As President Obama tries to remake the American health care system, the gutting of psychiatry by insurance company policies and other administrative forces is a good lesson in what to avoid. 

The endless red tape inherent in dealing with many insurers and the loss of professional autonomy to insurance company “reviewers,” has led many of the best and brightest psychiatrists and psychologists to accept no insurance reimbursement at all.  Psychiatrists have, if you will, acted out Atlas Shrugged, Ayn Rand’s cautionary tale of what can happen when institutions throttle individuals.  They’ve walked away and taken their gifts as healers with them.  In fact, when I refer patients to other mental health care professionals, it’s very challenging for me to find clinicians I consider in the top echelons of my field who will accept third party reimbursement of any kind.  A brain drain has siphoned off access to some of the wisest counsel available in psychiatry, except for those willing to pay cash, and I believe the same could happen (or greatly accelerate where it already is happening) in other medical specialties.

The influence of insurance company policies has also led to the public being served by professionals from allied health fields, such as clinical nurse specialists.  The need or desire for these companies to save money, which will only be accelerated by the current Obama plan, means social workers and nurses are the preferred providers of psychotherapy and medication evaluations to those battling depression and schizophrenia and bipolar disorder.  This phenomenon could find its reflection in the firm ground of internal medicine and endocrinology and obstetrics and other specialties yielding to intellectual quicksand, in which the knowledge and skills of physicians often disappear from the landscape entirely.

There’s nothing inherently wrong with getting your health care from physician assistants and nurses.  But these folks didn’t go to medical school, and didn’t complete residencies, and if I were confronting a serious condition I’d want to be treated by people who had.  I’d pay for it out of my own pocket.  And my guess is that we’ll end up having to.

Oh, one more thing:  Not only did many psychiatrists walk out on the system, lots of the ones who stayed let their practices be shaped by insurance company reimbursement policies that pay them more to prescribe medications than to talk to people.  So there are a whole bevy of shrinks who’ll see you for ten minutes once a month and just write you a prescription.  It actually pays pretty well, even if it leaves them out of seventy percent of what can restore patients—effective, expert psychotherapy.  That medical art is in danger of extinction.

See, Obama’s eight principles for overhauling health care address economics, access, prevention, safety and cost.  They don’t address how to preserve the core of the world’s most successful, powerful, inventive health care system ever:  the contributions and creativity and commitment of America’s physicians.

I looked at that photograph and thought about how the sighting of that aircraft must have played in the psyches of the previously ‘uncontacted’ tribal members on the ground.  The first response was, clearly, fear and a corresponding commitment to protect themselves by force.  That’s an understandable reaction when the unknown presents itself as a flying machine disturbing the peace of the Amazonian sky.

It speaks to the inherent capacity of man to join together, create a community and protect it.  It shows the inherent bravery at the core of every great people—whether numbering 250 million or a thousand.  It means that we are related in our souls even to the most “primitive” men and women, because the highest attributes we possess are not expressed in the machines we create or the buildings we build, but the relationships we forge, the value we place on our “villages,” and the courage we can summon in the face of adversity.

Perhaps the villagers will prepare for war.  Perhaps they will pray for peace or for strength.  Perhaps a sense of wonder and possibility will mingle with their raw determination to survive.  Perhaps that hope for something miraculous from the sky will overtake their fears.  I pray that they will not interpret the machine in the sky as the beginning of Armageddon, as the final chapter of their existence—but we know that communities much closer to home have needlessly seen the end looming near.

I imagine they will hold their children closer or kiss them in their sleep or prepare for them an oral or written history of the great event that took place in their lives before they were old enough to record their own life stories.  Maybe those who rushed outside at the sound and then sight of the aircraft above will be remembered for generations to come as heroes.

The truth is we could share gifts with these Amazonian people.  We have learned so much about maintaining our health, journeying to frontiers of scientific and technical knowledge previously unthinkable, and expanding the range of human possibility in communication and travel. 

Yet we also should be careful to note—for them and for us—that some of our achievements have transported too many of us away from our connections with ourselves and one another, away from our connections to nature and away from our connections to God.  And reminders of these invaluable assets, inherent to man, may be among the gifts these Amazonian people can offer us.

Late tonight, when I arrive home to my family after a short trip, I will kiss my wife and son and daughter in their sleep and remind myself—in honor of the “uncontacted” men and women and children in the rainforest—that human beings are much more alike than different in what we need and what we can give, and often more afraid than we need to be.

Dr. Ablow is a FOX News psychiatry correspondent. Visit his Web site at www.livingthetruth.com.

The news is, ultimately, about people—individual life stories that make up the story of America.  Nowhere is that fact more evident than in news of economic pressures that translate into personal stress and even psychological disorders.  When those pressures include foreclosures, the stress can “hit home” especially hard, bringing insomnia, marital discord, major depression, even suicidal ideation.

Our homes are more than financial assets.  They have deep emotional meaning.  For those of us fortunate enough to have grown up in houses owned by our parents, they were the backdrop for our childhood memories—the places we played and argued and hung our artwork and marked the door jamb with pencil lines as we grew taller.  For better or worse, the houses of our childhoods represented to many of us a good measure of the success our parents had attained, an outward expression of how hard work had paid off in comfort and safety and the respect of the community.   The lawn got cut.  The paint got freshened up.  Maybe a pool was added out back.  When things went well, our houses grew with us.

With the home foreclosure rate in America skyrocketing, our economic conditions translate into a true public health concern.  Losing one’s home can feel like losing one’s self.  Those being foreclosed upon can feel they have let down their families, that they have been “exposed” as failures in the eyes of the community and that the road back to stability is too full of twists and turns to even begin to think about navigating it.

This perfect storm of lowered self-esteem and perceived loss of face is indeed the growing place for divorce, panic disorder, major depression and stress-related medical conditions like hypertension.  That’s why a national program that would offer a kind of “outplacement” psychological counseling to those who are losing or who have lost their homes is needed.  Our community hospitals, academic medical centers, family physicians and community mental health centers should be prepared in a special way for the special burden that home foreclosure represents.

During my 16 years practicing psychiatry, I’ve worked with many people facing financial reversals, including home foreclosure.  Some were anxious or felt hopeless.  Some had developed symptoms of major depression.  Here’s some of what I learned. I hope can be of help to those who have lost their homes or are at risk of losing them:

·         Trying to white knuckle your feelings and fears can leave you feeling alone with them.  Voicing them puts them in context—as things happening in your life, not life itself.  Talk more about your feelings and fears, not less.

·         Every difficult chapter of one’s life story offers the chance to rise above it by showing grit or grace in the face of uncertainty.  Our loved ones and the community measure us by assessing our characters, not by calculating our finances.  The way you react in adversity is what defines you, not adversity itself.

·         Our financial circumstances are never entirely under our control.  The economic realities of the day truly impact what is possible for many of us.  Millions of Americans are losing their homes.  If you would not judge them as weak or unwise, try not to judge yourself.

·         Seek more information about the economy, not less.  You’ve learned the impact that financial markets can have, in personal terms.  Become an even better student of them.

·         When people look back at their lives, almost all can identify periods of great turmoil, personally or professionally or financially.  If this is one of yours, you are in pain now, but the overall arc of your life story can still be in the direction of success and happiness.  Abraham Lincoln, for example, suffered severe financial reversals and several political losses before his great successes.

·         No patient has ever described the real assets provided by his or her parents by the kind of house or apartment the family lived in.  To a person, the accounting has always been emotional:  Did he or she feel well-loved?  Was he or she listened to?  Were his or her dreams encouraged?  If you want to put something that lasts “in the bank” for your kids, tell them that whether you live in a big house, a little house or an apartment (or even in temporary housing) that you will always be a family and that you will think about them every day and kiss them goodnight wherever they go to sleep.

·         There is great power in shifting from seeing oneself as a victim to seeing oneself as a survivor.  Thinking like a survivor helps you marshal the resources needed to sure up your family now and your finances over time.

·         Conditions like major depression and panic disorder and symptoms like insomnia are among the most treatable in psychiatry.  If you are suffering in these ways, tell your family doctor or a mental health care provider.  Psychotherapy and medication (when indicated) work in over 90 percent of cases.

·         It’s important to take stock of your “assets.”  Are you healthy?  Are your children healthy?  Are they attending school without serious difficulty?  Again, while home ownership is a wonderful part of life, it pales in comparison to other gifts of stability your family may be enjoying right now. 

·         You can train your vision to look past today’s crisis to a better future.  Start planning how you are going to own a home again—today.  This can mean something as simple as opening a new savings account with a tiny deposit.  The concrete intention to begin rebuilding your financial position can help you feel like you have psychological momentum on your side, or will again soon.

If you know someone who is facing home foreclosure (or whose home has been foreclosed upon), please print out this blog and share it with him or her.  I hope the words I’ve written will be helpful, but I am certain that your show of concern will be.  Ultimately, the news is all about people.  And, ultimately, it turns out to be about help and hope and seeing that a better future is always possible in America.