471E4--Week 11 Questions/Comments--Tuesday

Grob has reached recent history is the later chapters of his book. His focus rests in community psychiatry and the importance of deinstitutionalization and community care. What lead to this being so important? ~Emily Barry

Grob continues to discuss the differing viewpoints on mental health by Presidents Kennedy and Nixon. What are their viewpoints and why does each man feel this way? ~ Emily Barry

I appreciate that Eghigian lists that numerous ways in which psychotherapy has become popularize/mainstreamed. The one I particular was interesting in was the advent of insurance systems covering psychotherapy. I would be interested to learn more about this. – Kasey

One fact that surprised me was on page 373 in reference to support groups, “in 2008, it was estimated that there were more than 113,000 groups and more than 2 million members in 180 countries.” I can’t even image all the various types of groups there are. Do they all follow these 12 steps and 12 traditions? – Kasey Moore

In regards to AA traditions -number 5 which states that “each group has one primary purpose- to carry its message to the alcoholic who still suffers”, I wonder if that is something that still exists today. It seems to me this “tradition” is more like evangelizing and prohibition movements. Shouldn’t AA primary purpose be to support those who want help rather than go around preaching? Secondarily, does this conflict with number 11, “our public relations policy is based on attraction rather than promotion”; maybe I’m reading this wrong?- Kasey

The section on the attitude of the counselor in client centered therapy brought up many issues that we have not discussed in class. Before I always just assumed that it was the therapist’s job to save a patient no matter what, but this is may not necessarily the case. What if the patient does not want help or like the patient in the example feels as if they were better off living in their dream world? This section also reminded me of a quote from Girl, Interrupted after Daisy took her life and Kaysen discusses the definition of suicide. It says that suicide happens when one takes their life prematurely, but how do we know that a person’s life is not ready to end? Kaysen said that for Daisy her life may have never have gotten better, so was it really premature for her to take her own life? So as a doctor are you supposed to help someone no matter what, even if there is only a little chance of them getting better? Or do you help the patient do what is best for them, even if that does mean possibly ending their life? - Morgan H.

Hi everybody, I’m writing a little more than normal tonight since I won’t be with you tomorrow:

Preventive Psychiatry (p250). Does this mean that a mentally ill person should continue to see a shrink even when they are not experiencing symptoms to help them maintain their course? Or that everyone should undergo psychiatric treatment to prevent a possible meltdown?

P251: “Some questioned the use of nonmedical personnel as “Mental Health Counselors….” This is pretty well the norm now. I personally prefer this kind of staff because they (obviously not without the occasional exception) are more down to earth and tend to have a more personal connection.

I’m so glad this chapter touched on the rivalry between MR and MH services. Grob calls it mutual hostility, which is perhaps unwarranted, in my opinion. There are so many people out there with a dual diagnosis, so we always overlap. Honestly, we get along fine. It’s not a matter of personality or ideology. The conflict always comes down to funding. “How come those A-holes over in MH got a brand new file cabinet? I just wanted the lock changed on mine and it takes an act of Congress to get it approved!” (Real life example. I promise I didn’t make a scene).

P273: As much as I identify with social control theory, I really can’t get on board with the idea that mental illness does not actually exist.

P282: Some urban CMHCs were associated with a radical political agenda? Tell me more!--Stef L.

Insurance companies began to routinely cover the cost of mental health care? That’s a bit of a stretch.

Mixed feelings about AA. I disagree with their attitude that there is only One Right Way to get sober, but they do help a lot of people to quit drinking. But is it substituting one addiction (drinking) for another (attending a million meetings and endlessly dwelling on your identity as an alcoholic)? I can’t answer that.

It’s easy to forget that PTSD was originally only applied to war veterans. Now all sorts of people can “catch it:” survivors of rape, abuse, etc. --Stef L.

I couldn’t help but notice many political undertones in Grob’s last few chapters. It was kind of distracting and there should be no place for such things in a work such as his. Then again this is his book and he has the right to write whatever he pleases. –Jack Hylan

Grob briefly discusses the decline in psychiatrist after the 1960s and introduction to community health programs. It would be interesting to see data on this supposed reduction and how dramatic it really was. Are there more or less physiatrists today than there were sixty years ago? –Jack Hylan

On page 369, the introduction to the “psychoboom”, I was surprised that psychotherapy was not acceptable for the middle class. After thinking about the pop culture history of mental illness there is usually a person of the upper class portrayed as using therapy. For one reason, it was more acceptable for upper class people to use therapy because they had more money. –Courtney Collier

In the section "The Intractable Female Patient,” I found it interesting and helpful when Dr. Houck’s therapy was compared next to the feminist therapy. It is interesting to see the term of “true womanhood” still playing a vital role in societal views on the norms and therapies for women. It’s sad that many women had social/mental issues because they were trying to escape the unwanted roles and the life they lived, yet doctors wanted to control and dominate them for their own beliefs rather than their health. –Courtney Collier

On the very first page of the "psychoboom" chapter they mention a shift from emphasis on "mental illness" to "mental health care." I think the change in terminology is significant to our talks about how the stigma of mental health changes over time...it makes it sound like its becoming less of a negative, foreign issue and a more common issue. --Carly W.

I had previously not thought of how the anonymity of groups like AA helped with the stigma of being labeled mentally ill. – Katie Tryon

It seems that institutions before the twentieth century were a dumping ground for a variety of patients. During the next decades the mental health care system seems to divide patients into separate groups and facilities, allowing better care. – Katie Tryon

I think what strikes me the most about the primary sources is how there is a shift to using more standardized methods of treatment. The use of the DSM also marked a change in diagnosing patients. Instead of having multiple, varying symptoms by which doctors could diagnose any disorder they wanted, the DSM ensured some sort of regularity among patients and their illnesses. Beck stood out to me in particular because he applied a more scientific method of treatment. By treating essentially reorganizing disordered thoughts of a patient, Beck implied that the etiology no longer held as much sway as it once did.--Chelsea Chin

Grob discusses deinstitutionalization and the resulting visibility of the mentally ill. A lot of his writing is about the political influences on mental health care, but I'm wondering about the process of deinstitutionalization. Who was discharged from the state hospitals and who was not? Did they then move immediately into community care? -Joanna Jourdan

It seems odd that the Federal government would take authority from the State government on matters of mental health only to distribute it down to the local level. Especially in an attempt to end patient dependency the federal model still had a centralized approach with top down administration, and functioned to either sustain dependence or totally lacked necessary services. Reading this is like seeing history repeat itself with the fallacy of curing instead of custody (instead of using both) while shafting the incurable. By further diversifying the system they failed again to address the root problems. –Scott Campbell

I completely agree with Scott about giving power to the local level. My main problem with it is that it causes such a wide range of diversity among the treatment of patients throughout the state is that there is no consistency. Also, I'm sure some counties put more funds into mental illness than others which translates into patients not receiving the best possible care. This seems like a huge problem to me. - Maggie Nunn

In Chapter 11 Grob mentions how the younger generation (the first generation to fully experience the community-based care approach) “generally fell into the schizophrenia category.” This would be at odds with the thesis presented in Metzl’s “The Protest Psychosis.” – Scott Campbell

I noticed that the 12 steps of AA are strongly religion-based, something I didn't know before. We addressed the place of religion in care for the mentally ill in the beginning of the class, but it seems to have mostly disappeared from discussion. What place do you think religion has in more recent treatments? Has it changed with deinstitutionalization? -Joanna Jourdan

While I know how popular AA is, I wonder about genuine the process is. By this, I mean that every person who goes through AA is not religious or looking for religious redemption. I wonder if every person truly believes in the AA creed and the religious overtones of the program. How does the religious aspect effect the process?- Maggie Nunn

Going off of Kasey's comment about support groups, I was happily surprised by the amount of support groups. I think it's amazing that there are so many support groups in our modern world and we don't lump them all into one diagnosis like we have seen in previous readings.- Maggie Nunn