I always did want to post this out-take from Southern Vapors. I liked it, even though my editor said it needed to come out of the book. She thought it was irrelvant. For anyone who knows me well, it actually says alot.
“Temporarily embarrassed.” That’s an old-fashioned phrase that perfectly describes how I felt about my situation in the summer of 2010: back in Atlanta, impoverished, one step away from going on the dole with my mother, rejected by prospective employers at every turn and living in an apartment with uneven floorboards and no thermostat.
I love this particular usage of the word “embarrassed.” It was often used in the Victorian novels I read as a teenager, the very same novels that introduced me to “the vapors” (only spelled “vapours” in the English way). The typical context was when a young dandy found himself “temporarily embarrassed” at the gaming tables, that is, out of money or credit, but sure to re-establish himself in short order.
As distraught as I was by my feelings of “temporary embarrassment” and worries about being jobless, my distress was often offset by moments of levity, courtesy of Suzy Marmalade.
I remember one day in that same summer of 2010 being on my way out of town for a quick trip to Hilton Head, South Carolina.
I decided that I had better fill up on gas and check the oil in my car. I pulled up to the pump, got the gas going and, in Suzy mode, made an instant assessment. “I don’t know how to open the hood and I have no idea how you check the oil on this car (having owned it for a year and a half). There’s a twenty-five-year-old guy in an Ole Miss T-shirt sitting over there reading a book; let’s rock n roll.”
I walked over to the guy and said, “How would you like to meet the last of a dying breed?” He looked up, made his own quick assessment, and answered, “What do you need help with?” I told him and he followed me over, asked me to pop the lid on the hood. Up until then his expression had been neutral, but I saw his lip begin to curl when I told him that I thought there was a latch in the car that popped the hood because I had pulled it by mistake before, but I didn’t remember where it was. He found it, popped the hood, propped it up and started checking the oil. As he went along, he gave me a little lesson, explaining where the dipstick was, how you pull it once and wipe it, then check it again—all things I’d done years ago, but somehow allowed to fall out of my memory.
Not “somehow.” It was Suzy, banking as always on the “temporary” part of “temporarily embarrassed.” Surely the day was just around the corner when once again I would have someone taking care of the details for me, right? So I smiled inside while the kid gave me a lesson he thought I needed, and secretly tuned him out. In truth, however, I’m not a total idiot and it actually was a little interesting, so I listened with one ear and afterwards I once again knew how to check the oil in my car.
Uh Oh, Here Comes Another Flatfooted Fix
It seems that the latest fix in the search to repair the broken mental health in the U.S. is to dial the primary care physicians into the equation. The thinking is that they are “first responders” and can flag issues, talk with patients, provide treatment options and act as both helper and gateway. David Satcher, former Surgeon General, and Patrick Kennedy have included this concept as a prominent component in their recently announced collaboration to improve the mental health system:
“We need to improve access to high quality care to provide the best outcomes for our brothers and sisters seeking recovery from mental illness and substance abuse. More than half our nation’s counties do not have a practicing psychiatrist, psychologist or social worker. We must increase the number of mental health professionals across the country, but we must also encourage primary care providers to make mental health part of their charge. Family practitioners are often in the best position to intervene early and improve mental health outcomes before conditions become worse.” https://www.usatoday.com/story/opinion/2015/02/04/mental-health-satcher-kennedy/22764289/.
This sounds like a great idea. I had heard of it prior to the Satcher-Kennedy announcement and in fact recently went to an initial consultation with a highly respected primary care physician in Atlanta with just this in mind.
I explained to her that I was having severe anxiety, but had already taken the psych med route and did not want to repeat it. To make the point that I had been through the med mill, I read her the following excerpt from Southern Vapors:
“Other than a couple of six month periods when I decided to stop taking medication altogether, I was on mood-altering drugs from 1980-2010 (yes, that would be thirty years). Sometimes it was a single drug, often two in combination and once it was a combination of four. I kept meticulous records (that was the lawyer in me), so I have the complete list from all thirty years. The traditional medications that I took were prozac, wellbutrin, effexor, phen-fen, depakote, celexa, serzone, xanax, paxil, ativan, klonopin, zoloft, cymbalta, topomax, lamictal, geodon, hydrozine, seroquel, phenergan, flexeril, vyvance, trazidone, provigil, lithium, valium, lexapro, resperidone and adderall.”
I looked up at her after I put the book down, and she said, “Have you tried Abilify?”
I wanted to hit her.
I have a follow up appointment with this doctor in a week, and I haven’t decided whether to go, change doctors (again), or try to educate her. If primary care physicians are going to be the front line on mental health, they actually need to know something about it. In my experience, few do. In their ignorance, they can do active harm in so many ways that it is hard to count them. Many already prescribe psych meds at the drop of a hat. I remember being offered a Xanax prescription by my gynecologist years ago. I said no, since at the time I had a psychiatrist in tow and figured a divide and conquer approach made more sense: brain to the psych guy, nether regions to the gyn. The worst, I think, is that we are taught to trust these doctors, and we hand them authority that they don’t deserve.
My take on this is beware of primary care physicians doling out mental health advice until we have a tested and proven system in place to educate them not only on the existing (or non-existent, depending on whom you believe) medical science of mental health, but also on the intricacies of the patient relationship when discussing mental health issues.