As a mental health professional who has spent the better part of the last seven years working with dually diagnosed patients in community mental health settings, both outpatient and residential, I can say that The Sun's attempt to report on the subject is misleading and sensationalistic ("Hooked on treatment," Nov. 7 and "Sheltered addicts, strained recovery," Nov. 8).
In regards to the question of diagnosing correctly or incorrectly, this is no simple matter of either-or. And while I'm sure that may of my colleagues will disagree with me when I say this, diagnosing mental illness is rarely an exact science; for instance, a patient's presenting symptoms can change regularly, therefore producing any number of differing opinions depending on the circumstances. So to cite some disagreements about a patient's diagnosis, including from the patients themselves, is a true oversimplification of a very, nuanced process.
When talking about the over-diagnosing mental illness, this too deserves more attention. Any person in recovery, and maybe even active addiction, will say, "You gotta be crazy to put that stuff in your body!" With that in mind, there is inherent emotional stress that comes with active addiction. The severe emotional distress that is consistent with the lifestyle can bring about real symptoms ranging from insomnia and anxiety all the way up to suicidal thoughts and attempts. So when an individual presents after having been in active addiction for an extended period, any number of psychiatric diagnoses may be appropriate. But these symptoms may also stabilize or even disappear as the patient's situation stabilizes.
In regard to the questions of how the residential facilities are run, while I agree that someone with 90 days clean or less does probably not have enough clean time to be in charge of others who are also in early recovery, the writer makes no attempt to contextualize this within the culture of recovery. I am referring to the point of high esteem in a person's recovery when they can begin to "give back" and help others earlier in their processes.
And why would the writer make several references to the "open air drug" markets and corners that exist close to BBH without also talking about the fact that any time a residential treatment facility attempts to open up within a neighborhood that has any sort of tax base, there is, at the very least, some protest.
Nor is it mentioned that BBH, and other facilities like it, are based within the communities where drugs are an epidemic because that is where the need is. Any practitioner of the helping professions can tell you that you need to go to where the client is, not make them come to you.
It seems that the writer was attempting to make a point without explicitly stating it, probably due to lack of hard evidence. While I have multiple issues with the public administration of both substance abuse and mental health treatment in the city of Baltimore, I also know that these are complex, multi-faceted issues that deserve more than just tabloid headlines. I invite The Sun to attempt such a story again but without the pre-determined agenda.
Nicholas W. Seldes, Baltimore
The writer is a psychotherapist in the Johns Hopkins Hospital Community Psychiatry Program.