Health Problems

TheNozz said:

oh that's right, here's a protip:

If you ever go to an ER, when they ask you if you have had suicidal thoughts, unless you're there for that reason, tell them "no." I made the mistake of telling them I was severely depressed and had thought about it a few weeks ago.

If all ERs are the same, they will treat you more like a prisoner than a patient. I had to have a 24 hour attendant until this morning. Everything in your room will be tied down. You will not have any privacy, even have to leave bathroom door open.

If you are at an ER because you think you will hurt yourself or are there because you did severely injure yourself in self harm or suicide attempt, then for the love of god TELL THEM THE TRUTH.

Click to expand...

Yeah I made this mistake once. Made me want to die even more. Psych wards are awful places.

TL;DR: medical confidentiality does not apply to suicidal ideation or plausible/credible homicidal threats (it's a different thing if you have an 87 year old LOL with late-stage dementia with behavioral disturbance saying she's going to crucify Abraham Lincoln.)

EDIT: Well, it applies in the sense that we don't blab it to the general public, but we do have a duty to disclose them to the proper authorities.

pharmakos said:

Psych wards are awful places.

Click to expand...

I'm generally skeptical about increasing social net funding, but more definitely needs to be done vis a vis the mental health system. I did my psych rotation in one of the most respected academic medical centers in Chicago. Even there, their psych ward was straight out of One Flew Over the Cuckoo's Nest. Bulletproof glass, pea-green fluorescent lighting, and furniture from the 1950s. You could imagine Nurse Ratched walking around the corner with that scowl on her face.

They are always talking about therapeutic milieu and the importance of environment in psych. How is anyone supposed to feel safe or be able to rehabilitate in a dingy environment like that?

iannis said:

I think everyone has occasional suicidal thoughts. Not all of them are born out of depression or despair. People just have a lot of vagrant thoughts, and if we're being honest "what if i just rammed into that tree with my car" is occasionally one of them. Bill Burr even has a joke about exactly that, and he gets a big laugh. Because -- yeah, everyone has those thoughts. I don't believe that is abnormal in the least. Consideration of our own death has a positive impact.

What is slightly abnormal is admitting to it. There is a stigma against expressing these thoughts directly which I believe stems from their prevalence. We don't want to reinforce that in each other so we stigmatize it. As adults. We learn in adolescence why we do that.

The distinction is that when you're to the point where you are willing to express them directly as an adult that's an indication that these perfectly normal thoughts are starting to become abnormal in either frequency or severity. Asking a man who's scared for his own health that question is a little unfair maybe... he's about as vulnerable and afraid as he's going to get, and you're going to find more frank honesty there than if you'd met him otherwise. But by that same token it's just about the best time you can ever ask him if you want a straight answer.

But yes, the treatment just can't be throwing you to nurse ratchet. That just can't help.

Click to expand...

People admitting to passive occasional thoughts of suicide is a difficult issue for me; I agree that perfectly sane people do have those thoughts infrequently, but ethically/professionally, I'm still bound to report. I think this is where the whole definition of "abnormal" comes into play. It's possible for people to think abnormally (defined here as "unconventional" or "different than the majority of society") without their thinking necessarily being pathological. I feel like Western society needs to get more comfortable with discussing death in general. It's never pleasant, but perhaps if we were, we wouldn't be quite so alarmed if someone admitted to wondering what it was like if they didn't exist. Gary Greenberg goes into this a bit in Manufacturing Depression, that feeling pissed off or hopeless about our station is fundamental to the human condition, that our society tries to hard to banish these feelings, and doing so really isn't productive.

Semi-tangent:
The tragedy is that ultimately many/most of the psych disorders are fixable or at least manageable with good social support, but most people with said disorders lack said support system. Child psych is super depressing, because the kids (again, generally) start snapping out pretty fast once they're removed from their shitty home environments. And then they're immediately plopped back into it once they show signs of improvement. One of those cycles you hate seeing.

Same thing applies to garden-variety anxiety/stress; remove the stimulus, and things often improve. I was in hell when I was working home health, and just getting out of that environment was enough to make me feel significantly better about life in general. But we trap ourselves in these self-sustaining process loops that prevent us from effecting any real change on our situations.