened?" "I gazed at others' assholes, and had others gaze at mine. Revelations galore in such a stained little pucker!"

Imagine the time, the effort, the conscience-stretching that could be done away with if we just stared at each others' assholes, say, once or twice a week. How many conflicts at work would just sigh away into forgotten corners, how many testosterone-induced brawls would be set aside, how many despots and rulers and warrior-kings would never have wriggled out of the muck if we had just all set aside a few minutes to look at each others' assholes?

Here's the question, though. If asshole gazery became the thing, if society was to experience a massive change in perspective and decide to pursue this ludicrously enchanting concept, would we all become equal, or would we simply develop new criteria for our snobbery and our submission? Would we all become obsessed with having the most beautiful, the smoothest, the comeliest assholes? Would there be a sudden upsurgence in the popularity of ass-hole bleach? Would we develop breath mints for our nether regions? Would it just become another—albeit hilarious—way in which to pit ourselves against each other for the prize of prettiest, most youthful, best smelling?

When everyone's an asshole, who do you believe?

The Pit and the Pedestal

Mostly people divide each other up into two categories: the ones who get put on pedestals, and the ones who get put in the metaphorical pit. We put people on pedestals because they do things we don't, and if we don't believe them special, somehow different and superior, what does that say about us and our pettiness and our jealousies?

The only defense against awareness of our own complicity in our failures is to swallow whole the belief that people who do extraordinary things are different from us somehow. More gifted, more brilliant, luckier, more beautiful. Bullshit. We are all capable of stunning acts of kindness, of bravery, of joy. Of simple gestures of friendship and love. The reality is that most often, we're not willing to do what they did, to get where they are. Ah, moral turpitude. Disguised with a smelly crust of resentment and denial.

Scott Peck says in _The Road Less Traveled_ that fear of change is really fear of work. In _The House Bunny, Shelly_ says kindness is just love with its work boots on. I take my truths where I find 'em.

The problem with putting people on a pedestal is that there is some piece of us, some tiny, festering bit of consciousness that always speaks the truth, and the truth will shoot you in the foot no matter what you do; especially if you try to squish it down with a big boot full of pedestalism. And the truth is, that the value of a human being cannot be measured, weighed, squirted out, devoured or leveled by any means of measurement that human beings have. Money is not the measure of a wo/man, nor is popularity, or the size of your house, the make, model, year of your car. Mother Teresa has none of those material things. George Bush was loaded with them.

And what do all those things mean, anyway? Or, more accurately, what are they supposed to mean? Safety? Security? Those things can be obliterated by the might of God and strangers in a heartbeat. Are they a measure of how good we are? Proof that we deserve a celestial head pat? Are they the psychic equivalent of a billboard that says we are loved, deserve love? I know plenty of people who have money, cars, houses and are not particularly interesting or appealing.

Anything that we can accumulate can be lost. Anything based on our physical beings will inevitably be ravished by time.

What's left? Honor, love, humility, dignity. Not incidental physical accouterments or acquisitions, and a hell of a lot harder to come by than a new Lexus. But we continue to perpetuate the belief that these concrete things have value more than fun, more than the experience they offer. What the hell are we thinking?

Every time we hoist somebody up onto the pedestal ("he's so smart, handsome, brave . . .") it immediately becomes clear that the clown has a rip in his pants, or a fear or snakes, or an inability to commit, or picks his nose in private. Zounds! What blasphemy! So we grab some other poor sap, shake out the big ropes, and begin the hauling process all over again. And then it turns out that this idiot takes steroids, or dresses in women's clothing, or yells obscenities at his kids, and _Bam!_ We are disenchanted again. But not enlightened. We just begin yet another squirrel hunt, and so the process goes. Over and over and over.

Then there's the pit. Repudiation, shame, ostracism. Jail, beatings, shower rapes. Nothing too bad for the schmuck who gets tossed in the pit. And then, damn if that small bit of reality intrudes once again, and we are faced with the fact that the face in the pit looks astoundingly like us. Like me, anyways. Maybe I just imagine all this stuff while I sit in my chair, tap, tap tapping away, waiting for the footsteps down the halls. What sins could I commit, what deeds would I be capable of, if _this_ or _that_ or _something else_ had happened to me, too? I've screamed, shrieked, humiliated and hit. I've gone to drunken sleep knowing a child was going hungry because of my direct action or lack thereof.

And they love us still. Drunken parent and pedasterist alike. I bet the little girl who was murdered by my client—or her mother, or both— loved right up to the last blow.

Because we've already taught them the untruths of the pit and the pedestal. And guess where we've taught them they belong? The pit, of course. Pedastery is simply the Pedestal carried to one of its many extremes.

If they don't see a difference, should we? Or should we wipe out the artificial boundaries between different types of soul-stealing, and be a little more honest with ourselves? Abuse is abuse is abuse. Why is a burn with a cigarette less of a violation than a penis in the mouth? It's not. There are a million ways to neglect, mistreat, terrify and abuse a vulnerable human being. Only a few of them involve sex. All that stratification of abuse does is provide a convenient rationalization for those of us who have not done specifically _that_. I'm not saying forgive the child molesters, I'm saying let us give the same weight to all aspects of child abuse. It's an illusion, that one of us is better than another, by virtue of what acts we've committed or refrained from.

Crazy-Smart Dignity Dance

The memo is out; it's official. Crazy is no longer an appropriate term to use in reference to people who are . . . crazy. Which begs the question, of course—is it still okay to use when referring to myself? What if I only refer to myself as crazy in a cohort way and not in a professional way? I wonder how I will feel about myself, if caught referring to myself as 'crazy,' considering that I often am. I resent myself already. Is it really the word— _crazy_ —or is it the sly glance I give to myself when I use this piece of apparently derogatory slang to describe me?

Because, I rather like the word 'crazy'. It's short. It's pithy. We all know exactly what we mean, and who we are talking about when we use it on each other. It describes that sort of goofy but harmless behavior that makes us all blink our eyes once or twice, grin, shake our heads in a 'so glad it's not me' gesture. According to the memo, 'insane' is still okay. I usually don't feel insane, though. I just feel crazy. Pretty frequently, now that I'm thinking about it. Crazy is when you decide to visit a nudist colony for the first time in your life to celebrate your fiftieth birthday. Insane is when you strip naked during a congressional hearing about your abuse of government funding, and go dancing around the bemused congress-folk waving your pistol and screaming, "Pork Barrel!" Crazy is when you sell your used Toyota and buy a Ferrari on payments. Insane is when you run your Toyota off a cliff and steal a tank, then go driving it down main street, crushing every vehicle and person you can find. Crazy is when you live in KKK Central and decide to give speeches in the park every Sunday about the benefits of interracial marriage. Insane is when you put on one of those pointy white sheets and hurt the people who give the speeches in the park. Moses, doing the 40 years in the desert thing? Crazy. Elijah, with the bears that ate the kids who teased him about being bald? Insane.

All in all, I'd rather be crazy than insane, any day, but the commie-HMO bastards have decided it would be bad for me.

Those Commie-HMO Bastards

1909

Freud, having discovered that neurotics will pay for a 'talking cure,' rushes over to share his discovery with his American counterparts. His bid for a franchise is turned down.

Former mental patient Clifford Beer founds the first grass-roots lobby on behalf of those who suffer from mental disorders. From trepanation to bedlam, some would consider him about 20,000 years late.

Realizing that people are actually paying attention, the fledgling mental health industry scrambles to defend its previously carte-blanche practices.

1918

Money is beginning to be made, so the American Psychoanalytic Association finds a way to regulate it by declaring a monopoly on the right to decide who may and may not practice psychoanalysis.

1936

Lobotomies, which require neither licensing for practitioners, nor any of that pesky 'listening' stuff, become popular.

Two drunks meet and help each other get and stay sober by using the principles of honesty (the out-loud kind), doing the right thing and righting past wrongs. The entire concept of the power of the group and of peer support starts here. Eventually, these ideas get co-opted and become the basis of group therapy and peer and family support services. As per usual, the alcoholics don't get credit, nor do the societies which predated the AA movement and upon whose philosophies the AA principles were constructed. The Washingtonians were a group of 19th Century drunks who found that sharing their experiences, belief in God as demonstrated by their actions, and relying on the power of the group could keep a man (or woman) sober. The Oxford group (in which the co-founders of AA participated until they struck out on their own) was an early 20th Century religious movement whose credo was confession, amends and reaching out to others.

1940s

Quack treatments, such as the aforementioned lobotomies, electroshock treatments and medically induced insulin comas, abound. A paradigm shift in which mental illness goes from mockable to medical begins to occur with the average Joe. Vets coming home from war with a variety of mental health issues create a demand for two things: a reliable classification system for disorders, and the expectation that if it's a medical condition, there should be a treatment for it.

There are two major schools of psychology at this time: the school of the mysterious interior—people like Freud and Jung,for example; and the school of the empirical experiment: Pavlov, Skinner, Watson. The empirical school, which has never been as flashy or as fun as the psychoanalytic school, gets a leg up during World War II, when the empirical notion of tossing out all that soul-searching subconscious stuff in favor of a mechanistic focus on quantifiable behaviors found favor with the military. Which makes perfect sense when you think about it: Why would a general send a spiritual being who is fully his equal into bloody battle, when he can send a meat-bot instead?

The rat guys all get busy quartering up the complex mechanisms of the human psyche into measurable behaviors that can be easily counted, and in developing methods of changing those behaviors. Before the breaks were put on, these were the guys that were using cattle prods to stop head-banging in autistic kids, as well as being the philosophers behind the now-famous experiment where subjects were asked to deliver increasingly painful electric shocks to people they had never met, just to see how far they would go.

1950s

As medical treatment increasingly becomes a socialized provision of Eisenhower's post-war administration, accompanying it is the idea that mental health care should be paid for through the same sources that caused the mental disorder in the first place—namely, the government. Eisenhower would nowadays be diagnosed with _survivor's guilt_.

1952

First edition of the _Diagnostic and Statistical Manual of Mental Disorders_ (DSM) is published by the American Psychiatric Association, to help with that pesky diagnosis and classification thing. We are now on edition _IV T-R_ , by the way, with edition _V_ due out in 2012. While it was originally conceived primarily to help standardize diagnosis so clinicians could communicate easily and accurately with each other, its primary function these days seems to be as the yardstick by which HMOs decide who's going to get treatment and who's going to get left out in the cold.

1960s

Everybody is running for the shelter of Mother's Little Helper—the time of better living through chemistry is upon us! Insurance companies, which previously had not spent a lot of time on mental health aspects of health care, are surprised to find the percent of dollars going to mental health treatment is climbing steadily.

1970s

As the war between therapy proponents and pill prescribers heats up, suddenly everybody is doing studies to determine for once and for all which is the most effective treatment for the various disorders nobody had until the _DSM_ was foisted on them. Insurance companies are starting to squawk under the heat of paying for all this stuff. Therapy is suddenly an extremely lucrative business to be in, mostly because up to this time, health insurance companies had not considered it important enough to exclude or limit. Schools of therapy spring up like mushrooms, each touting its own methods and insisting that everybody else has it wrong—not unlike religious organizations.  
Major disappointment is felt all around when it is first discovered that many therapy techniques turn out to be hard to attach numbers to. Second major disappointment comes when the pill prescribers discover that pills alone are no more effective than therapy.

1970

There are 30 HMOs in existence.

1972

Richard Milhous Nixon, 37th president of the United States and so corrupt even Congress couldn't stomach him, decides that the Johnson Administration has been throwing away money by the bucketfuls in health care. In the five years since the inception of Medicare and Medicaid, costs (charges billed by medical professionals) have skyrocketed. The words 'cost containment' first begin to be muttered around the pork barrel. The Nixon administration began exploring ways to cut costs and control spending while providing the most minimal health coverage possible to stop the tidal wave of public feeling that everyone should have access to health care. There's a great tape on Youtube, by the way, that features Ehrlichman and Nixon figuring out how to best screw the public over national health care. You can also catch it in Michael Moore's film, _Sicko_.  
Erlichman: _I had Edgar Kaiser come in... talk to me about this (health insurance) and I went into it in some depth. All the incentives are toward less medical care, because... the less care they give them, the more money they make.  
_ Nixon: _fine._  
Edgar Kaiser, the guy Erlichman asked to come in and explain managed health care, was the guy who figured out how to make money from a non-profit health care plan, and by providing doctors with major kickbacks for not providing needed medical care.

1973

When Ted Kennedy and Wilbur Mills both proved they couldn't keep the party in their pants contained, the two biggest opponents to Nixon's "the less we do, the less we pay" philosophy of health care were effectively removed from the playing field. Mills was actually removed from office, courtesy of his fountain frolic with Fanne Fox. Kennedy was just kicked around a for turning his back on Mary Jo Kopechne as she drowned in his car. The field having been cleared for him, Nixon plows ahead by authorizing $375 million in federal funds to assist in the development of HMOs, over-rides state laws that ban prepaid health insurance groups, and requires any company with more than 25 employees to offer HMO insurance.

1980s

The race is on to determine the single most effective way to treat mental health problems, and continue to get insurance to pay for it. First, of course, you have to completely discard all that messy emotional stuff that can't be easily measured.

90 percent of the American population is enrolled in an HMO at this time.

1995

Now that psychology has been reduced to what can be measured and acted on (interfered with), researcher Martin Seligman is hired by _Consumer Reports_ to determine which is the most effective form of therapy. He does, and shocks everyone by releasing findings that show the most effective thing a therapist can do is to be empathic and show warmth and interest in the client. All the techniques, all the pills, none of them is more effective than a therapist who really cares about his or her patient.

1996

Seligman's research is pretty much discarded out of hand, except by the psychotherapists, who are proving a little slow in the head. Then again, insurance has never really been their racket anyway, so who cares?

There are over 600 HMOs in existence in the US, with about 65 million members.

2000s

HMOs have cornered the market on providing health insurance to the masses, and they begin to turn on each other, and on those pesky humans that keep demanding services, in a feeding frenzy not unlike that of a school of great whites when a confronted with a bleeding seal. We, by the way, are the seals.

2007 to present

A major recession begins, gaining momentum as it goes. While Bush flails around, defending his pork barrel buddies and complete lack of ability to see past his own nose ( _there's_ a guy who wouldn't pass the marshmallow test), a growing grass-roots belief that government pork barrel spending is at fault. When the 2008 presidential election rolls around, Obama wins, partly on the platform of cutting government glut. And guess where a whole bunch of that glut is? Federal and state administered public health services. Can you guess what has driven the glut factor up exponentially, while service effectiveness has decreased? You betcha—HMOs.

If you don't consider that pesky human aspect, it's only logical to suck up as much money as one can, I suppose, while finding reasons to refuse to provide anything remotely resembling effective care.

One of the ways they find to refuse and limit treatment is through the use of what we've taught them, namely, that mental health care can be distilled down to numerical components. Thank you, all you cognitive-behavioralists out there, and Drs. Hathaway and McKinley, too. These two docs, by the way, are the creators of the Minnisota Multiphasic Personality Inventory, which took the quantification of the human mind to entirely new levels. Or depths, depending on your point of view.

The MMPI, as its affectionately called, is one of the most popular personality test ever. The current version has over five hundred short statements that the subject reads and scores either 'true' or 'false.' No thinking, studying or interpretation is involved in getting the results. You can just lay a template over the score sheet and total up the responses. Or, you can use a computer program that handles that for you. The computer then spits out what the numbers mean. One of my kids could do it, if they had the patience to wait around for an hour or two for you to finish the test.

The thing about the MMPI is that it's free-floating. The items it contains frequently have no meaning whatsoever, other than their likelihood of being endorsed by people with different mental health programs. The scores are derived, from comparing your scores to those of other people who've taken the test.

When Freud worked out and popularized the basic tenets of talk therapy, many people were unconvinced that a 'talking cure' could work. Too simple, too hard to prove, to show, to demonstrate. To measure. So the cognitive-behavioral movement develops, ignoring the whole pesky subconscious/unconscious problem, by declaring that it doesn't matter what you think and feel—what matters is what you do. Cognitive-behavioral psychological treatment, which focuses on actions rather than insight, is measurable, neat, and rarely involves people crying in your office. Eureka!

Eventually, the pendulum swings again, not all the way back to Freudian psychoanalysis, but at least as far as Rogerian, person-centered therapy (which leans away from tabula rasa as well) and, later Family Systems Therapy in all its many hydra-headed manifestations. When Seligman's _Consumer Reports_ survey came out, it was seen as a big endorsement for all the touchy-feely treatment camps.

Touchy-feely, however, never seems to go over big with for-profit corporations that are making money hand-over- fist with complete disregard for human suffering. Have enough touchy-feely stuff going on, and pretty soon people are talking about 'what's right' instead of 'what's expedient,' and wanting to do things that actually help people get well.

Speaking of getting better, managed health care has come up with a wonderful way to handle that pesky problem, too—they've lowered the bar on what exactly 'getting better' means. For example, if you were alcoholic, getting better used to mean that you stopped drinking. Managed care, however, found that it was _hard_ to get drunks to stop drinking. It's what we _do_ , after all. Keeping that in mind, the industry standard is not for clients to quit, the standard is that they reduce their drinking, by self report, for six months to a year. Keep in mind that hardly any alcoholic just waltzes into the treatment center one days and says, "I woke up this morning and decided, damn! What a good day to quit drinking!"

_Au contraire_ , my friend. Most of us are dragged into treatment centers kicking and screaming, due to legal, marital or job pressures. Which means that when we are asked to respond to statements like "I drink less now that I have completed treatment," we are also prone to say _yes_ , even if we have to cross our fingers when we say so. Because if we don't, reports of our failure may waft back to the courts, the judges, the spouses and the boss. Maybe, if we're on probation, we even are drinking less, because we're being tested and monitored.

Brilliant, huh? Lower standards equals better response. It's a strategy that also allows them to pretend that they're actually doing something meaningful besides setting up golden parachutes for their CEOs.

Back to touchy-feely stuff: Seligman's study seems to indicate that caring is an important factor in getting better. But the big boys hate that shit. How do you determine whether someone cares or not? Meet with each therapist and ask? God forbid! Hence the birth of the Customer Satisfaction Survey.

It seems logical to think that a person who is seriously mentally ill isn't always capable of determining how well treatment is working for them, but a CSS is a lot easier to manage than actually trying to take an objective snapshot of whether or not the client's functioning has improved. It also puts a new burden on the touchy-feely guys, because now it's not enough for them to love their clients, they need the client to love them back.

Needing to be loved back creates another conundrum, of course. How do people get to know you well enough to love you back, if you're a tabula rasa?

Don't get me wrong; I think that customer satisfaction with the therapist is important. I also think that looking at the effectiveness of treatment is an important piece of keeping us on our toes. But when the analysis is based on a self-serving set of numbers that has little or nothing to do with actual quality of care and patient improvement, as consumers, we're fucked. It's like the police are policing themselves, and instead of asking important questions, like "How much crime did we stop? How many innocent people did we mistakenly shoot?" the question is, "How many bullets did we use?" because bullet inventory is much easier to keep track of than sending someone out to talk to citizens who reported crime, or were victims of police brutality, or, God forbid, got shot.

Customer satisfaction as the primary measure of success has another flaw, along with its cousin, getting paid by the billable hour. Sometimes, to be a good therapist, you have to ask the tough questions. You have to poke a little, and prod. You need to encourage your client to do some damn hard work to get better. Recovery is a tough journey. It's the turnaround from letting the past control the present to choosing the present that will control our futures. But if your job depends on how well people like you, and your paycheck depends entirely on enticing someone to keep coming back, how many tough questions can you afford to ask?

Not surprisingly, there's been an upsurge of therapies that don't require a patient to think or feel—or to share all that icky stuff with the therapist. Eye Movement Desensitization and Reprocessing (EMDR for short), the Matrix Model of treatment for alcohol and other drugs; any cognitive-behavioral/dialectical behavior therapy that involves filling out forms, doing 'homework' and changing behaviors without discussing them. There are tons of programs out there now that are based on bits and pieces of research which say, for instance, 'customers with jobs are more stable' so lets get everybody jobs and _bam!_ our therapy work here is done. No muss, no fuss, no icky emotional stuff. Therapists are now employment specialists. And employment counselors, cheerleaders and homework monitors don't need to be psychiatrists or doctoral-level psychologists. Nah. By and large, the great majority of mental health services being provided nowadays are being provided by master's level, bachelor's level or even associate's level mental health professionals, technicians and paraprofessionals.

Psychiatrists have been turned into prescription cranks, who are allowed fifteen minutes of contact with each client a month, psychologists into administrators and (empirical) testing specialists.

If it wasn't for a pesky study that showed that medicine alone is no more effective than therapy, and that therapy and medication treatment together provide the very best results, we'd be reduced to the status of vending machines that dispense mood stabilizers and antipsychotics as if they were Pez.

So this is the boondoggle we've set for ourselves: therapy is no longer a long-term, intimate relationship between a patient who wants to get better and a highly trained professional who is fully aware of all the steps in getting there. In our race to measure, quantify, standardize and economize our mental health treatment, we have reduced ourselves to a bunch of mental health MacDonald's morons, catering to the government and big business, and allowing ourselves to be forced into a posture of buddy-ism with our clients.

Our psychiatrists and psychologists have allowed themselves to be turned into a bunch of ass-kissing pencil pushers, responsible for signing off on a bunch of ass-kissing counselors I wouldn't trust with a potato gun, much less the care and healing of someone I love. Turns out, the only people I do trust are the paraprofessionals. At least they're not lying to themselves and everyone else.

Damn! Time to get an unlisted number again.

In Praise of the Paraprofessional

My client, as it turns out, is a paraprofessional behavioral health worker, for MegaMental, one of the big, local therapy mills. Ethical considerations prohibit him from obtaining services at the same location at which he works, so he's been sent to me for some tune-up counseling. I hate the word 'tune-up' when it refers to mental health treatment. Like we're machines that need a good radiator flush and then _zoom_ , back on the road. Still, he's a nice guy, hopeful, with that naively trusting aspect that folks who are mentally ill often have. Believing others are more powerful then we are being one of the prime common denominators of mental illness. But that's just me. Of course, that naive humility is coupled with real narcissism and lack of empathy for others at times, along with anger, hurt and pain, and I've learned never to take people at face value based on their initial presentation.

Still he's likable, has some knowledge of mental health treatment, and is invested in maintaining his own stability through staying on his medication and jumping through whatever hoops industry standards say he should. He's part-time at his job, which in all likelihood he's still collecting disability for his troubles—literally. He's one of the guys who's managed to jump through _all_ the hoops, no mean feat. Well enough to work, sick enough to collect the measly amount of cash the government has determined it's appropriate for a mentally ill person to live on—which isn't much. Although, with food stamps, free health insurance, subsidized housing, some people are always willing to give it a go.

The federal government, by the way, considers that medicine, including psychiatric medicine, is an industry, not a profession.

Shysmile once again begins with a nonsequitur, eyes on my wall. "Who's that guy next to him?" I pick up the thread—he's looking at Hunter Thompson again. Is there something in that blackjack gaze that pulls him? An unconscious comparison of wounds inflicted and received?

"The other guy is Oscar Acosta. He was a lawyer, and very active in the Chicano rights movement in the late sixties/early seventies. Thompson wrote about him a lot, back in the day."

"Was he famous?"

"Sort of, I guess. But Thompson called him 'Dr. Gonzo,' in the book, and said he was Samoan. I don't know how many people would have recognized him from the book."

"He looks like he's doing a hell of a lot better than that writer guy. I thought maybe he was Italian."

"Italian?" He's got me stumped.

"Mob, you know? He just looks like somebody out of one of those Godfather movies."

I look at the photograph for a moment. My perception of Acosta is completely colored by what I know of him; it's hard to make room for another impression.

"Was he a doctor?"

"Not that I know of. It was kind of a joke. Gonzo was what Thompson's writing style was called."

"I know what gonzo means. Ted Nugent, balls—" he coughs. "I mean, full speed ahead. That kind of stuff."

I suppress a sigh, lean back in my chair, getting comfortable for the days tally of woes and misfires.

He recognizes the cues, and begins unraveling his story once more, then stops. "Why don't you ever take notes?"

I shake my head and smile at him. "I'll make some notes for myself later. But while we're together, I'd rather focus on you."

He frowns. "It's really different here. At MegaMental, there's a computer form the counselors fill out while the customer is meeting with them. At the end, they print it out, and the customer and the counselor both sign. It's got a bunch of boxes on it that the counselor checks to show if you knew where you were, if you participated good, what she taught you that day. If we keep just talking like this, are you going to have time to teach me anything? And how long is your hour?"

I am torn between explaining to him that MegaMental is run by a bunch of money-grubbing, self-serving sociopaths, and sticking to brief responses to what he actually asked me, hoping that part of his journey to wellness will be his _own_ realization that MegaMental is run by a bunch of money-grubbing, self-serving sociopaths and I won't end up blacklisted. I consider my response for a minute. The problem is that he has been normalized to a perverted form of pseudo-therapy that operates like a fast-food drive-through.

I decide to answer the last question first. "I do a full 60-minute hour," I tell him. "I do the paperwork afterward, on my own time. And my focus is usually not on 'teaching stuff' so much as it is on helping you decide what you need to learn. I'm guessing that's a little different from how you've worked in the past, but if you'll give this way a try, and you find it's not helpful, I can always dig up some forms for us to use. What do you think?"

He studies his feet for a minute, probably contemplating how fast they can get him out of here, then looks up and shrugs. "Okay, I guess I can give it a shot. But what are you going to talk to me about for sixty whole minutes?"

I try to repress a sigh. "In this kind of therapy, _you're_ the one that does the talking. I listen."

He's looking at his feet again. This is going to be a long sixty minutes.

Ethics are for People who have no Morals

Ethics, ethics, ethics. I do more tapping after Mr. Shysmile leaves and I have time to contemplate the ethical dilemma that led him to me, dangerous, reckless, rebellious, form-free guerrilla subversive that I am. I wonder if Acosta is laughing at me. the word subversive seems to have morphed quite a bit in two decades.

I firmly believe that we wouldn't need ethics—Ethics Guidelines, Ethics Policies, Ethics Training, Ethics Tests—if only more of us had an actual sense of right and wrong. Ethics are what are put in place for people who are unwilling to confine themselves to doing what's right, which probably indicates that rather than exerting their influence on vulnerable folks in need of help, they should be making license-plates somewhere secure.

Of course, some people would say that the solution to this is to divest the field of practitioners who can't exhibit moral responsibility to their patients, but patients aren't actually patients anymore, they're customers, and mental health is an industry, just like auto manufacturing or soap making anyway, and who expects a factory worker to have morals?

Mr. Shysmile has been hired at MegaMental by the movement within HMOs to respond to consumers' desperate and pesky need to actually talk to someone who understands them and what they're going through. Of course, it also allows the HMO to cut costs even more, because who needs to pay a therapist $25 bucks an hour (only for the customer who shows up, of course), when you can hire a paraprofessional for hourly minimum wage?

Now that Mr. Shysmile has been put to work at MegaMental, however, he is no longer allowed to get treatment there. He has two choices; he can drive sixty miles to MegaMental's chief competitor, CounselingCorp, or they can find some nice, low-level non-threatening ass-backwards private practice bozo like me to take his case.

Did I mention that they're idiots?

Chapter Two: Perfecting the sense

of right and wrong

or

How to embrace the crazy in us all

The Middle Sessions

So, here I sit, stripped by a collection of fuzzy patchwork thinkers of my prescriptive authority to determine the course of therapy for my client. This kind of gives the lie to the whole doctor-of-something-thing, and makes me wonder why I'm required to go through a licensing process that makes my ears bleed every single time I renew. I face a client whose expectations are that I will fill our sessions with checklists, lectures and concurrent note-taking, which pretty much uses up all the time I would otherwise spend listening, thinking, responding.

I suggest taping the session so I can contemplate it later, but the patient-client-customer's eyes start to bug out when I mention this. This is not paranoia of the clinical type. I have quasi-special standing as a professional in the eyes of this person. On one hand, I've got the diploma, but doctors are the ones who push the pills these days. And I'm working as a counselor; the same sloppy title applied to a long line of slovenly, burnt-out list checkers. I have to be confined by ethics, because it is presumed that I am without morals. Why should he trust me?

The understanding that has been cultivated over years of practice, supervision and feedback, the formal education that I have paid thousands and thousands of dollars for, years learning in that institute of higher education? They've been reduced to a series of manipulated cognitive interventions that look marginal on paper and are measured by the lowest common denominator of psychic lethargy.

And maybe that's what Mr. Shysmile deserves. What exactly is _his_ role in delivering himself to my office a jaded connoisseur of painless, effortless superficial change? There was a time when we all knew that change was work; an uncomfortable process that involved soul-searching, unrelenting honesty, a modicum of courage and a willingness to face reality on some level deeper than had been faced previously. We do that, we see ugly things. We learn stuff we've been keeping secret from our conscious selves for years. And we learn to be proud of every inch of freedom we acquire.

Now, the government takes money from all of us to pay for the services that it will later foist off on our neediest brothers and sisters whether they want it or not. It will be the lowest standard of care possible to conceive, with money skimmed off services and delivered into fat, greedy fists until every dime screams in pain. Then we convince our mentally ill that they should not only accept, but depend on these services, which substitute medication and paperwork for genuine and honest human contact, because it is 'free.'

And we're getting exactly what we pay for.

Remember the movie, _On a Clear Day_? Barbara Streisand's slick psychiatrist boyfriend makes her pay for sessions despite the intimate nature of their relationship (now there's a guy who has no morals!) with the authoritative refrain, "if you don't pay for it, you won't get better!" I've heard many versions of that during my professional career, mostly from older practitioners, who used it both to justify their fees and in the belief that if we did not build up some equity in our own recovery, it wouldn't be worth having.

I'm not entirely sure they're wrong. I see a lot of people dribble into therapy because someone else thinks they should; because they've been threatened with jail or divorce or unemployment. Because they want the drugs, or an excuse (or at least a justification) for their behavior. But if change is work, and we're only willing to participate if we don't have to think, feel or pay, where's the work? How do you get invested in something that costs nothing and means nothing?

It's yet another role that therapy (and the therapist) had taken on by default: the identified agents of change. In many minds—including, unfortunately, many of our own, we are the 'fixers,' the bad-mind-redesign team. Courts ship 'em to us, we go in, and force the change that jails, divorces, bar-fights, lawsuits and physical debility can't make a dint in. Maybe.

And of course, while we are being tougher than a judge, more violent than a car crash, more wounding than a defecting spouse, don't forget—we need the client to like us, too.

Huh.

The Power of Peace

There's a thing, a secret power that recovery people have, which we can tap into once we fully embrace the change that is coming over us. Actually, there's a few, and together, they add up to the meaning of life as we know it, the meaning of everything. The funny thing is, these same 'secrets' have been being shouted from the rooftops since approximately the day after God created everything. Maybe the secret is in whether or not you really want to know.

Sometimes, us humans don't listen so good. It's both part of our charm and one of our most integral flaws.

Here's the secret: everybody really is equal.

Sure, I was bitching up a storm earlier about forced and unnatural equality in the therapeutic session. I think that pretending my patient and I are intellectual, life-experience, educational equals is a form of lie if we really aren't. We foist our deceptions and incongruities off on vulnerable people. Neither my life nor my time is worth more than anyone else's, and stuff is never more important than people. Ever.

The problem with lying to the vulnerable in the guise of being helpful, is what Freud pointed out quite succinctly—our most vulnerable brothers and sisters have been lied to all their lives. That's how they get so screwed up. What they need from us is the truth. And the a real ability to help.

So how do we balance expertise and equality? What is equality if it's not sameness? The kind of equality that I'm talking about is the Viktor Frankl kind. Do you know him? He was pretty damn popular back in the old days when people still thought that psychiatry was within its scope to contemplate the big picture questions like "why are we here?" and "what is the meaning in life?"

Viktor Frankl was imprisoned in a German concentration camp during WWII, and experienced atrocities that drove some people mad. Others, it killed outright. Frankl emerged with a new understanding of what it means to be human, and what life is all about.

Frankl said that the Nazis had a flawed belief system. Not because they believed one group of people were inherently superior to another, so much. Just about everybody thinks that about one group or another— usually their own group. The flaw was that they believed that genetics, or eye color or the smell of your shit could be used as an adequate measure of such superiority. They believed that their finite human mentalities could measure the infinite possibilities contained within each human soul. The infinite possibilities each human soul contains simply by virtue of existence on this plane.

Human beings, Frankl asserted, are infinitely valuable. There is no way to measure the worth of one human being against another. The grace of humanity is contained within our infinite possibilities, not in our _stuff_. Not in characteristics with which we were born. Not our hair styles and acquisitions and ability to hit a high note or shove a ball through a hoop.

The meaning of life, Frankl asserted, is that we each _search_ for meaning. Our own, precious, special meaning, the unique path we trudge with all our foibles and gifts, to contribute to our society, our brothers and sisters, our great family in all its diverse joy.

By pretending to myself and my client that we're peers in therapy, I'm lying just as much as I am when I pretend that because I'm better equipped in this particular arena, I'm a more worthy person. I muddy the waters of the job each of us has to do during the therapeutic session. I don't see honesty and humility in pretending to be buddies, or pals or partners. I see honesty and humility in accepting my role willingly, in not pretending that I don't know what I know or see what I see. Just as I don't deny what my patient knows and sees.

The old-style psychoanalysts have it all over the rest of us in one respect: in order to become a psychoanalyst, it wasn't just about the school, the degree, the residency, the _practice_ ; you had to complete your own psychoanalysis before you were pronounced ready. What happened to that ideal?

Somehow, as personal belief and understanding have devolved into classroom practice and recitation of history, we have nonetheless glommed on to more and more phony omnipotence at a breathtaking rate. And it's all a big sham. The only power we have over each other, really, is the power we give one another. When we fully come to realize we are the most powerful force in our own lives, just as everyone one else is the most powerful force in his or her own life, that's when we get equal in the therapeutic field.

It's the lies we tell each other that are the sickness. And it's the lies we allow ourselves to believe that keep us there.

You know how to get rid of a pesky practicing alcoholic or drug addict in your life? Start telling the truth. Truth. It's the real anti-drug.

Here's another secret: truth doesn't hurt. As much. No matter how hard or painful hearing the truth seems to be, it's never as hard or as painful as keeping up whatever mental pretense we hold on to in order to keep the truth from spilling itself. Because we are made to be honest. When we don't speak the truth, I can guarantee, we will end up acting out the truth at the most inopportune time possible. Strapped down truths are like weeds under concrete. Eventually, the small, soft leaf will push around or even through the rock, and there will be the truth, damn it, bobbing it's pretty yellow head for all to see.

The thing is, lies don't change reality, however we would like to cling to that illusion; the only thing that lies change is our self-respect when we tell them. Truth outs itself, because we are built to be honest. That lie we tell about not being equal—the lie where we try to hunch over and be smaller, giving away our power hand over fist, or blowing ourselves up into great, pompous windbags, thinking or letting other people think that we are more than we really are? Those are the most fundamental lies of all.

Want to see one of those big, pathetic lies in action? Look at the mental health practitioners who run around, claiming 'tabula rasa' because they don't understand what it means to be human at all. They're scrambling to maintain a façade of happiness, calmness, control. Life isn't about happiness, calmness and control. Life is about having purpose, doing the right thing, throwing the doors open.

Bill W., a co-founder of Alcoholics Anonymous, said, "happiness is doing the right thing because you want to." Much earlier, Plato described happiness as the byproduct of a well-lived life. Dead nuts on, in my opinion, an anathema to folks who confuse happiness with euphoria, entertainment or security. And more effort to achieve.

The pesky word 'work' rears its ugly head again. Damn!

How do we define mental illness?

Have you ever stopped to think, really think, about how you would define mental illness? Hearing voices? Moses did, Jesus did, Gandhi did, Anthony Hopkins does. So does one of the guys from the Red Hot Chili Peppers, and so does John Nash, a Nobel prize-winner in mathematics.

So hearing voices alone is not the definition of mental illness. Depression? Many people feel sad and blue, but still get up and go to work in the morning. Or afternoon. Whatever.

Mania? Robin Williams. Rest my case.

Mental illness is not just a feeling, although it used to be (see the first version of the American Psychiatric Association's _Diagnostic and Statistical Manual of Mental Disorders_ ). Mental illness is defined by symptoms that can be observed by other people and that are outside the range of 'normal' experience.

Plainly put, it's not hearing voices that's the problem, it's doing what the voices tell you— if what they tell you to do is not normal. It's not being sad that's the problem, it's bursting into tears every time someone asks for the ketchup. It's not thinking that people are out to get you, it's covering your windows with aluminum foil and storing your urine in the refrigerator that's the problem.

In other words, we have come to define mental illness as symptoms and behaviors that inconvenience, puzzle, offend or disturb other people. Basically, we've turned mental health into a huge game of High School.

Some people, even a lot of people, suffer horribly with mental illness without an awareness that there is another way. Like alcoholism, many mental disorders can convince the sufferer that they're okay, it's everybody else who's fucked up.

Do we really want a mental health system in which eccentricity is obliterated by the vote of the cheer-squad? It's like the whole Salem witchcraft trial thing, where teenage girls lead the charge to purify society based on a bunch of squicky pubescent rules for what a person should look like, think like, act like. We all know how well that ended.

Stress, biology and mental illness

At the end of the 19th century, schizophrenia, that state in which a person exhibits paranoia, confusion, delusions and psychosis, was considered a disease of the brain. Something was rotten in there, and unless the brain itself could be fixed, there was little hope for the person who exhibited the symptoms.

As the practice of psychiatry became more popular, there was a trend toward viewing schizophrenia as a mental rather than medical illness, with the implicit possibility that with good treatment, recovery from schizophrenia was possible.

When antipsychotic medications were developed and demonstrated a significant ability to affect symptoms of schizophrenia, the pendulum once more swung toward the 'medical' side of the scale. Of course, if you were giving me tranquillizers strong enough to drop a full-grown elephant in its tracks, I probably wouldn't be screaming about voices in my head either. I'd be too busy trying to make sure that it was my feet on the floor and not my brains. Anything's more manageable when you wash it down with the chemical equivalent of a lobotomy.

Then Thomas Szasz came along and postulated that there is no such thing as mental illness. This was quite a shock to the status quo, who'd been arguing about whether mental illness was biologically or environmentally based for so long, they forgot that they'd neglected to have the argument about whether or not it was _real_. Evidence in recent years had tended to confirm that schizophrenia has a strong biological basis.

Genetic markers have recently been identified that indicate schizophrenia is, in large part, something that a person is born with—like blue eyes or brown hair. Twin studies likewise confirm that a predisposition to schizophrenia is in the genes.

However, and this is where the symptom-based diagnosis thing gets sticky, research also shows that schizophrenia can be _caught_ —as is demonstrated in people who were exposed to certain strains of virus in utero; and that it can be _inflicted_ —as happens in people who have experienced brain damage through the use of drugs, traumatic brain injury or extreme forms of childhood abuse.

Of course if everyone who was born with genetic markers, was abused as a child, had a structural abnormality tucked away in the old brain pan, used drugs, got a head injury or experienced a prenatal viral exposure became schizophrenic, well . . . who'd be left to do the studies, right?

So now there's a biological model to explain why a heck of a lot of people should be schizophrenic, but no model that explains why all of them (us) aren't.

So more than biological factors had to be incorporated into the model to account for all cases of schizophrenia. This model is called the diathesis-stress model. Think of it as the 'final straw' model.

A concrete block can have a serious flaw. But if it's the top block on the pile, it may never break. Put it at the bottom, though, and the whole thing may come crashing down. Or consider a camel who has a bad back, but can still carry a small load of straw. If you forget and overload it, however, there eventually comes a point where one straw too many and _pow!_ The camel's back is broken, and the camel's straw-hauling days are over.

The diathesis-stress model says that a person can have a predisposition to certain illnesses—maybe the genetic markers are all lined up, or the person has an intense susceptibility to mood-altering drugs, but there's a certain trigger that needs to happen to complete the circuit and turn the switch to 'on.' Maybe a traumatic life event. Or, in the case of the susceptibility to mood-altering drugs, the person has to get high to trigger the effect.

I might have thin bones, even a family tendency toward low calcium and osteoporosis, but if I never fall down the stairs, no big deal.

I rather like the diathesis-stress model; it makes sense to me, and explains things simply. I personally take it a notch further, however, with the following:

Every factor that we have identified as a predictor for schizophrenia effects brain function. Wider ventricles, damage to the temporal lobe, drug abuse, prenatal viral infection. The result of all of these things is a change in brain function from what we consider 'the norm.' To be more specific, it is a change in the ability of one neuron to communicate with another.

Communicating with each other is all brain cells do. It is their _raison de être_ , as it were. Back and forth, and forth and back, all day, all night. They pass messages, they chat, they gossip, they tell. It's how we learn. Brain cells all busily passing messages, taking in new information and transmitting it to all the other little brain cells that need to know. The brain is a learning machine. So, when the brain is not accurately taking in, processing and passing along the messages it gets, when neurotransmitters are either missing or over-produced, when cells are either not receiving or not sending, what else is that, except a learning disability?

A learning disability. Biologically-based brain dysfunction which results in mental illness is a _learning disability_.

And what happens when you have a learning disability?

There are numerous possibilities. If you have deficiency in the ability to calculate figures, for example, but you're a fierce and agile hunter, racing across the plains in search of elusive prey, your inability to do higher math may not ever even be noticed, much less counted as a deficit. After all, would a cave gal rather be well-fed and covered in rich furs, or have the satisfaction of knowing the geek she's with can do long division in his head?

If, on the other hand, the area in which you are incapacitated is one that has a direct impact on your daily life, your life may be based around your deficit, your sense of failure, guilt, shame, and your abiding hatred of sadistic denominators is going to put you in crisis. Are you going to learn from those crises? Possibly. Probably, even. But if you have a learning disability, how's the info going to get ping-ponged around your brain?

Answer: It's going to be distorted, possibly severely distorted, by your stress, frustration, and difficulty in fully grasping the concept to begin with. And it's going to be greatly influenced by the demands of the society in which you live.

I see this playing out in two ways. Our hunter, say, has great speed, kinesthetics, agility and visual-spacial perception. Say also has some hearing abnormalities and some random-firing problems in his brain, along with an overabundance of dopamine. He hears noises that no one else hears. His brain takes those occasional random noises, and learns to read them as voices. We always seek patterns in random occurrences. It's part of being human. And our hunter is human. Our hunter is also a happy guy. His mom loves him. The girls love him. The tribal council loves him, because he spreads the beef around. His voices reflect what he's been hearing all his life: You're Great! We Love You! Way to go!

Our second guy has exactly the same skills sets and processing problems as the hunter. They could be twins. Except guy two works in an office. He's forced to sit for hours at a time and stare at a little computer screen, and watch numbers float by. It's the only kind of job available to him in his society. And it's driving him crazy. Literally. On top of that, he's spent his entire childhood and adolescence being scorned by every adult he meets.

"You're an idiot!" "I hate you!" "I wish you'd never been born!" Say mom's not balancing on all four tires, and he's had to endure being locked in the closet whenever she gets mad at him, toss in some brutal physical abuse. This guy hears voices, too. Guess what his say? "You're an idiot!" "I hate you!" "I wish you'd never been born!" and so on.

Consider this: at least four percent of the population says they hear voices. But the rate at which schizophrenia is diagnosed in our society is closer to one and one-half percent of the population. The rest of those voice hearers are doing just fine, thank you, and many of them say they are not only able to 'cope' with their voices without psychiatric help, but that the voices enhance their lives. Try Googling 'hearing voices.' These folks have their own support groups, blogs and official position papers.

Why are these folks not considered psychotic or schizophrenic? Because neither they nor their loved ones are disturbed by what their voices are telling them. _Because the voices do not negatively affect their ability to function_. Their experience of hearing voices has not been negatively affected by negative learning.

That negative learning is so sad. We take people (especially little people) who are absolutely great at being exactly who they are, and instead of giving them love and encouragement to find even better ways to be who they are, we spend all our time as a society trying to shove their beautiful round pegs into our ugly, square little holes. Christ.

Another example of how society shapes our uniqueness? Hermits and monks.

In the Middle Ages, if you were revolted by the needs of the flesh, sensitive to the point of pain to other people's voices, emotions, needs, never were so happy as when you were sitting quietly by yourself and contemplating life, love, nature, God—no problem. You find yourself a snuggly little cave, peasants bring you loafs of bread in exchange for your words of wisdom, and you can threaten to call down the wrath of God on your noisy neighbors.

Now, society has become so demanding, so prescriptive of normal and abnormal, that if you spend too much time out in a cave by yourself, you're asking for trouble. All the land is owned, so unless you can afford to buy a cave of your own, you're probably trespassing on somebody. You're supposed to file a tax return, have a Social Security Number, and have a picture ID with you at all times. And if you come into town to file your taxes, wearing your long brown robes and with your hair and beard all overgrown and locking up, maybe stopping for a brief street-corner sermon as long as you're there anyway, you're liable to get tossed by the police, and find yourself sitting in a psychiatric ward somewhere, trying to convince a bored practitioner that forsaking society and the pleasures of the flesh _is_ your job. Fuck! Can't a dude just go hermit anymore?

Apparently not.

The Importance of Unlearning

When considering the possibility that mental disorders are actually the product of a symptom or potential based in biology, coupled with triggering traumatic experiences and which are incorrectly routed through the brain due to a learning disability, it becomes apparent that any successful approach will need to be multi-tiered, just like the disorder.

You can address biological potentialities and learning disabilities to some degree with biologically based intervention—medications, for example, or ECT or lobotomies. But all these interventions change is the biological potential. And some of them have the unfortunate side effect of changing everything else, along with the targeted symptom.

So let's look at the unlearning part. On a positive note, anything that can be learned can be unlearned. This is the heart of real therapy, and this is the part people avoid like the plague.

You have to go back, look at what, why and how you learned, process that with the help of someone who—hopefully—has a better set of processing skills than you have, unlearn the old stuff, and then learn the new stuff. Along the way, you get the joy of seeing all of the things your old learning led you to do that now make you ashamed, guilty or angry. Then you get to go out and do the work of finding new lessons to learn and apply, as needed.

We, as human beings, are programmed to avoid pain, like any good mammal. That programming gets in our way sometimes, as our brains confuse physical, life-threatening pain with emotional pain. The only way to get through emotional pain is to experience it, grok it, learn from it, grow with it. Eventually, I swear, all the shame, embarrassment, guilt and anger loose their grip, and just become things that happened. But it takes awhile, and you have to be willing to get sloppy, confused, brave and really, really sad, angry, glad and afraid.

Learning is experiential. It takes time to build the new experience and change the learning. Learning isn't one blinding flash of knowledge that explodes into the head and changes everything in a heartbeat, although sometimes it seems that way, if the subconscious has been chewing on it for a while. Learning is the accumulation of a thousand little bits of data that validates the new idea. There's no way to put that in a pill and choke it down.

You have to come to an understanding that your past learning is flawed in some way that significantly impacts your ability to respond to the present, and sit down to unravel how you learned it, to trace all the roots and webs and sticky fingers that incorrect learning has sent out to warp your understanding of the world and the people around you, and then slowly, determinedly give yourself the experiences that countermand your previous learning.

I'm exhausted just writing about it.

And here's another gem: a lot of the people who we hire to provide treatment for mental health issues don't understand it either, which makes it really difficult to lead a person through the process. It makes it really difficult to understand why they've chosen to work in mental health at all, really, but that's another discussion—for the people who have ethics, instead of morals.

The Secret life of an Average Man

Mr. Shysmile describes his life, his history, his days and nights to me. He is able to point his finger at an angry mother, a disappearing dad, a troubled and abusive older brother, but is unable to voice what he learned from these pivotal people in his life. He can describe with some gusto what they've done to him—even seems to take a bit of pride in the tales of his abuse and mortification at their hands. Kind of a 'my scar is bigger than your scar' bravado. But he is completely unable to describe in any meaningful way what he _learned_ from these experiences. And I see the fear that lurks underneath his surface.

Terror lurks in the deep end of the pool, in the belief that these people are right, that he was worthless, stupid, worthy of abuse, neglect, horror. He has gone out and done things equally horrible, attempting to achieve success in the world he believes is out there. He becomes subject to fits of hysterical rage, assaultive in a sneaky and Gollum-ish way, has used drugs and alcohol and vulnerable women to assuage his sense of fear, his sense of self.

He thinks no one can know these things, no one could imagine, no one could tolerate him if they knew. And nearly every drop of psychic (as in mental, not as in fortune-telling) energy he has is devoted to keeping the lid on all the ugly. See, he can't face the fear. So not only does he keep all of his unwieldy, awful secrets tamped down tight, he has to keep his own knowledge of them locked up, too.

Sometimes, I think, it's not the traumatic experience itself that leads to impaired functioning; it's the energy we put into not revealing how it hurt us—and the energy we put into keeping secrets from ourselves about what we've learned from it, what we've done because of it.

When we reach the point described in Orwell's _1984_ —the rat point, we break. In _1984_ , Orwell's hero has a phobia for rats. He is tortured by having his head placed in a dark box, then having rats turned loose to feast on his tender ears, nose, lips and eyes. The torture only stops when he sacrifices that which is most sacred to him: he begs the guards to put his true love's head in the box instead of his—and means it.

When one's desire to survive overcomes one's desire to preserve what is most sacred to us, we start losing our humanity and becoming our coping mechanisms. Symptoms spiral down on us with grips like iron, obstructing vision, movement, the ability to focus on anything else except that narrow crux point in which we balance our symptoms and our blindness.

I catch my fingers moving restlessly as Mr. Shysmile explains to me in a defensively grandiose tone how he 'felt' about his early experiences. He sounds like a book on tape, documenting the life of some other man. He brags of getting in a fistfight with his older brother, of walking away from his mother, of the beautiful wife that is not with him any longer, how he deserted his children—as if this were a virtue parallel with actually changing—"because I was no damn good for them."

He darts a glance at me to see how I am reacting. Here's the real tabula rasa: I think he's a self-centered dick, and it's not showing on my face.

I forcibly refocus, remind myself of my own journey through the dark, all knee jerks and posturing; that in order to help him, I need to be able to love him, to look for the sparkly bits inside that all the drek and deception and dishonesty hasn't entirely dulled. I remind myself of the level of horror a born-wonderful human being must have to experience to become this passive-aggressive, vaguely offensive human being I'm sharing air with today.

Because, see, as long as he's still breathing, he is still invaluably human—there's no measuring stick ever designed that can fully capture not just what _stuff_ a person has, what _things_ they've done, but what their potential is. And I've come to accept that I'm not gonna be the one who figures it all out.

I wonder how many therapists have colluded with him to keep the knowledge that it's not the experiences, but what he made out of them—what he learned—out of the therapeutic conversation. It makes me wince inside. But it seems to be part of the evolution of mental health. First, it was all in our minds, and we worked to uncover and explore our subconsciouses. Then it was all about mechanics, us being big computers, and it became all a matter of changing behaviors. Then it became all in our bodies, and was a matter of changing medicines. Better living through chemistry.

If it's really just all about having the right drugs, how come Anna Nichole Smith wasn't the happiest woman on the planet?

Hard questions

I ask Mr. Shysmile how he feels about his past treatment. This throws him. He clears his throat, considering. "You mean, how it made me feel? Good. It was good. I had this one therapist who had all these board games to play. It taught you stuff—you know, like what to say when people were picking on you. I always felt good after we played one of those games."

The person who invented board games for mental wellness should be burned at the stake. There are catalogs full of them, if you ever are interested in them. Board games to teach ethics—morals being out of favor at present. There are board games to build coping skills, board games to build social awareness—when the hell did we reduce mental health to a goddamn board game? I'm pretty sure I didn't get a vote on that.

"Is there such a thing as gonzo in counseling?" Mr. Shysmile wonders aloud, eyes on the grainy photograph on my wall. I follow his eyes; Thompson glowers while Acosta smirks.

Even Szasz was well-mannered in his opposition. "I don't think so."

"Why not?"

"Didn't need to be, I guess. People like Thompson, like Acosta, they seem to come to the front when they're needed—to create that window into a different reality . . . ." I falter to a close at that idea. Shysmile's eyes shifting from the photo to my face. Have we reached such a point that unlikely heroes are called for? Defectively effective in raising awareness of the absurdity of the system in which we're all racing around like rats? Has the state of mental health reached the state of the Nixon-led Republican party, the clash of students and conservatives during the summer of love, or even of the horseshit and the hats piled up at the Kentucky Derby?

Shake it off, forget the big picture. It's not uncommon for clients to deflect scrutiny from themselves when the going gets tough—don't we all? Back to work on the minutiae of Shysmile's life.

I don't know what's more defective—the insurance company who pays for this kind of shit (meaning the public mental health system), the therapist who tells him or herself that this is a productive use of therapy time, or the patient/consumer/client/pal who is such a dupe they consider this a good method to improve their symptoms.

"Actually, I was asking something a little bit different, but I'm glad to hear it made you feel better. But I'm not talking about feeling, exactly. I meant what had the biggest impact on you? Over time. Has anything really stood out to you as helping you to feel and function better?"

He smiles, like he's speaking to a child. "Oh, my symptoms are never gonna go away. A social worker told me that once. 'Bill,' she said, 'You're one of the most serious cases I've ever seen. You're not going to get better. So we're not going to waste our time on that. We're going to work on ways you can cope with your symptoms, and keep them from making your life such a train-wreck. That's what we're gonna do.' And that's what we did. Nothing's gonna make my symptoms go away."

If I come across that social worker somewhere, I'd go gonzo on her ass in a heartbeat. She'd probably get famous for writing a paper on treatment of PTSD with mayonnaise and jogging.

Shysmile's sold on retaining his symptoms—of course—that's what allows him to continue not looking at himself. But I can't help it. I ask anyway. "What if we could really change how you feel? What would that mean for you?"

I sense the fear curling in his gut, as he thinks about the monumental shift this would cause in his mind, in his life, in his goals and expectations and responsibilities. Peace rather than liability? Happiness by doing rather than euphoria by taking in what's there? His eyes go suddenly flat and suspicious. "I'd lose my benefits, that's what would happen."

I say, as softly and persuasively as I can, "Because your future would be full of glorious possibilities. Maybe you wouldn't need benefits. What would life be like for you, then?"

This is more than he can bear. He stands and glares at me. "No wonder you can't get a job at a regular place. Pictures of hippies on your walls and stuffed Freud dolls. This is crazy. I don't want to get turned into somebody else. I just want _treatment_. What kind of nutcase are you?" He huffs to express his disdain, and then stomps to the door. Hand on the doorknob, he turns. "I'm asking for another counselor," he says, as a parting shot.

I lose more patients that way.

Oddly enough, or telling enough, Mr. Shysmile doesn't cancel his appointment for the following week. Failure to play by the rules as a passive-aggressive attempt to express hostility, or sign that he is conflicted, even wanting to return? Like Van Morrison says, "If you never hear from me, it just means I didn't call."

Finally, Shysmile's day arrives, and I sit in my office, reviewing the state of my bodily functions, tapping my pencil, listening for the footsteps past the receptionist, past the bathrooms, softly, softly to my door. Sure enough, there they come, there he is. I put a non-judgmental face on, waiting for the knock. His smug embrasure of his mental illness, his passivity in the face of opportunity for a real chance of recovery, all of it are engendering a sense of moral repugnance in me, which I do my best to take out, examine and dismiss as the autocratic assumption which it is: my time, not his, and I know best. I am the doc, after all.

I wait awhile, wondering, as he stands on the other side of the door, trying to decide whether he wants to enter or not. Couldn't he have figured this out before he drove here? No, of course not. If his thinking, reasoning, judgment, processing wasn't impaired, he wouldn't be here in the first place.

I find it strangely unsettling that he might have judged _me_. Of course, we all judge each other constantly. Humans are social beings, herd animals, and that constant measurement of each other comes deeply embedded in the genetic code.

Finally, he taps on the door and I relax. Another chance! "Come in," I call, and the door opens. _Hello, Mr. Shysmile._

New Beginning

I'm mildly giddy with his return, with his acceptance. There's a certain type of person—and I went to school with several—who pursues a PhD in psych because they think it's an easy way to be called _doctor_ without all the mess and ungodly hours of going for a medical degree. Actually, those are usually PsyDs. The year I was accepted into the doctoral program at my university, there were 25 slots available in clinical doctoral psychology programs throughout the state. There were about a hundred slots available at med schools that year in the same state.

However, the point is, some people are attracted to doctorates for the status it gives them. I always wonder how those same folks do when they're out in the field working, and they end up spending most of their waking hours in the company of people they wouldn't be caught dead with at the country club. If they are working for a company or clinic that monitors consumer satisfaction, they're not only spending considerable amounts of time with people they'd normally recoil from on the subway, they're actively seeking their approval.

So why was Mr. Shysmile's approval so important? I'm like any other human being. I want to matter, to make a difference, to live a life of meaning and value. I want to know that what I do is real and valid, and by coming back, Mr. Shysmile validates that I have something worth giving away. Plus, it's just plain ol' gratifying.

Sometimes karma is awesome.

Captain of the Squad

Along with my giddy delight at being chosen—rather like a prom queen right after the vote is announced, or Sally Field picking up her Oscar—I feel a heightened sense of power. After all, he picked me, right? Not just out of the phone book, or through a referral by someone else. He came, scoped the office, scoped me, and came back.

"I wasn't sure about coming back," he says, taking a seat—gingerly!—on the chair.

What? What? Am I not the prom queen after all? Horror of horrors!

"I talked to my mother on the phone last night," he continues. "She says, 'as long as it's free, give it a chance.' So I came back."

He looks at me expectantly as I sort through the multiple levels of meaning here. My gut reaction is that anyone who lets their mother pick their therapist for them is a bubble off plumb anyway. My second reaction is—because I'm free? I give him a steely look. "I'm not meeting with you to please your mother. I'm meeting with you because you indicated a need for therapy."

"Well, no, not exactly."

"Not the mother part, or not the need for therapy part?"

"Mostly the need for therapy part." After another steely glance, he starts to squirm a very small amount, which I figure is the least he can do.

"I mean, I have to have therapy to get my medication. Plus, it's in my treatment plan. But I don't need therapy for anything. I like how my life is."

I consider this, along with what he told me last time. "But you were doing . . ." I realize I can't make the word 'therapy' come out of my mouth to describe what he was doing before. "You were doing counseling, right?"

"Yeah. It was fun. Actually, it was kind of like a fortune teller game or something. The counselor asked questions, I answered, then she'd tell me how I was doing or if I was heading for a crisis or what my stress level was or something. Like that stuff on the Internet—how old are you, really?—you know."

I do know, and actually cringe when I come across it accidentally. I shudder now.

Looking for a positive way to address this, I try, "People do therapy all kinds of different ways, Mr. Shysmile. What if therapy can actually help you to get a better understanding of yourself, develop the courage to make new choices for yourself?"

He looks at his shoes thoughtfully. So do I. They're not very inspiring. Finally, he looks up, shrugs. "Mom said I should give this a try, so I guess I will. Can't argue with free, right?"

He sneaks a glance at the wall. "I didn't tell her about the gonzo."

I marvel. Has this become my personal icon in his fantasies of me? A faded picture of two guys, long dead, who were as much a joke as a statement? Or am I just getting so damn old that there's no one left who gets that the joke _is_ the statement?

Or maybe I'm just spending too much time with my clients. There's a whole new pile of things to worry about.

It's going to be a long session.

Needs versus Wants

I read an interesting article recently, written by a therapist. The writer talks about needing to meet a client's _wants_ (and whose need is served there, I wonder?) in order for them to engage enough to work on what the client _needs_.

If a woman is not comfortable with a male therapist, the theory goes, she will never _want_ to disclose enough to him to start working on what she _needs_.

Immediately, I think that working with a male therapist may be exactly what she needs, if her issues regarding her discomfort about males are any part of the reason she is seeking treatment. If, of course, therapy will go on long enough for these issues to be brought to the surface.

_Long enough_ is the significant phrase in that sentence. If therapy is going to be six weeks and out, as determined by someone who has never met either therapist or client, I can understand why homework and checklists, the lowest common denominators of pseudo-psych, are so important. But it's not enough time to deal with complicated issues or deeply held pain.

Sadly, that's where the checklists, board games and behavior mod tactics come in. The snap-your-fingers style hocus pocus that turns a lifetime of bad learning into a few weeks worth of rewiring the circuits and blowing the dust off the old transistors. In AA, you'll hear people say, "this is a program I'll be working for the rest of my life." Not only is there nothing wrong with that—like we have something _better_ to do? It's not specific to alcoholics, either. Bad news to the board game set. Choosing to live a different, and hopefully better life _is_ a life's worth of work, and every second counts.

Still, all the mental health gatekeepers are sitting around somewhere, watching therapists and clients scrambling around, wildly trying to cram something meaningful into what the rules allow—using spy cams and drinking the schnapps they've banned from the repertoire of our indulgent psychoanalytic forefathers, no doubt, keeling over with laughter, snickering and finger-pointing as they watch the mockery into which they've morphed any kind of real or meaningful care?

Have you ever considered how the marketplace affects the mental health industry? Sure, it sounds like it's all sweetness and light and let's all cough up some cash so those other poor schmucks can get the help they need.

In reality, it's just the same old rampant profiteering in a vastly unregulated industry that only gives lip service to the noble goals and the rigorous practice that used to make therapy actually useful. As patients, we have traded working our way to real wellness for dangerous drugs, a small pittance in cash and flood of pseudo-interventions that I wouldn't waste on my dog, much less an actual human being with heart, soul and potential. Modern mental health has turned into the new opiate of the masses.

As clinicians, we have allowed ourselves to be nibbled to death by ducks. Paperwork ducks, money ducks, policy ducks and bureaucracy ducks. We have recklessly thrown away what we know in our hearts for what can be demonstrated by a ten-minute customer survey in the middle of a public mental health system that was designed to do the most harm possible while putting on a federal song-and-dance designed to fool the liberals.

And as voters, we have allowed our judgment and integrity to be overridden by a plan that Nixon hatched thirty years ago that to date is allowing a bunch of tit-sucking profiteers to bilk us of billions of dollars a year while laughing up their sleeves at us, our loved ones and the pain and desperation that comes from living with serious mental illness.

Look:

Originally, psychotherapy was considered primarily an affectation of the rich. Psychoanalysts and their patients were pretty much social peers.

PHASE ONE: Demand Exceeds Supply  
Early 1900s. Freud controls the supply of psychoanalysts: both practitioners and patients are carefully selected. The purpose of psychoanalysis is to allow the patient to break the iron grip of the past and allow them to choose their futures. Psychoanalysis is only performed by a limited number of medical doctors who have completed their own lengthy analyses while in training. Psychoanalysis is limited to those who are wealthy and who have the time to spend two to three years in analysis. There was no regulation of practitioners except self-regulation.

1909

Freud has discovered that neurotics will pay for a 'talking cure.'

Clifford Beer founds the first grass-roots lobby on behalf of those who suffer from mental disorders.

The mental health industry scrambles to defend its practices.

1918

Money is beginning to be made, so the American Psychoanalytic Association finds a way to regulate it.

Eventually, the pressure was on the tightly controlled psychoanalyst franchise to induct more members into their inner sanctum, and for a fee (of course) they became willing to do so.

PHASE TWO: Supply expands (and diversifies) to meet Demand  
1920s and '30s. the rank and file of psychotherapists expands beyond Freud's hand-picked band of brothers, psychotherapy practice gets broadened in two dimensions: Interested non-medical parties pointed out that since there is no touching of body parts involved in psychoanalysis (unless the analyst is really, really naughty), the analyst shouldn't need a medical degree as long as they have their own analysis done. Secondly, it's argued that since everyone who wants psychotherapy doesn't have the time and/or the money to go through an analysis that costs as much as an upper-class home and takes as long as a college degree. Starts as a trickle, but soon, the supply of analysts is just about equal to the number of wealthy neurotics who can pay for them.

1936

Lobotomies become popular.

Two drunks meet and help each other get and stay sober.

Not only does supply meet demand, psychotherapy becomes stratified allowing consumers more choice in providers and in the duration of the therapy itself.

PHASE THREE: Supply exceeds Demand  
Early 1940s, a glut of professionals start looking for new markets in which to peddle their wares, just in time for World War II. They bring the promise of voodoo psychological warfare to the table—and bring in the red-headed stepbrothers of the psychotherapy field, the behaviorists. The behaviorists have been watching the fortunes being amassed by those sexy psychoanalysts; and they want some too. There's nothing generals like better than being reassured that all those wounded kids are just meat machines—it's a marriage made in heaven. Or hell, considering what their knowledge was used for.

1940s

Quack treatments abound. A paradigm shift in which mental illness goes from mockable to medical begins to occur with the average Joe. Vets create a demand for two things: a reliable classification system for disorders, and the expectation that if it's a medical condition, there should be a treatment for it.

There are two major schools of psychology: the school of the mysterious interior; and the school of the empirical experiment. The empirical school gets a leg up during World War II.

The rat guys get busy quartering up the complex mechanisms of the human psyche into measurable behaviors that can be easily counted, and in developing methods of changing those behaviors.

When the war ends, once again there's a glut of professionals on the market. But there's a difference in the mindset of the glutees this time: they've seen that the real money to be made is at the government trough.

But how to convince the government that it should still pony up the dough?

PHASE FOUR: The Supply creates the Demand  
1940s and '50s. Psychologists and psychiatrists need a new market once the war winds down, and they find it, in the American public. And they can prove it's needed. One of the byproducts of the funding for psychology during WWII is that it presented an opportunity for psychological research on a scope never before imagined. Armed with data gathered from thousands of subjects, practitioners can use statistics to open the government's pockets and keep them open. Vets who have returned home from the war are now dealing with a condition called shell shock. At least, that's what it used to be called. Now, it's renamed Post Traumatic Stress Disorder, and the cost for treatment goes up accordingly.

1950s

As medical treatment increasingly becomes a provision of Eisenhower's administration, there's the idea that mental health care should be paid for through the sources that caused the mental disorder in the first place—namely, the government.

1952

First edition of the _Diagnostic and Statistical Manual of Mental Disorders_ (DSM) is published by the American Psychiatric Association.

1960s

Everybody is running for the shelter of Mother's Little Helper—the time of better living through chemistry is upon us! Insurance companies are surprised to find the percent of dollars going to mental health treatment is climbing steadily.

They've had over sixty years to work on the damage to the wounded psyches of vets from half-a-dozen wars. Considering all the money that's been siphoned out of our pockets and into programs for vets, it sure seems like someone should have gotten better by now.

PHASE FIVE: Supply worries about Demand Drying up  
1960s and '70s. WWII vets are getting older—old enough for them to heal despite the treatment that's offered them; some are dying from natural causes, consequences of their post-war lifestyles, and from suicide when they don't recover from their mental health issues. It's easy to see that the market is going to start drying up again, Korea, Viet Nam and the Gulf War not withstanding. Public health insurance has been a hot topic for a good couple of decades—why not include mental health in there as well? Nixon is at the wrong place in the wrong time for an anti-social republican. The masses are screaming for public health insurance, and there's no way he can stop the juggernaut without being crushed himself. As they see the public health pie getting divvied up, those pseudo-psych bureaucrats make sure they get a piece themselves, as heads of a huge new industry.  
Not surprisingly, mental health services soon become available to the general public, first for crisis intervention, later for preventative and on-going treatment.

1970s

Everybody is doing studies to determine for once and for all which is the most effective treatment for the new, DSM-defined disorders. Insurance companies are starting to squawk under the heat of paying for all this stuff. Schools of therapy spring up like mushrooms, each touting its own methods and insisting that everybody else has it wrong.

1970

There are 30 HMOs in existence

1972

In the five years since the inception of Medicare and Medicaid, costs have skyrocketed. The Nixon administration explores ways to cut costs and control spending while providing the minimal health coverage.

Edgar Kaiser figures out how to make money from a non-profit health care plan, and by providing doctors with kickbacks for not providing needed medical care.

1973

The Kennedy and Mills scandals remove the two biggest opponents to Nixon's health-care philosophy. Nixon authorizes $375 million to assist in the development of HMOs.

1980s

The race is on to determine the single most effective way to treat mental health problems, and continue to get insurance to pay for it.

90 percent of the American population is enrolled in an HMO at this time.

1995-6

Seligman shows the most effective thing a therapist can do is to be empathic and show warmth and interest in the client. His research is pretty much discarded out of hand.

There are over 600 HMOs in existence in the US, with about 65 million members.

2000s

HMOs have cornered the market on providing health insurance to the masses, and they begin to turn on each other and their patients.

2007 to present

A major recession begins, gaining momentum as it goes. Obama wins the presidency, partly on the platform of cutting government glut, including public health services.

The supply-and-demand history of psychology as a business focuses on the promoters, the deal-makers, the P.T. Barnums of the field. But that's a narrow view. There are two opposing forces in mental health, and the type and depth of care that is provided always ends up being a result of the interplay between those two forces. On the one hand, you have people who actually care, are actually knowledgeable, and actually feel some responsibility to insure that patients get the care they deserve. Then there are the bottomless-pit, greedy-eyed soul-suckers—the aforementioned promoters, deal makers and P.T. Barnums, who just want more. There's a slyness to them, a contempt for that which they pretend to uphold, that guarantees that while they're making money, they're also making sure they screw over as many people as they can in the process.

Come to think of it, there's a third hand: the people who got into the field actually wanting to help, but who are completely undone by the amount of other people's pain they have to face on a daily basis, by the smaller and smaller hoops the bureaucrats keep holding up for the rest of us to jump through. They're the ones who want to default to the checklists and the rapid eye movement crap, because there's some justification for it, however half-assed, and it removes them from direct contact with the pain.

Here's an example of how the dance works:

Somewhere, a dewy-eyed do-gooder decides some people need help, and _damn it!_ the government ought to do something. The do-gooder tells someone else, and pretty soon (like Arlo Guthrie said) it's a movement.

Eventually, some jaundiced government official looks it over and says something like, "geez, those idiots out there are screaming that something be done about this issue."

A politician perks up his ears and says, "I could score some serious electoral points with this one," and begins pointing out how the current government is not helping with this problem, but if elected, this politician will.

The politicians currently holding the reins look the situation over and say, "Well, if everybody's going to keep screaming about this, I guess we better do something. So, how can we make this work for _us_?"

Usually, the answer is to hire some cronies to manage the situation and make it look like something's happening, while making the politicians look good and beneficent. Of course, they have to scream loudly that they, and only they, have the ironclad solution to the problem. If they can convince enough people of that fact, they're in. Which takes a lot of cash. Not cash to the poor, not cash to those who need it, not cash directly applied to the problem originally noticed and pointed out by the do-gooder.

I can't think of a more sterling example than Obama's mortgage bailout. People everywhere were losing their houses at the logical end result of balloon payment and adjustable rate mortgage scams that started out cheap and ended up putting their payments through the roof. I lost a house this way myself, when our adjustable rate kicked just as Chuck was experiencing his first in a string of heartaches that took him out of the employment loop for a significant period of time.

I tried reasoning with the mortgage company, I tried explaining what had happened, thinking that surely they would rather gimp us along for a couple of months than go through the lengthy and ultimately exorbitant process of foreclosing. The bastards didn't even blink at taking the house back. Not a smidgeon of remorse at putting myself, my ill husband and our five kids out of our home, a house in which we had nearly fifty thou in equity.

You can probably imagine my reaction when the mortgage companies tanked because they were stuck with a bunchabuncha empty houses and no one to pay for them. I've never handled anything more complicated than a check book, and _I_ could see what was coming. I was ready to form a conga line at their funerals, the greedy sons of bitches. The entire country was aroused at the way the short-sighted money-sucking bastards had bankrupted middle America.

It was a movement. Do-gooders clamored for the letting of some dollar-green blood. Then the government officials started looking at the issue, as it could threaten their lame-ass jobs, and then the politicians got involved.

And some how, the entire issue changed from the raping of the citizen into a multi-billion dollars bailout for the fuckers that had screwed us to begin with.

Huh.

All those naive, riled-up citizens sit back and shake their heads, unable to believe that a government—and a big business like the mortgage industry—could conspire together to take away homes and futures from us middle-class schlumps like the privateers they really are. Much less that they're rolling around laughing like hyenas as we get shorn like sheep.

There's a pervasive feeling that someone up there must know what the hell they're doing, and the raw indignation, the desire to right the wrong fades away, and we start slowly groping for another way to move forward.

It's the same in the psych _industry_. Cash gets spread at the top, among the powerful, the influential, the 'names', who will make sure they put on a good show, while not making any waves. Best way not to make waves? Hire a bunch more credentialed professionals to deal with the matter. Then, no matter what happens, you can always point at all the experts you have on board and say, "They're tops in their field! It's best practice! They said so!"

It gets tricky sometimes, telling the tricksters from the tricked. Because not all of the experts are unethical bastards who just want a quick buck; some of them actually are concerned about the people they are supposed to be helping. Additionally, you get some of the do-gooders milling around at this point, some as figureheads, some on the front lines. So you begin getting this kind of watery service delivery, composed partly of what's expedient (like checklists and employment assistance) and partly of what works (like talking seriously about the problem and what to do about it). Of course, medication plays a prominent role as well, because there's nothing more quantifiable than those little blue pills and those big, big pharmaceutical dollars.

The plunderers want money, the government wants to look good, the do-gooders want to do good, and the experts want to be right.

Where the hell's the poor schmuck who needed something?

The plunderers are pressured to come up with a plausible plan, the government is pressured to fix things, the do-gooders are pressured to do more, and the experts are pressured to come up with a concrete, measurable and fool-proof fix. And it all has to look good on paper.

_Where's_ that poor schmuck who needed something?

As it turns out, most major mental health problems are highly individual, time consuming and involved. There is no fool-proof fix, because there's no 'one-size-fits-all' approach that's ever going to work for everyone. Ever.

However, there's one thing that the plunderers know that can fix almost anything: Money.

So they rig the system so that there's a payoff for the recipients of the trickle of services that actually do reach the masses, and if the payoff isn't money, it's pills. Opiates actually _are_ the opiates of the masses. And if you play your cards just right, you can get both money and drugs.

If we throw out the totally fallacious sop thrown to family members to erase that taint of culpability—that environment has nothing to do with mental illness—we can take a more honest look at what the environment has taught our clients/patients/partners/buddies. Namely, that authority figures can't be trusted. That there's no hope, that people aren't capable of change, that looking out for number one is the way to go.

Why do we expect these guys to choose the high road when we've repeatedly shunned it so many times ourselves?

Sure there's some do-gooders who realize the system isn't doing so good, and there's always someone somewhere that actually expects to get the help that will get them better, and is astonishingly puzzled and vocal when they fill in all the little checkboxes and do all the little homework assignments and nothing gets better. But hell, you point out that they do, after all, have a mental illness, and there's an automatic credibility gap that most people won't rise above.

Because the mentally ill are different, you know.

What the hell's the matter with me?

I know I'm pretty cynical, but it's not that I don't care. I care very much. Do I sound like I think the whole 'mental illness' thing is a big crock of shit? I don't think that, either.

The thing is, I've seen people who are really, really ill. A paranoid schizophrenic woman who lived in a trailer piled a foot high with trash, surrounded by at least 60 cats—alive, dead, consumed by other cats, you name it. Folks with bipolar disorder who ratcheted up so high they couldn't stop moving for days. People who were catatonic with depression.

Then I see some schmuck clogging up the clinic seats asking for medications s/he isn't going to take, to preserve the illusion that they are so ill they can't function, so they can continue to receive the disability and other benefits that keep them from having to get out into life and learn the lessons grown-ups learn. And I see the bureaucracy that pumps billions of dollars into keeping the bloated system afloat, while delivering lowest common denominator services to people who don't actually want them, because—hey—if everybody got better, we'd all get fired. Right?

Fuck that.

Chapter Three: Closure

And that's all the time we have for today

And then it changes

Today, Mr. Shysmile walks into my office projecting an attitude both ominous and pompous. "I have something to tell you," he says, giving me a stern look to make sure I understand how serious this is.

"I thought a lot about whether or not to tell you this, and I finally decided it's important for you to know. I-was-sexually-abused-as-a-child." No shit, and weren't we all. I'm continually amazed at the idea some people have that nobody would guess that if you're really fucked up, something really fucked you up.

He proceeds to give me a fairly detailed description of a pitifully familiar story. I listen, trying to tease out the way this experience has shaped his reactions to life as a whole. There's almost nothing of his response, what he internalized, what he learned or mislearned from these early experiences. And I doubt the telling is cathartic. The glitter in his eyes is both angry and gleeful, the telling polished to hit the high notes for sympathy and pity. He draws to a close.

He produces his abuse story like some men produce their penises—a shameful treasure vulnerable to invalidation. I wonder how many times he has been cajoled, required, pushed to repeat this story, divulge the humiliating secret at the heart of his difficulties, before he shifted from honest emotion to a sly mockery of the truth, realizing the power it had to elicit sympathy, praise and another renewal for his disability claim. There's victimization for you—and we're the ones that do it.

When he finishes, I ask a few questions, mostly to reassure him I was listening. Once he feels safe—that his story has gone over, that its horror is appreciated, I start encouraging him to ponder other aspects of his abuse—what it 'taught' him, how it affected his thinking about authority figures, males, the family members who were too daft or oblivious or afraid to upset the applecart to do anything to protect him.

He appears disconcerted, blinking rapidly. He's told the story so often, and the therapeutic focus is always on—oh, the list is so predictable: processing what happened. Putting it _behind_ him. Grieving for his lost innocence. Forgetting. Remembering. And blah, blah, blah.

None of those things really deal with the heart of what we learn from childhood abuse: we learn we are not equal. That our wants and needs—for safety, security, freedom from pain and horror—are not as important as some bigger, stronger being's need for immediate gratification. Sometimes we learn that the person we depend on is willing to sell us out in order to maintain the status quo. And we often learn that with great adult power comes great pain for those too small to hurt back. And those 'lessons' play out in all of the dysfunction we later manifest.

Unlearning those lessons can be a lifetime's rewarding work.

When the session closes, Mr. Shysmile leaves my office, still looking a little dazed. He is struggling with the idea of looking as his past through a different lens, and not sure he wants to. It's a crux point in therapy, where we either begin to dig in to some real work, or whether he retreats into his checklists and homework assignments with someone who won't insist on bringing up those pesky words that are the bane of patients everywhere: _work_ and _change_. Yeah, I don't like 'em too much myself. But if nothing changes, nothing changes. And it takes work to change. How many times have you wanted to change something about yourself and then decided that it was too much work? Human, natural, understandable. But if it's not what you're here for, get the hell out of my office. I've got no magic wand, and I do believe this stuff works—I want to invest my time where it can actually do good, not help defraud the government of yet more of my tax money.

So What Have We Got?

Loosely speaking—and that's a habit I just can't break—what we have in America is a top-heavy system of mental health care, designed by Nixon and Ehrlichman, which takes sixty-nine billion dollars to run. Approximately one third of that money goes to administrative costs, before any of it actually reaches the estimated fifty-seven million people who will struggle with a mental disorder this year. Skim the cream off the top, and you've got approximately eight-hundred and forty-two dollars per year per person.

Take sixty-nine billion—no skimming—and divide it by the same fifty-seven million people, and you get twelve hundred dollars per person.

What if we just gave 'em all vouchers, and let them purchase the mental health care services _they_ choose?

Jesus.

I can hear the arguments—buoyed by harrumphing from all the guys currently making a killing on this.

_First Argument_ : They're mentally ill—we can't trust 'em to make the right decisions for their mental health care. Bullshit. Talk about stigmatizing people. If they can't be trusted with their voucher money, file a court order and convince a judge. Don't deprive people of their civil liberties without at least going in front of a judge first.

_Second Argument_ (which is creepily reminiscent of the first one): We need experts! Regular people can't figure these things out! What do they know about getting better? More bullshit. People know if they're getting better or not. And people get better all the time, with and without experts.

_Third Argument_ (although you'll never hear it said in so many words): Who's gonna pay _me_ , then? Wah, wah, wah. Get good at what you do, maybe somebody will want what you've got to offer.

_Fourth Argument_ : We can't just have all these therapists running around willy-nilly! What about _ethics_? They need someone to supervise them to make sure they're not doing anything _unethical_! Bullshit. What you're doing is allowing people without ethics to get licensed. Refuse to license unethical people and— _bam!_ —the problem goes away.

A Funny Thing Happened on the Way to my Paycheck

There's a really weird thing about being a therapist. You're not actually required to _have_ mental health in order to be deemed fit to provide mental health services. What you have to have is a degree, and a license.

Getting a degree mostly consists of reading and writing—a lot. You have some familiarity the all the major schools of thought in your field. You've done some observed work in group, and reported on work you've done with individuals. You're not mandated to practice any particular way, though, once you've completed the requirement of demonstrating that you can practice whatever way your school, professor or practicum supervisor prefers. And you are never, _ever_ expected to apply these tenets to your own life.

What if you were? What if we took all the tests that psychologists and psychiatrists have come up with to ferret out the hidden weaknesses of our clients' psyches, and gave them to ourselves? What if we set a cap on what our scores must be for those who want to work in the field? _There's_ a novel idea. Mental health services provided by the mentally healthy. Maybe, if the only people practicing were the ones who had healthy egos, meaningful personal lives and loving relationships, we wouldn't need ethics to tell us not to boink our clients, go into business with them, or falsify documents to make it look like we're doing more than we are. _Huh_. Another aspect of bureaucracy shot down in flames.

We could also stop treating paraprofessionals like pariahs, and actually trust them to go out and do what they do best—share how they've healed themselves, what worked and didn't work. Offer compassion and a helping hand to those who need it. Because mentally healthy folks wouldn't do work they don't believe in, ergo, they believe this stuff works.

We could stop demanding that people participate in therapy when they don't want it, and just let them choose the services they actually want and need. We could stop handing out disability benefits to people who are capable of learning from their experience.

We could, however, demand that people who do collect disability benefits show up sober for therapy, and not indulge in illicit substances that will fry their brain cells and produce whatever symptoms of mental illness their ingestors do not yet have.

Don't have to kick 'em off the dole, so to speak, but we could mandate treatment. We could demand that doctors not write scrips for opioids and tranquillizers for people who are diagnosed alcohol or drug dependent. Ever. _Never ever_ , even.

I love the idea that people who qualify could get vouchers and go see the therapist of their choice, instead of being forced to choose what's available and recommended by a federally funded, cookie-cutter mental health clinic. I love the idea that we would actually be required to apply some of the ideas we espouse about mental health to ourselves. And I love the idea that we could increase by _one third_ the amount of money that would be available for direct treatment of qualifying clients.

And what about all the bloated pork barrel profiteers? Them I don't care for so much. I think I could live with myself if they got a chance to see what life is like on the other side of the trough.

But that's just me.

Mental Health and Mental Equity

There are too many of us in mental health that have made the decision to role over for public funds. I know I'm one of them off-and-on, depending on what our financial status is, and what's being offered. But counseling, really, is a vocation, not just a profession, and we need to start treating it with the holy respect it deserves. We need to take vows to do no harm, to maintain our client's privacy, to put the client's needs first, not just sign ethics statements. We need to be willing to demonstrate that we believe in the tools we use by applying them to ourselves with the same alacrity we use to apply them to others. And we need to start treating our treatments with the same respect that a priest or priestess shows for their sacred duties.

Jails, Institutions and Death, Oh My!

It's a saying we have in recovery—"Jails, Institutions and Death, Oh My!" just like the Wizard of Oz characters did it in the movie—then we all laugh, because it's bone-deep true, and what can you do besides laugh? We've all cried and felt sorry for ourselves quite enough, thanks. While there's a lot of consensus that the mentally ill don't really belong behind bars, they take up an amazing number of beds in the federal, state, and county lock-ups: prisons in America hold three times more of the mentally ill than our psychiatric hospitals. And on any given day, there are about 50,000 of the mentally ill are in psychiatric beds.

In 1973, Dr. David Rosenhan wrote up a study he had conducted. It was called "On Being Sane in Insane Places." In his paper, he described what happened when he and a handful of colleagues got themselves admitted to psychiatric hospitals under false pretenses, and without the staff knowing that they were, in fact, 'sane.'

They started by pretending to experience auditory hallucinations long enough to get admitted to twelve different psychiatric hospitals. Once inside, they denied any further hallucinations, and acted completely normal.

Not one of Dr. Rosenhan's pseudo-patients was ever found out by a staff member. Nearly one-third of the patients they were hospitalized with, however, developed suspicions that these people were 'normal.'

Down to the very last one, staffers believed them to have ongoing signs of mental illness and they were forced to admit to this, and promise to take anti-psychotic medications, before they would be let out. Several were kept in the hospital for months.

Contact with their doctors averaged a little over six minutes per day. Staff rarely interacted with any patients except to perform official duties, they were talked about freely by staff while able to hear what was being said, they were watched while going to the bathroom and their possessions were searched on the whim of staff. If you want to read a real horror story, look up Dr. Rosenhan's study on the Internet sometime.

Lonely, Lonely, Lonely.

If we really are herd animals, with a herd mentality, can there be anything more brutal than not touching, not connecting, not being loved by other human beings? Our mentally ill are walking ghosts in many ways, passing by the rest of us without acknowledgement, without notice and without being able to comfortably bump shoulders as they trudge the road to their own forlorn destinies.

I sit in my office making notations in a chart and I think of Mr. Shysmile and others like him. They are conditioned to believe that medication is truly the answer to all their problems today. That conditioning comes from the fervent hope of their counselors, case managers, therapists and doctors, a hope born of a desperate need to believe that medication will work, because they have neither the time, supervision nor expertise to help the client with real therapy.

I don't need a crystal ball to surmise what life has been like for Mr. Shysmile. Even if I didn't know he was working at MegaMental for a sliver over minimum wage, twenty hours a week, carefully figured not to interfere with his disability benefits, I could guess he's probably living right on the poverty line. SSI is about six-fifty a month, and a person on SSI can earn about seven-fifty additionally per month without jeopardizing their benefits. So, working like he is, I'm guessing his yearly income is about sixteen thou. For that, he gets the added bonus of being treated like shit by all the 'professionals' at his place of employment. He's probably not trusted with a key to the building, his opinions are disregarded without thought at every meeting he attends, and he's expected to kowtow and ass kiss everyone he works with whenever they decide to toss him some menial task. After all, every single person there knows he's seriously mentally ill and they've found him this bullshit job, so he should be grateful, right?

Even working just twenty hours a week, he's got it way over most folks who have a mental disorder—at least fifty percent of his peers with a serious mental disorder are living on ten thou a year or less. The median income for individual earners in the US is over forty thousand dollars a year.

I know he probably doesn't eat very well; in order to follow the federal nutrition pyramid faithfully, he'd have to spend between forty and seventy percent of his income on fruits and vegetables.

In Mr. Shysmile's lifetime, he's fifteen times more likely to be assaulted than Mr. Normal; one-hundred-forty times more likely to be robbed. Just by virtue of being mentally ill, he's knocked about twenty-five years off his life expectancy.

Odds are that he has been homeless at some point in the past; one out of six are. He's probably been arrested, too. His odds of being arrested are three times as great as Mr. Normie's. And finally, he's one-thousand times more likely to commit suicide than Mr. Normie. I make a note to ask about past attempts.

Sure, mental illness strikes across all income brackets, but realistically, how many people are there in high income brackets, anyway? About five percent of the US population are worth more than a million dollars, that's how many. How many seriously mentally ill people are there in the general population? Nineteen percent, give or take a few. So how many people are struggling with a mental disorder so severe that they are unable to work, support themselves and function in society and who are not independently wealthy? Nearly three million.

Think it's a crock? Ever try to do a job interview while disembodied voices are screaming in your ear, or while you are twitching uncontrollably as a side effect of the medication that helps manage your psychosis?

Serious mental illness isn't just a phrase. It's a designation the government uses to decide who gets the money. To get into this category, you have to have a qualifying diagnosis. You have to function well below what is expected of other folks in your age group and you have to be in real danger of getting worse if not treated. Theoretically, at least. I've repeatedly seen doctors certify a person as seriously mentally ill for a variety of reasons besides being seriously mentally ill. Because they're broke and with a seriously mentally ill endorsement, they can get medications for free; because they nag the doctor until it's easier to do the paperwork than it is to keep listening to them; because parents, spouses or other professionals demand it; because they think it will help them avoid those pesky legal consequences for their actions. If we don't agree with the criteria as established, let's get proactive and change the criteria. Otherwise, we're just wasting exorbitant amounts of money rather than standing up to clients who aren't really entitled to the level of services they are receiving. The most visible members of the mentally ill population are the ones brandishing life-size wooden crosses on main street, the shrieking bag ladies, the ones who shoot at passing cars with bows and arrows to convince people the end is near. But there are many others, odd in their own little ways, who we shun as a society and as individuals due to our blind indoctrination into the holy high school trinity of healthy, wealthy and beautiful. There's a lot of talk about 'stigma reduction' and public education to address incorrect ideas people have about mental illness. But how do you get people to stop turning away? To not feel embarrassed to be seen talking to someone who hasn't taken a shower or put on clean clothes in a month? To not believe that the mentally ill somehow stubbornly persist in causing their own illness, and that they could be better if they just took their pills and stopped thinking bad thoughts.

It may be a legitimate herd animal instinct to avoid those who don't meet the herd norms, and maybe that's just the way we're wired. But we are more than animals, right? The real proof that we've evolved is that compassion, kindness and understanding are more compelling than the need not to be associated with the stragglers. Hopefully, a _lot_ more compelling. Ever think about what it would mean for your life if you were seriously mentally ill?

Even if you have an income above the federal poverty line, avoid arrest, homelessness, robbery, suicide and lung cancer (ninety percent of schizophrenics smoke, as opposed to twenty percent of the general population), eat plenty of fresh fruits and vegetables, then you can still be done in by the one thing that nearly everybody embraces as the only real solution for serious mental illness—your medication. Depending on what you are prescribed, you can experience grogginess and delayed thought processes (remember the 'thorazine shuffle' from the glory days of LSD?), relentless dry mouth, reduction or even complete shutdown in your sex drive, liver and kidney dysfunction, metabolic changes that lead to significant weight gain, developing characteristics of the opposite sex, tremors, tics, uncontrollable muscle spasms and permanent changes in your brain chemistry.

Many folks with mental disorders don't want to take medication, and looking at the list of side-effects, I don't blame 'em one bit.

Sure medication reduces those pesky symptoms that annoy other people, but at what price? Tardive dyskinesia is what we call it when a person develops permanent tics due to taking neuroleptics (the older antipsychotics). Tics are not a good thing. They can be scary to other people, gross and off-putting, and make the victim feel even more isolated and strange than they did before. Tics like this can involve tongue thrusting or rolling, facial twitches and grimaces, all kinds of automatic movements that single out the bearer as _different_. But people who struggle with psychosis have the decision made for them on a fairly regular basis that what they suffer in having a tardive tic is less important than the inconvenience it causes us in dealing with them. And it's not uncommon that once medication has triggered the tic, there's no going back. You can't stop the medication and stop the tic; it's a permanent new addition to a person's functioning and social interactions for the rest of their lives.

And we've gotten so used to schlepping pills that when a person asks for alternative treatment, we have no idea what to do.

Symptom reduction through medication doesn't make others more accepting of our mentally ill patients. Hell, I've taken my medicine, so I no longer think you're out to get me, but now I'm fat, slow, completely uninterested in sex, have acquired facial hair, and can barely pull in minimum wage. Of course, I can always get a job at Wal-Mart. Plus, people have been ostracizing me for years, so I've developed no social skills at all except duck and cover. Think I'm making this shit up?

A group in Australia asked seriously mentally ill people about their social lives and found that almost one in six had not touched, or been touched, by another human being in over a year, while half had no close relationship. The number of normies with no close relationship runs about fifteen percent of the population at any time.

Another thirty-five percent had not had any sexual contact in the previous 12 months.

There's a rap at the door and the receptionist I share with three other docs sticks her head in. "You know your patient—Mr. Shysmile?"

I nod and brace myself.

"He gives me the creeps. He's always smiling, and he doesn't blink enough."

"He's doing his best, Rosie. I don't think he realizes how he comes across. He's just trying to fit in."

"He's an asshole."

I sigh, close the chart.

"Dr. Quimby's patients never act weird in the waiting room."

Apparently, her cup of compassion doth not run over today. "Dr. Quimby specializes in people with sports injuries, Rosie. I treat people who've been hurt inside. Different crowd."

She sniffs and withdraws her head. "He's still an asshole," she says as she closes the door. I wonder if MegaMental has room for one more.

Of Mice and Men

Mr. Shysmile comes in and sits down, and I try not to notice how often he blinks.

We talk in a desultory fashion for a few minutes, the warm-up, as I think of it. It's like dogs sniffing butts—we reassure ourselves that we're both still who we claim to be, before getting down to business. His job, his coworkers, a picnic for MegaMental staff. He is both proud and wary of going to the staff picnic. He is glad to be part of an organization that does such things, glad to have a job like normies do, but past experience has taught him he will be on the sidelines when he attends, receiving patronizing tidbits of other people's attention, being largely ignored, possibly avoided. But he can't not go, lured by his own hope that things will be different than all the past years of his experience.

Abruptly, he switches topics. "You really think that therapy can cure me?"

I shrug, and settle back to watch how he hears my response. "First, tell me what you want to be cured of."

The question takes him aback. I can see him thinking. What does he want to be cured of? Finally, he offers a cautious answer, like an unsure contestant on Jeopardy. "My mental illness."

I lean forward. "In order to talk about being cured, I need to know what you want to be cured from. Bad dreams, insomnia, anxiety, all those things. I know you've been diagnosed with a mental disorder, but what is it, really, that the mental disorder disturbs in your life? How will you know when you're well? What will change?"

He is silent as he ponders this. I wait him out, something that counselors are no longer trained to do. Everyone wants to rush in and fill the silences, as if those thinking pauses are dangerous potholes in the rush to symptom reduction.

Finally, he answers. "I think maybe I wouldn't be so scared, anymore."

"What are you afraid of?"

He looks me in the eye. "Everything."

That's more insight than he's shown previously. A lot more. "Maybe you should make a list."

"Of the things I'm afraid of?"

"People, places and things. And the same for everything that has made you angry."

"What good will that do?"

I stand up and walk over to a whiteboard that I hardly ever use. My back to him, close to the board so he can't see what I'm doing, I trace my left hand with a dry-erase marker and step back.

Mr. Shysmile looks from me to the board uncertainly.

"Can you tell me what is on the board?"

He squints, as if it's a trick question, and missing some microscopic detail will make a fool of him. "You traced your hand?"

"How can you tell that?"

"By the shape of it." He switches into mild annoyance, a defense against the wrong he's now sure he's going to be.

I surprise him by beaming a congratulatory smile and sitting back down. "Exactly. And that's exactly how a list of all the people, places, things that you have feared or been angry at will work for us."

"I don't get it."

"What scares me, what I get angry about, are not the same things that scare of anger someone else. When you put a list together, it's going to be unique to you. And seeing what the shape of it is will show us the hard core inside that the fear and anger come from."

He thinks again, even longer than the first time, eyes flicking to the board over and over. Finally, back to me. "I don't think I want to do that."

"It's scary, putting things like that on paper."

He shrugs, stands up and walks over to the board, where he stares at the tracing of my hand, back to me so I cannot see his face.

"It sounds stupid. It's like saying that everything I'm afraid of is just one big thing. Same with things I'm angry about."

"Maybe one thing. Maybe a few things. Telling another person how the inside of our minds work can be pretty hard."

He snorts. I still cannot see his face, but I like this facet he is showing—a little smart-assy, a little challenging—a lot better than his previous demeanors. He's not thinking about pleasing me, he's saying what comes to mind.

"Everybody knows that it's the medicine that makes you better. It's all brain chemistry stuff." He sounds angry now, and whirls around so I can see him. His face is red and strained. "What the hell do you need to know what I'm thinking for?"

No time to answer before he goes on. "You're just a big, fat, nosy bitch, that's all. You just want to know this stuff because it makes you feel better than me."

It's not the first time I've heard that.

"Sometimes you have to push the envelope to let in a little reality."

"Gonzo?"

I laugh, and he smiles. "Maybe a little." The air cools, the heat of his anger drifting toward under the door.

"No one's better than you. And this is all your choice to do or not to do. You want to manage your symptoms, or you want to be free?"

The anger comes back, a quick flash, quicker than it departed. His frustration and stuckness on this point is not soluble by the waters of my acceptance. His adult life is built around his justified subcitizenship. He fights losing it like it's a live thing he clings to. "I-Have-A-Brain-Disease," he says like I'm a moron. I'm guessing that's how he's feeling; he's got to put it back off on someone. Reaction formation, in a microsecond and a nutshell. "I've had it since I was little. It's not going to go away. It's never going to go away. I'll always be like this. Screaming and scaring people and being scared and not knowing what do to. Always. _Always!_ "

Abruptly, he stands and bolts. He makes for the door and pulls it open, then slams it behind him as he stalks down the hall. I hear Rosie's voice, raised in a question, probably about his next appointment, I hear him snap back at her in a tone laden with nasty, followed by a screech of indignation from Rosie. There's a bang as the front door is wrenched open, then . . . wait for it . . . the crash of offended door glass as it shatters and falls to the floor. More screeching by Rosie, getting louder as she races down the hall to my office.

I lose more receptionists that way.

The Nice Guys Don't Like me, Either

I lose more offices that way, too.

Of course, they can't just stick a note on the door that says 'pay up, then get out.' We have to all get together like jolly good friends, and have a serious talk about why they feel compelled to kick me out. And like a jolly good friend, I'm supposed to make them feel better about it.

"We just didn't realize what kind of clientele would end up coming in to see you," says Dan, all earnestness.

I beam at him and look baffled at the same time. "What kind of clientele is that?"

Quimby, the sports doc, snorts. He's not buying it, but Dan is searching desperately for some tact. He didn't think he'd actually have to spell it out.

"You know," he says finally, "people who are kind of . . . cuckoo."

"Cuckoo? You spent how many years in med school and the best you can come up with is cuckoo? Give me a break, Dan," I say, still beaming. I think my face may be freezing this way. My husband will never recognize me.

Dan's still trying to salvage some dignity. "I . . . we . . . we just figured it would be men with mid-life crises, women who are depressed because they're getting divorced. That kind of stuff. Not people who go around frightening the receptionist and busting doors. Rosie was scared stiff yesterday. Who knows what someone like that is capable of?"

"You should be you worried about what _I'm_ capable of." No more beaming. Mentally, I'm berating Rosie. She didn't sound scared; she had sounded like a grade-A bitch who couldn't miss the opportunity to fuck with the guy who was having a problem.

Dan leans back a little, in case I sprout fangs.

"Listen," I say, standing up. "It's your practice, your building, your door. You have the right to do whatever you want with it. But don't make me sit here and pretend that I agree with you. Crazy doesn't equal dangerous. Maybe some of them don't have the impulse control that you do, or they get a little loud when they're excited. But I'm not seeing anyone who's perpetrated a violent crime." _That I know of. At the moment._ "I can't be a psychologist without occasionally treating someone who's a little out there. I'll pay for the door, for Christ's sake, but I'm not going to make you feel better about what you're doing, because it's damn shitty. I at least need some time to let my clients know and to find a new office."

Quimby just raises his eyebrows, but Dan looks like he's going to have an attack. The third partner, a woman, is named Rachel Landers, as upper-upper-class as they come, and she looks like she smells something really bad. Fuck.

"Thirty days," Rachel snaps out. "And I'll give you the bill for the door as soon as we're done meeting."

I give her a dark look. "I'm already done meeting. Dan, did you have anything to add?"

He's still hemorrhaging over the word shitty. Head high, I sail out the door, already trying to figure out where I might find an office before my thirty days are up.

More mice and men

Actually, finding a new office turned out not to be so bad. I found a small, cozy space in an office duplex on Main Street, a cute, quirky place that was converted from a lazy brick home to a pair of cute office spaces. I have a real estate agent as my next-door neighbor. More important, the walls are soundproofed. More privacy, no receptionists to piss off.

I sent out news of the move in plain white envelopes, writing the addresses by hand, which reminded me of how incredibly bad my handwriting is. Thank God for computers. It didn't take long for people to start drifting by to say 'hey' while I was getting my office set up, which was pretty cool, because I got to catch up on how everyone was doing.

There's some stupid study that corporate mental health institutions pass out every so often that supposedly demonstrates that you don't have to like your client in order to be able to help them. _There's_ a crock of shit in a fancy hat. Depends, of course, on how you define 'help', for one thing. And it rather implies that people are too stupid to be able to tell whether we like 'em or not.

I don't know about you, but I rarely don't know who likes me or who doesn't. Most people know. Even really crazy people. Often victims of abuse, assault, and cons, they probably are better tuned in then your average normie.

My thought is that while I can spew advice at a spectacular rate, I need to feel real love and compassion for a client in order to go that extra mile willingly. I'm not talking about the 'sure, I can drive you to the grocery store,' kind of cheap substitute for caring, but the kind of love that empowers us to hold up the mirror without being condescending or smarmy.

Honesty takes courage. Kindness does, too.

I don't forget clients because I haven't seen them for a while. I think about them, hope they're doing well, wonder what they're up to. So when they stop in to get a look at the new digs, catching up can be a lot of fun, and very satisfying.

Sometimes, I think they should be hogtied and force-fed a good dose of reality, but I accept that wellness can't be forced on a person. They have to choose it for themselves.

Happy in my new office, I think about my former colleagues, the tight-sphinctered morons. I heard I'd already been replaced by a podiatrist. They had refused to let me see Mr. Shysmile, the door-slammer, the pisser-offer of receptionists, in their pristine, tidy offices again. So when he cooled down and called me for his next appointment, I'd explained I was moving and asked him to continue working on his inventory until I got situated.

He'd sounded good on the phone, so I was surprised to see the long face when he came through the door for his first appointment in the new building.

I waited, though, for him to be ready to get to it, and we spent a few minutes in desultory talk about the pros and cons of being on my own.

Finally, he looked me in the eye, and I figured this was the moment for the big reveal.

"MegaMental says I can't come back anymore." His voice was tight, and I was a little confused.

"Can't, or won't? It's okay if there's someone else you'd rather—"

He raised a hand to stop me before I got any further. "It's not you. MegaMental is making me switch to another therapist."

Huh. "Do you know why?"

"Not enough hope."

Now I was really stumped. "Maybe you'd better explain that one to me."

Shysmile flushed and looked at his feet. "It was my fault. Every week, after the session, I'm supposed to fill out a checklist about how I felt after therapy. You weren't meeting the 'instilling hope' quota."

I chewed that one over in silence. It had been one of Yalom's old premises that one of the purposes of therapy was to instill hope in the patient—hope that change was possible, hope that life could get better, hope they'd be cured before their insurance ran out; all kinds of hope. Yalom was still the guru of group therapy, and his books were swallowed like psychological popcorn by grad students. Somehow I'd missed the fact that his premises had been distilled down to a Likert scale.

"They asked you to rank how you felt after each session?"

"They always do. With their own customers, too. On a scale of one to five, rank how strongly you feel each of these emotions in the time immediately following today's therapy session. Then there's a list: Scared, Angry, Happy, Hopeful, Calm, Depressed, Anxious. You know. I thought we were doing pretty good, but my supervisor said I'm supposed to be hopeful and happy. The last couple of sessions, I felt a bunch of different things. Angry about the idea of doing so much work, scared about what would happen if I did change, anxious about the future. I didn't know I wasn't supposed to feel like that."

His eyes flick back to mine, pleading.

"Shy, it's perfectly okay to feel any way you feel. I'd be scared and mad and anxious too, if I was getting ready to go on the kind of emotional voyage you are. There's nothing wrong with that."

He relaxed subtly. "I was hoping you wouldn't be mad. I was kind of thinking that I'd like to keep going, if you would. I wasn't sure I could afford it though, if I had to pay out of my own pocket."

"You'd go to see the therapist they pick for you, then come here and see me, too? And pay out of your own pocket?"

"If it's not too much."

I realize he's gripping the arms of the chair so hard his knuckles are white, even though his face is calm. It's a big deal to him, and seeing that gives _me_ hope—that he's serious about getting better.

I tip my head and look at the ceiling. I don't want to name a figure so high it makes his life difficult, nor so low that it degrades what we'll be doing together. The money itself is not as important as what it means to him. I lower my eyes to look at him. "I could probably cut it down to twenty dollars a session."

He swallows, then nods. His fingers lose their death grip on my furniture. "I could do that. I might have to skip a session once in a while if the money got too tight, but most if the time, I could swing twenty bucks without too much of a problem."

I leaned across the desk and put out my hand. "It's a deal, then."

We shook solemnly.

"Well, that's that. What would you like to work on today?"

"I, uh, had one more business thing before we got into the session," he said, giving me a real grin instead of the ass-kissy one that had constantly been on his face when I first met him. "Rosie told me you got kicked out of your office because of what I did. She says 'hey,' by the way. She worked out a payment schedule for me on the door."

I was flabbergasted. "Rosie? Rosie the receptionist? How did you manage that?"

He shrugged. "I kept thinking when I came in that she looked familiar. Then I finally remembered. She was in a Life Skills group with me a couple of years ago. Before I got hired at MegaMental."

"You're kidding. Rosie was in one of your groups?"

"Yeah. I finally figured out where I knew her from when she got pissed off. She used to get pissed off in group a lot. So I went back to apologize for breaking the door, and I reminded her where I knew her from, and next thing you know, I was asking her out and she said yes."

Goes to show that you can't actually know a person without knowing them. I thought she was stuck up. But a lot that was probably her own fears, worries and desire to control her environment. No wonder she had such a strong reaction to the door thing. Every client I had that came in probably put her on edge. Was she dreading that someone would recognize her and blurt something out in front of her employers? Or was she just projecting all the feelings she had trouble managing onto other people who had mental disorders?

"So how's that going?"

"Good. So far." Caution? Was that caution in his voice, his eyes? Caution was good in a relationship. Especially one sparked by the shattering of a door. "Can we get to work, now?"

"It's your dime," I replied, and we plunge into the emotional, scary and sometimes angry world inside his head.

The last word

A few days ago, I was driving home, and when I came to the street Megamental was on, I surprised myself by turning impulsively to drive past.

I pulled up the curb across the street from the large, ugly building and shut off the engine, rolling down the window when the AC stopped flowing. No landscaping, no color, just a piss-yellow paint job and clumps of people milling around—in the parking lot, around the door, one clump on my side of the street, all guys, standing around smoking cigarettes.

I watched an obese, flush-faced woman drag an adolescent girl across the parking lot, and then jam her into the car like she was jamming trash into a dumpster. I saw her eyes skitter to see who might have noticed. I could hear the guys smoking cigarettes make sneering small-talk about their upcoming substance abuse group, venting thinly disguised frustration and anxiety by sneering at their 'facilitator.' I watched half-dozen employees pull into reserved spots, wearing nice clothes on flabby bodies, smoking their own cigarettes.

Apparently, the "NO SMOKING ON PREMISES" sign did not apply equally to staff and clients. Nor did the parking spaces.

I saw a man with a nasty facial tic visibly battling his fears to propel himself onto the porch and through the doors, provoking a jolt of laughter from the teen boys gathered there, delaying until the last second before entering.

A counselor walked out of the building, and there was a hush, hearty greetings that rang false on the afternoon air, and then narrowed eyes watching until he was safely enclosed in his car before the noise started up again.

How does this all get so fucked up? We're supposed to be helping. The folks gathered here as clients have no friendship, trust, respect for the folks gathered here as therapists, and you can all but see the therapists' skin crawl when forced to acknowledge their clients outside of the session.

Do you ever carefully consider doing something, and even as you determine there is absolutely no way it's going to end well, you do it anyways? Every once in a while, my desire to make a statement rides right over my common sense and takes over my brain. It just happens. Kind of a 'to hell with the consequences and full speed ahead.'

So I felt only mild surprise when I found myself standing on the roof of my Jeep, and hollering out in one of those piercing obnoxious-mom voices that can be heard for miles, "Everything that is happening here is a total crock of shit. Why are you people wasting your time playing games with these assholes? Don't you believe you can get better?"

There was a complete cessation of sound. A few people drifted away. But more came closer.

"Whadda you mean this is a crock? You mean the counseling stuff?"

"I mean what's getting passed off as counseling. Real counseling can work, if you work it," I said. "You're getting totally ripped off. Don't put up with this! Demand some real help!"

An elderly woman the size of an elephant made a wheezing sound that turned out to be a laugh. "You think they give a shit about us? They're not gonna help." She spat on the ground. "And who the hell are you?"

"I'm a therapist, and I'm telling you I know it can work."

"Work if you do it?" some kid piped up, and I could tell by his tone that he thought I was trolling for some new customers.

I windmilled my arms. "With anybody, if you and your counselor actually put some effort into it. Christ! With anyone who actually gives a shit!"

Elephant Woman was looking at me sharply. "Why the hell should we listen to you? Who the hell are you?"

I grinned at her. I think of Acosta. The original Dr. Gonzo. Shades of Thompsonesque foolhardy bravado. There was a movement at the edge of my sight, and I looked toward the MegaMental building to see a couple of curtains flicking. Someone was watching.

I sat on the roof and made myself comfortable. I had an audience, and I had things I wanted to talk to them about. Before long, the teenage kids and the smokers had wandered over, along with some parking lot stragglers.

"You come here for what?" I asked. "To get better? To feel better? To make life better?"

A few people nodded. "Something like that," one guy said, walking closer.

"You know that the life you have is not going they way it could. As well as it could. You feel things . . . fear, anger, loneliness, and you wonder sometimes if its you, or the things that have happened to you. Wonder if what's happened to you so far in life is going to leave you crippled, sidelined, enduring for the rest of your life until the day you die. Enduring, grinding on, deadening it when you can, until you give up and die, or someone punches your ticket and it's over."

I saw one woman flinch, several more nod.

"None of this has to be. Life doesn't have to be just one knee-jerk reaction after another to a bunch of shit you don't understand and can't control."

"And you know the secret to that, I suppose," said Elephant Woman.

"That's just it. There is no secret. The idea that there's a secret is just another piece of the big bunch of shit that gets pushed on you every fucking day by people who see your pain as one more thing to cash in on. There's no fucking secret. Face your past. Be a better person because it's the right thing to do. Don't hurt other people, even if it makes you feel better, because it's _wrong_. You can't improve your self-esteem without doing something— _being_ someone—to be proud of. For Christ's sake, you can't _be_ anything without doing _something_. The past doesn't control today. Today—the choices you make today—control tomorrow. There's no such thing as a free life, you get what you pay for. And all that other crap that people have been persuading you for years that there's an easier, softer way to travel around."

I took a breath. "There is no easier, softer way. Fear, fear of fear, it runs all of us, unless we face it, every day, in every forgotten shadowed corner. The only way not to be driven by fear, anger, pain, is to take it out, look at in the light, and do the right thing anyways, regardless of how fear- _full_ the consequence."

"That's a crock. My counselor says forget about it, put it behind you and move on."

"And do you want the life she has? Really?"

There was a silence, then a burst of reluctant laughter. "Christ, no."

"Well, then, use your head, not your ass to do your thinking with."

"So you're saying there's no way around any of this shit except by doing it the hard way." That was Elephant Woman, not to be derailed.

"What you've been told, told yourself is the _hard_ way is the _only_ fucking way. Anything else is just spinning your wheels. You know—you know in your heart, and you always have—what works and what's running away. If you want change, work it. Every fucking day. Don't accept pills to sedate you and meaningless games to distract you. Do what you know you need to do and stop dancing with all these jerk-offs who can't even practice what they preach. How long are you going to expect something for nothing and then get pissy when it doesn't pay off?"

The woman who had flinched earlier stepped forward, a bitch look on her face. "How dare you sit up there and say my son doesn't need pills. He's A-D-H-D, and he's liable to do anything, get into anything, without those meds. We need 'em." She pronounces ADHD, each syllable distinctly enunciated, like it's some kind of badge of abnormalacy.

"I"m not saying anybody doesn't need anything. But if you really believe nothing happens for a reason, that all this shit just occurs by accident, because we can't help it, for no reason, no logic, you're way more fucked up than your kid, lady. What exactly are you doing to face your past, change your present and teach your kid something different, that's as meaningful as making him choke down a handful of pills everyday to sedate him into some facade of normality?"

She huffed and gasped and jerked back, but she didn't leave. She didn't leave.

"And you're saying all these people here, those whole building, the doctors, everything, is just one big lie?"

`I nodded. "Yeah, pretty much. You don't need to do checklists with some asshole who can't figure their own life out, take drugs to keep you sedated enough not to question what's being done to you, to take a little bit of money, a little bit of food stamps to keep your mouth shut and hang on to your 'disability' with both hands so they can keep getting paid tomorrow." I snorted. "What a crock of shit that is."

"They're the ones that said I had a disability, not me," says a thin, jerky man from the back. "I can't help who I am."

"That's the whole fucking point," I shouted, exasperated. "If you can't help who you are, who the fuck will? If you don't believe it, who the hell is going to? Are you fucking crazy?"

People started laughing. "She's got you there, Bill," snickered Elephant Woman.

As we talked, I noticed more curtain flicking going on, all but one furtive, with the watcher staying out of sight.

I checked my watch. I'd been talking with people outside MegaMental for a good fifteen minutes, and just like staff had stopped coming out, there weren't any clients going in. I was doing serious damage to someone's billable hours.

"Look, they're going to come out here in a minute and tell you I'm crazy. I probably am, because I know things don't have to be like this, and I seem to be the only one. This whole system is fucked up. Don't take this shit off of anybody. You can get better. You start by _doing_ better. Getting better comes after. Decide who you want to be. Tomorrow. Next year. Then look at what the people who are what you want to be are _doing_. If you want what they have, do what they _do_. It's not fucking rocket science, and you're not lab rats. Check lists and flicking your eyes don't make you better. Figuring out what you're really afraid of and facing it makes you better. Recovery's not for quitters. Life's not for quitters. So get your ass in gear and start doing something. Anything!"

The man standing at the window, curtain shoved aside, not trying to stay out of eyesight looked vaguely familiar. A minute later, I found out who he was, when he came striding out of the building, face flushed, heading straight for me.

At the same moment I realized where I knew him from, Elephant Lady said, "Oh, shit!" Then, quieter, out of the side of her mouth, she croaked, "You better beat it—the director of the clinic's coming."

I watched him approach. Bill Radley, former student in a grad class at the local university. With any luck, he'd still regard me as an authority figure, which would give me an advantage. I didn't think he'd recognized me yet, as he was busy shooting threatening looks at the people around me. He walked stiffly, quickly, practically shaking with outrage. When he reached the Jeep, he stopped, glaring up at me.

I love having higher ground.

"Hey, Bill, how you been doing? Director here now—just seems like yesterday you were my student."

More glaring, then he said, "You being my teacher for one class has nothing to do with what's going on now. I don't know what the hell you think you're doing, but you're creating a public nuisance. Get the hell out of here."

"Hey, I'm just trying to instill some hope."

"Hope? You're here to instill hope? I could hear every word you said. You're trying to disrupt our workplace and scare away our clients."

I shook my head and grinned at him. "Exactly. I'm instilling the hope that someday, they'll meet a therapist who's actually competent, and then they'll get well."

We both heard the siren at the same time. Bill jerked his head toward the noise. "Get down here right now, and I might decide not to make a complaint."

"Fuck off, Bill," I said. In retrospect, that might have been a tactical error on my part.

Two cop cars raced down the road and swung in to the shoulder, blocking the Jeep front and back. The cops got out of their respective patrol cars and walked over. Bill went to meet them, and they stood there, quietly whispering. for a short period of time Elephant Lady and I watched silently. Finally, she shook her head. "You got no judgment, you know that? A smart person would have beat it before the cops got here."

The little bastion of testosterone broke from their huddle and walked over to where I sat, waiting.

"Ma'am, you need to get down from there right now. I'll give you to the count of three, and then we're going to carry you down."

Huh.

They got me off the Jeep, but it took them a while.

When I had both feet on the ground, the officer who had offered me the countdown turned to Bill and said, "Sir, would you be satisfied if she left the premises and promised not to do this again, or are you going to make a complaint?"

Bill pretended to give it some thought. "Neither. Obviously, this woman has had some sort of breakdown. I'd like to check her into a psych bed and have her evaluated by our psychiatrist."

I gaped. So did the folks standing around me. "You son-of-bitch, try it, and I'll kick your ass."

"Ma'am, calm down," said one of the officers. "It's not that bad. Seventy-two hours, max. It'll pass in a heartbeat. You might even like it. Three meals a day, take naps, talk to the psychiatrist, get some nice pills to help you feel better."

"Shut up, you fucking asshole. I'm a colleague of his. I taught one of his psych classes."

Bill smirked. "See? She's just delusional as hell. We need to get her checked out before she hurts someone."

A wave of rage swept over me so fast that I swung on him before I even realized my fist was moving.

That's when I got Tased.

For the first time.

Tasing is a funny thing. And I don't mean funny ha-ha. Every muscle in my body spasmed and clenched at the same time, and I thought it was going to break my back. The noise was horrendous. And my brain completely stopped. For an endless moment, there was a fist that would not let go, a complete absence of thought, a pain that turned into sound that turned into my heart beating again. I was on the ground, and drool was coming out one side of my mouth, and I got on my knees and launched myself at the motherfucker who had caused it. I could hear Elephant Woman screaming something, but then that giant fist grabbed me again, bowed my back and slammed me on the ground. Above me, when thought returned, I could see Bill, still smirking. What allows someone to be so wrong and not feel it? I shook my head, which made my brain jounce around like jelly, and tried for him again. That time, it took longer to come around, I think, because there was no more screaming. When I came to, someone had propped me in a sitting position against the Jeep. One of the cops had two fingers pressed against my carotid artery.

Apparently while I'd been out, Elephant Lady stopped screaming and stepped up to the plate to suggest that they check on me before letting Bill haul me off to the psych ward. "They were having a hell of an argument before you got here, and he said she'd been his teacher once. She wasn't doing anything. We were just talking." Other members of the crowded nodded or called out that we were all just talking.

One of the officers turned to Bill. "Is this true?"

Bill looked a little flustered. Obviously, he hadn't thought through the consequences before lying to the cops. "She was disturbing the peace and creating a nuisance."

"I'm thinking I'd prefer going to the psych unit. Because when you verify who I am, you can be charged with false imprisonment, maybe kidnapping, and even with making a false report, Billy. I can prove you were in one of my grad classes, for one thing, and for another, I can sue your ass off. Actually, I probably can now, since your false statements led to me getting Tased."

From my sitting position, I beamed up at him.

The cops were now looking at _him_ funny, instead of me.

He harrumphed a few times, then conceded.

"If she's that opposed to treatment, I probably won't force her, unless she does it again. If it happens again, she's gonna end up in four-point restraints." There were some jeers from the crowd.

I struggled to stand up, and one of the same cops that had dragged me off of the Jeep's roof now stretched out a hand to help me up. I put a hand on the door handled, ready to hop in and go home.

:Ah, ma'am? We're still going to have to take you down to the station."

"For what?"

"Twenty-four hour cool off period."

"What? Why?"

The one that had so much fun with his Tazer a few minutes ago looked at me hopefully. It reminded me of that whole Dirty Harry 'Make my day' thing.

"Would you prefer to be charged with striking an officer of the law?"

"Did I do that?"

Behind the cop, Elephant Lady nodded.

"Several times, actually, ma'am. Although the last time, I think you were having a seizure. That one probably wouldn't count."

I opted for the twenty-four hour cool down, and let them put me in the patrol car.

The next morning, I was getting ready to leave the holding area, when one of the yesterday cops walked in and made a beeline for me.

"There are some reporters outside. They want to ask you a few questions."

Oh, this could be fun. "I'd be delighted to."

"I had a couple more questions for you, too."

"Was there anyone with you yesterday at MegaMental?"

" _With_ me? I don't get it."

"You know, a partner. Someone who shared your feelings about MegaMental."

"Nobody," I said, puzzled. "Why?"

He laid three pictures side-by-side on the counter I was standing at. They were Polaroids of MegaMental, looking almost like it did yesterday. But there was one significant difference.

Someone had tagged the building. In letters ten-feet tall, in colors bright enough to sear a cornea, was an inscription.

"Gonzo was here!"

"You have any idea who might have done this, ma'am?"

I shook my head, not trusting myself to speak without bursting into laughter. I'd bet a hundred it was Shysmile. I tried to keep my face blank.

Maybe they'll think it's a movement.

More Info

_Dr. Gonzo_ is a melding of fiction, opinion and fact in which I get to take a few pokes at the abuses that the mental health field—and its precious and vulnerable users—are subjected to on a daily basis. While I make no apologies for the fiction and the opinion, I wanted to spend a few words on the facts. The numbers I have quoted, often with some alarm, are all drawn from non-fiction research, much of it sponsored by the federal government. While there are a number of things I would take the feds to task for, the ability to generate large-scale studies and accumulate huge amounts of data isn't one of them.

If you are interested in the sources that I used in _Dr. Gonzo_ , you can find most of it in the Surgeon General's Report on Mental Health. This report is based on the collaboration of the National Institutes of Health (NIH) and the Substance Abuse and Mental Health Services Administration (SAMHSA). The report was published in 1999; the unfortunate thing about large-scale studies is that they take forever to analyze and write up. The Center for Disease Control (CDC), also has excellent information on mental illness in America.

Diagnoses and definitions of mental disorders come from the Diagnostic and Statistical Manual for Mental Disorders (they're on version IV-TR now, I believe). It's way too expensive for the average person to buy, but you can find it online at www.PsychiatryOnline.com/dsmLibrary.aspx, or you can take a look around your local library. If you're in a college town, check their library. Learn why you have the diagnosis you've got.

In a class by itself is an organization called the National Alliance on Mental Illness (NAMI). You can find them at www.nami.org. NAMI is a grass-roots advocacy organization for those with mental health issues. If you want to get perspective on what it's like to live with a mental health disorder, or to get more information, support or ideas for dealing with a mental health issue, I strongly recommend NAMI.

The Hearing Voices Movement, started in 1987 by Marius Romme and Sandra Escher, is an international society for those who hear voices. You can find them at www.InterVoiceOnline.org.

The Mad Pride movement, which started in London in 2000, has it's own book, _Mad Pride: A celebration of Mad Culture_. You can find this saucy and energetic bunch at www.MindFreedom.org.

I mention all of these organizations for one simple reason: There's power in the group. If you have a mental disorder, or love someone who does, and you don't like the treatment that's being given, don't understand all the convoluted ins-and-outs of the benefits you are entitled to, or just plain old think the whole system sucks—there are people out there who are trying to do something about it, and they understand where you're coming from.

One of the best ways to reduce stigma is to get out and talk to people. It's extremely tiresome to listen to professional people over and over telling their clients to do things that they are not willing to do themselves. My observation has been that most people who throw around the term tabula rasa don't really have a great grasp of the concept, confusing it with an ethical stance, and not realizing that it's an analytic tool.

Often, it's used as an excuse to be a hypocrite, with therapists offering advice and handing out rules for living that the therapist can't manage to live by themselves. I've never been able to sympathize with counselors or probation officers or judges, for example, who demand people on their case load attend and participate in AA, when they've never attended a single meeting to see where they're sending people to, much less had the nuts to do an inventory of their own lives. There is redemption. Get the hell out there and try it. Once you've done it _yourself,_ tell people to do the same.

Here's the quote from Arlo Guthrie that I lifted the 'maybe they'll think it's a movement' thingee from at the end:

_If one person, just one person does it, they may think he's really sick . . . And if two people, two people do it, in harmony, they may think they're both faggots and they won't take either of them. And three people do it, three . . . they may think it's an organization. And can you, can you imagine fifty people a day, I said fifty people a day (doing it) . . . they may thinks it's a movement.  
_ —From Alice's Restaurant, ©1966,1967 (Renewed) by Appleseed Music Inc. All Rights Reserved.

Get off your ass, get involved, and make change happen. Go Gonzo. We could be a movement.

With much love,  
Dr. Gonzo

