Episode 13: Make a Right at Philly

Welcome to the podcast. Thanks for joining me. I’m your host, Christopher Gajewski.

Let’s get naked about mental health!

In this episode, I had something different planned. Much different. Then, a post I read on LinkedIn, well, pissed me off. I know Big Willy, via The Legend of Bagger Vance, you have to look on it with soft eyes. I tried, and did eventually, but the SW Philly boy came out as well. As a Philly boy yourself, you should understand.

So, I get into my response, teletherapy, health care professionals, and just talking.

Before getting into the episode, the important stuff: I just want to remind everybody that I am not a psychologist, psychiatrist, therapist, or any kind of professional with an –ist at the end of their title. I am just a guy who has been there.

If you are in crisis, or know somebody who is, I implore you to reach out to a professional. There is now a national hotline you can call or text. 988.

I’ll repeat that because it bears repeating. If you or someone you know is in crisis, I implore you to reach out to a professional. Dialing or texting 988 will put you in touch with a crisis counselor instantly.

Now, let’s get into the episode.

Let Them Eat Cake?

I was triggered by a post I saw by a mental health professional. They posted the following and a picture of an advertisement they saw on Facebook for teletherapy:

“I find this advertising to be misleading,” she wrote, “traditional therapy can provide most of this and with better quality. I might add in [the traditional therapy] column: “Choose your own therapist. Use your insurance benefits. Get a diagnosis and treatment plan. Have a motivated therapist who is making more than $30.” Now if I only had millions of dollars to run competing Facebook ads….”

I looked on it with soft eyes. There was a part of me that agreed with her. Then, there was the Philly boy, the Philly attitude, and 50 years of experience of dealing with the mental health care system in this country. That part of me interpreted the post, by a woman who calls herself Maryland’s Mental Health Maven and practices psychotherapy with about 5,000 followers, as “Let them eat cake.”

“Let them eat cake,” wrongly attributed to Marie Antoinette, “…is taken to reflect a princess’s frivolous disregard for the starving peasants or her poor understanding of their plight.”

Yes, there is the Philly in me. There is also a seasoned journalist and critical thinker that would like to invite constructive dialogue on the matter.

But I found myself back in SW Philly, in a working-class neighborhood. Though I have seen some improvements in recent years, I am a child of the 70’s that witnessed the devolution of the mental care system, particularly for the poor and underserved.

My mother was diagnosed as manic depressive with schizophrenic tendencies. When she was hospitalized in the 70’s and 80’s, it was mandatory 30 days. Over the decades, that would drop to 15, then 10 and then finally three, where she would be sent home so medicated that she could not function.

I replied to the post that I both agreed and disagreed. More SW Philly came out than seasoned journalist I’m afraid.

“I’ve been doing the therapist dance now for decades,” I wrote. “I need it now. When I had insurance, I didn’t have the time. When I didn’t (don’t) have insurance, I can’t afford it…” 

There is the issue of finding the right therapist. I jump through hoops, make the appointment, do the intake, make the commute, and then find the therapist is not a good fit. I give it a few more sessions hoping for…something. I am typically already in a depression because therapy has become more like triage than anything else. 

You need patience. I think I read that each medication has a 40% chance of being effective and you need to take it for 30-60 days to see if it works for you. I see therapists as the same.

You need to find a therapist that is a good fit for you, that you can establish a sound therapeutic relationship with. As with meds, you might get lucky on the first try. More often than not, you make do with what you have or start the dance again. 

I did finally find one who was truly making a huge impact on my life. I was working in combination of weekly therapy sessions and monthly psychiatry sessions. I felt that after 45 years, I was finally on the right track and making a lot of progress. Dr. Ralph of Spectrum Behavior Services was amazing.

Just as with medications, though, you can become resistant. Dr. Ralph had guided me through the process of switching from the Zoloft I had been on for 15-20 years to a new med, Viibryd. My very good insurance did not cover it, so she supplied me with samples as she fought with the insurance company to force them to cover it.

I did not become resistant to Dr. Ralph. I had, and continue to have, the highest and utmost respect for her and her abilities. She was the best doctor, psychiatrist, I had ever dealt with. But she sold her private practice to a company.   

I couldn’t get through anymore to refill my meds. Then, Covid hit, and a difficult situation turned ugly. I ran out of meds.

Every doctor on the planet will tell you not to just stop taking these kinds of meds. Hell, even if you are suffering from bad side effects, you are still cautioned to wean yourself off of them. I finally went to the emergency room.

The ER doctor said she was not supposed to give me a prescription, but, given the special circumstances, she would, but urged me to find another provider.

The SW Philly did come out in the letter I mailed to that company. Or maybe it was just the withdrawal symptoms?

No, it was definitely the Philly. After singing the praise of Dr. Ralph like the Vienna Boys’ Choir, the terms “shit show” and “cluster…[edited]” came up a lot. I remember in the closing of the letter, I mentioned how Dr. Ralph was part of the solution to the mental health care crisis, but the company was part of the cancer in the mental health care system.

After the medications were back in my system and I was feeling better, I was finally able to make an appointment with a telehealth provider, a psychiatric nurse practitioner who was very good at her job.  

Telehealth as opposed to traditional therapy?

I wrote in my reply to Maryland’s Mental Health Maven,”On a battlefield, you take whatever is offered.”

At that point, during the pandemic, with everything going on, with my depression and anxiety really kicking into high gear, the last thing I needed was to worry about running low on meds.

She replied, “I’m sorry to hear that was your experience. Do you think a platform like [teletherapy] would have given you the quality care you needed?”

The SW Philly boy heard the echo of, “Let them eat cake.”

I replied, still trying to look with soft eyes, but then memories surfaced that had the SW Philly boy punching me between the eyes. “What is quality care,” I wrote. “Where do you get it and who do you get it from? Would, say, the head of a psychiatric hospital, with multiple degrees, provide better care than a therapist from a teletherapy provider?”

One of the potential triggers of my PTSD occurred the day after I sat with mother and her psychiatrist, the head of a psychiatric clinic. This amazing transformation had taken place in the ride to the emergency visit. My mother was deep into a psychotic state, considered herself an instrument of Satan sent to spread disease on the earth, and was about to kill herself.

You are taught in writing classes to never talk about a person’s eyes, that the eyes are merely parts of the body, and you can’t see anything in them. The only thing you can see in them is the lens and the pupil. You have to describe it, show it, not write some corny line like, “I saw insanity in her eyes.”

But I did, and the insanity was the smallest part of what I saw. She had sat there on the sofa, scratching the disease on her arms, and there was something beyond madness in her eyes. Looking into her eyes was like looking through a window into hell. Madness radiated off of her like heat waves as she rocked back and forth and scratched at her arms.

In the doctor’s office, she was a woman with an IQ well beyond genius level, a master manipulator, who did not want to be hospitalized–it was in the hospital during her last three-day hospitalization that she “caught” the disease she now spread.

I was told my mother was fine. There was an unspoken disapproval, a glance at the multiple degrees and awards hanging on the wall, as if I just wanted a break from caring for my mother.

The following morning, police burst through the front door of my two-floor apartment. In a moment of lucidity, my mother had called 911. The doctors said it was a miracle she survived. They could only guess that it was fortunate for her that she attempted suicide by two routes, slicing and pills. The pills had slowed her heart enough that the blood congealed and gave her time to make the call.

I was not so fortunate. I still remember walking through my apartment in October of 1999, wondering how much blood there was in a person. My mom had paced after she sliced and it looked as though someone had taken multiple cans of red paint and splashed them throughout my kitchen, bathroom, hallway and then poured a can or two on her bed for good measure.

My own period of decompensation began, my time of madness. Without insurance, and without access to therapy –not to mention teletherapy, I wonder if it would have made a difference? It would be six months before I came the closest to following my mother.

Would a platform like teletherapy offer me the quality therapy I needed?

“I would have to research it more,” I replied. Had she even researched it before posting? “But I know that just having someone to talk to is a huge help. I know that BetterHelp.com is another one where you can switch therapists as often you like until you find a good fit.”

I did not know of the company the Maven had posted about, Talkspace, but I do know BetterHelp. Following an interview on a podcast with a licensed psychologist, who spoke highly of them, I reached out to them online. 

I had not been thrilled with the intake interview questions that “matched” me with a therapist, but I did get an appointment right away. I also knew that I could switch therapists as often as I needed until I found a good fit.

The cost was something I could afford. Well, I could afford it but lost my job before I began therapy so was forced to cancel. They refunded me the money I had paid upfront.

Perhaps beating the saying, “Let them eat cake” to death, I put myself on bread and water rations until I could find a new job and possibly get insurance.

“Quality care is expensive, beyond the means of most Americans,” I replied to her. “The health care system has been circling the drain now for decades.”

“…I welcome any and all alternatives. I would like it to be quality care, but I wish everybody just had access to care—and took it. I hope to help end the stigma of getting care and will promote any way a person can reach out to talk to someone.”

I reached out to the mental health professional in a private message. I told her I understood their position and apologized if I had come across too harsh in their post. I wrote that a lot needs to be done and I would welcome a conversation about it.

They wrote back, “…I know care navigation is a huge problem. Good luck.”

Let them eat cake?

I need to do more research. I need to talk with professionals and teletherapy care providers. I am trying to arrange an interview with Leo Flowers, host of the podcast, “Before You Kill Yourself!” who interviewed me about my new book.

Are you there, Leo? As one of my few subscribers on Podbean. Leo? Leo? Buehler?

That’s just my sense of humor. Nothing Philly or passive aggressive about it.

One thing I worry about on my podcast is bad information. As I stated at the beginning of my show, and every show, I am not a psychologist, psychiatrist, therapist or anything kind of profession with an –ist at the end of their title. I am just a guy who has been there.

I just try to be an authentic voice to get people talking. To anybody.

We definitely need a better answer than my podcast. We also need a better answer than, “Let them eat cake.”

But let’s make a right at Philly. Coming from the south, we’ll cross over the Walt Whitman Bridge and soon be on the Atlantic City Expressway, one of the most absolute boring rides I have ever taken in my life. In an hour or so, we’ll be in Atlantic City. We drive through the casinos, maybe park in one.

Forget about it! We’re not here for the that. The women we pass? Forget about them too. No, let’s just stroll down to the boardwalk, cross over the wide wooden walkway, and make our way down to the beach, and then the quarter of a mile or so to the ocean.

We can sit in the sand and look out over the waves. It is much easier to look at a sunrise with soft eyes.

Or, in my case, wait for the sunrise and even the pre-dawn. Something happened to me a while back. I started waking up early, very early. 4 am today. I look at my clock, know that I could go back to sleep, but something pulls me to the coffee maker instead, makes me start it and then begin my day.

I’m tired, know that I will crash for a nap about 10, but I just want to start my day and begin doing something.

This morning, Saturday, I feel guilty. My dog, Dani, woke up with me. Before I broke my ankle, I had her trained. I’d take her out when I woke up to do her business. She begs to go out. I can’t do anything about it. I have a tiny back patio where I leave puppy pads. All I can do now is hope she uses them.

But what can you do?

Bagger Vance would say to look at the upcoming day with soft eyes, look at the entire field. It is not a dragon to slay.

If you are struggling, if you are jumping through those hoops to begin therapy, or to get meds, there are things you can do right now.

First, don’t do what I do. Don’t start the coffee maker. Go back to sleep and get your rest. Leo made it a point to talk about it in our interview and I found it odd at first. He wanted to talk about sleep, good sleep. I looked into it after the fact and remember something that I learned.

There is a direct correlation between sleep and depression. I figured it out while I drove across the United States on my odyssey. When I was exhausted, started out the day exhausted, my mood was directly affected.

But you don’t have to take my word for it.

There are a ton of articles online about the bidirectional relationship between sleep and depression. It is the chicken and the egg question, which came first? Bad sleep leading to depression or depression leading to bad sleep. Doesn’t matter to me when looking at the pre-dawn with soft eyes.

7-9 hours of sleep each night is essential. Do what you have to do to get there. Therapy and meds can help, but if you don’t have access to either, or are waiting, there are steps you can take to get there anyway.

First, establish a routine. Make it a point to go to bed at the same time each night. For me, that is about 10 these days. Before I broke my ankle, I’d go to bed about 10 and then wake up at about 5 or 6. My 7-8 hours. It makes a difference.

One thing about being stranded in Mexico is access to meds is much easier. I can buy most over the counter or with a prescription I get from the doctor who is in the pharmacy. I get a 3–5-month supply of my clozapam for $25 or so. 1.5 mg enables me to turn my mind off at night and fall asleep.

All of my life, I was a coffee addict. I could drink coffee right before bed and still fall asleep. That changed. Now, I know that I have to stop in the afternoon. I still crave coffee but have switched to decaf. With the help of my friend, Sara, I found an excellent one that I enjoy. I have a funny video about it on Instagram that I will link to on my website for this episode.

Cafe Bustello. It is a Cuban coffee I make in an Italian Expresso Maker and then add hot water to make a full cup.

Avoid booze. I was never a big drinker, but I did enjoy my beers. And I know the struggle. That booze should help me fall asleep. Enough of it and I pass out. But I also know what happens.

Booze is a depressant. Yes, it does relax me. Yes, it can help me fall asleep. But I also know it metabolizes in my body and starts working as a stimulant mid-way through the night and it wakes me up, whether to go to the bathroom, stomach issues, or a sugar rush.

I also know how it affects me the next day. It brings me down, makes me feel like shit. Even just a few. The older I have gotten, the more it affects me the following day. It can make me unproductive the following day, which then makes me feel like shit, which then makes it harder to fall asleep because my mind is racing with all of the things I should have and could have gotten done that day.

Yes, I take a break from my routine once in a while. I go out and have a few beers, but I try to limit it to only once in a while and stick with two, maybe three, beers. I know that that is my limit. I can still function the next day. Four beers? Nope.

If you do have access to healthcare, I highly recommend talking to your doctor about a sleep study. And there is an app for that as well. Many people suffer from poor sleep because of snoring or sleep apnea and never know.

I never knew that I snored until my wife pointed it out to me. She never knew that she snored until I pointed it out to her. She didn’t believe me of course so I recorded it one night. On video. I got a great shot of one of the dogs being startled awake.

There are dental appliances that can help with the snoring as well as light to moderate sleep apnea. I swear by mine, the DSAD by Panthera. One of the best things about it is that it is covered by health insurance, not dental insurance, which is typically better.

As I told Leo, though, as a professional in that field, don’t get one of those over-the-counter things unless you absolutely must. I think they are all crap and the ones you get nowadays from the direct-to-consumer companies where you make your own mold and send them in even worse. They need to be fitted by a qualified specialist or else you run a risk of damaging your teeth and jaw.

Something else you can do, that I make it a point to do each day even with the broken ankle, is get the hell outside. All the studies are clear on that. Getting outside and spending time in the sunshine helps.

Hell, my doctor here, Dr. Sibaji, wrote me a prescription for it. No shit. At least one hour, but I should be doing three, in the sunshine. So, I gimp my way up to the roof with my iPhone and listen to music while soaking in the sunshine.

Let’s face it. If you are suffering from anxiety or depression the last thing you want to do is go outside, you want to isolate. Don’t.

Aye, I know what I am asking here. I am asking you, like I told myself, to change lifelong habits. I am also telling you to battle the depression and anxiety. It is hard, difficult, but there isn’t a magic bullet here to solve all my problems. It takes work.

I think just by doing the work, just by taking action, helps me with the depression and anxiety. Popping that pill I don’t want to take, doing the small things and the bigger things, makes me feel better, makes me feel like I am more in control of my life, wresting the power back from the depression and anxiety.

It empowers me.

But let’s back to the list. There are still a few more things that you can do, that I do, to empower myself.

Exercise. There is a direct correlation there as well. Exercise releases endorphins, something missing in the right quantity in those with depression.

Be realistic like I am, though. I stare at the gym right across from my front door. These days, laid up with my ankle, I stare at it even more. I see the people using weights and jumping on the treadmill or the elliptical. I stared at them even before I broke my ankle and there is a really good chance that I’ll be staring at them after I heal, though I know I need to get in there.

I went for walks each day instead. Just strolls, with my iPhone and headphones, at least two miles a day. These days, after sitting on my butt for two weeks and having bruised my ribs that made using the crutches impossible, I couldn’t do anything until I healed. Now, I crutch my way up and down my apartment complex. And make my way up to the roof.

Yoga was a huge help for me and in many places, they offer free classes. I don’t like the apps and videos to use at home, but you might. It was part of my “getting out” thing.

Besides being exercise, yoga also teaches an important lesson that is especially helpful for those suffering from anxiety, depression and PTSD: mindfulness.

I personally noticed huge improvement in my mood and energy level when I was practicing a couple times a week.

Mediation is something I can and do practice at home now. There are a load of free apps for it. It is part of the mindfulness thing. Just 10 to 30 minutes a day. Just like yoga, it is difficult at first. Practice. It really does make a difference.

Aye, I know. I’m from Philly as I mentioned. I didn’t believe in any of that crap. Yoga, chakras, meditation? Exercise? Quit drinking? Sleep? I always said I’d sleep when I’m dead. Well, I almost was so started looking into things.

I did an episode a while back where I discuss the Mental Health Triangle. Self-care, to me, is the base of the triangle, that supports the other two sides, psychiatry (or meds) and psychology (therapy). It’s the part I ignored the most throughout my life. Don’t be like me. Start putting in the time and effort on all of these free things and see what a difference it makes.

And that is a wrap for this week’s episode.

I’m still reading off a script even though this is live and I’ll now open it up to questions. But as I am writing the script beforehand, and for those who are listening to the normal recorded session, I’m now going to gimp my way up to the roof and enjoy my hour of doctor prescribed sunbathing.


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