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I'm a psychiatrist. It is always amazing to me that despite four years of medical school, six years of residency and fellowships, and four board certifications,
by phren0logy 10y ago
I'm a psychiatrist. It is always amazing to me that despite four years of medical school, six years of residency and fellowships, and four board certifications, the assumption is that I have no idea what I'm talking about and have evil motives.
There are fair criticisms of psychiatry, there are bad psychiatrists, but mostly there are crappy generalizations. Good psychiatrists have an understanding of what medications can and cannot do, and a well-rounded view of the person they are treating as a whole human being.
I work with the mentally ill who are involved in criminal justice, both juveniles and adults. I can assure you, having more psychiatrists would help a lot of people.
- e40 10y agoAnd some of the problems that cause bad outcomes are outside of what you control. Laws forbidding families from getting information about their mentally ill adult children, for example. Also, "the system" (insurance companies, the courts, etc) sometimes make it very, very hard to get someone the help they need. I had a mentally ill colleague that was very difficult to help. His family was ready and willing, but it was just impossible, given the legal constraints on everyone, to get him the help he needed. He was homeless for 6-9 months before he was committed and then got back on his meds and was able to go home.
- digitalarborist 10y agoThere's a reason those laws exist. Mental health is still a taboo topic and as soon as anyone knows there's an issue the reflex is for everything to go into lockdown. This comes up on reddit with some frequency [1][2]. Some of the stories are pretty harrowing. Though a lot of this is to do with the poor state of many mental health institutions. 1) https://www.reddit.com/r/AskReddit/comments/3hlcyu/serious_redditors_who_have_been_in_a_mental/ https://www.reddit.com/r/AskReddit/comments/3hlcyu/serious_r... 2) https://www.reddit.com/r/AskReddit/comments/1tdoc1/redditers_that_have_workedbeen_admitted_to_a/ https://www.reddit.com/r/AskReddit/comments/1tdoc1/redditers...
- slededit 10y agoYou know the one interesting thing about these "sane person stuck in a mental institution" stories, is they always talk about how nuts the other people were. If it were as common as suggested that normal people end up there for slips of the tongue or other mundane reasons then I'd expect there to be more "normal" people finding each other in these stories.
- dTal 10y agoMy understanding was that being trapped in an institution with crazy people, being treated like a crazy person, stripped of your dignity, and put in isolation or force-fed medication if you try to upset the status quo or challenge your incarceration in any way is enough to drive people crazy. It certainly would me. In this personal account, someone who on admission was merely ADHD with possible depression ends up snapping and violently beating someone: https://www.reddit.com/r/AskReddit/comments/1tdoc1/redditers_that_have_workedbeen_admitted_to_a/ce6yryf https://www.reddit.com/r/AskReddit/comments/1tdoc1/redditers...
- digitalarborist 10y agoProbably that otherwise normal people just don't make it into the stories because they're not as memorable. Though often you'll hear of people otherwise healthy who are down on their luck, addiction problems, abuse, or just general anxiety and depression. The other problem is that the definition of sane changes depending on context. I recall watching a documentary on Japanese school children and their attitudes towards baseball, ritualistically crying when they lost a game. A western therapist could easily justify feeding them all meds, but in reality it wasn't particularly unhealthy. I feel like a lot of ADHD is kids being kids and teachers and parents wanting an easy way to deal with it. Lobotomies used to be common less because anyone believe they cured anyone but because they rendered the patient docile. Mental health ends up being as much about societies easy function as it is about helping the patients.
- pm90 10y agoI feel this comment really hits the spot on the current "epidemic" of ADHD diagnosis and prescriptions. Parents are sooooo worried about their kids not being "normal" (i.e. docile and obedient) that they will do anything to make that happen. I almost feel that it was better before we had modern medicine when parents were resigned to dealing with their kids' unique character instead of chemically forcing them into submission.
- heygiraffe 10y agoAny chance you could answer some questions? I'll get to them after a couple of (relevant) anecdotes. I was diagnosed with depression by a psychologist. I got a referral to a psychiatrist, and I was told that the psychiatrist would probably want to do his own assessment of where I was at & what kind of therapy would best benefit me. Nope. It was, "You've got such & such diagnosis; let's try such & such drug. Bye!" Some years later, I was treated by another psychiatrist. Same deal. Second, I've read a fair amount about various psychoactive drugs. One thing I've noted in the literature is that often drugs are only found to be effective when used in combination with other kinds of therapy: counseling, etc. So if I am taking a psychoactive drug regularly to treat some condition, then I always get regular counseling for that condition as well. I have mentioned this practice of mine to both psychiatrists, and both indicated their approval. But in both cases, counseling was never mentioned until I brought it up. I'm thinking that, if I were a psychiatrist, then I might insist that my patients get regular counseling in addition to my treatment. To avoid even recommending it strikes me (in my highly inexpert opinion) as an awful practice, possibly rendering psychiatric treatment ineffective. One might even call it a violation of professional ethics. So, my questions. 1. Would you say my experiences related above are typical? 2. Would you say that these experiences point out problems (with the two psychiatrists at least, and with the profession as a whole, if the answer to #1 is "yes")? 3. If these are problems, then what do we do about them?
- phren0logy 10y ago1. These experiences are not the norm, but still much too common. 2. Psychiatrists might not recommend talk therapies for a number of reasons (even though they probably should). Many insurance plans don't cover it, and lots of people aren't interested and want a "quick fix" to the problem in the form of a pill. Finally, the education for licensed therapist varies WILDLY, and there are a lot of really bad ones. That can make it hard to recommend in some parts of the country where few/no good therapists are available.
- heygiraffe 10y agoThanks for the reply. > Finally, the education for licensed therapist varies WILDLY, and there are a lot of really bad ones. I hear you there. I had some iffy experiences early on. But a few years ago I found a really good one. He retired, but recommended someone else to me, who also turned out to be really good. I'm seeing him these days. Maybe what needs to happen is for the norm to be that psychiatrists who see the general public (so not people like you, perhaps) do so in the context of a joint practice that includes various counsellor/therapist types as well. The approach could be that each patient is a client of the practice, with the various specialists contributing their expertise as needed. (Maybe that already happens a lot. I couldn't say.)
- Joof 10y agoEveryone's different, but as a programmer, I'd like more explaination of my psychiatrist's thought process on why they choose particular diagnosis and the medications they use. And preferably a decent bit of pharmacology and statistics of expected outcomes (especially when I ask). Obviously it's a complicated profession. The medication changes your brain and often only has moderate success. Sometimes the medications can put you into a bad mood (and who do we blame? Probably the doctor). Diagnosis are partially based on subjective information. I was ruined myself by a psychiatrist that over prescribed benzos and later tried to use her authority to sell 'multilevel marketing' goods and services. It's hard to blindly trust someone based on their degree after that.
- phren0logy 10y agoYow. Hopefully you reported her to the licensing board?
- haaen 10y agoTheodore Dalrymple (a retired prison psychiater from England) wrote a book about how psychiatry undermines morality. It is called 'Admirable Evasions' (1). One of the things he notes: many people call themselves depressed nowadays. Few people call themselves unhappy. (1) https://www.amazon.com/Admirable-Evasions-Psychology-Undermines-Morality/dp/1594037876 https://www.amazon.com/Admirable-Evasions-Psychology-Undermi...
- swift 10y agoMy money is that that guy will prove to be utterly on the wrong side of history, and in the long term serious crime will turn out to be mostly a medical problem.
- fossuser 10y agoI think part of the difficulty is that we don't have a great understanding of consciousness or how the mind actually works. It feels a bit like medicine prior to germ theory. Even for relatively more understood things like depression it's not like we can test the serotonin levels to validate it before SSRIs and then check them after. It seems to be a mixture of this seems to work, but given the high variation among people and general complexity of mental states the science is difficult.
- sosuke 10y agoIt is a difficult field I'd say only out done in complexity by nutritional science. What works for one person fails on a dozen others.
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- bitL 10y agoSome of it might come from creepy movies or sad history of psychiatric institutions, which is unfortunate. However, recently there was an unexpected result regarding schizophrenia suggesting it might be just a result of a genetic bug of extensive deletion of redundant neurons in the brain, a bio-computational problem when you look at it with the eyes of a hacker. If confirmed, this would invalidate a lot of previous research and force the whole field to take a bit different, algorithmic view on many issues.
- codefolder 10y agoDo you have a reference? I didn't hear about this
- dredmorbius 10y agoMeta-comment only: interesting handle, in context of your comments.
- mattnewport 10y agoI'm curious what you make of the claims Robert Whitaker makes in "Anatomy of an Epidemic" and elsewhere? Psychiatry comes off looking quite bad in his analysis and he is far from the only critic of the profession. My attempts to find convincing rebuttals of his claims from Psychiatrists have so far drawn a blank. In a nutshell for those not familiar with the book, he presents convincing evidence that most psychiatric medicines have no significant short term benefits over active placebos and in fact worsen long term outcomes and that the profession has been complicit in presenting unsupported hypotheses about chemical imbalances in the brain causing conditions such as depression as established fact and in pushing drugs as the primary means of treatment without sufficient evidence of their efficacy and largely ignoring worrying evidence of long term harm. I'll admit to having a pre existing suspicion of psychiatry stemming from taking a degree in psychology in the UK but after reading this book and digging more deeply I have to say it looks far worse for psychiatry than I previously imagined.
- djcjgshjjc 10y agoIt looks like meta-analyses published after that book support the efficacy of anti-depressants, are you familiar with this evidence? https://en.m.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor https://en.m.wikipedia.org/wiki/Selective_serotonin_reuptake...
- mattnewport 10y agoThis seems to be a fairly balanced (and pretty long!) review of the evidence from Scott Alexander who is a psychiatrist (I believe) which comes down on the side that the balance of the evidence is that SSRIs do have an effect that can't be explained purely as active placebo: http://slatestarcodex.com/2014/07/07/ssris-much-more-than-you-wanted-to-know/ http://slatestarcodex.com/2014/07/07/ssris-much-more-than-yo... Here's another 2014 article leaning the other way by Irving Kirsch, one of the more prominent researchers to question the evidence for anti depressant efficacy: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/ In Anatomy of an Epidemic Robert Whitaker details many of the problems around the published studies that raise real concerns how bias free the remaining positive results of these studies might be. In addition, pretty much all of the discussion above is based around short term effects and perhaps the most worrying part of Whitaker's book for me is the suggestive evidence of devastating long term effects of many psychiatric drugs, SSRIs included. Personally I think the bar should be rather higher for evidence of short term benefit for any drug than the 'optimistic' view of the evidence for SSRIs and especially in light of evidence of the drug making the condition it is supposed to treat significantly worse over the long term. Given that even proponents of SSRIs seem to accept that talk therapy is equally effective I know I'd rather take the drug and side effect free option but Scott Alexander gives a different take on that in his article, pointing out that drugs are much cheaper (and hence more profitable for both psychiatrists and drug companies as Whitaker points out in his book).
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- morgante 10y agoHow often do you cure your patients? I'm skeptical of any medical profession which seems to build and depend on lifetime customers.
- artimaeis 10y agoWhat a strange question, what does it mean to cure a patient? Say a patient goes to a doctor and is diagnosed with heart disease - is there anything that can be done to cure this? Or do we simply alleviate the symptoms to make way for a better life? This is the case with so many illnesses: diabetes, cancer, arthritis, the list is so long. But do you have the same skepticism of a doctor? Of a surgeon? We are not simple machines, us humans. When there are bugs in us they are often not currently fixable. This applies to psychiatry as much as it does to internal medicine.
- morgante 10y agoIt means to restore them to a level of health where they are not dependent on the doctor or medicine for continued care. > Say a patient goes to a doctor and is diagnosed with heart disease - is there anything that can be done to cure this? And they'd say there possibly is (such as lifestyle changes), and encourage them to pursue those changes while providing temporary medical relief. > This is the case with so many illnesses: diabetes, cancer, arthritis, the list is so long. The fact that we don't yet have a permanent cure for some of these illnesses is considered a major problem. Medical professionals are working tirelessly to find cures for conditions like cancer. Meanwhile, psychiatrists seem to be almost completely uninterested in finding or promoting permanent cures (even when such cures likely exist, including through lifestyle changes). They want to put you on a lifetime drug regime. I recognize that we're not going to have permanent cures for everything. But psychiatrists don't have permanent cures for anything. If internal medicine insisted that every condition required costly lifetime treatment, I'd be equally skeptical of it. In cases where a cure isn't available, other specialties admit that the best they can do is treat the symptoms—meanwhile, psychiatrists have an attitude that lifetime drug use is the "cure."
- 10y ago
- smegel 10y ago> I have no idea what I'm talking about Long term brainwashing can do that to people. Would you respect someone who has studied Scientology for 10 years, just because it's a long time? I think in that case, the longer the worse. Psychiatry is no different, pseudo-scientific quackery that exists largely to provide politically comfortable answers to questions society does not want to confront. Oh, and to rubber stamp who the courts excuse for crime. A generation of boys on ADHD drugs, thank psychiatry for that. It is a corrupt and disgraceful occupation.
- internaut 10y agoIn Science there exist certain topics that are minefields. Differences between human groupings. Race. Class. The Brain or Mind. Sexuality. Future/Past analysis. Most of economics. Most interesting subjects contain taboos and dangers that should you cross them, shall ruin your career or life. That is why if we're really as smart as we think we have to use the Dark Arts. I don't know what would happen to a modern day Darwin but I doubt it'd be pretty. The most controversial debate on science I ever saw was on Intelligence Squared on the subject of Organic Farming. My intuition is that one side felt strongly enough that they rigged the vote, and that the moderator knew it too when he saw the results.