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Listening to St. John's Wort

MANAGED CARE July 1998. © MediMedia USA

Listening to St. John's Wort

What's a doctor to do when her patients embrace the untried and outlandish — sometimes with their insurers' blessings?
Doreen R. Orion, M.D.
MANAGED CARE July 1998. ©1998 Stezzi Communications

What's a doctor to do when her patients embrace the untried and outlandish — sometimes with their insurers' blessings?

Doreen R. Orion, M.D.

When I recently moved my psychiatric practice to Boulder, Colo., I expected some major adjustments. Managed care was just taking hold here, and I knew I'd have to somehow find a niche in an area with one of the highest per-capita concentrations of therapists in the country. I soon discovered, however, that the plethora of peculiar practices performed in this community "nestled between the mountains and reality" seemed to put the psycho squarely into psychotherapy. In conservative Tucson, the biggest obstacle to reimbursement had been overcoming patients' tendencies to keep conflicts to themselves; in Boulder, I find myself practically begging my patients to restrict their conflicts to this lifetime, if not this planet.

Since moving to Boulder, I have been confronted with crystal therapy, magnet therapy, Hakomi therapy; rebirthing, regression, rebalancing and holographic repatterning; auras, aromas, and astral projections; primal scream, past-life regression and prenatal communication; mystic grandfathers, transformational energy shifts and equine myofascial release. It all makes me long for simpler days when only EST epitomized strange therapies.

The Number One bizarre "treatment" I have come across is the unfortunately all-too-aptly named "auto-urine therapy": drinking one's own urine to flush toxins from the body. Kidneys and porcelain? How passé. One particular perpetrator — ah, purveyor — of this practice wrote in his ad that he did not meet his clients in an office. Rather, he met them in a coffee shop (inexpensive and expeditious) and was never encumbered by time constraints (What, no other appointments to rush off to?). I, personally, would rather keep the toxins. Now, on to Number Two.

After all that toxin-rinsing from the front end, the back end clearly deserves its own spin cycle. Never fear — colon hydrotherapy will plunge in, rectifying any remaining obstructions to expulsive wellness. Any clinging enemal enigmas are flushed out during their initial appointments; potential patients are reassured by claims of "state-of-the-art equipment" and "all tubes disposable." Well, why didn't they say so in the first place? Bear down with me here: Colonics, after all, have historically been a path to exceptionally earnest enlightenment.

I imagine that after suffering through auto-urine therapy and colon hydrotherapy, long-distance healing (what we used to quaintly refer to as talking to the patient on the telephone) would sound pretty appealing. Although one of its practitioners claims to be a "personal success coach," she obviously does not feel the need to meet her clients personally.

Another long-distance healer specializes in doing so "on a cellular level" — but is that anatomy or telephone technology? Perhaps she acts as her own case manager, restricting sessions to off-peak hours to cut costs. In any event, in addition to helping people achieve telephonic relief from depression, addictions and panic attacks, she also purports to treat colds, flu and arthritis over the wires. So can I. "Phoning in a prescription" is what I call it.

I can't help wondering if all the far-out treatments out there are a response to years of therapies (and the practitioners who love them) pushing back against managed care — in a kind of "if you can't beat 'em, enjoin 'em" mentality. In trying to avoid the constraints of their nemesis, the proponents of these questionable practices do set themselves apart, but at the expense of reinforcing the very problems that engendered management in the first place -- the health care industry was out of control and needed regulation. In performing treatments that are beyond the fringe, they endanger their patients by providing the illusion of effective care, thus discouraging access to what might be truly healing.

Adding insult to injury, isn't it a wonder that so many of these so-called therapies are called "work"? Body work, breath work and dream work, to name a few — these are tags that foster the impression of sweat and sacrifice, when in fact, these "therapies" offer the patient nothing more than a quick, painless feel-good fix.

My husband, a medical director at a local psychiatric hospital, who frequently finds himself in the position of explaining to skeptical primary care colleagues what he plans to do for their patients, feels particularly pressured by these mental hygiene high-fliers. The gatekeepers, used to snickering "no" to core energetic, polarity and integrative body psychotherapies, can hardly be blamed for their suspicions when my husband proposes any type of legitimate psychotherapy. In Boulder, after all, there's bound to be a planetary healer in the woodwork.

Still, I've got to make a living. So, I am contemplating remedying the deficits in my medical education (which taught me how to be a doctor but not to practice like one) by taking courses in aston-patterning, osto-craniosacral balancing and esogetic color puncture. Why invest time in the O.R. when I'll be able to perform "psychic surgery?"

But, enough of this irksome reflection. I'd much rather bask in the glow of my firelight crystals, breathing in (slowly and with my chakra) Bach flower essences, guided by feng shui as I ascend my own unique path to spiritual emergence, intuitive empathy and kundalini energy while remaining grounded in my tantra. And believe me, it's no small feat keeping your feet on the ground when you astrally project, a technique that will enable me to visit other dimensions, times and planets, spreading my reikian healing across the galaxy and into past and future lives (only with their permission, of course, and that of all their past and current inner children).

Maybe I can get Medicare to cover this.

Doreen R. Orion, M.D., is the author of I Know You Really Love Me: A Psychiatrist's Journal of Erotomania, Stalking, and Obsessive Love (Macmillan 1997). It will be published by Dell in paperback this month.