One of the primary conflicts we have currently across the board in the medical field, but definitely more pronounced in mental healthcare is that the people who have been trained to be in this service in many ways cannot identify with their clients. This has become the largest hindrance to the advancement of treatment. We have people at the top who have made “good choices” from “good choices” to choose from and had it work out. This has resulted in the disconnect of their understanding to anyone else. I have a relative who works in the healthcare industry. She emulates the practice what you preach of living a healthy life and showing an outward desire to help others. My recent attention on my gut health as directed by my rheumatologist led to my relative expression of empathy towards me by her sharing the lack of research given to females in the medical literature. I deal with complicated autoimmune symptoms which were made severely more difficult to manage after my COVID 19 shot back in 2021. To follow recent flare ups I reached out for some support and guidance from this relative. The delayed response to my at that point critically presenting situation showed how significantly different our worlds are, in both our distinctly varied day-to-day realities but also our prioritization of others needs compared with our own. After pushing for assistance what I heard back was, “Sorry, I don’t know much about helping people who are sick. I know about how to be healthy and give advice to stay healthy but once it is to this point, I am not sure.” We are only able to conceive the world as we have experienced and been exposed to it. The higher educated is at a place where what they are largely in need of is humility.
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As an individual I have seen this conflict most frequently in the medical world through the tests ordered by primary care physicians. This is difficult to navigate on multiple levels. What I am about to describe is more unique to those who are not in the Medicaid class, nor the professional working class of the physician colleague. This is a plague that mostly impacts those in the middle class, particularly the lower middle class. This element is one I have identified as pitting those in the lower working class against those in the welfare class. It should be considered for small business owners and those whose best option for insurance is a high deductible plan. It is related to the position liability has put doctors in when it comes to their ability to discern their objective medical opinion. It is when you present with a symptom and they order follow up tests and specialty referrals at times without giving consideration to the financial component and how it may affect you. This was notable at one point during pandemic and my spouse was having some chest pains that were concerning him. This doctor ordered three tests that ended up totaling thousands of dollars that this paycheck-to-paycheck family just didn’t have. There were at least two of the tests that, had I been allowed to attend the original appointment, I would not have approved of due to my general medical knowledge combined with my observation of his symptoms and knowing WE JUST CAN’T AFFORD THAT. But doctors and advanced licensed providers don’t get it. The joke I always make about the big whigs versus the rest of us is, “I bet they’ve got their bills on autopay without thinking twice about it”. And let’s be honest, it’s the truth.
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I remember one LMHC I worked with who was incredibly judgmental. Often and openly, she voiced her discontent with the field she has chosen. Repeatedly I heard her reference how she should have been a pediatrician – though I don’t think her demeanor would have flown in peds. One time she referenced how unfathomable it was that the majority of Americans would have trouble being able to cover a sudden five-thousand-dollar expense. I asked if she knew that 9 out of 10 American families live paycheck-to-paycheck, and the concept didn’t seem to fully register. As with so many that dislike working with people in this field do – she volunteered to be in a leadership role. Another voluntary leader and licensed clinical provider once pulled me aside after she had a “traumatic event”. She shared with me how there had been freezing rain after leaving a late shift for home. Her brakes had locked up and she slid down a country road hill with her husband safely to her rescue within thirty minutes time. She went on to share that now anytime there was freezing rain, she feels a physical trauma response. She had been a licensed clinical provider for more than twenty years and admitted to being paid to counsel people that she did not believe when they told her they had physical trauma responses. I should win an award for not blowing my lid and losing it on her right there in that room. One time my car needed a repair that I couldn’t afford and that same provider shared how when that happens to she and her husband they just put it on the credit card – as though she couldn’t understand a life where one’s credit cards were already maxed out.
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Leadership and other providers in mental health are consistently filled with neurotypicals and those in a higher economic status. If they are someone who has had exposure to mental health treatment it was adequate care – which is far from standard. These people, albeit often well intentioned, aren’t most suitable for guiding and providing treatment to the vulnerable population of the most neurodivergent. In 2019, I finally received the paired entry diagnosis of ADHD Anxiety. This was Sixteen years after my first misdiagnosis by a psychiatrist. The therapist that diagnosed me was someone who struggled with ADHD herself. She sent me home with research articles as the most readily identifiable and consistent trait in my life is my love of learning. This allowed some normality to what I’d gone through. The article revealed that adults who receive an ADHD diagnosis have statistically seen and been given inaccurate diagnosis by 3 providers. My experiences definitely skewed this number in an upward manner, but still – I was not alone. Perhaps the most vital takeaway that could ever come for mental healthcare from a preventative lens is the aspect of understanding and companionship.
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It’s time for the professional community to humble themselves to all that they don’t know. They preach “the science” as though there is any historical record that really indicates we are doing anything correctly or that change is not the one constant. We’ve invented these “norms” that perhaps aren’t as normative across the general public as we’d like to think. As a fourth-generation higher educated individual, I have to point out that the current state of the United States education system is the highest form of colonialism that there has ever been. Every BS position I worked was trainable with a high school equivalence combined with two years of life experience. I used to say that I never minded being overqualified for a position and at first and while on nightshift, I meant it. I loved my patient facing position. One of my specialties is to work with those in high levels of mental distress. This is likely due to my genuine interest in how the person came to experience the symptoms in combination with having had many of them myself at some point. The primary motivator for me to go get my MSW was just how arrogant and condescending individuals with letters are towards the knowledge of those without the same. It is nauseating. Then you add the fact that there is not room for economic advancement with only a BS. Even before I went for my graduate degree those who knew me well would say I knew more than at least half the therapists I worked with, and still, it didn’t matter without a degree to back it up. My continued disgust by those who were most unknowing to the client’s life caused me to pursue a means to make real system changes. What we are dealing with in mass proportion is the repercussion of the attempt to standardize individualized human processes. I want to be clear that I am not devaluing decades of research or that we may not take away brilliance from all that we have learned. I am completely calling to question our practical application of research and how disastrous it has been.
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