A Psychiatrist’s Year In Appalachia: “You Cannot Catch An Addiction.” More Complex Reasons Than Swallowing A Pill

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Psychiatrist Dr. Satel spent a year in Ironton helping patients

(6-28-21) Dr. Sally Satel, a practicing psychiatrist who works at a methadone clinic in Washington, D.C., told me over lunch one day about her plan to spend a year in an economically depressed Appalachia town treating patients for addiction.

When she moved to  Ironton, Ohio, population 11,200, for twelve months, I wondered what she would discover.

She has now returned to Washington and has written two articles and been interviewed by journalist Nick Gillespie in Reason magazine.

Gillespie writes: Dr. Satel, “challenges conventional theories of addiction that characterize it as a disease like diabetes or Alzheimer’s. Substance abuse, she says, derives from both inborn predilections and a person’s environment, or what she calls ‘dark genies’ and  ‘dark horizons.’ Satel stresses that the best way forward is to give individuals tools to make better use decisions while improving their chances to live lives with open-ended futures.”

“You cannot ‘catch’ addiction,” Dr. Satel writes. Her year in Ironton convinced her that drug/alcohol addictions are not so simply explained by saying an individual got hooked because they drank their first beer or swallowed their first opioid. Rather those treating an addiction must spend time trying to uncover the underlying causes – environmental events or what is missing in someone’s life – to truly understand. (Dr. Satel can be reached at slsatel@gmail)

Bravo!

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Norman Mailer Didn’t Reply, But Literary Killer Wrote Me Back: A Sad Prison Tale

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Norris Church and Norman Mailer 1981 Photo By Adam Scull/Alamy

This is NOT about mental health. 

(6-25-21) From My Files Friday. I spent a year as a reporter in the 1980s roaming around a maximum security prison doing research for my New York Times Bestseller, The Hot House: Life Inside Leavenworth Prison. Now forty years later, I am working on another prison related book.  As part of my research those many years ago, I read Jack Abbott’s book,  In the Belly of the Beast, which describes his experiences in prison. Sadly, not much has changed. In April 2010, I posted a blog about Abbott and his relationship with Norman Mailer.

Norman Mailer, Jack Abbott and Me. 

The son of an Irish-American solider and Chinese prostitute, Jack Abbott had spent nearly all of his life in jails and prisons. In 1977, he learned that Normal Mailer was writing a book about Gary Gilmore, the first prisoner to be executed in 1977 after our nation re-started the death penalty ending its short constitutional hiatus. Mailer’s book about Gilmore, The Executioner’s Song, won the Pulitzer Prize and helped revive his career.

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Being Stashed In Dirty Hospital Room, Waiting For Psychiatrist Sends Message: You Are Not As Important As Other Patients.

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(6-21-21) What is treatment? “Too often, patients spend most the day wallowing in their misery and uncertainty waiting for the next meal or group meeting.”

A recent email from a frequent patient at Virginia Hospital Center in Arlington, Virginia, caught my attention. It echos complaints which I have heard about the quality of care available to individuals with mental illnesses. The writer specifically mentioned a disconnect between a patient and psychiatrist.

In my speeches, I often talk about how my son has had seven psychiatrist since his first break, but only two have taken the time to learn anything personal about him. They simply listen to his symptoms, prescribing medication and send him out the door – usually in under 15 minutes, which is all the time an insurance company wants to reimburse.

But I believe treating the brain also requires treating the whole person.

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Advocates Want Older Hospital For More Psychiatric Beds, Owners Want To Build Expensive Homes For Sale

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Older Hospital To Be Developed Into High End Housing or a State Mental Facility?

(6-18-21) How long does it take for someone with a mental illness to become stable enough to be discharged from a hospital?

Roughly 30 percent of Virginia residents are discharged within seven days, according to a report. The others are discharged within 30 days.

Henry Johnson, the chair of Alexandria’s Community Services Board (which oversees mental health services in the county) said it took him 11 months.

He is urging Virginia Governor Ralph Northam to use state money to purchase one of the oldest hospitals in Virginia and convert it into a new state mental health hospital. INOVA has announced that in 2028 it will close its 318-bed Alexandria Hospital, which has operated for 149 years, and build a new complex in a former, large shopping mall that closed in 2017. It wants to raze the older hospital and sell the land  to housing developers.

It remains difficult in Virginia on some days to find available beds.

In addition, Johnson is calling on legislators to create a new classification that would make it tougher for hospitals to discharge psychiatric patients. Before a patient could be discharged, Johnson would require them to be able to advocate for themselves, have insight into their illness, and be willing to cooperate with a treatment plan for at least ten days.

In a recent letter, Johnson wrote: 

“This would be a huge step towards the long term health of the chronically mentally ill, and I believe would reduce crime, reduce recidivism, reduce overall cost of mental health treatment by making recovery achievable for all, and likely have profound effects on chronic homelessness in the Commonwealth.”

The anti-state hospital movement of the past is being challenged more and more, with several states expanding and building more hospitals. What do you think about Johnson’s call for more longer term beds and tougher discharge criteria? What do you think about using the INOVA hospital for mental health rather than high end housing? Tell me on my facebook page.

Here is a copy of Johnson’s recent letter to Delegate Charniele Herring, the majority leader in the Virginia House of Delegates.

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New Mental Health America Leader Says Advocates Should “Walk boldly into the new territory of social justice.”

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“We reaffirm that we are committed to the mental health and well-being of all individuals, that we are committed to healing and recovery for all those who seek it, and we are committed to inclusion and equity for all people. All those we serve, and all of us,” – incoming MHA president and CEO.

(6-15-21) Schroeder Stribling has been named President and CEO of Mental Health America, the nation’s oldest advocacy group for individuals living with mental illnesses. She replaces Paul Gionfriddo, the parent of an adult son with a mental illness, who has run the organization since 2014.

According to a press release, when she was introduced last Friday at an annual MHA conference, she said her experiences as a gay woman helped form the basis of her commitment to social justice issues.

“While my primary experience as a gay person has been one of acceptance and inclusion, this wasn’t the case for my biological father who himself was gay and who grew up in a very different time and place…his personal journey was difficult, he struggled mightily with depression and substance abuse.

“In my late teens and early twenties, I cared for him—as best I could at the time—while he was dying of AIDS…As you might expect, the experience was also traumatic for me—it overwhelmed my 20-year-old capacity to absorb the impact and led to anxiety and depression of my own. It took me many years afterwards to find the help and healing I needed to unwind the long tentacles of trauma. Three decades later now, my lived experience and that of my father, is the basis of my personal case for hope and my commitment to social justice.”

Mental Health America was founded in 1909 by Clifford W. Beers, who launched the group after being abused in both private and public mental hospitals. Historically, it has been the voice of individuals living with mental illnesses, although the larger National Alliance on Mental Illness, which was started in 1979 by parents, has recently expanded its membership to draw from that same base. A marked difference between the two groups is that MHA has traditionally opposed Assisted Outpatient Treatment while NAMI has endorsed its use as a last resort.

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Using Housing To Get Patty Into Treatment: Part Three of Skid Row Doctor’s Story

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Image of random homeless woman by Wolfgang van de Rydt from Pixabay

(6-11-21) This is the third and last in a series of guest blogs written by Los Angeles Skid Row doctor Susan Partovi about Patty. As with all guest blogs, the opinions expressed are those of the writer. Please post your thoughts on my facebook page. What do you think about Dr. Partovi’s actions?

“Treatment First, Housing Second”

By Susan Partovi, M.D.

I hadn’t seen Patty for several weeks.  I had made a very difficult decision. If she came to me for help, I would only put her into a hotel if she agreed to begin taking a long acting injection version of the antipsychotic she had been trying to take orally. I struggled with this decision.

Am I manipulating her into taking her medications? Am I using a human rights need as a carrot in order to persuade her into taking her medications? 

No.

The only way she could stay in a hotel without destroying it or getting kicked out was for her to be mentally stable.  Otherwise we would just be wasting our grant money. Yes, she was safe when she was in a hotel, but her behavior was so unpredictable that she would continue to get kicked out.

It was a very difficult decision.

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