Depression and what it's really like

as far as the profession internationally is informed by the successive editions of the DSM, i'd say it's an unusually labile framework compared to the majority of technical professions

psychotherapy as a field is something broader than that tho, and certainly doesn't belong wholly to the world of the medical

― wang mang band (Noodle Vague)

the main way it belongs to the world of the medical is when it comes to getting paid... the thing that makes the MH field interesting, from a US-based perspective, is that the majority of the field is solo practitioners. you go to see a doctor, even if they're a solo practitioner they have an office staff who take care of billing insurance and making appointments and all that stuff. MH professionals are doing all that stuff themselves, most of the time.

which means that the ability of something like the DSM or whatever to enforce hegemonic MH standards is kind of limited. first off the DSM isn't a billing standard... like it can set up whatever diagnoses it likes but for someone to get paid they're gonna be billing, in the US it's probably gonna be CPT codes, and these are a standard set of CPT codes for therapy. honestly one code, really, you're just gonna submit 90834 probably, and then the insurance company is gonna want a diagnosis, and that comes from a _different_ set of standards, that's the ICD-10. this is where it gets tricky because american healthcare is fucked, right? this is why it's hard when therapists bill their own codes. so say you're treating someone with gender dysphoria, and you're in, like, tennessee or texas or something. see, where i'm at, here in oregon, it's probably fine to bill F64.0... that's not actually "gender dysphoria", there's no billing diagnosis for "gender dysphoria". gender dysphoria is in the DSM-5, but you have these list of codes from this standard that they came up with in, i don't know, probably the early 2000s, and so the diagnosis code they're gonna bill for me is "transsexualism". and you know what, fine, they're working on a draft standard for the ICD-11 which the AMA will spend another 20 years fighting because it makes it harder for their doctors to get paid, in the meantime you use what you have available. except, i mean, if you're a therapist treating someone in texas maybe you wanna use a generic F32 ("depression") code. because maybe there's some fucking law in place that makes it illegal to pay for it, or maybe some insurance company has some policy in place saying that they don't pay for gender affirming treatment, or whatever the fuck. it's a fucking pain in the ass, billing insurance, which is why most providers don't do it themselves, they hire somebody else to do that bit for them. therapists, though, they don't have the resources that an MD does so they're stuck doing it all themselves. i'm not a therapist, but part of me thinks dealing with the insurance companies might be harder in some ways than dealing with the clients. i mean you're treating somebody for mental health issues and at least they mean well, you can't really say that about insurance companies.

this is kind of a... i'm kind of into the weeds here on this, and i'm not doing it from a clinical perspective because i'm not a clinician. this just happens to be my professional background, figuring out how the hell providers can get insurance companies to pay them for the work they do. and i think that's important because it comes back to something that is kind of unavoidable when talking about any kind of health care in the US, which is to say that the whole thing is completely and utterly fucked. the idea of anything in american healthcare being done based on a safely approved guidance manual reviewed every 5 years, that's just so far removed from the reality of things here. it's really hard to follow a system when the system you're supposed to follow is completely unworkable, you know? you kinda have to just improvise things sometimes.

which makes it in theory high-risk because you never know when you might run into a dr. eugene landy, but usually? usually those providers aren't therapists. usually they're the ones doing the prescribing. i've had therapists that worked out well and therapists that didn't, but when in terms of going through medical abuse, which i have gone through, that wasn't something i ever got from therapists.

idk i guess that's kind of a ramble, i got a... lot of experience with mental health, and mostly it's as a patient, but shit, you spend a long enough time around these kinds of places you sort of pick up a thing or two. particularly since i do have some professional understanding of how the donuts get made.

now, how that all plays out in Canada or the UK or whatever, i don't have any idea. really my only experience is within the US.

That was a great post Kate! I totally appreciate the “code compliance” issues.

Most days I’m good at just suppressing it and “carrying on”, as it were, but then it sneaks up on me and hits me all at once to be reminded of how much it sucks to not have any good friends.

I’ve written a much longer post about 8 times, but it all feels kind of futile and doesn’t get the point across well. I’d kill to even have one of those text groups I’ve heard about where friends bullshit with each other. Sounds cool.

Hell, I’ve been posting here for the better part of two decades and I don’t have a single one of you I interact with outside ilx (I mean, considering how often my threads sink to the bottom, it’s not like I actually “interact” with many of you on here either lol). Yet I stubbornly persist.

sorry man

I'm glad you're here jon. I don't actively post on many threads and I lurk on maybe a couple dozen, but your posts on the annoying coworker threads get me smiling and shaking my head in recognition and commiseration every time.

Most days I’m good at just suppressing it and “carrying on”, as it were, but then it sneaks up on me and hits me all at once to be reminded … Hell, I’ve been posting here for the better part of two decades and I don’t have a single one of you I interact with outside ilx (I mean, considering how often my threads sink to the bottom, it’s not like I actually “interact” with many of you on here either lol). Yet I stubbornly persist.

Jon, I hear you. I often think to myself who I would call if I were in trouble or needed someone and the answer is always "shit, no-one". Then I get depressed and this is exacerbated by remembering how I don't have anyone to call when I'm howling and crying and then I howl and cry more. Then I fall asleep and I wake up and it doesn't matter until I start remembering it again hours or days or weeks later. It just sneaks up.

Sorry, didn't see this had been bumped. Appreciate the thoughts.

It's just been hard, as my son has gotten older and is spending more time with friends and I've found a little more free time, the lack of friends has become more glaring. I keep thinking, "hey, it would be cool to go see that band with someone" and then remembering there are absolutely zero people I could reach out to for that sort of thing. Not that I'm afraid to go to shows solo, I do it a lot, just would be nice from time to time to go with someone to talk about it with afterwards or w/e.

Part of the challenge, beyond just how hard it is to make friends as an adult, is that most of my interests don't alight with chances to get to know more people, even those who share said interests.

Not going to most of the gigs I'd like to go to is a thing I accept nowadays to the extent I mostly forget that I could even go on my own. I just...don't do stuff.

^^^
i used to buy advance tickets in an effort to make myself go, but soon realized it was just a waste of money

hey jon, i just wanted to say that i really appreciate the breadth of your knowledge and your generosity on ilm, and all the times i make a post about a random harder rock band and see an enthusiastic response from you it raises my spirits. you rule!