why is psychiatry just like armed interventions

Is that right? You have 72 doctors right now? There aren't even that many specializations!

Actually, the very first good doctor that I saw was on-call! A young doctor, too! In county mental health - not at my current county, but at an adjacent one. My regular doctor there was at times OK, but during crucial periods very very bad. Once I told her that I was manic having been off all meds (I stupidly decided to save money on meds in Europe where I had to buy them) for a couple of weeks (which means ages for me, as I now know). I just came back - she had not seen me in months. She... refilled my prescriptions and scheduled me back in TWO months! And I went on to wreak all sorts of havoc - I was in a state where one needs at least an IOP. But the on-call doctor whom I visited later on when starting mania despite medications really cared for me. He gave me life-saving advice complete with medication samples: when beginning mania, use Zyprexa PRN (as needed rather than on a continuous basis) to squelch mania and get a good night's sleep. It worked! I was so impressed that I tried it on a continuous basis (which was not his advice). That was not a good idea - I put on many pounds during my one month trial. His advice was to use it perhaps once a year. And I believe in June I had one occasion for it and I did use it PRN and it worked great and I slept very soundly without any ill aftereffects. And now I know that the state of mind that precipitated my manic suicide attempt was EASILY treatable with Zyprexa PRN. Unfortunately, at that time I did not have a good doctor and the ****** one that I had could not think of anything better than Valium (Diazepam) which only gave me two hours of sleep (I know now that I do not respond well to benzos in general) and did nothing to suprress the episode. So this young on-call doctor gave me life-saving advice! He also mentioned in passing how important healthy sex life of his patients is to him. So clearly the patients matter to him. Gosh, I do not even know his name. One day I will request my record from the county, get his name and send him a card thanking him for Zyprexa PRN advice. He was my first American outpatient p-doc who was good - he deserves to be thanked.

Psychiatry is just like armed interventions, interesting analogy Venus. I spent some time thinking about it and got my mind going good.

Both are in positions of power trying to control what they see as a hazardous situation, but with numerous unknown factors.

Just like a bomb aimed to take out "bad guys", meds are sent in to take out "bad symptoms". Both can hurt innocent people in the way. Both claim the benefit will be worth the loss. The truth to that will probably depend on the reality experienced and perspective of the one telling the story.

Usually these people in positions of power like pdocs and politicians believe what they're doing is in the best interest of the people. But also these people make a lot of money and it could be assumed some are in it for the money, or the power.

A good pdoc like a good politician should be all for the people, remembering they are in this position to help, speak up for, empower the people. They are the ones who try therapy/diplomacy first. They are the ones who are honest, like the pdoc that spent years working with me before handing me the bp dx. And then the honest and good politician would be like our senator that refuses the free healthcare for government workers until it is also offered to all Americans.

With both, there are times where they see a danger that has to be addressed by putting someone on a psych hold and eval against his will to save his life or deciding to use military force to save a country. Both of those cause good and bad, depending on the situation, who's telling the story and so many unknown factors.

Yea, people need to step up to make the changes in government, and be involved in their mental health treatment. But probably more often than not people don't have the means to do that, whether it be they weren't able to get an education, or if their mental health symptoms are so severe that they can't function well, or they don't know they have options because a politician or pdoc never helped educate them....

Psychiatry boils down to cost-benefit analysis - but then so does all medicine.

I think that a huge problem with the world, always cost first. I dont think it's having cost as the first priority is such a great thing. Lots of the other methods of treatment can be little to no cost. But they often don't try those first, maybe its cost-finanial gain ( benefit ) first.

Some doctors in private practice think of the benefit to them, not to the patient. Hence more prescriptions for the latest and greatest and fewer prescriptions for Lithium than would have been ideal. Lithium barely costs anything, unless it is the ER form and even that is not too expensive compared with the latest and greatest.

Diet changes = free, exercise = free, meditation = free, mindfulness = free, perseption = free. These are somethings with huge potential for benefit, yet they are all free, and non invasive. These are just some of the things I can think of. I'm talking outside of pills, because I honestly do not think that out treatment should be pills first, and the rest later or never.

Lithium is cheap, here it is about $13 a month, where as Zyprexa is about $750, and Seroquel about $ 600, which do you think I get offered the most of out of these? You are right. But my pdoc isn't a private practice. My first pdoc who sugested other threatments , he was private. I'm not sure what that says, he had his heart in a better place I think.

Lithium is also one of the most damaging drugs to your kidney. There are also a lot of negative side effects which makes it intolerable to many.

Seroquel is cheaper now. It's released as generic.

These are the two drugs I'm prescribed. My doctor also "prescribed" exercise.

Meditation where I live costs 10 dollars a session in a yoga studio. By myself I cannot do it. $10 a session is too expensive for me. When it was $7 a session, I went, but when they raised the price, I stopped. Exercise can be free but not necessarily so - from gym memberships to biking gear to yoga studio fees, it costs money. Perception is free. Diet changes - protein is expensive, and protein-rich diet seems to be beneficial for bipolar. Carbohydrates are much cheaper than protein. Think of pasta versus cold water fish (which is supposed to be especially good for bp).

you live in Cali? No wonder Sheryl Crow sung, long time ago, about how is gonna Soak Up the Sun while it's still free.

Did they start charging for that since this was a hit?

(and most people CAN learn to medidate my themselves. Looking for good omens is also free...)

Beans, legumes, nut butter... Dont have to be pricey. Plus is you move into less meat you also cut down the not so great things that meat can also offer. Meditation is free, you can do it at home. You can exercise for free, dont need a gym pass, same as yoga. You could probably even find a free bike on freecycle.com or other places. I went gluten free, but I don't buy much of the gluten free food. It's not needed, I stick to veggies, fruit, protien, and grains that I can have.

I have 3 kids, and I live on $1,300 ( Canadian ) a month, I also live in a pricey valley, in a pricey province, cost of living is quite high here. Yet we all have bikes, we snowboard, we play tennis, skate, can go jogging and hicking, swimming, roller blading ... And eat healthy. It's doable, you just have to get creative, and find otherways to meet your needs. Thrift stores are a good place to get sporting equipement. Living a healthy lifestyle doesn't need to cost a lot of money.

Hamster have you ever looked into a food co-op? Those can be an awesome way to get fresh produce, local grown, and low cost. Some even include meat.

I get two boxes of produce twice a month for $25 a month, and they deliver it to my house. If you find a food co-op that's already established all you usually have to do is pay your cost per month and that's it. I get mostly organic produce from the local farms. They co-op pools all the money and buys direct from the local farmers, at a discount. It's good for the enviroment, the local farmers, and for you.

If you google it you should be able to find some in your area. And considering where you live, you would probably get great variety. Even here in the winter I get a good selection.

I live - I live not in the most expensive area of Cali. My yoga studio is not the most expensive one in the vicinity. I have been to much posher yoga studios. Meditation is never free - it is rather costly because it consumes one of the most valuable limited resources - your time. So it better provide very significant benefit! Nothing is free - there is an old saw from the Chicago School of Economics "There is no free lunch". Now you may not subscribe to the ideas of Chicago School of Economics but in this they are quite right - somewhere someone always bears the cost.

Take my migraines. What I currently do is drink drink drink lots of liquid all days long to keep myself REALLY hydrated. My migraines get triggered by dehydration. Drinking helps. It does not prevent all migraines but it lowers their frequency. So I come to work, have a cup of coffee and then begin my "routine" - I take two BIG mugs and make tea (to prevent boredom, I rotate through decaf black and fruit teas). Then when it is cool enough, I drink it - gulp after gulp, two big mugs. Then I IMMEDIATELY make myself two more cups. And this is like a second job for me ALL day long. And of course I have to go pee all the time. This is annoying. But it helps. I still get migraines though, just not as frequently. When I get them, it helps to catch an attack very early on and treat it with Imitrex nasal spray. Yesterday it really took the edge off the pain - really did a good job. Sometimes it doesn't though. It depends. Imitrex costs about $300 a month. Right now I get it for free from the county. I have also asked D. to bring me some from Europe because it is cheaper there by a lot. But if I do not get a permanent job and my supply of European Imitrex runs out, I would have to buy Imitrex out of pocket starting in January when I stop being eligible for free county care. And I would pay $300 because the alternative - a much cheaper Depakote that prevents most migraines - sucks because it causes weight gain and considerable tremor. So I am prepared to make and drink tea around the clock and pay for expensive Imitrex just to have a better figure and a steady hand. So what is it? It is a cost benefit analysis at work - the monetary cost of Imitrex plus the time and annoyance cost of frequent drinking and peeing are justified by the benefits - having a better figure (I have lost weight since stopping Depakote) and not having tremor. My next alternative? Topomax. Prevents migraines as effectively as Depakote but causes a weight LOSS. Luring, no? To kill two birds at once: lose weight and prevent migraines -- surely it is very attractive. But not so fast - many many people report cognitive side effects and I need instant access to my extensive vocabulary in all the languages that I speak or read. I would not be able to live with cognitive side effects. I need to be articulate etc. So the benefits of having a better figure and not having migraine attacks do NOT outweigh the potential cognitive cost of Topomax. So what will I do? I will ask my doctor for Topomax to try and see if it causes cognitive side effects. If it does, I will stop. If it does not, I will continue. Because you never know - you may luck out! I did not luck out on some drugs (Seroquel, Depakote), but I did on others (Prozac so far has been implicated only potentially and only in very slight tremor - per my daughter, "you would not notice it unless you know what you are looking for" - I can live with that, it is not like the tremor I had from Depakote; my sleep aid, Amitriptyline, first caused morning grogginess and an increase in appetite but then my body adjusted and now it causes no side effects; Lithium causes two side effects - acne and thyroid dysfunction, but both side effects are 100% remedied by additional drugs - Tazorac and Levoxyl, respectively - and these additional drugs do not cause any side effects themselves - moreover, Tazorac keeps me wrinkle-free so I am going to use Tazorac for the rest of my life even if I have to pay out of pocket for it ($300 but it lasts many months) so with Lithium everything is manageable and I have perfectly functioning kidneys (well with the amount of water I consume I better do...). Geodon is 100% effective against mania and psychosis but the cost of Geodon - unorgasmia - is not justified even by those big benefits, so I am going to discontinue it. So as you see, it is nothing but cost-benefit analysis applied to every drug or drug combo on an individual basis. Some drugs pass with flying colors while others get discontinued. The benefit of orgasms is enormous so a drug that eliminates them is not justified even it is very effective for mania and psychosis and does not cause a single side effect other than unorgasmia. Exercise (unlike benzos) takes time so there is cost, but there are so many benefits plus for me it is more effective against anxiety so I would use exercise and skip benzos. Standing rather than sitting is hard but I do it because the immediate benefits (being completely free from piercing shoulder pain) plus the LT benefits (prolonged sitting reduces our lifespan by two years) justify the work that I put into standing at my desk. Same thing: cost-benefit analysis. But nothing is free - standing may seem free but it is not - it is hard. Maybe one day it will become second nature but for now it is hard.

Another drug that I am happy with is Metformin. Not only has it probably helped me to lose weight (a bit, and I am not even sure because of the confounding factors - I also stopped taking Depakote), it has also restored my original taste; I do not know what drugs screwed up my taste at some point but I used to be unable to drink tea without sweeteners so I was consuming record amounts of carbohydrates in the form of stevia which was not good for me. On Metformin, I can drink tea just as I did in my childhood - without any sweetener. I returned unopened stevia to the grocery store. Plus, now I will for sure not get diabetes. I was already low risk because my blood sugar was borderline low, but with Metformin it is a surefire deal. And side effects? NONE. No digestive discomfort that is reported so commonly, no nothing. $20 a month (I got it from a private clinic rather than the county, hence it is not free). $20 a month is fully justified by not having to use sweeteners, being for sure free of diabetes and possibly losing weight. The benefit here clearly outweighs the cost.

I really do not know what there is MORE to medicine in the end than cost-benefit analysis.

Yeah, I was thinking more of fish and lamb chops that I like so much. But I, too, like pea or lentil soups.

With all due respect for the legumes, the strongest evidence - which is still not conclusive - for any bp-friendly dietary change is for cold water fish, isn't it?

I will look into coops, that is a good idea. I eat wheat-free unless it is at a party and low-carb (no rice, limited potatoes) but other than that I eat everything. And I enjoy both herbivorous and carnivorous eating)!

legumen are mood food. ALl I know that consuming a lot of hummus helps.

I don't do posh. I am from the Eastern Bloc... and no nouveau riche (I laugh at those. And *that* is for free). In fact posh yoga studio is a glimpse of "what is wrong with the world". Yoga and meditation is not about posh. And it shouldn't be.

And as for time? Well, you can either spend the time being miserable, or you can try to meditate. I came to point where i can meditate hanging on the pole in tram with my iriver player with some trance music on (and best place to meditate... said one of my spiritual tutors is... *tadaaaaaaaaaaaaaah* your bathroom. No fancy yoga studio. You get into alpha state when sitting on your toilet).

And as for the med paragraph... tbh, I don't see my life as cost-benefit scenario. I don't see myself as slot machine either or complicated (or not so complicated) computer program. I no longer think of "i will do this and it will lead to this". I no longer track my moods. I just go with it. Trying to live and all that.

How about LIFE?

Where healthy eating is REALLY expensive is cat food. I buy the best cat food on the market, from Amazon. The brands I buy are BFF (Best Feline Friend), Weruva, and Before Grains. Chicken, quail, tuna, tilapia, salmon, 100% animal protein as appropriate for cats. No fillers - no starches such as pasta or rice, no nothing. 100% wet food. I also give them human food: yogurt, kefir, and rotisserie chicken. Wet food is always more expensive than dry food. But it is better for the kitties. And I think that ultimately when my cats get old I will recoup some of this cost via not having to pay veterinarian bills for treatment of diseases that are caused by substandard feeding practices, such as diabetes and kidney disease. But I can tell you that buying crap is considerably cheaper than buying 100% carb-free wet food.

Well I already take fish oil, plus nuts are also a good source of omega's too. The thing with fish, is how clean is it? Oil spills, contaminated water, disease and other problems including environmental in farmed fisheries. Fish is good, just know where the fish came from. Same with beans and legumes, are they genetically modified or not, I want to know what's in my food, and that is getting more and more complicated. I eat chicken but not often, but for me I've always had a difficult time with meat, aside from seafood.

I hope you can find a good co-op because it's a really good way to cut your food costs down. Everyone could use that I am sure.

I have ordered your brand of fish oil; in capsules though. When I run out of my regular fish oil, I will start on your brand, and if I like it, I might splurge on the oil itself.

I have realized what psychiatry is about besides cost-benefit analysis; it is about trial and error. Unfortunately, no way around it. No magic balls anywhere. And ultimately you need luck with it.

it is also question of what you consider acceptable. And there is usually some social consensus (lobotomies/carpet bombing of cities acceptable) and few individuals who say "no, it's NOT". I guess I am the second group. I don't think that because things are done "so" makes them okay. And no, I am not talking of need to develop better drugs (or even better drones). I am talking about how far we are willing to go. What we think is okay. How should we treat collateral damage. How we should look at humans.

And yes, the current system sucks, no matter how many great doctors and good-hearted politicians are there... and it can be changed, just like slavery could be changed, how fascism and communism fell... or how we no longer lobotomize and lock up people. But it comes to what one is willing to tolerate. People willing to take too much crap, because it's the best there is... they broke the world, few times over.

Yes, from reading this board, a lot of things suck. Someone yesterday had not been sleeping for 67 hours, had called the p-doc 4 times and had not received a response.

bump for additional thoughts....

is there a way to trust others that they have your interests and only your interests in mind when asking for "help"? But can you do it alone?

Be it a struggling country or struggling individual.

It a way it seems you can't win, unless you learn to play a system.... but if you are struggling to the degree of asking assistance others............. are you even able to play the system?

I think that some people have the character to truly be there for others and some do not. I have two people in my life now that are trying to help me in their own ways.

One is physically, time-wise and financially there. He expresses that he will do whatever he can to remain so.

The other, whom I had a long realtionship, professes his support and is there to talk... but its the typical platitudes...."think positive, don't dwell in it... pull yourself up and get past it". He doesn't understand my illness and though I've sent and given him ways to, doesn't try to. He is not that type of person.

So I think that people, and on the larger institutions are the same way. It has to do with the character of the ones running it/them.

I personally KNOW that I can't do it alone.

is there a way to trust others that they have your interests and only your interests in mind when asking for "help"? I always trust until otherwise proven wrong but that does not mean I'm not an informed partner.

But can you do it alone? I don't feel anything can be accomplished alone. That does not mean medication. Occupational therapy, self help, psychotherapy, lifestyle changes and any other thing should be tried before medication and while being medicated.

It a way it seems you can't win, unless you learn to play a system.... but if you are struggling to the degree of asking assistance others............. are you even able to play the system? I don't feel learning to advocate is ever playing the system.

Hamster- if you get snap/food stamps/ ebt you can use them to buy fruits and vegetable seeds. There is also .25 seed packs at the dollar tree.