health care

My therapist maybe as much as anyone else in my life is responsible for the person I am now.

A couple of months ago I learned my therapist is retiring. Last week I had my last session with him. Off and on for more than a decade, he has helped keep me on an even keel. Not only during the turbulent times of my life but also when its waters were calm.

When I arrived in Hawaii I was recovering from a not-so-small breakdown; one reason I moved here was to get away from a significant source of stress and heartbreak. With no plan to make Hawaii home, I came here to “sort my shit out,” which included seeking out therapy (and medication if need be). While I had been in worse shape not that long before arriving here, I was still pretty screwed up at that point.

Dysthymia and Pills

So, before I had any job or health insurance, I saw a doctor at Leahi Hospital in Kaimuki. I only went the one time. After some testing and questioning, the doctor there was the one who diagnosed me with Dysthymia. I knew then I couldn’t be casual about finding a regular doctor, but a steady job and health insurance were both important prerequisites.

The idea of “shopping for a shrink,” as I called it, was not remotely appealing to me. So I count myself incredibly lucky that I was able to find this doctor from a referral rather than by trial and error.

In the beginning, I was singularly focused on trying to understand what the hell was wrong with me. At the time I believed that if I could understand the root causes of my mental dysfunction, I would be able to make corrections.

Eventually, my therapist convinced it that the causes mattered less than getting better. I recall I resisted a causeless approach, but I was determined to get better. So I acquiesced.

In addition to an insistence on finding root causes of my dysfunction, I was fundamentally opposed to accepting any kind of medication. At the time, though a part of me really understood what it meant to be depressed, I didn’t think I needed medication to get sorted. And again, he convinced me it was worth a try.

And so I did.

For better or worse, it quickly became apparent that medication wasn’t going to help with what was wrong with me. For that I needed good, ol’ fashioned talking it out.

Off and On Maintenance

That was more than ten years ago.

Eventually, I got to the point where I didn’t think therapy had anything to offer me. After years of frequent and regular sessions, it felt like I was graduating to a new life. Or, at least a new perspective.

I was happy consistently for the first time I could remember. Or at least what seemed like happiness; I was content. And so it was for years. Until the wheels came off my wagon again and I resumed appointments.

After some time, I returned to my own equilibrium, but continued what I now refer to as “maintenance therapy.” Some weeks are better than others, and the regular check-ins have done a good job keeping said equilibrium.

I’m in pretty good shape now, for the most part. I don’t claim to be “fixed.” After several small relapses and at least one big one, I’ve accepted completely both the good and bad in me. Maybe I’ll be even better in the future, but for now… I’m good.

Retirement and Thanks

I’ve had doctors retire and relocate on me in other areas of my life. Since being diagnosed with Crohn’s Disease, I’ve been passed along through four Gastroenterologists. While annoying, none of those changes necessitated a blog post.

My therapist, maybe as much as anyone else in my life is responsible for the person I am now. Maybe there will always be a part of me that is broken. But for the old me, for the former me that would have been enough to send me retreating to the dark corners of my brain. The now me both understands I might change and accepts if I don’t.

That may not sound like much of a revelation, but for me, it’s the difference between happiness/contentment and dysfunction.

So this retirement and changing of the doctoral guard is, for me, much more meaningful. Poignant. I am thankful for who I am now. I like me. And for being able to say that I have my therapist to thank. While an appointment to a new therapist is pending, it’s hard to imagine I will be as lucky to have another that I like and so appreciate.

Change, for me, is somewhat challenging and this change is no different. I write this to remind me of the good work I did with him. The work he did with me. And to say thanks.

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I’ve been an introvert, avoiding crowds and mingling with new people, since I was young. For a long time, I though my shyness a hinderance, something that needed fixing. Like so many things about me.

As I’ve gotten older, however, I’ve learned to accept, to a certain extent, the way I am, rather than trying to “fix” myself. This isn’t to say self-improvement isn’t a good thing, but within realistic expectations. I will never be an extrovert. I’ll never be completely comfortable in crowds or with new people. But over the years with help and practice, I’ve gotten to the point where I can overcome these character traits in limited bursts.

And I think I’m fairly good at it. I know how to be polite, personable, and how to talk to relatively large groups of people without freaking out. But it comes at a cost. One I didn’t completely understand until I went to Washington D.C. to complete my Masters Degree capstone project.

D.C. Was a Tiring Blast

I had a great time in D.C. I, for the first time during the two-year program, had the opportunity to meet some of my fellow classmates. Because the program is entirely online, we took classes together, but resided all across the country: Virginia, New York, Nevada, Florida, Michigan, Nebraska, and more. With different backgrounds, career paths, and political ideologies, we were quite the hodge-podge of folks.

While I enjoyed the days spent together with these fine people, being “on” as it were, for eight to 10 hours a day was exhausting for me. Yes, there was moving around, getting up early, and having to be mentally sharp during the day, but it was really the social interaction that took the biggest toll on me each day.

Constant Reminder

Though I learned better my limits during the D.C. Residency, I was nonetheless reminded about those limits just a week ago.

It was Opening Day of the Hawaii State Legislature. A day for pomp and food and talk-story. And glad-handing and lobbying.

In the past when I’ve attended the Opening Day festivities, I’ve usually done so with friends and long-time colleagues. Though socializing is involved, it has always been easy because I’m around people I know fairly well. But this year, as I branch out doing some consulting on my own, I travelled the halls of the Capitol with a new client.

It was fun, to a point, and I think we made some good contacts. When I decided it was time to return home to do some other work, I said goodbye to my client and made my way home. I had every intention of doing work. But once I got home, changed clothes and sat down for a minute, I was hit with a wave of exhaustion. Despite knowing my socializing limits and the toll it takes on me, I was surprised at how tired I as all of a sudden.

A nap was required.

A Measured Approach

Most people I know who are involved in political activism are extroverts. They enjoy the work in all the ways which I force myself to be good at. In all the ways it energizes them, it knocks me out. And though this is something I know about myself, I also think it’s something of which I’m going to have to be regularly reminded. Long days of socializing, meetings, engaging at the Legislature and Council, etc. likely won’t end with me back at the home office doing more work. They’ll likely end with me laid out, mentally and physically exhausted.

Knowing this and trying to adjust for it might mean limiting how much time I spend each day, or week, being “on.” And it might mean late afternoon naps followed by late night sessions at my desk. In any case, Opening Day was a reminder about knowing my limits and doing a better job accounting for them.

I accept these aspects of my personality, though sometimes I wish it was a bit easier. A bit less work. Maybe as I get older and continue to “practice” it’ll become easier. But I’m not counting on it.

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Some of my friends and colleagues have been opposing bills which would abolish the Hawaii Health Authority (HHA). The HHA was established back in 2009 “to develop a comprehensive plan to provide universal health care in Hawaii.” Unfortunately, while the Legislature established the HHA, it and three different Governors have neglected to give them any funds for staffing, etc.

I believe those good people opposing Senate Bill 977, among others, are missing the forest for the trees. Abolishing the HHA doesn’t close the door on universal health care in Hawaii, but rather changes how the State might go about creating a plan.

And while they bird-dog the HHA issue, they have, neglected to pay attention to other, more damaging bills. House Bill 407 is just one example, that I became aware of myself just the other day.

The bill, Relating to Insurance,

Authorizes the issuance of employer-sponsored high deductible health. Requires maintenance of health savings accounts in conjunction with high deductible health plans. Requires the employer to fund deductible costs. Specifies that employers and insurers that buy or sell high deductible health plans remain subject to the Prepaid Health Care Act.

This is a bad, a dangerous bill.

Currently, Hawaii has no high deductible health care plans. In fact, I believe the State had previously asked for a specific waiver from the ACA partly to avoid having to create such a plan. But now, the Legislature is considering reversing course.

The bill’s upside would mean insurance premium cost savings for employers who opt for these high deductible plans. It also allows for the creation of Health Savings Accounts (HSAs).

Put another way, the bill shifts health care costs from employers to their employees by requiring high deductibles. So, the hotel industry, for example, while doing gangbusters with high occupancy rates and higher room rates, wants to keep more of that money by cutting benefits to their employees.

Make no mistake, that’s exactly what this bill does. By reducing their premium costs, they are also forcing their employees to pay more out-of-pocket before their insurance kicks in. Sure, workers may save some money with the assistance of HSAs, but in the long run they will be paying more while their employers are increasing their profit margins.

Intended to makes people more discerning about why and how often they see their doctor, high deductible plans actually reduce positive health care outcomes for people. That’s because high insurance deductibles serve as disincentives for people to seek health care.

Only employers benefit from high deductible insurance plans.

Hopefully HB407 will become one of hundreds of bills that won’t make it to the finish line. Until then, I encourage you to take a look at the bill, spread the word, and do what you can to oppose it and others like it.

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