Today is, or I guess I should say was, the eighth anniversary of the garage -- not the alphagarage that shae and I put up in September, but the public, open-to-all-comers one that lasted till 2001. If seven years is a long time, I'm tempted to ask, what's eight? In those years, a tremendous amount has changed -- some of which makes me feel very vindicated. At the same time I can never quite shed my apprehension at how much work there still is to be done.
On the credit side, there's a public awareness of adolescent emotional disorder that was very foreign to us in 1998. Just recently the New York Times has run a four-part series that amounted to broad-brush case studies, and put them on the front page... where eight years ago you wouldn't have found, for example, an article on anorexia nervosa. Some of the stigma that attaches to disordered adolescents is fading, slowly, as people -- not only the teens themselves, but their parents and their therapists -- speak truth to power. Therapists seem to have a better understanding of the ethical responsibility that prohibits colluding with parents. Medication, as we always said, is not an end in itself, but can only provide a time of clarity during which client, family, and therapist can arrive at strategies. Most heartening of all, the 90s' fascination with toughlove is in steep decline, and the new insistence is for family collaboration, parental involvement, and problem-solving. How many times did we hear on the boards "I'd talk to my father if he'd just talk to me?" It may be happening more often.
Therapists and clients are also being much more skeptical about medication. The horror stories we used to tell among ourselves are on the front pages too: weight gain from Risperdal and Depakote, weight gain and pre-diabetes from Zyprexa, liver damage from Serzone, increased suicidality from Paxil, and there are many others. Parents have become, I think, much less prone to say "Can't we just give the kid a pill?" than they were years ago.
But even knowing that we used to be right about many things, I still pause when I look at contemporary realities. Getting meaningful care and coverage for emotional disorders isn't easier than it was at the turn of the century. Almost all of us now are 21 or older; quite a few of us, when we hit 23 and had to be taken off our family medical insurance, discovered that we couldn't replace it with individual insurance -- or that if we could, the cost would be far more than we could pay. I have good friends now who are 23 and 24 and 25 and are saying "No, I don't have insurance, I'm pretty healthy, I'll be okay." Yes, you might, until the night you get treated in the ER and slapped with a four-figure or five-figure bill that will have you arguing with your county for years. Even if the bill is finally reduced to a sliver, the time you had to waste in the interim was worth something.
War stories about medical insurance would be one thing if they were in any way exceptional. But in the papers, hard on the heels of the news that the US population had reached 300 million, came the sheepish admission that 50 million of us were now uninsured. Excuse me, that's one out of six? And the number of uninsured is increasing faster in proportion than the population.
I'm also worried about therapy itself -- I mean about the state of it. On the one hand, therapists are still practicing in offices with Oriental rugs, fake for public agencies and real for private-pay, and with bookcases, the more and taller the better. The online therapeutic community calls this "the fancy box," and it's a 19th-century setting, anachronistic now to the point of being weird. Clients are saying, in one way or another, "You mean I actually have to go to your office to do this? And you don't work weekends?" In a world of notebooks, PDAs, and cellphones, we need a therapeutic paradigm that has the same mobility -- the same portability -- we do. Physical medicine has figured this out. Psychology hasn't and, I suspect, doesn't want to.
Okay, so let's look at online therapy. The largest organization (I think) devoted to it is the International Society for Mental Health Online, which was founded in 1997; I'm a member, I get their e-mail digest, and it seems to me that they're spending time on a lot of the same problems we did. When I talk -- not just to regular therapists, which might make sense, but to online therapists -- about some of the stuff we used to do in the garage, they still regard it as pioneering. Meanwhile I tried to conduct a census of online therapists, because I'm thinking of doing a survey as part of my thesis, and I found about 300 in the English-speaking world. I really don't think there are many more than that. There are exciting developments here and there, especially in virtual communities, but the overall development and testing of online therapy is happening too slowly among too few people.
It's a leisure we can't afford. Adolescent suicide attempts are becoming more prevalent, and so probably is adolescent drug abuse -- if you look at the real numbers, not the USG's. Another scary estimate is that one out of seven teen girls, and one in ten teen boys, practices self-injury in some sense. I'm a psychology student now and I get the honest numbers, not the ones in the paperback self-help books.
For myself, I'm working on a master's degree in counseling, which I'll probably finish in December. From now until October I'm in training at a crisis agency in the East Bay. I'm trying to structure my thesis so that, with a reasonable amount of effort, it can be turned into a book. I'm still fighting the fight and loving it. I hope everybody here is fighting the fight, at least the one every day for yourself. Happy anniversary, long live us, &muchlove.