How Managed Care Is Changing Mental Health

Gin Lane Hogarth

Those with an interest in the history of American medicine will recall how the delivery infrastructure has evolved through the years, from careless care to poorly managed care to mismanaged care to the paradigm currently in vogue, managed care.

Seems simple enough, and yet, there are as many definitions for managed care as there are for quincunx, so let’s cut through the clutter and have a look at what it actually means, especially in a mental illness/mental health context.

Historically, care could only be denied on a case-by-case basis, which was very time consuming for care providers. Insurance companies struggled with tremendous overhead because it was necessary for them to maintain large departments staffed by professionals skilled at denying claims one at a time.

Then, in the 1980’s, computer technology changed all that when the first integrated health networks were formed. These sophisticated health delivery systems linked hospitals, physician practices, labs, rehab facilities and other participants with insurance providers creating a vertically integrated continuum of care! For the first time, all members of the healthcare delivery infrastructure were able to communicate on-line real-time, sharing vital patient information and updating the data pool on an ongoing basis.

Suddenly the healthcare denial process was brought into the digital age, and with it, a whole new level of care inaccessibility. For the first time in many years, health insurance companies were able to offer a truly inspiring panoply of mental health care options since they could be certain there was no chance they would be delivering them.

Muckrakers, malcontents, and professional whiners complained about this, calling managed care a “devious, disingenuous, deleterious, dastardly dupe designed to fatten the pockets of capitalist bloodsuckers by draining the life from unsuspecting hod carriers.” Managed Care industry spokesman Reginald Entwhistle responded thusly.

“The human body is an astonishing mechanism. Chief among its virtues is the ability to heal itself. Indeed, as that government which governs least governs best, so that healthcare delivery system that heals least heals best. Now, specifically how does this work? Let’s start with a real life example.

“You are overcome with an attack of Munchausen By Proxy. Panic stricken you hop a cab to Holy Guacamole Hospital where you are denied admission because, thanks to access to your Online Medical Record, it is revealed that your plan, Criss-Cross of America, only covers regular Munchausen’s – without Proxy.

“They refer you to Whassamatta U., (a teaching hospital), which sometimes takes on psychiatric cases pro bono as long as patients don’t mind participating in studies.

“On the long cab ride across town you have plenty of time for your body’s natural healing process to take place and you arrive at Whassamatta U fit as a fiddle, sound as a dollar, strong as an ox, and healthy as a horse. With luck, your insurance company picks up 85% of the cab ride, after you have met your deductible.

“Elegant in its simplicity and made possible by the magic of computers!”

Our Preeminent Mental Illness Humor Blogger

Alistair Scooter Hat

When you get to be my age you start asking yourself questions like, “What time is it?” and “What am I doing in Tijuana?” and “What is Martinizing and why does it only take one hour?”

If you are about to celebrate a birthday, (if celebrate is the right word), you may be tempted to gaze across the seemingly endless succession of impulsive decisions, high-speed car chases down cul-de-sacs, and manic spending sprees littering the ravages of what you generously describe as “your life” and wonder how you managed to squander the cornucopia of opportunities strewn at your feet as a child.

Or not. With a birthday looming large there is no time for such whackadoomiousness because I stand before you now, (imagine I’m standing), a man who has reached the pinnacle of his profession, the Everest he set out to conquer decades ago. That’s right, I am the Preeminent Mental Illness Humor Blogger in The United States!

Do not think I reached the pinnacle of my profession through some quirk of fate, some whim of circumstance, some chance twist of unpredictability, some like it hot, oh no, anything but. My ascent to this lofty height came about through the execution of a carefully constructed plan well in place before I received my first pair of full-length trousers.

Without any further adon’t, here it is: First I learned to write. Then I developed a sense of humor. I did this by carefully studying the creative output of Garrison Keillor, Sacha Baron Cohen, Andrew Dice Clay, and Gallagher to make absolutely certain my work never resembled theirs.

Then came the exciting part – choosing my mental illness. The selection was vast, almost dizzying. I wanted an illness I could take with me on trips, couldn’t be bothered with a lot of heavy equipment. Affordability was also a factor; some mental illnesses are prohibitively expensive! I was also looking for a mental illness with a little style, flare, panache, je ne sais quoi – whatever that is.

At last I settled on bipolar disorder, which came with a very impressive pedigree including many of my favorite writers, painters, and composers. The rest, as we say, is show business history.

So remember, most people don’t plan to fail, they plan to plan, and fail to do so long before they ever get around to it.

5 Ways Internet Use Causes Mental Illness

crazy drawing icon

The Internet is a repository for mental illnesses of every description, but did you know that the Internet is also one of the leading causes of mental illness? That’s the conclusion of researchers at The Institute for Advanced Study of Studied Institutionalization (IASSI).

At a recent press briefing, IASSI spokesman Reginald Frampton elaborated.

“Mentally Ill People, referred to as MIPs in our document, are particularly susceptible to the sustained level of psychosis that characterizes Internet traffic.

“MIPs are already having difficulty sorting out what’s real from what’s not, and extended immersion in the stew of dementia found in Facebook and other so called ‘social networking’ sites – which we at the institute call ‘nutworking’ sites – exacerbates an already worrisome situation.

“Unlike most think tank studies, which are roughly as deep as a Frisbee or the typical TED Talk, we have provided 5 action steps which, if aggressively implemented, will make the Internet safer for MIPs, and a whole lot less tiresome and irritating for non-MIPs. Here they are.

No more photographs of bacon. Everybody likes bacon; bacon does not need advocacy. The obsession with bacon is wreaking havoc among MIPs with eating disorders.

The word ‘awesome’ must be eliminated, that’s right, eliminated, except in cases where others are being told that the word ‘awesome’ must be eliminated, such as this one.

Clowns and mimes are universally loathed and feared, but nothing arouses existential dread quite like a talking baby. MIPs are okay with the occasional magician or ventriloquist; but the world of big pharma simply isn’t big enough to handle what happens when a MIP sees an infant cracking wise in a Brooklyn accent better suited to a 45-year old, beer swilling stevedore.

Magical thinking – ‘Click Here to End World Hunger’ – posts. These posts, which collect signatures for morally attractive liberal causes in hopes of influencing the powers that be so as to ultimately alter social policy for the better, thereby making the world a cheerier place inhabited by unicorns crooning Frank Sinatra tunes – never work. We know this, but MIPs do not. They click ‘Like’ for hours and, when nothing happens, become ever more despondent.

GIFs of people shooting themselves in the foot, walking into moving cars, or exploding. MIPs are no more appalled by lowbrow violence than the average citizen, however, the problem is that these twisted mini-movies repeat endlessly, thereby locking MIP viewers into a kind of video prison. Many a MIP suffering from OCD (Obsessive Compulsive Disorder) has been rendered catatonic by the incessant, repetitive cruelty that only GIFs deliver.”

At that point, Mr. Frampton reached for his smart phone and concluded the conference.

Scientists Believe Neanderthals First To Be Depressed

Neanderthal

We have known for some time about genetic predisposition to various forms of mental illness, snarkinuss eruptus and clinical depression to name only two. But if an illness is to be passed down from one generation to the next, it must have a point of origin. Now, researchers at the Department of Anthropological Psychology at the University of Basingstoke-on-Trent think they have discovered the answer.

Professor Chumley Meriwether Throckmorton announced that a recently completed in-depth study demonstrates conclusively that Neanderthals were the first humans to experience what is now referred to as clinical depression.

Professor Throckmorton elaborated at a recent press conference. “Neanderthals looked upon the world very differently than modern man. For them the world was vast and unknowable, an endless expanse of hostility and weirdness. Animals, inclement weather, and a noticeable lack of indoor plumbing loomed malevolently, providing an ongoing cavalcade of hazards.

“Unlike today’s human, who feels bolstered by an unwarranted illusion of mastery over the elements, supported as he is by a cornucopia of technological gizmos resting like arrows in his quiver, which, he trusts, with endearing naiveté, are at the ready to defend him from whatever the universe may fling in his path; the poor Neanderthal had little, if anything, at his disposal. Animal pelts for clothing, sticks and stones for defense, and for comfort, well, only the sweet oblivion granted to the truly clueless.

“But if the Neanderthal knew of no other reality couldn’t we assume he was happy in his lot, no matter how modest his circumstances? Yes we could, but we would be wrong. While certainly this state of blissful ignorance characterized the earliest part of Neanderthal man’s suzerainty of the earth, knowledge, like the proverbial garden apple, crept into his consciousness on velvet slippers, had velvet existed at the time, which it did not.

“It became obvious to Neanderthal man from gazing at his reflection in ponds and other glossy surfaces that he was, bluntly, unattractive. Thusly did low self-esteem enter our collective unconscious, setting the stage for poor self-image in millennia to come.

The prospect of a rapidly approaching Ice Age, if an Ice Age can be said to approach rapidly, played negatively on Neanderthal man’s view of the world and contributed to his feeling that it was inhospitable and beyond defeat. Worst of all perhaps were the occasional skirmishes with homo sapiens who, combining cunning, cruelty, and superior tool-making skills, crushed Neanderthals with relentless consistency.

“This overriding anticipation of inevitable doom settled into a dense crust of depression, gradually overtaking Neanderthals.

“Once depression had burrowed into the marrow and encoded in Neanderthal DNA, the die was cast. Next came dating, or intermingling, if you prefer, with homo sapiens, which transmitted the DNA through generations all the way to you, me, and the rest of humanity.”

Passive/Aggressive Olympics

You Will Never Never Make Me Happy

Passive/Aggressive Behavior ( PAB ) plays an integral role in various kinds of mental illness. Historically referred to as Obnoxious Behavior ( OB ) or just plain Irritating Behavior ( IB ), Passive/Aggressive Behavior has been identified as both symptom and cause of a dizzying assortment of psychological maladies including, but not limited to, paranoia, paranormia, pareschewed, and Chumley Standpipe Syndrome ( CSS ).

Early psychiatrists, realizing PAB to be a very sneaky and elusive foe, adapted an innovative approach to treatment. They reasoned that, rather than causing patients to feel guilt about passive aggressive behavior, long-term recovery goals would be much better served by luring PAB out of its lair with promises of rewards, praise, and lucrative commercial endorsements. Far easier to treat a condition after it’s ventured into the open, they reasoned.

Dr. Zick Meind Phrawed stunned Zurich’s psychiatric community with the publication of his breakthrough paper, “So What If You Don’t Like My Paper? I Don’t Even Care!” In it, he argued passionately for a venue where passive/aggressive individuals (PAI) could proudly showcase their skills in a competitive context.

Dr. Phrawed managed to have his idea reviewed, and ultimately approved, by The International Council Of Psychologically Based Sporting Events (TICOPBSE). The first officially sanctioned games, held in Zurich, either were or weren’t a great success depending upon whom you ask and when you ask them.

Popular Events At The Passive/Aggressive Olympics

1. The exasperated sigh.

Extra points awarded when combined with eye roll and impatient foot tap. (World-class practitioners of this subtle skill have been known to train in high altitudes to build up lung power in oxygen-deprived environments.)

2. Conversation Hijack

Points are awarded for speed, abruptness, and implausibility of transitions. Once the conversation has been successfully hijacked, additional points are awarded for duration of control.

3. Pin The Blame On The Flunky

Blame may be shifted to an opponent, teammate, or referee. Points are awarded for shamelessness, smarm, and chutzpah.

4. Excuse Me!

The goal of this event is to provide excuses for failures that make the opponent appear to be responsible for the competitor’s fault. Extra points are scored if the opponent himself is actually convinced.

5. Going My Way?

This event seeks to discover just far out of the way an opponent can be gradually nudged into going. Extra points awarded if the opponent is manipulated so far out of his comfort zone he cannot find his way home.

Don’t miss a minute of this year’s Passive/Aggressive Olympics! Or do.

Wing Nut or Phony?

Mannequin Chair Sidewalk

In a culture as deeply superficial as ours it is often difficult to tell the authentic from the false.

It is easy to sympathize with the phonies, poseurs, affected wannabe’s and disingenuous empty vessels passing off pilfered ideas as original, skating past any serious analysis or criticism by others as an ant might slide across a non-stick sauce pan slathered with extra virgin olive oil.

Their dilemma is not unfamiliar. How does one stand out in an atmosphere of mass homogenization where, thanks to the constant recycling of mediocre ideas discarded by others, we are reduced to virtual clones, unable to generate anything original or even recognize originality in others?

With apps ever ready to do the work and thinking for us, today’s Johnny & Jane Lunchbucket simply don’t have the energy or ability to develop attributes sufficient to earn the name “personality”. So what’s a faker to do?

Simple – steal one! This is not as odd as it sounds, indeed, throughout history residents of society’s inner circle – where tedium is sought out and bland banality honored as a virtue – have looked beyond the castle walls for character, creativity, flair, vision and style. Shamelessly pillaging the campsites of society’s least loved minority groups they returned home with loot enough to pretend they were interesting.

And thus, gentle reader, do we arrive at the crux of this tale. You see, crazy is the new cool – and so – these days there are a lot of creeps passing themselves off as wing nuts when in fact they’re square bears in chicken outfits. This leaves the average citizen with the challenge of separating the honest to goodness wing nuts from the phonies.

Keep an ear out for these phrases; they will help you differentiate.

“I’m crazy, man, I’m dangerous, man. I could snap just like that.” Phony

“I am perfectly sane, no need to worry about me!” The Real Thing

“When I walk down the street, children run and hide.” Phony

“I stepped onto a Moebius strip to get to the same side.” The Real Thing

“My thoughts are too advanced for society.” Phony

“Wearing my underwear outside my clothes makes laundry day easier.” The Real Thing

“I hear voices and they all sound like Oprah Winfrey.” Phony

“I hear voices arguing with each other and ignoring me altogether.” The Real Thing

“I drink to forget something I’ve forgotten because I’ve been drinking.” Phony

“The more you drink the more talented I become.” The Real Thing

Hope these help! Be on the lookout, poseurs are everywhere!

Crossing The Stream Of Consciousness

Ferry Small

For all of us, and when I say “us” I refer, of course, to those who society might describe in terms less than entirely flattering, for example, “laughing academy graduates”, “strange rangers”, “those who dance to the beat of a different marsupial”, and of course, “Followers of Lord Whackadoomious”, to cite only the most widely circulated, familiar to schoolchild and senior citizen alike, there comes a time and, speaking from experience I assure you it is a time one remembers as vividly as one’s first blackout, if that’s not oxymoronic, when one realizes with clarity, certainty, brevity, and afternoon tea that what is commonly referred to as “mental illness” is no mere passing fancy, no hobby or experiment, no entertaining divertissement or amble through a funhouse gallery of distortion mirrors but, rather a way of being, not a lifestyle per se but merely a life or, more properly, truly a life, a complete life, which is to say, one will be doing all the things of life, the stuff, the occupations, the challenges, yes, the disappointments and frustrations as well, as a mentally ill person quite distinct from people who, through no fault of their own, are not mentally ill and must raise families, force themselves through meaningless occupations which they call jobs, without even the slightest smidgen of mental illness to make them interesting, and when one has this epiphany, if I may use such a highfalutin word, when a word as unassuming as “realization” would have served just as handily, there is that sinking feeling one experiences upon dropping car keys down a storm drain, that frozen moment of heightened awareness, like the instant before two steam locomotives, accidentally guided onto the same track, collide, colors are more vivid, sounds more intense, even one’s sense of smell is heightened, those keys, frozen in mid-air, no way to reach them, all is gone, all is certain, the die is cast, the cast has dyed, and as the keys descend through the cast iron grill, smiling a mocking, toothy smile broad as the face of a 58 Buick, the knowledge settles in the pit of your pendulum and you make peace, sweet peace, you let go, sweet release, embracing your reality with a brave little smile as you step off the ferry to tread on terra incognito.

Insanity An Unaffordable Luxury

Rochester Psychiatric FacilityV2

According to a study released recently by the American Association of Associated Americans (AAAA), insanity may soon be out of reach for all but the super-rich, if current trends continue.

Chumley Throckmorton, PR Liaison for AAAA, explained the findings at a recent press event.

“America was founded on democratic values,” he began, “our constitution guarantees specific freedoms like speech, religion, and the pursuit of happiness. Happiness means different things to different people but one thing is certain, for many of us it means embracing our inner whackadoomian and smiling shamelessly as the cheese drifts slowly off the cracker.

“If one quality has helped to shape this nation more than any other it is the enthusiastic celebration of personal insanity,” he smiled.

“Madness was no mere colorful side road of the American experience, oh no, looneytude carved Main Street out of a hostile wilderness, tied the sky with wire, clogged the air with carbon monoxide and made the racing rivers glisten with mercury. Toxic levels of greed, ambition, and aggression drove a long parade of pathologically disturbed explorers, industrialists, bankers, bookies, assassins and interior decorators to ravage a utopia of incalculable natural wealth and beauty.

“That didn’t just happen,” Throckmorton continued, hammering the podium as the word “happen” arrived, “it took vision, the vision of men and women not afraid to make their demented dreams a reality.

But today,” he looked down, removed his glasses, cleaned them on his assistant’s tie, put them back on his face, and proceeded, “all that is in jeopardy.

“The ever-widening gulf between them what got and them what got not is having a chilling effect on insanity which, in the vast majority of cases, has simply become unaffordable. The result is that our once marvelously wild and obstreperous nation of misfits, malcontents, rabble-rousers, gangsters, and entrepreneurs is becoming whitebread, drab, listless, and dull. If this continues at its current pace it won’t be long before we’re indistinguishable from Belgium…or even Switzerland.

“Nationwide, those who do choose to experiment with insanity today are opting out of the glamour, high-maintenance diseases with force enough to bend rivers and level mountains for disorders that are more annoying than truly pathological. Complaints like triskaidekaphobia, arachnophobia, and phobophobia may qualify as maladies of the mind, but we are kidding ourselves if we think we can build the nation’s future on a foundation of triviality.”

Throckmorton summed up thusly. “If America hopes to be the nation it was once and frequently claims to be now it must first find a way to make insanity universally affordable. The painful irony here is that now it is only the rich that can afford insanity and, typically, they have absolutely no idea what to do with it.”

Searching for Extraterrestrial, Mentally Ill Life

Demented Space Alien

Since slightly before the dawn of time, man has set his gaze on the immensity of space and wondered this – given the billions and billions of tiny dots out there, which are probably quite similar to the thing upon which I reside, circling the sun, or other large objects – and knowing what I do of statistical relationships and relationships of probability, which is to say, the likelihood of events – how could I possibly be alone in this universe?

When you really stop and think, isn’t it far more likely that somewhere, somehow, on one of these lonesome magma clumps there is a form of life – however humble – striving ever upwards along its agonizingly slow evolutionary rise which, ultimately, will lead, over endless millennia of failed experiments, to something resembling me, and when I say me I do so because we must take as our starting point the assumption that humanity is what they refer to as The Crown of Creation and as such is the standard by which all others are measured, assuming there are others to measure, which we are, because frankly that is the point of this exercise.

So let us argue that, given an infinite amount of time to do so, and an infinite amount of government funding to squander, not to mention a rugged little spaceship able to withstand asteroid collisions, exploration would inevitably discover life of one sort or another. According to the legions of marginally employed scientists who have time to untangle these hypothetical quandaries, this is a given. Given, perhaps, but their belief sheds no light whatsoever on the presence, or lack, of mental illness among intelligent aliens.

Since roughly one in ten Americans suffers from some sort of mental illness, it is reasonable to assume that at least one out of every ten extraterrestrials would suffer from some sort of mental health issue, which in itself would not be bad, after all, we cannot allow ourselves to be prejudiced against extraterrestrials any more than we should allow ourselves to be prejudiced against mental illness at home – however, in the interests of practicality, and practicality must be our watchword here, it is necessary to realize that not every extraterrestrial intelligent life form in the entire universe is likely to adhere to the blissfully benign standards of peace, dignity, respect, love, understanding, compassion, tolerance, fairness, and justice we subscribe to here on earth.

This is significant since, in a culture with technology more advanced than ours, the behavior of a mentally ill populace, not to mention its leaders, could be catastrophic. So, if we consider space travel at all, we must be prepared for close encounters with alien civilizations in evolutionary stages of development far different than ours, with tastes and belief systems differing drastically from those we hold dear. Consequently, it behooves us to diagnose and understand alien mental illnesses before we encounter them.

Scientists will quickly point out that it is difficult to study the unknown, which is why we will be forced to take the unpopular option of relying on psychics, faith healers, and social media experts. The time to act is now; before we first encounter mentally ill aliens and wonder what sort of treatment might help them; or protect us from them.

So, as you gaze out upon the limitless pinpoints of light strewn zig zaggedly across the squid ink dark expanse of night, consider this; someone who is not all here may not be all there, either.