For experts and for lay people offering impractical advice.

From Addendum: "Why didn't she just...?" by Freddie deBoer.  He had a post the other day about a woman's experience in psychotherapy and received such a deluge of email that he had a second post just to respond to common themes in the emails.  One issue in particular caught my.  

“Why didn’t she just get a new therapist?” This was asked not only of the therapist in question but the prior one who she conceded she had not been making progress with. It’s a frustrating question, for me. Let me use my personal example to discuss this one: I have had deeply imperfect access to mental health care over the past two decades, given that this is the American medical system, but I have had superior access to most people. And I still have consistently struggled to get into therapy. I should have been in therapy constantly given my mental illness and my biography. But I’ve barely been in it at all. Consider immediately after my last hospitalization. I was highly motivated to get a therapist; my life was a wreck, after all. I had time away from work to look. And I had access to NYC union health insurance, which is well-known to be strong despite years of erosion of benefits. What’s more, New York has one of the highest therapist/analyst/mental health professional densities in the world. I don’t have kids and my schedule was more flexible than that of most.

And yet trying to find a therapist was a nightmare. A truly discouraging number of places didn’t take my insurance or take insurance at all. Out of pocket costs that were cited were like $300 and up. Tons and tons of promising-seeming options were not taking new patients and several told me there were waiting lists. Also, many told me that they were “not the right therapist to meet your needs” when I told them about my bipolar disorder and recent psychotic episode. Two more discouraging stories. First, I went to one place, had an intake appointment, everything seemed fine, at the end the guy said “your appointments will be Mondays at 2:00 PM.” I said, that doesn’t work for me; back then I worked 8 to 4 PM, and it would be an hour commute on either side, meaning I’d be leaving work at 1 PM every Monday and not returning. I couldn’t imagine asking that of my boss. I’m sure I could have forced them to let me for ADA compliance but I was already in a very awkward situation given everything that had happened, and for the record I liked that boss. So that was out.

The other one really pissed me off. I had been having so many problems with insurance that I made sure that the therapist I was going to see was in-network. I went, had the intake appointment, it went great, she said they could be flexible with my work schedule, and then she said “your therapist will be Dr. X.” I was surprised. It turned out she just did that intake appointment and would not be my full-time therapist. That was annoying as I just shared a lot with her, but fine. I then found out that the therapist she assigned me to did not take my insurance, despite being part of the same group/place/whatever as the woman I had researched. Let me remind you that an intake appointment typically involves delving into some personal and traumatic background information. That incident left me feeling completely powerless.

I see this all the time in social policies designed by people with university degrees, living in nice neighborhoods in intact families, and a solidly middle or upper-middle class life.  They have a relative blindness to the operational aspects of life for people outside those conditions.   

I gave an example of this last week in Time is money - Using mass transit takes on average 1.4–2.6 times longer than driving a car.  All the city planners who are trying to get more people to use public transportation (and failing) seem to consistently ignore the time value of money and that time is the one thing for which we are equally constrained.  None of us have as much time as we wish. 

City planners think they are doing something good, and they certainly are striving towards a desirable outcome (equal access, lower cost, etc.) but that is not what they are delivering.  Were they to have their way, they are discounting poorer people's time 360% compared to wealthier people traveling by car.  

Similarly with bike lanes.  I live in a city with a desultory commitment to bike lanes and a resident population substantially opposed to them.  The actual facts of bicycling as an enhancer of community well-being just do not match measured reality. The percent of the population for whom bicycles as a primary source of commuting is practical is miniscule.  See some past posts for details.  

Ideologues and advocates simply have a hard time understanding the life patterns of anyone other than themselves.  Their enthusiasm is estimable but their will to power ends up causing more harm than good.  

I like deBoers' post because he is of the chattering class but has mental health challenges which makes him more knowledgeable than most.  More importantly, he pays attention.  As he says, he is far better positioned to change therapists than most and yet even for him there are numerous unconsidered barriers.  

Time to invoke once again the formidable H.L. Mencken in 1920.

There is always a well-known solution to every human problem—neat, plausible, and wrong.  

For experts and for lay people offering impractical advice.