Your Doctors, Therapists, and Psychiatrists Are Probably Lying to You
Perhaps it’s time to retire the pipe dream and divorce from the billable hours
Below is a common exchange between patient and provider:
“I’m feeling really anxious and brain fog and overwhelmed.” See a psychiatrist for an SSRI.
“I’m constantly exhausted and can’t lose weight.” See an endocrinologist for metformin.
“We’re trying to have a baby, but I have PCOS.” See a gynecologist for clomiphene and/or hormonal birth control pills.
“I’m having a really hard time focusing. I wonder if I have misdiagnosed ADHD.” See a neurologist or physician for Adderall.
This is a very, very short list of what has become widely accepted as normal in our Western society: unnecessarily medicating lifestyle problems. The young woman who claims to be constantly tired and overwhelmed is not asked about her poor sleep schedule, which consists of going to sleep at 2AM and staring at her phone in the minutes before putting her head to the pillow. Her PCOS and high body fat percentage isn’t seen as resulting from a highly unhealthy diet consisting primarily of ultra-processed food, minimal protein, antioxidants, or fiber, and sugary coffee drinks instead of water. And her lack of focus can’t possibly be because she fuels her body with junk, she isn’t appropriately managing her stress, and she’s using excuses as to why she’s so sedentary. Your problems are lifestyle problems, so here is a pill to treat those.
I’m unsure why this isn’t spoken about more regularly: the rates of all of these conditions, and all-cause mortality, are sky-rocketing… at the exact same time our spending to “treat them” is. If I weren’t scientifically-minded, I’d think there was an association between pharmaceuticals and sickness…
Should you be a young student or one just starting their career in some form of healthcare, it’s important you reevaluate your purpose. I don’t say this to sound grim or hopeless, but to offer a realistic insight I wish I would’ve been taught in my years in graduate school and practicum. Cash rules everything, specifically the manner in which our country attempts to service people in need. The best way we can arm ourselves with knowledge and the thick spine needed to make it through this field with our sanity is to understand that its entire structure is based on incentivizing illness. This is done by brainwashing staff into basing treatment recommendations on those which earn the company the highest reimbursement rates. When you follow the money, you will set your mind free. You’re not a conspiracy theorist or right-wing extremist, just a person with sense who sees “helping fields” as little more than playing dress-up and billing for it. “Helping people”, at least under our healthcare system, will typically only lead to broken spirits, cynicism, and the making of another miserable cog in a dysfunctional machine. Allow me to explain.
I first went to graduate school for clinical psychology. I envisioned a rewarding career of pulling people out of the depths of their own pain and guiding them to the greener grass that their illness convinced them was little more than a paranoid delusion. My own experience with overcoming anorexia and learning to manage myself independently despite extreme discomfort was something I knew I could give to others, with the right tools and unconditional positive regard for their pain.
They were not the paranoid and mentally poisoned ones. I was the one that was deluded.
I’d find that the field of psychology, specifically that which treats psychiatric patients in hospital settings or clinics, is entirely uninterested in rehabilitation or even care. Their doctrine mirrors America’s prisons: they’re surface-level “interventions” that aim to make a point more than they hope to teach valuable skills to reintegrate stragglers into society. Healthcare agencies incentivize billable hours through use of the codes that offer the highest reimbursement rates: prescribing medicine, lengthy and often unnecessary medical procedures, or repetitive sessions with a psychiatrist. In the field of therapy for children, the highest reimbursement rates come from the use of technicians, as they’re paid like dirt but still contribute to the bulk of a company’s income. The company then profits immensely off of every one of their hours in the trenches; higher-ups don’t even have to be present, they can pay people minimum wage and call it “meaningful work”, and they can make themselves appear to be the noble ones fighting the good fight against autism or anxiety or whatever trendy diagnosis is increasing at an abnormal rate. Disturbingly, and I don’t think many young clinicians of all industries realize this: none of these billable codes require proof of progress. Literally nothing. They actually don’t even look at any form of data to determine if the intervention itself is working. They’re concerned only with the manner in which you can craft a document to make it insurance-ready.
What this means for any billable service is that billable hours can only continue if the person remains a client. I’ll continue to repeat this point until everyone out there with a God complex recognizes how limited they are in their capacity to help. To retain clients is any billable industry’s largest aim, as they’re decades and sometimes life-long patients who pay in droves to see minimal to zero progress but be told they’re receiving quality care. In fact, therapeutic fields have recently begun referring to themselves as “quality assurance providers”. What a steaming pile of horse shit. The providers are young bucks in their 20’s who were taught in graduate school to only offer band-aid solutions to very deep-rooted but also very simple problems.
We’ve begun billing for trainings covering topics like “trauma-informed care”, which essentially is a clan of women projecting their own childhood nuisances onto their young clients and believing they’re teaching them to uncover their buried trauma. This is, according to insurance and the company, “billable”. Important to note, though, is this is not for the client. It is for clinicians who like to hear themselves talk and have an inflated sense of self-importance. These should ideally be people withheld from serving mentally ill and disabled populations. But, to again refer back to billable hours… narcissists and incompetent dimwits can still bill. Why stop them?
I have yet to meet a single clinician in any medical or therapeutic field who legitimately or even remotely finds their job meaningful. I don’t honestly think it can be, so long as it’s constrained by insurance and money-hungry administration. One of the sickest aspects of therapy, specifically, is its insistence on squeezing the juice out of every clinician and client so as to preserve a steady stream of revenue. They do this through use of “making up” for billable hours lost. When clients progress, they require less therapy. It’s similar to a client that is in the ICU and becomes stable enough to be moved to a less intensive suite of the hospital. This should be worth celebrating, right? WRONG! Your agency immediately flags progress as a deficit in revenue and will proceed to demand you “make up” for any lost hours. These requirements are as silly as “making up” for .75 billable hours “missed” in a month (and no, I’m not joking or exaggerating). My best example to compare this to is the idiocy that is the “snow day”. Schools are required to stay in session for a specific amount of days each school year. Which, at this point, is comical, considering we allowed students to stay at home for 2 years because of a virus that minimally affected them and had next to zero risk of imminent harm. But I digress. If enough snow days are utilized during the school year, administration is then required to tack on these days during the summer months, to “make up for” the lost time.
When these snow days are added, do you think they repeat the same lessons that were planned for the snow day? No. If kids miss school because they’re sick, do the teachers all repeat the lesson from the sick day to make sure the recovered kids are all caught up? No. This is not how learning works. I’ve seen similar illogical reasoning in the fitness industry. A woman who was preparing to go on vacation decided to workout twice per day for an entire week, to “make up for” the time she wouldn’t be working out on vacation. Oh sweetheart. That is not remotely how fitness or even common sense works. What occurs instead on a snow day or a hail merry day is something readers have likely all experienced: a bunch of teachers and kids fucking around and complaining that they even need to be there in the first place. It is perhaps the least amount of learning that could possibly take place between school hours. So what purpose did the “make-up day” serve? It allowed the school to check off a box so they don’t get sued or their funding sources don’t get pulled. I can’ reiterate this enough: follow the money.
Similar debauchery occurs in the medical industry. Aside from acute problems, like getting a cast for a broken arm or being revived with Narcan from a drug overdose, I strongly suggest people with “chronic” conditions consider other sources of information as it relates to symptom management and recovery. Medicine and therapy are simply not designed to address the root cause of problems, as doing so runs the risk of actually helping people so they’re no longer patients. And what happens when people are no longer patients? I’d hope you know the answer to this by now.
Some scoff at my seething hatred toward billable industries, citing stories of their own success with medicine and/or therapy. I do not want to discount these experiences, and as I mentioned, there are more acute cases that billable industries do a fine job in managing. But there are a couple of things I’d like to point out, one more broad in the sense that this logic is faulty and another pertaining to our country’s sickness statistics. Regarding logic, we cannot use our own personal stories and anecdotes as exceptions to general information. For example, should I make a statement about weight-loss drugs being dangerous and not adequately addressing the behavior and psychology of eating, an individual may exclaim “BUT I TOOK WEIGHT LOSS DRUGS AND NOW I’M OFF MY INSULIN AND HEALTHIER THAN EVER!” This is wonderful! But also--- your story of taking weight loss medication does not stand to negate the factual information that was mentioned. It’s also worth investigating whether or not it was the weight loss drugs that helped, or a constellation of other behaviors (exercise, diet, nutrition education in tandem with weight loss pills).
Secondly, our country is ill. Almost disgustingly so. Over 70% of young people between eighteen and twenty-one years old are too unfit to join the military. Are you kidding me?! Being a young adult is supposed to be the age when you can do a Michelle Kwon triple-axle off of the hood of your car, onto a cement curb, and still manage to keep your ligaments intact. It’s also supposed to be an age when you’re physically spry, energetic, and more capable of running a mile without stopping than your grandmother. But for the majority of young people to be this physically unwell? I’m unsure why there is no outrage for that. Yes, let’s continue to talk about eradicating stigma for morbidly obese people.
There’s also the fact that some high-powered individuals find it useful to spend insurance dollars on making drugs like Ozempic accessible for everyone. Or that they believe accessibility is the true problem. I’m sorry, but as Andy Dufresne from Shawshank Redemption stated, “How can you be so obtuse?” In other words, I urge you to pry your head from out of your rectum. We cannot actually believe that the sky-high rates of mental illness and our country’s sickening obesity statistic is because people simply just don’t have access. And the bigger joke is perhaps the “solution”: No, don’t change your lifestyle! Inject yourself with medicine! If this doesn’t describe billable therapeutic fields, I honestly have no idea what does.
So here’s what you can do. I’m not sure you’re ready for it, considering it’s conspicuously simple. But that’s exactly the point: the media and billable institutions rely on your belief that health is complicated, confusing, and unattainable without medicinal or professional intervention. They’ve been quite successful in divorcing people from reality and their basic understandings of themselves to persuade them into a logical stupor. The fact that nutrition and basic health are complex and only available to the elite is an utter farce. The preliminary steps are straightforward and almost too accessible: Walk every day. Eat whole foods that don’t come packaged with an ingredient list and label. Strength train, at a minimum, twice per week. Sleep between 7 and 8 hours a night. That’s literally it.
But Kayla, walking won’t make me less anxious! But Kayla, eating a vegetable won’t make me lose weight! But Kayla, but Kayla, but Kayla. This is our problem: the constant and relentless laundry list of excuses as to why something won’t work even though we’ve never tried it. So perhaps some scientific evidence for the ladies (considering it’s almost exclusively women I hear produce such excuses) will be of use to better bring my point home.
PCOS is one of the most diagnosed issues amongst women, which has led to young women my age and younger having serious issues with fertility. This is unbelievable, as women my age, decades ago, could essentially blink in the direction of a male and get pregnant. One of the key drivers of PCOS and infertility problems is high insulin. PCOS, alone, has gone up 65% in the past decade, with the diagnosis affecting 20% of women worldwide. A fifth of women are struggling with fertility issues!!! This is, frankly, wild. An important aspect of high insulin and PCOS to note is how closely it is tied with being overweight and being obese: the prevalence of obesity in women with PCOS is 80%. What’s encouraging about this, though? Weight loss through lifestyle changes, like eating 800 grams of vegetables and low-glycemic fruits a day, and increasing skeletal muscle mass through strength training, can all improve insulin sensitivity. Is this prescribed by doctors, though? Likely not. Women instead are given birth control pills or metformin, and they become fast vessels for the insane amount of money required for in-vitro fertilization. A big win for insurance.
And what happens when a woman becomes a mother that is overweight, unhealthy, or obese? She may report symptoms of chronic fatigue and muscle aches that she’s given drugs and injections for, despite her highly sedentary lifestyle, mass consumption of ultra-processed food, irregular and deficient sleep, and unstable blood sugar levels. Because these symptoms have become normalized as “adulting” or “hot mess express” or simply just existing as mothers, they’re dismissed as par for the parenting course. Important to note, though, is that an obese mother with diabetes has quadruple the risk of having a child with autism, and double the risk of having a child with ADHD. Developing brains are apparently highly susceptible to irregular sleep patterns and diets laden with shit. Even antibiotics in childhood are being shown to cause issues: antibiotics dispensed in childhood increases the risk of mental health issues as children age. After all, when you’re using these drugs to “heal” by destroying the entire gut microbiome, we have to suspect that the home for serotonin production will be altered.
It's not cute to be in a constant state of exhaustion or distress. It’s not adorable to drink wine every night because we’re incapable of managing day-to-day stress. It’s not admirable to be late because we’re unwilling to better manage our time and it’s certainly not noble or “brave” to be on 10 different pills for issues that are largely diseases of lifestyle. I imagine a world when we incentivize health instead of incentivizing sickness, and we admire perseverance instead of foam at the mouth over a celebrity mentioning their struggles with mental illness. This is not “acceptance”, at least not to me. It is an unhealthy obsession with people who have serious problems, an obsession which gives us tacit permission to be lazy, to be chronically “overwhelmed”, and to assume the position of helpless.
You are not helpless. You are not confused. And you are not overwhelmed. You don’t have “gym anxiety”, you have a lack of experience in the gym and therefore you’re self-conscious about how you move your body. It’s quite similar to a child learning to walk or a person learning a new language. You’re not anxious, you’re a noob. And we all are, at some point or another. Try turning off the news or your Instagram feed for even a day and see how quickly your perception of yourself changes.