One point made in Joe Bageant's transcript of his talks at Berea College and Adler School was that psychologists are prescribing so much Ritalin that the penguins are peeing Ritalin these days. I have to make a minor dispute - psychologists (except in a handful of jurisdictions) can't prescribe medications, so it should be the psychiatrists who are doing it. Except that most of the time it's the primary care physicians and pediatricians who are prescribing all these medications. And, if you really drill down to the heart of the matter, it's teachers who are the ones really doing a lot of the "prescribing." I've worked with a lot of kids who had ADHD, and a fair number who were thought to have it but didn't, and in all those cases I've never known a teacher who'd made up their mind that a kid needed to be on medication who didn't get their way eventually. That, or get the kid removed from the classroom.
Even when a psychologist tries to do a good assessment and really try to establish whether a kid really has ADHD, where's half of the information we need to rely on coming from? From the Conners Questionnaire that the teacher fills out. So one way or another the teacher is likely to prevail. And it's most often male students who are referred; a lot of boy behavior (and especially pre-adolescent and adolescent boy behavior) interferes with the orderly process of running a standard American classroom of the 2000's, so the behavior has to go. I don't know if it interferes with learning (at least for that individual student), but it certainly seems to distract the teacher. So we have a medicated classroom.
And speaking of primary care physicians prescribing medications, for the last few weeks my staff has had to deal with a parent who wanted their insurance to pay for Abilify for a 16 year old who was reportedly out of control. The school couldn't handle him, the mom couldn't handle him, and the family doc told them he was bipolar and should be getting dosed with a medication that was developed to treat schizophrenia in adults. Oh, by the way, mom has issues of her own that have been going on for quite a while, and the kid happens to be smoking blunts. No wonder she wants the kid medicated. No one in this whole situation wants the one thing that might actually stand a chance of helping, which would be family therapy. It's much simpler to give him pills. After all, what are we paying for this insurance for?
I own stock in a pharmaceutical company, (not that it's ever hunted very well), so I can't be too critical, but it really annoys me to hear commercials on TV that tell people they should try to talk their doctors into adding another medication - an atypical antipsychotic, for Pete's sake - to whatever other medication they're already taking, when they don't think they're feeling better enough quick enough. Nowhere does it say that they should be getting some help from a good cognitive-behavioral therapist, which is what the research would suggest, and nowhere does it caution them that a psychiatric evaluation might be a good idea if the general practitioner isn't able to control the depressive symptoms well enough with one medication. And even the misguided commercials specifically caution against giving Abilify to kids and teenagers.
One would think that getting the kid to stop smoking blunts might be kind of a good idea, too.
When someone had the kind of depressive disorder portrayed in those commercials back in he 1980's when I was working inpatient psychiatry, you'd probably have considered ECT - aka shock treatments - for the patient. And don't scoff - they actually worked pretty well for a lot of people. And for someone with cardiac risk factors, the doctors used to tell us that ECT was actually safer than medication a lot of the time. But that was "barbaric." Oh well, we make progress. Don't we?
Thursday, April 9, 2009
Wednesday, April 8, 2009
Banjo Picking with Joe Bageant
I met Joe Bageant on Saturday, and played some guitar and sang with him. So it seems we kinda see eye to eye on a bunch of things. I hadn't read his book, Deer Hunting with Jesus, and I had to miss his talk at the Adler School of Professional Psychology (where I teach part-time) because my of other job, but I was glad to see that his talk was pretty much reproduced on his blog and I thought it was pretty provocative and right in a lot of ways. I since bought a copy of "Deer Hunting with Jesus" and found it to be - first - kind of depressing, and - second - eerily prescient about the financial meltdown that happened last year as a result of the housing bubble. I'm on the "guns" chapter now and find that pretty interesting. It challenges my liberal assumptions about gun control but is also pretty thought-provoking in the sense that maybe the "bloodline of values" I talked about in an earlier post really does include a strong streak of wanting to be able to resist oppressive government by having an armed populace. If so, that's kind of scary.
I haven't had the kind of life experiences Joe has had -- I've never lived in Belize, or tended bar on an Indian reservation -- but I still think, as Studs Terkel said shortly before he died, that "the big boys are not that bright." And that we all need to help each other out and pay attemtion to human needs, and that this wonderful system of capitalism and markets that we have come up with will NOT solve very many of the problems we face. But I do participate in it (it's next to impossible not to), and I think it has its uses.
So thanks, Joe, for your nice remarks about my singing and my choice of tunes ("Hard Times Come Again No More"). I appreciated your funny blues lyrics and you made some good points in your political observations in the bar there, which sounded prettty much on the money. I didn't get to ask you if you were a U. Utah Phillips fan but I wouldn't be surprised if you were.
My earlier entry here about the way I hoped our economic meltdown might lead to a return to some of the fleeting hopes of the 60's and 70's seems to be in line with a lot of what Joe has to say. And I agree with him that making music is a good way to get people out from in front of their TV sets. The interesting thing is that a lot of what you run into while delving into old time music and down-home entertainment is so closely tied to that whole Scots-Irish tradition and culture that Joe talked about. In fact all of us who hang out at the Old Town School of Folk Music and take classes there would cringe sometimes at some of the politically incorrect song titles (Google Uncle Dave Macon if you need examples). Notwithstanding my defense of "Blue Tail Fly" last year on my blog.
Even Stephen Foster, who was the subject of some of our conversation, had to be edited to avoid being too offensive. The state of Kentucky had long used "My Old Kentucky Home Far Away" as the state song. It was only in the last few years that they thought to take out the reference to "darkies" in the lyrics (ya THINK?). But actually, Foster was strongly empathetic to the issues that the African-American community of the day (largely consisting of slaves) had to deal with on a daily basis. A lot of country music has its roots in that kind of sensibility. One example" "Faded Love," made famous by Bob Wills and his Texas Playboys, and later by Patsy Cline, was a reworking of an old song called "Darling Nellie Gray," about the plight of a slave who was separated from his love when they were sold to different owners. But back to Stephen Foster, a recent CD of his songs had a version of "Hard Times" by Mavis Staples, who is of course a major singer of civil rights songs. So it's not hard to find a rich vein of social awareness in the songs of someone who was dismissed for years as a hack who played up the cornier aspecs of Southern life.
But music prevails over prejudice and ignorance, and learning about the common threads between African-American music and Appalachian, Cape Breton, Irish, Scottish, and even English folk tunes is kind of reassuring. People always find ways to create connections through their music.
On a larger level, I agree with Joe that there is an American "hologram," in the sense of some consensually validated myths that serve as a backdrop for personal, community, and political judgments and values. Alfred Adler (who was actually pretty subversive, in my book) based his theories of human behavior on the idea that all human beings operate according to a set of fictions that shape behavior by allowing people to set goals for themselves. Pathology usually happens when a person's "private logic" is too far out of whack with the common sense of generally accepted fictions about ourselves, people, life, and how to get along. But Adler's theories also allow for the possibility that "common sense" could be out of whack with what's good for all of us (including what's good for the planet we all have to share and hand to our children and grandchildren). Adler, who had to flee the Nazis in the 1930's, was acutely aware of the fact that there can be widely accepted but "socially useless" belief systems. Adler spoke of how the social instincts that served early humans well (like loyalty to the tribe) may not serve modern humans so well. This implies that we need to use our reasoning brains to guide our innate instinct to band together (our community feeling) in the right direction. It also means that people need to be willing to question their assumptions - learned from parents, culture, religion, and the social milieu - to be sure that those assumptions are in line with what is socially responsible and useful for humanity as a whole. Adler saw the rapidly shrinking "global village" (although that name hadn't been invented yet), and knew that we were going to need to transcend our old-fashioned nationalism, with its striving for power, and instead develop assumptions and values based on our shared humanity. See how well we're doing at that these days...
Anyway, Joe Bageant is a hell of a writer and a pretty good blues singer, and an interesting guy to have met. I'll try to scan the photo I got back of him and me singing and post it on here.
I haven't had the kind of life experiences Joe has had -- I've never lived in Belize, or tended bar on an Indian reservation -- but I still think, as Studs Terkel said shortly before he died, that "the big boys are not that bright." And that we all need to help each other out and pay attemtion to human needs, and that this wonderful system of capitalism and markets that we have come up with will NOT solve very many of the problems we face. But I do participate in it (it's next to impossible not to), and I think it has its uses.
So thanks, Joe, for your nice remarks about my singing and my choice of tunes ("Hard Times Come Again No More"). I appreciated your funny blues lyrics and you made some good points in your political observations in the bar there, which sounded prettty much on the money. I didn't get to ask you if you were a U. Utah Phillips fan but I wouldn't be surprised if you were.
My earlier entry here about the way I hoped our economic meltdown might lead to a return to some of the fleeting hopes of the 60's and 70's seems to be in line with a lot of what Joe has to say. And I agree with him that making music is a good way to get people out from in front of their TV sets. The interesting thing is that a lot of what you run into while delving into old time music and down-home entertainment is so closely tied to that whole Scots-Irish tradition and culture that Joe talked about. In fact all of us who hang out at the Old Town School of Folk Music and take classes there would cringe sometimes at some of the politically incorrect song titles (Google Uncle Dave Macon if you need examples). Notwithstanding my defense of "Blue Tail Fly" last year on my blog.
Even Stephen Foster, who was the subject of some of our conversation, had to be edited to avoid being too offensive. The state of Kentucky had long used "My Old Kentucky Home Far Away" as the state song. It was only in the last few years that they thought to take out the reference to "darkies" in the lyrics (ya THINK?). But actually, Foster was strongly empathetic to the issues that the African-American community of the day (largely consisting of slaves) had to deal with on a daily basis. A lot of country music has its roots in that kind of sensibility. One example" "Faded Love," made famous by Bob Wills and his Texas Playboys, and later by Patsy Cline, was a reworking of an old song called "Darling Nellie Gray," about the plight of a slave who was separated from his love when they were sold to different owners. But back to Stephen Foster, a recent CD of his songs had a version of "Hard Times" by Mavis Staples, who is of course a major singer of civil rights songs. So it's not hard to find a rich vein of social awareness in the songs of someone who was dismissed for years as a hack who played up the cornier aspecs of Southern life.
But music prevails over prejudice and ignorance, and learning about the common threads between African-American music and Appalachian, Cape Breton, Irish, Scottish, and even English folk tunes is kind of reassuring. People always find ways to create connections through their music.
On a larger level, I agree with Joe that there is an American "hologram," in the sense of some consensually validated myths that serve as a backdrop for personal, community, and political judgments and values. Alfred Adler (who was actually pretty subversive, in my book) based his theories of human behavior on the idea that all human beings operate according to a set of fictions that shape behavior by allowing people to set goals for themselves. Pathology usually happens when a person's "private logic" is too far out of whack with the common sense of generally accepted fictions about ourselves, people, life, and how to get along. But Adler's theories also allow for the possibility that "common sense" could be out of whack with what's good for all of us (including what's good for the planet we all have to share and hand to our children and grandchildren). Adler, who had to flee the Nazis in the 1930's, was acutely aware of the fact that there can be widely accepted but "socially useless" belief systems. Adler spoke of how the social instincts that served early humans well (like loyalty to the tribe) may not serve modern humans so well. This implies that we need to use our reasoning brains to guide our innate instinct to band together (our community feeling) in the right direction. It also means that people need to be willing to question their assumptions - learned from parents, culture, religion, and the social milieu - to be sure that those assumptions are in line with what is socially responsible and useful for humanity as a whole. Adler saw the rapidly shrinking "global village" (although that name hadn't been invented yet), and knew that we were going to need to transcend our old-fashioned nationalism, with its striving for power, and instead develop assumptions and values based on our shared humanity. See how well we're doing at that these days...
Anyway, Joe Bageant is a hell of a writer and a pretty good blues singer, and an interesting guy to have met. I'll try to scan the photo I got back of him and me singing and post it on here.
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