Imagine seeking help and being turned away. You have insurance, income, referrals to programs and analysts who can help you with a mental-health or substance use problem. You want to change your life, diagnose and treat whatever ailments. Yet no one will undertake your treatment. It’s as if you’re a drudgery too costly and timely for which no commitment can be made.
Rejection is a brand of affliction that courses through you daily, in professional and personal spheres, like the substances you used to repress the sting of denial. Imagine you are in your mid-20s. You are insured and you have a steady income, but here’s the catch: You’ve got years of mental-health and substance abuse issues that need addressing. Now imagine that, between nearly a dozen psychologists, four psychotherapists, three psychoanalysts, two out-patient treatment centers, and one post-doctoral clinic, nobody has agreed to treat you.
“We are unable to offer you psychoanalysis at this time,” one clinic wrote in a form letter. “This decision is no reflection on your need for or ability to benefit from psychoanalysis.” In order to receive this rejection, you’d first completed a nine-page application on which you answered questions that forced you to not only relive past traumas, but to keep them under 300 characters.
As you explained in the mountains of paperwork, you feel depressed and suicidal, and have found alcohol to be taking over your life. In writing all this down, in every questionnaire, you feel more depraved, and you plunge further into despair. This was the third such application you’d filled out in this month.
Too often people are disqualified from the treatment they need. The system has no room for outliers.
“Getting denied for a needed mental health care service or treatment can be a frustrating process,” reads a phlegmatic section on the National Alliance on Mental Health Illness website.
You are alone. There seems no way out.
The Substance Abuse and Mental Health Services Administration identified 22.5 million people in 2014 who needed treatment for drug or alcohol abuse. Of them, only 18.5 percent found treatment. Even fewer found a treatment facility.
Among the more famous examples is the man who, after being rejected by a psychiatric ward, picked up serial killing. Or the suicidal 28-year-old hearing voices who was turned away by a Massachusetts hospital hours before stabbing to death one woman and killing another man (he was later shot and killed by police). Or Brandon Ketchum, the 33-year-old Army National Guard veteran grappling with post-traumatic stress disorder (PTSD) who was denied treatment at a Veteran Affairs facility.
Ketchum posted to Facebook shortly after his rejection:
I requested that I get admitted to 9W (psychiatric ward) and get things straightened out. I truly felt my safety and health were in jeopardy…. At this point I say, “Why even try anymore?” They gave up on me, so why shouldn’t I give up on myself?
Later that day, Ketchum killed himself.
Treatment exists for many as a pendulum, with traditional treatment on one extreme, relapse and death on the other. Existing in the middle of the pendulum is abhorred by the industry, and society at large. But there are the outliers, those who realize the best forms of treatment are the ones you lasso for yourself.
Outliers come in all variety of despair: those who don’t see the pegboard slots of addiction centers, or the mental wellness facilities, as suited to their needs; those who don’t believe in the forced camaraderie of Alcoholics Anonymous or that a single drink of alcohol, hit of marijuana, or bump of cocaine necessitates the same reaction as one hundred drinks, one thousand hits, as the ideology of most 12-step programs states. Often, many people don’t feel that they fit within those single-track modalities. Some people simply do not have the luxury of taking a month off from work to enter rehab, or possess the necessary insurance to cover it. So they seek out alternatives.
Fifty years of science supports new modalities, yet the inherent problem of the more-knowledgeable-than-thou rehabilitation offerings is their unwillingness to change. It is the patient’s problem for not being suited for treatment; it’s not the treatment plan that fails.
Too often people are disqualified from the treatment they need. The system has no room for outliers.
A study published in April by Edyth London, a professor of molecular and medical pharmacology at the University of California–Los Angeles’ David Geffen School of Medicine, found that exercise — albeit combined with traditional behavior therapy — aided in curbing the cravings of methamphetamine addicts. Go outside, her research says, join a gym, talk openly about the issue at hand.
“But good luck getting insurance to cover that,” says Maia Szalavitz, the author, most recently, of Unbroken Brain: A Revolutionary New Way of Understanding Addiction(and an occasional contributor to Pacific Standard). A longtime writer on neurology and herself a former heroine addict, Szalavitz views the system of alternatives to brick-and-mortar establishments as devolving and not progressing the field of drug treatment. The in-patient and out-patient programs, to ebb and adapt themselves with current trends and data-proven treatment methods, need to adopt what people are finding elsewhere, Szalavitz adds—easily and without a checkbook.
“A lot of people find that in spirituality, in an actual person, in having kids or taking on a political cause or whatever it is,” she adds. “Finding a passion to channel that energy into is a very important part of recovery.”
Spiritual wellness. Séances. Vision quests. Wilderness experiential therapy. Hypnotism. Some methods seem cut from a bohemian cloth rather than a form in which actual rehabilitation can thrive. These can only work for those who, in finding no other way, seek it on their own.
Research into alternative modalities and treatments is scattered at best, making it difficult to distinguish what works when applied to broader sets. National institutions and advocacy groups consider mental health and substance abuse two separate afflictions. If recognized as one issue, they’re called “occurring disorders,” adding another variable.
Todd Crandell believes that traditional, established facilities for mental health and substance abuse counseling focus too often on the patient being wrong, that it is their sickness causing relapses, their slack constitution that can’t help pull them through. “I come from the notion of what do you need to do it right,” he says.
In 2001, after years of struggling with addiction, Crandell formed Racing for Recovery, a support group that marries exercise and nutritional lifestyle choices.
“We’re replacing it with a new lifestyle that exercise is a part of, but it’s not about doing the Ironman to be sober. The message is to get emotionally fit and spiritually fit,” says Crandell, who himself has competed in endurance races.
Many seeking treatment don’t feel the need or find any benefit to communal therapies, and instead hope to treat themselves one-on-one with holistic approaches they’ve either heard about through friends or through independent research.
As a child, Kat Savino was touched inappropriately and then never touched again, ostracized by the family she needed most but could not reach. This fostered within Savino what she described in a personal essay as an “animal ache” that “always felt feral.” She’d sough treatment, once weekly therapy sessions, but found the ache returning and needed something different.
“I was looking more for an integrated approach, centered around trauma,” says Savino, a Brooklyn-based writer. “I didn’t have insurance at the time. Really, I had not a lot of options.”
On a tree-lined strip in Brooklyn, Third Root is a community health center that provides holistic temperance applied through yoga, acupuncture, and massages. The process is less the 30-minute mega-mall approach; the sessions take on a therapeutic bend, the masseuse as shamanic guide. For Savino, it proved incredibly effective.
“I wasn’t really expecting it to be useful and help with my stress,” says Savino, who went in the midst of a bout with her PTSD. “Even I went into it not aware of how much it would help me.”
Merging cognitive behavioral therapy with hypnosis is in its infancy yet. Cognitive behavioral therapy was shown to reduce fatigue and anxiety in breast cancer radiotherapy patients in one 2009 study, and in 2005 for treatment of acute stress disorders, though national data on patient use has not been recorded. Alicia Ramos, a hypnotherapist in Los Angeles, says patients come seeking her treatments as a form of supplemental therapy.
There are “eye fascinations,” which “help to induce a trance-like state” — think sawing pocket watch, twirling spiral parasol. “But it is completely different than the typical stage hypnosis,” Ramos says. For wellness and mental-health purposes, an involved intake session prepares a patient while also helping the practitioner gauge the susceptibility levels of the patient.
Typically, Ramos says, patients see results in four to five sessions, which can last about 50 minutes, or a therapeutic hour, much like that of the massage or a more conventional couch and notepad approach.
Treatment options differ in application, as many aren’t specifically geared toward rehabilitative therapy but have been found to assist some patients. In nearby Thousand Oaks, California, Cathy Castelazo offers bio cell body wraps as a detoxification treatment, tiny strips that are wrapped around a patient and applied with a cream to “stimulate” the body’s natural lymph elimination functions. One patient claims Castelazo’s 90-day treatment, which costs between $100 and $200 per session, helped with her mental-health issues.
Anyone whose breached the wall of sobriety and made it beyond the first maddening weeks following withdrawal — beyond the hospital sidewalk and the rejection of yet another program — can offer their own method to recovery: the irascibly redundant use of hallucinogens; the elementary pet- and art-based therapies; gardening. Desire to change and persistence, however, are key to formative treatments.
While alternative treatments are available, the prices further cast into despair the patients seeking them. What frustrates Szalavitz, the author, is that cognitive behavioral therapy, and the motivational therapy offered at in- and out-patient facilities, are just as good as those sought elsewhere. They’re just difficult to access.
“Everything is backward,” she says. “But you can’t get them for free in church basements.”