Dilemma Part I

I've recently cut back to part time at work both to spend this last year of extra time with my twins, and to enable me to go back to school. I'm torn between getting an advanced degree in social work and going into nursing. This post and the next will explore the options.

If I go for social work I could do research on the needs of women with mental illness who are pregnant. The undertreatment of pregnant women can be shocking. OBs don't want to treat them because they are mentally ill, and psychiatrists don't want to treat them because they're pregnant. Women here are locked up for months with no psychiatric treatment until they have babies. Now, I don't mean any disrespect to women who choose that route with their private pay insurance and chosen physicians. Some psychiatric medications certainly have proven adverse effects on unborn children, such as neural tube defects and cleft palate, because some are class X. An insightful and educated woman with the advice of her doctor might well forego them. I'm concerned about often indigent women who have limited choices in doctors and treatment centers and little insight into their mental illness. They don't get second opinions. They don't get doctors who know them personally and are in any position to advocate for them. I don't blame this on physicians at all, I'm aware of the vastly different working conditions and institutional rules they are subject to. And doctors who do advocate treatment are bucking the system at great risk. I'm primarily concerned about the trend to prescribe class B and C medications for non-lethal conditions which are not psychiatric, but not for non-lethal psychiatric conditions. Hay fever should be treated, but schizophrenia is too mild?! What about of giving them Clozaril (B) or Haldol (C) instead of locking them up? After all, we could lock up women to keep them away from allergens. But we don't. Because we respect that they deserve treatment for their legitimate illness. Maybe if I could do research on outcomes women with severe mental illness will be treated more humanely.