Seeing is Believing

The proof is in the pudding. Don't count your chickens before they're hatched. A bird in the hand beats two in the bush.

There are so many old adages that say virtually the same thing. Yet, there is no shortage of persons who come to my office--usually women--who are angry and puzzled because a man with whom they've been involved didn't do as he said.

The oldest rule of psychology is that past behavior is the best predictor of future behavior. If you want to know what someone's future behavior is likely to be, don't listen to what the person promises. Look at his or her past behavior. Yes, people can change. But they usually don't. Trust me; if everyone who could change their behavior came to psychotherapy in order to change that behavior, I would have a lengthy waiting list and so would every other therapist, and we would all be rich. I fly economy class. Most people with negative behaviors and personality problems never go to therapy and aren't interested. A man who is a chronic cheat or a habitual liar is unlikely to become a different person. In most cases, his cheating and lying works for him and he doesn't care how it affects others.

You (probably) deserve better. This advice is free.

"Medicare for All" Would Not Be A Panacea

"Medicare for All" is a slogan I've been hearing a lot lately. Unfortunately, those of us who have been Medicare providers know that this would be no panacea for our nation's healthcare woes.

I've stopped accepting Medicare patients. I got tired of re-submitting the same claim form 3 times because an i wasn't dotted or a t wasn't crossed. I also found it impossible to find out in advance how much I would be paid, which is not the same rate for every patient.
I had a patient who had Medicare and Medicaid, and when I tried to bill Medicaid for the co-pay--the usual procedure--I was told I could not, for unclear reasons, but also that I could not bill the patient. I ended up being paid $50 per session for this patient, which is below my lowest fee.
When I signed up for electronic funds transfer, it took Medicare more than 6 months to process my one-page application form.
When I didn't get paid for a patient for unclear reasons, I had to get my Member of Congress to intervene before I was finally paid.

I believe the general public is unaware of how difficult and unprofitable it is for healthcare providers to deal with Medicare. It's naive to think "Medicare for All" would mean guaranteed healthcare, because an increasing number of providers no longer accept Medicare. Health insurance is useless if healthcare providers won't accept it as payment.

Tips for Rekindling Desire

I thought this marriage counselor's blog post had some good tips about sex:

http://www.psychologytoday.com/blog/save-your-sex-life/201109/reconnecting-couples-using-physical-intimacy

Why I Don't Make Appointments Via Third Parties

About once a month, someone contacts me to make an appointment for a friend or relative. I no longer respond to these calls, because I don't have time. The fact is I don't take third party referrals, because I know the person won't show up if someone else makes the appointment.

I've pondered whether the person making the call really believes that their relative, friend or significant other will attend an appointment made by someone else. It's occurred to me these individuals making the calls may just want to be able to tell themselves that they tried to help. A better way to help someone is to tell the person what your limits are. If you find someone's behavior to be intolerable, the best thing for you to do is to stop tolerating it. Doing work for them that they could do themselves, such as making a psychotherapy appointment, does not help. If someone won't make a phone call to set up an appointment for treatment, that person definitely is not going to actually go to such an appointment. Going to therapy is a lot harder than making an appointment for therapy.

Let Them Smoke

It's an old joke among mental health workers that people with schizophrenia live for three things: Coffee, food and cigarettes. Schizophrenics still have access to food and coffee, but today we live in a country in which smoking is forbidden in most places and the cost of a pack of cigarettes is prohibitive for the poor--and most people with severe mental illness are poor.

These changes were made for the benefit of "society", but the people whom they benefit are primarily middle-class people who can quit smoking if they choose to do so. The laws punish those who have the hardest time quitting smoking (and may have no incentive to do so) and can least afford the financial cost of cigarettes.

People with the worst cases of chronic schizophrenia live in state psychiatric hospitals, where smoking is forbidden. Even if they had the money, they could not choose to smoke.

Years ago, a schizophrenic patient commented to me that he didn't understand how I could drink coffee without smoking cigarettes--"because the coffee brings you up, and then the cigarettes even you out." Some may think that the psychiatric medications our pharmaceutical companies have created are substitutes for cigarettes and coffee, but they aren't. They don't provide pleasure nor do they have a social aspect. And many of them cause weight gain and diabetes. Diabetes is a fatal illness--a fact many people forget. Smoking kills, but so does obesity.

Well-meaning policymakers--as well as grandstanding politicians--often don't think about the consequences of their actions on society's vulnerable members.

Nanny Diaries

I've had several patients who were nannies, and other patients who hired nannies. I realize some people need nannies to watch their children, but I believe hiring a nanny should be a last resort.

People hire nannies based usually on the nanny's references. These references are from adults who hired the nannies. The only people who can actually report on the nannies' behavior, however, are the children. Parents often have no idea what is really going on between the nanny and the children. A publicized example of this can be seen in the film "The King's Speech," in which Colin Firth's character reveals that he was victimized by his nanny. If the future King of England doesn't get a good nanny, how can anyone know for sure that the nanny they hire is any good? They can't.

Abusive nannies are almost certainly in the minority. A more common, almost inescapable problem occurs when the nanny is good. The children bond with the nanny, seeing her as another parent. Many biological parents are probably in denial about the parent-child bond that can develop between nannies and children. When the children get older and no longer need a nanny, the nanny is typically fired. She may or may not continue some contact with the children. Children who lose a parent before age 11 are at higher risk for depression as adults. Losing a nanny can be just like losing a parent. Could this be the reason why so many children of the wealthy seem to end up on drugs or as suicides?

Daycare, which offers less individualized attention but more peer interaction, is a healthier choice than a nanny.

Children Need Risks

I appreciated this story in The New York Times, "Can a Playground Be Too Safe?"
http://www.nytimes.com/2011/07/19/science/19tierney.html?_r=1

Children need to feel a sense of adventure in play. Too-safe playgrounds, hovering parents and overregulated schedules damage children's self-confidence and creativity. Not to mention contributing to weight gain.