Health Care Bedlam

Bedlam means a scene of uproar. The word comes from a shortening of the name of Bethlehem Hospital in London which became one of the first "lunatic" asylums in 1547. What one doctor considered a lunatic in 1547, another doctor would probably have a more definitive diagnosis for in 2010 like schizophrenic, manic, obsessive or even Alzheimer's. I have done no study on the comparisons of people who were locked up in the 1500's to those locked up in 2010, but I suspect that they were very different.

Regardless of the practice of mental health care, the end result in the unit can be very much the same. The bringing together of all the individuals who need specialized attention to tolerate structured society still creates a scene of uproar in many cases. As a nurse who has worked in mental health patient units for over thirty years, the uproar isn't always just the pathology of the patient, it is also very much the pathology of the treatment.

Just as doctors in the 1500's were unaware of many of the chemical and social pressures that caused things they called "lunacy," mental health treatment is often still a stab in the dark at offering answers for things that may not be understood for years, or possibly ever. The main goal of the mental health unit is to provide safety to the patient and to others from the patient until a higher level of stabilization can be reached. Just the fact that getting from unstable to stable is part of the goal of a locked unit indicates how much uproar is occurring.

When I got up this morning I wasn't sure what I was going to blog on today. The president has said that all that can be said has been said about health care, and I know I have enjoyed reading the well researched comments of others today more than I have enjoyed trying to puzzle out things that are 2,000 pages long.

So today's blog is going to be a little picture of bedlam. A little allegory of the treatment that is being performed on our health care and the uproar that that has caused.

Let's make the patients in the unit, not individuals with health care needs, but the different, individually operating parts of the health care system. We have the Bipolar drug companies who lavish money on doctors, research and ads in their high moments of great discoveries, and then become suicidal when they can not charge and keep "patents" or are pressed to offer drugs at prices people can afford rather than prices that cover their lavish expenses. We have the schizophrenic doctors who live in the multiple worlds of money, charity, urgency and necessary risk prevention. They still have traditional duties such as not to harm and to provide for the poor off of the capacities of the rich  yet they are losing power to control their own actions so quickly, that much of their practice has become empty attempts at appeasement to demand rather than carefully studied exploration of need and treatment. We have the deeply depressed hospitals who have given and given and given, and tried to cooperate with laws, regulations and demand and still are being emptied of their capacity to serve. We have the sociopathic medical supply companies that suck money out of health care by keeping their wares at free market competitive levels with no thought that they are pricing health care through the sky. They are the new leaches that bleed the needy through money the way doctors did in the past with leaches. We have the obsessive-compulsive Medicare and Medicaid systems who demand that things be done exactly as they want them all the time, without fail, or fault, or variation which is of course impossible, but they have to keep believing it is possible. And last but not least, we have the self mutilating States, who are so confused about what is helpful and right to do, that they have started cutting themselves up hoping to find some answers.

President Obama is the young, newly graduated psychiatrist who has studied it all in a book and is doing his best to make it match reality - but it never does. The Senate is the staff - therapists, nurses and social workers who try to show the patients what they need to do to help themselves, but the advise never quite gels  because what the patient reports when locked up is not exactly revealing of what is happening at home, or in the work place, or even deep in their soul no matter what is seen on the outside.  And the House is the Patients Rights Group. They are trying to make sure the patients get their rights because they are convinced that all those who have complete access to all their rights will get the best outcome.

My Bedlam is not far fetched.  In fact, it is just a clearer picture of what everyone is saying when they observe that our health care system is broken. It is broken in spirit, unable to function for social productivity, and on the verge of self destruction.

The House is trying to guarantee rights, which will not empower health care. The Senate is trying to force it to do what it needs to do, which won't happen. The President is trying to understand, diagnose and treat it, but he is not competent enough for the job. Change does not occur until it is self determined. The biggest secrets to fixing crisis are giving them time and space to fix themselves.

In general, more pressure equals more crisis, less pressure equals less crisis.

I see in the great health care reform bill the same treatment pathology that repeats itself over and over in psychiatric units across the country. The patient is able to avoid facing truth and responsibility because someone will believe in their suffering enough to argue that someone else should take responsibility. The patient goes forward looking for who it is that should be responsible and never figures out that they can actually do something themselves to make things different. The therapists in my little allegory are not healing anyone, they are trying to fix things as they think they should be, and that never works.

I liked the self-determined attitude of the people who were demonstrating in D.C. today against the health care bill. They wanted to figure it out and be left alone to make a difference for themselves. I'm pretty sure that is what being an American is about. It isn't easy, but in the long run, it is the only thing that produces success.