Before You Close the Gates

[mallorys_camera]

I love this photograph beyond words for reasons I can’t even begin to describe…

It’s a French factory. Building began in 1891. Builder was Louis Marie Hilaire de Chardonne who invented the first artificial silk. Unfortunately, his silk didn’t catch on. The stuff that did was called rayon.
Oxymandias for the 21st century. If only I was Shelley…

###

I saw a therapist yesterday. I picked him at random out of a phonebook because he was both a social worker and a psychotherapist. His office was incredibly sparse and untidy with big clear garbage bags of used Gimme Coffee cups strewn about. He’s a rather big, hulking guy who may have had a speech impediment at one point in his life. In fact, he kind of reminded me of the villain of Thomas Harris’s Red Dragon if Francis Dolarhyde had been a good guy. No matter. One enters into these situations with a certain fatalism, accepting the luck of the draw: Here’s where the conveyor belt has taken me.

I have Medicaid, of course, and no I’m not ashamed of that: When I was making $150,000 a year, I paid into the tax system. Time to get some back! But I use the Medicaid for RTT MD calls basically. I never see a doctor myself. And I didn’t want to use it for psychotherapy, figuring we don’t actually value that which we don’t actually pay for. Yes, my taxes paid for it way back when but I no longer have a visceral connection to that. If I used Medicaid for psychotherapy, it would seem like I was getting it for free.
So I negotiated a payment rate: Twelve sessions at $20 a pop. The goal is to get an actual job in that time that would not involve standing behind the counter of a Quiki Mart checking underage ID at 4 in the morning. Then we renegotiate the payment.

“How dysfunctional do I seem to you anyway?” I asked. A reality check.

“You don’t,” he said.

“So I’m still maintaining?”

He nodded slowly. “Pretty much. Although obviously, you’re deeply depressed.”

Didn’t feel any kind of emotional connection but that’s okay: He’s a mirror and a tool.

Around 9pm, B called ostensibly to talk about RTT although he could have done that through text. Something he said set me off towards the end of the call so I hung up on him, after telling him, “By the way, have I told you to go fuck yourself recently? Then I’ve been remiss. Go fuck yourself. Fuck you. Fuck that cunt Jayne LeGro that you used my fucking car to go fuck that spring while you were padding your escape route.”

He immediately called back and left a message about how he and I and Robin should all go together to the Trumansburg Fair this weekend and then he just kept texting me till midnight which was just plain weird.

Comments

[jdquintette.livejournal.com]

And I didn’t want to use it for psychotherapy, figuring we don’t actually value that which we don’t actually pay for.

I can assure you that I valued the hell out of the 13 years of psychotherapy I got in Canada "for free." It's the reason I'm only half crazy today.:-P

I've never gotten that, "we don't value that which we get for free" bit. Does that mean my wife doesn't value her birthday present, or if I gave you a gold bar you'd absentmindedly leave it in a taxi? I was hanging with some native indians up in Canada recently, and they don't get this kind of stuff at all, and I kind of agree with them. The greatest stuff in life, in fact, life itself, is "free," but it's still the greatest gift at all. If you can't accept "free" stuff with the grace it's given, that's kind of sad.

[mallorys-camera.livejournal.com]

Feel free to buy me presents any time you want, John! I will value them, I assure you. In fact, your friendship is a gift with no strings attached and I value it highly.

Psychotherapy is not a gift.

And I'm an economist by training.

[jdquintette.livejournal.com]

Well,with all due respect, I've heard some pretty cockamamie stuff come out of the mouths of economists, most lately Allan Greenspan.

Some other joker was going on during the HCR debate about 'free' healthcare being like free beer, that people would overuse the system and drive costs up. This was an online argument I was participating in, and he seemed completely unconvinced when I pointed out that (A) people tend to be less enthusiastic about free colonoscopies than they are about free beer and (b) countries that have universally available healthcare all spend less per patient (sometimes a lot less per patient) than we do. But that's all "logic" and shit, and he didn't want to chit chat.:-P

I'd suggest that the decision of how much value your psychotherapy has is entirely up to you, not some abstract economic model. You'll get as much out of it as you decide to.

And your gold brick is in the mail. Greenspan is going to the Post Office for me.:-P

[mallorys-camera.livejournal.com]

Well, the majority of healthcare is not colonoscopies; it's people going to doctors for every minor ache, pain and sniffle. Physicians end up spending a lot of time on the administrative details of such visits and are therefore less available to provide care for people who actually need it. Co-pays make these people think twice. I think co-pays are good.

It's been years since I studied the healthcare system in any country but my own, so I can't debate you there.

Disagree with you totally about the value of psychotherapy on "other people's money" (OPM!) I'm not sure that anyone perceives any value in psychotherapy anyway: It's just talking for God's sake. I can talk to you! But presumably with a competent psychotherapist, it is something more than just talking. Anyway, I wouldn't have much choice over who Medicaid decided to give me as a psychotherapist, and I wanted choice here -- so possibly this is is a moot point.

A gold brick? I was hoping for sex toys!

Allan Greenspan is a disciple of Ayn Rand, not an economist.

[jdquintette.livejournal.com]

It's been years since I studied the healthcare system in any country but my own, so I can't debate you there.

You might want to look into that sometime. There simply is no emperical evidence supporting the "people will overuse and bankrupt the system" trope in nations with free-at-point-of-delivery care. The reasons for this are doubtless complex, and I'm not saying no one EVER does it, but the numbers are there. I don't know about you, but I've oten foregone what I perceived to be needed medical care because I couldn't afford the expense (co-pays and deductables) in this country. But there are other elements in play. My doctor recommended a colonoscopy for me several years ago, but I took a pass, because it would have been prohibitively expensive, even WITH insurance. Ironically, if I'd just forgone about three months worth of "insurance" premiums, I could have paid out of pocket, but we all know what happens to people with"pre-existing conditions" in this country when they drop their coverage.;-P The thing is, just between you and me, I wasn't completely unhappy to have a financial excuse to avoid the procedure.;)

Co-pays make these people think twice. I think co-pays are good.

When I had a urothroscopy done in Canada about 25 years ago (urothroscopy! More fun than free beer!) the system was undergoing a brief flirtation with what they called "user fees" up there, and I had to bring 25 bucks to the hospital the day of the surgery. The supreme court ultimately ordered the provinces to stop doing this (health care is managed at the provincial level,but the feds enforce countrywide standards of care) because it was a regressive fee that impacted the poor to a greater degree. But it was also seen as a cost-saving measure, because people who put off things like checkups and minor complaints often cost the system more in the long run due to these turning into major illnesses than if they'd had those "aches and pains" looked into in the first place. Again, I'm not saying Canada doesn't have it's share of hypochondriacs, but that was the number crunchers ultimate conclusion. This was long before "freakonomics" mind you. I always find it interesting to see the unintended consequences of many of the "common sense" arguments for continuing certain monetary policies within American health care. In many cases they turn out to be less a matter of financial prudence than a way of punishing poor people, and that deep, irrational hatred of the poor has always seemed to me to be a defining characteristic of American Exceptionalism.

[jdquintette.livejournal.com]

Disagree with you totally about the value of psychotherapy on "other people's money

But how you define "other people's money" is entirely your choice. I read somewhere recently that about half of Tea Party members receive some form of government funded assistance, be it medicare, medicaid, social security, farm subsidies or whatever. When questioned about this, they insisted they had earned these benefits through hard work, whereas others were just sliding by. When you had health insurance, did you feel others were paying for your care then? Because that's how insurance works. This stuff is all perception, not fact. My father's friend Alex Comfort had a doctorate from Oxford which he received absolutely free, since British universities did not charge tuition prior to 1997. I can assure you neither he nor anyone else thought it was worthless.

Anyway, I wouldn't have much choice over who Medicaid decided to give me as a psychotherapist, and I wanted choice here -- so

I always found the whole 'choice' meme in American health care kind of laughable, really. Choice is always restricted, everywhere, for everyone but the super rich. In Canada, I could choose any doctor I wanted, but of course the very best ones were always harder to get in to see. In America, supposedly the land of choice, I have to choose from a list of quacks on my insurance companies "in network" list. Or, now that I'm a medicaid patient like you, just accept what I'm offered. All politics aside, I prefer Canada. At least my choice was determined by supply and demand, not insurance company bureaucracy.

[jdquintette.livejournal.com]

Allan Greenspan is a disciple of Ayn Rand, not an economist.

Totally agree, but he was thought to sit on the right hand of god when he was chairman of the fed, and still trots out regularly on the talk shows to opine on matters financial, most recently during the debt ceiling debacle. I keep waiting for him to be met with gales of derisive laughter when he shows up on these things, but apparently there is absolutely nothing you can do to lose credibility in this country if you are old, white, and far to the right.

[auntysocial.livejournal.com]

"we don’t actually value that which we don’t actually pay for."

I remember an actual therapist telling me something like that. I didn't think it was true at all. I thought the therapist I paid with cash just treated me better than the therapists I saw at government expense.

[jdquintette.livejournal.com]

In Canada psychotherapists are in the medical care system, so they are "free,' as are all other medical procedures performed by MDs. Counselling psychologists, on the other hand, must be paid privately, since they're not MDs. I was never able to test the difference, since I liked my shrink and had no desire to look elsewhere.

I've certainly noticed that the perception in America is that the "government" stuff is shabbier and I guess as a newly unemployed/uninsured person I'm going to find out fairly soon if that's true. But in Canada, for 30 years, I received excellent care in a timely manner for whatever ailed me and it was absolutely free at point of delivery, and no my taxes weren't any higher (not running multiple foreign wars can save you big money). And I absolutely did value the care I got.

[auntysocial.livejournal.com]

Right-wing propagandists have been promoting the theory that government is evil for a long time, here. I personally don't believe it.

[mallorys-camera.livejournal.com]

I'm not sure I would describe myself as either a right-wing or left-wing propagandist -- although it generally surprises people to find out I'm somewhat conservative on fiscal matters.

I'm of the opinion that the only meaningful government is local government -- which means I'm not a fan of the federal government because I think, thanks to ineptly administered health care programs (Medicaid, Medicare) it is waaaaay too big.

Breaths oxygen? Check. Has opposable thumbs? I suppose. What else do I have in common with 306, 900,000 of those 370 million Americans I share a national identity with? Not a whole lot.

I have a lot in common with the people I live near or have lived near, however.

I would probably be in favor of a community-administered health program but I'm not smart enough to come up with a payment mechanism.

[auntysocial.livejournal.com]

I don't think of you as being on the right or the left, either.

[mallorys-camera.livejournal.com]

But why did he or she treat you better?

[auntysocial.livejournal.com]

That's a good question! There are too many variables to come to much of a conclusion, but I have theories.

My experience with psychotherapy spans decades. The first was when I was a depressed 17-year-old. Paid for by my parents insurance. Nothing from me, not even a deduction from my allowance. It helped, but only because the therapist convinced my parents to stop picking on me so much. It didn't turn me into the person I wanted to be. Ten years later, another therapist, on a government program. Most people on this program were treated by interns, but for some reason, I got their teacher. There was a certain lack of communication. Too much of a generation gap, perhaps. I wonder if she would have perceived me differently if I had been paying for the therapy. Fifteen years after that, another therapist. I had some money, my husband had an income, so I paid cash. It was a much better experience. I actually felt understood! There was a sliding fee scale. When my husband's income increased, I offered to pay a little more. When my husband's income decreased, I wanted to pay a little less. That's when she said the patients value therapy more when they are paying for it. I switched to seeing her every other week, and eventually stopped. Even now, some twenty years later, I don't know what I think of therapy in general, or my experience in specific. I take an anti-depressant, and it really helps. It seems to help more than the psychotherapy ever did, but I don't know what it would have done by itself, without the psychotherapy.

I'm surprised your therapist is willing to see you at such a low rate. In the 1980's, the bottom of the sliding scale was $55. I have no idea what the standard price for a 50 minute hour is today in this neighborhood.

[mallorys-camera.livejournal.com]

I'm surprised your therapist is willing to see you at such a low rate

I negotiated. Pitched myself as some who would pay more once she found a job! :-)

'Course at my age and in this economy, I'm, not sure that's possible.

[auntysocial.livejournal.com]

Of course, your therapist is suffering from the depressed economy too.

[auntysocial.livejournal.com]

Well, I wrote a lot about my experience, but not about my theories. One of them is that therapists have some degree of class prejudice and don't respect their poorer clients as much. Even when prejudice is not involved, the middle-class therapist may not understand the realities of poverty. I think the theory is that the client is making a financial sacrifice in order to bask in the presence of the therapist for the better part of an hour, and will make better use of the time. The trouble with this is that the $15 co-payment made by the recipient of managed care may be more of a sacrifice than the $150 made by the private patient. It may be none of the above. Maybe the therapist is just tired of the paper work involved with government paid programs.

[mallorys-camera.livejournal.com]

The trouble with this is that the $15 co-payment made by the recipient of managed care may be more of a sacrifice than the $150 made by the private patient.

I totally agree with that.

Alas, in life as in poker, people keep score with money.

[bel-ebat.livejournal.com]

i am happy you are trying this guy out.

Didn’t feel any kind of emotional connection but that’s okay: He’s a mirror and a tool.

yes. though i always find it hard to KEEP going unless the emotional connection develops—even if the emotional connection that develops is still all about one, anyway.

[mallorys-camera.livejournal.com]

Aw, good to see you! I think about you and hope you're thriving. Do you know about this?

http://www.esquire.com/promotions/contestandsweeps/fiction-contest?src=rss

[bel-ebat.livejournal.com]

aw, i think about you, too! :)

i am doing pretty well! i just started my fall semester and am continuing research in an independent study class for the paper i wrote for my media law seminar last spring—a paper you originally inspired, actually, when you posted that link in your FB about the start of ad-endorsements by fb users!

i had to come up with a title for this self study for my transcript yesterday and called it "media law and the normalization of personality rights", which i figure is just indulgent-enough sounding. it is all about people who are famous for being famous, instant (particularly internet and reality) celebrity and self-styled pr and whether it will expand to the point of meaning anything legally. right up our alleys, right?

and thank you so much for linking me to that esquire competition!! i hadn't heard about it, and it will be easy for me to enter. do you think you will enter it as well?

[mallorys-camera.livejournal.com]

do you think you will enter it as well?

78 words? Sure! Why not? Even if it takes me a whole hour to choose them! :-)

I'm very pleased and flattered to have inspired this fascinating independent study in some small respect. Jackie O, too, is smiling in heaven!

[millysdaughter.livejournal.com]

Here, Medicaid has a co-pay, so it is not totally free.

[mallorys-camera.livejournal.com]

That's a good system. I think co-pays are a good thing.

[anais-pf.livejournal.com]

I don't know what will get you out of your depression, so I'm glad you are getting some help. I think it's probably not necessary for you to connect with the therapist emotionally, so long as you respect him and think he knows his stuff. Good luck.

Ben IS just plain weird. I suppose he's ignoring your "outburst" hoping it will just go away. Ugh.

[mallorys-camera.livejournal.com]

Yep, ignoring the outburst. We have this odd dual mode of interaction because we have remained good friends and I'm not in love with him anymore. As I've complained ad nauseam, I just think the situation is unfair. And because the GF is so fucking weird, the friendship is marginalized.