Aging

I was bothered when the Generation Z asked me if I could refer her to someone her age.  

Generation Z was apparently born 1997 to 2012.  , current age 11 -26

Millennials are currently 27 -42 and Gen X born 19981-96 current age 27 too 42.

Boomers were over 60. They use Facebook and read mainstream media.

She was 18 and wanted a psychiatrist who was her age.  “It took me 12 years of post high school education to become a psychiatrist”.  I’d only agreed to see an 18 yo old because the local pediatricians and child psychiatrists are sending their patients out into the adult world and none can find psychiatrists and the pharmacists want their complex medications prescribed by specialists.  I felt injured and realized I’ve always been sensitive because I haven’t had children.  The Lord of the Flies group toughens parents up and helps them survive as adults.  Teen agers are the fast lane in the freeway for adults learning to protect themselves for witticisms, satire, irony and general verbal abuse.

Ageism is rampant in Canada. Trudeau hates everyone but the generation Z because no one votes for his imbecility. 

I felt old. Having told her that there’s a shortage of specialists and that she could ask her family physician to find a young psychiatrist for her I wrote her complex prescription and thought how I really don’t like doing adolescent psychiatry any more. I saw so many a decade ago but now in my post retirement state I really don’t want criticism. I’ve had 40 years of working with the toughest crowd, the most demanding, most difficult, least desired, most critical and most complex patients in pscyhiatry, trauma, head injury and addiction and pain disorders.  I’m tired.  

Next a millennial, another woman in her 20’s says she just wants me to listen to her and doesn’t want to hear my anecdotes no matter how funny they are.  I have listened to her complain, yes complain, and walllow in self pity, yes wallow in self pity and go on for hours describing her negative mood and wanting me to ‘listen’.  We stopped doing that as psychiatrists in the 30’s . Cognitive behaviour therapy is a ‘teaching model’.  The patient isn’t being observed like in Freuds time.  Giving medications I spend a lot of time talking about the pros and cons of medications. I’m a drug salesman. I also share about other patients positive responses and help delineate what is biological , psychological and sociological. A lot of college kids and patients with counselling have just enough knowledge to hurt themselves.  S

Psychopharmacology is like all other areas of specialist medicine.  Diagnostics in psychiatrist is most difficult because we don’t have a scan or a blood test. But the actual approach to medication trials isn’t that complicated. It was for me working with head injuries. There’s 50 plus neuropathways but the treatment of deperession and anxiety are well mapped out.  The trouble is that people smoking dope don’t have the same reaction to meds as others and psychiatric treatment in general is highly individualized.  

So now I don’t want to talk. I miss my years of psychoanalytic psychiatry where it was relatively easy as patients had jobs and relationships and educations and I saw them twice a week and knew them intimately and didn’t even speak for months,  The patients kept dream journals and were highly active an weren’t escaping to ‘my medication needs adjustement’ when they were challenged by an interpretation. Now I see people at 3 months intervals, sometimes 6 months, and they’re on medication and they haven’t worked through fate and free will and haven’t even done CBT 101.  So they praise success and attribute it to themselves and blame failure and attribute it to others.  

“If there is something I’m doing that you don’t like I need to hear about it today. Generalizations are not helpful. I am seeing you today and if you wish for me to listen to something today I can yet I asked if you had anything you wanted to share at the beginning of he session and you said no so I started talking.  I am quite capable of listening the whole session but if you’re not talking and don’t have question naturally I’m going to dissess medication and address biological, psychological, sovilolgical seenvarios and yes anecdotes are part of my therapeutic strategies.  Story telling therapy was developed to by pass resistances and help people access unconscious issues in parallel as well as seeding. The difficulty is that in modern psychiatry we know that dwelling on the negatives and staying in the problem rather than focussing on solutions is not helpful.  That ‘type’ of therapy is available still through psychologists and analysts but its done weekly and not something I’m providing as a walk in clinic psychiatrist. These clinical resources are available for government services but my patients have genearally only found group therapy available.  Personally as a specialist I’m discouraged from seeing patient more often than at 6 month intervals and am pad less for seeing people at monthly and three month intervals. That’s however my loss but I’m more comfortable with that.  

Of course the patient is merely frustrated with her illness and displacing that onto the therapist . Expectations are all being thwarted in this post covid time when the mentally ill are most being tried by the inflation an increasing government and society demands and the pressures of competition and the successes of the rich. None of my patients can even afford the dream of owning a house or perhaps living in Vancouver and their struggles are real. I’d be able to offer more with weekly and twice weekly therapy but the government wants me to supervise and consult. I struggle because there are no resources for the many.  Everyone was promised a family physician trained in psychotherapy ad most of my patients can’t find a family physician and are left with physician assistants in walk in clinics.  

I’ve worked in scarcity for decades . The last 10 years the worts. I think of retirement.  I would travel read and write but I still have the majority of patients and colleagues thanking me for coming to work despite aches and pains andd age.  I just wish someone would explain to people that the problem is their government and not all of us who ware working. The money for health care was stolen for administration.  There’s been a rape of the system. There’s too many demands and too few works. There 80% burn out. Thee are shortages everywhere. The administration meanwhile is daily caught for unethical behaviour and corruption but demands perfections from doctors and imposes more and more expectation on them while we are paid less and less

It’s a pressure cooker. That’s what my patients are experiencing. They are young anf it’s tragic seeing in Vancouver what I saw all the time when I was a flyin doctors and working on northern reserves where lack of resources was the normal.  Here the kids are still being sold pretty pictures in high priced education systems which no longer are matching the education with what will be high paid incomes.  It’s a cluster fuck and I say daily it’s going to get better,

And we made it through another winter and the sun is helping and more patients are coming out of their misery with relaxed restrictions , more jobs, and summer sunshine.  ‘I’ll continue to work.   It’s okay.  All shall be well.