4 ms·

A psychiatrist that behaves as you describe is literally engaging in malpractice. You are a perfect example of what the article describes: your rationalization

A psychiatrist that behaves as you describe is literally engaging in malpractice. You are a perfect example of what the article describes: your rationalization process for mistrusting experts seems rational at first glance, but upon closer examination it falls apart as quite simply an irrational fear used to rationalize not trusting an expert. The thing about free advice online is that... you didn't go to school for 4-6 years and practice under an established expert for years further to learn how to give good advice the right way. The idea that some jack in an online forum will provide better advice than a licensed psychiatrist simply because you're irrationally afraid that the psychiatrist will engage in malpractice -- frankly it's ludacris! It's literally insane to me. But this is how we end up with an America where multiple doctors diagnose you with cancer but your Facebook Group swears by essential oils and power crystals....

DoreenMichele 8y ago
A psychiatrist that behaves as you describe is literally engaging in malpractice. Not if he is giving the standard advice everyone in the industry gives. There are lots of conditions where the standard expectation is that "people like you don't really get well" and "symptom management is the name of the game." It would be considered malpractice to even tell people with certain diagnoses that you will shoot for curing them. But if you don't even try to get someone well, if you only shoot for muddling through, don't you think that has bearing on the kind of results you get? If actually getting them well isn't even a goal, no, of course, you won't get them well.
- criley2 8y ago
  Not if he is giving the standard advice everyone in the industry gives. There are lots of conditions where the standard expectation is that "people like you don't really get well" and "symptom management is the name of the game." It would be considered malpractice to even tell people with certain diagnoses that you will shoot for curing them. This is not a fair summary of your previous point. You previously implied that a psychiatrist will maliciously give information they know to be against the patient's interests purely to continue a financial relationship. In this second post, you have walked back your irrational and ridiculous claim from "a psychiatrist will give you bad advice so you pay them forever to" "a psychiatrist will offer you evidence and science based advice that doesn't lie to you about your condition or future and instead seeks to give you the best options or advice that evidence teaches us can help" Sure, that sounds great to me. That's why you trust an expert. Now you seem to be mostly upset that a specific mental illness or condition isn't curable and may be permanent as the result of damage or pathology, and are blaming humanity's best experts for not having a panacea for your troubles.
  - DoreenMichele 8y ago
    I haven't walked anything back. An awful lot of people are woefully misreading what I said in a much more negative light than I intended, then acting like I changed my story when I try to communicate about the issue. It's probably best for me to walk away at this point. Most of the remarks here do not strike me as good faith engagement.
    - deleted 8y ago
      [deleted]
    - jestgrade 8y ago
      If lots of people are simultaneously misunderstanding you in the exact same way, it's probably not that they're all stupid and malicious. Cf. https://xkcd.com/1984/ https://xkcd.com/1984/
      - DoreenMichele 8y ago
        No, but remarks like this essentially are malicious, regardless of whatever else is going on here. It's basically a personal attack that in no way tries to engage me about whatever point I was trying to make. The fact that you created an account just moments before taking a dig at me only reinforces the idea that this is absolutely not a good faith comment by you. There are lots of things that can cause a conversation to go sideways. It's really common for the group to then blame the person at the center. It only serves to compound and entrench the problem.
      - slededit 8y ago
        Its a malicious rhetorical tool to use attempts at clarification as evidence of retreat. That's what politicians do. People here are not professional communicators, you can't expect them to say things perfectly the first time.
        jestgrade 8y ago
        I think you meant to reply to criley above; this has nothing to do with what I said. I did not accuse anyone of "retreat"; I replied to a complaint about being misunderstood.
jjoonathan 8y ago
> A psychiatrist that behaves as you describe is literally engaging in malpractice. That's only a deterrent to the extent you can prove it, which is zero. > frankly it's ludacris! Nearly every professional I've ever been in a position to independently assess has "rounded in their own favor," often quite heavily, frequently egregiously, and always with a firm rationalization in hand. Psychiatry has especially blurry lines to round -- but you expect me to believe that psychiatrists buck this trend? Frankly, that's ludicrous.
sheepmullet 8y ago
> but upon closer examination it falls apart as quite simply an irrational fear Yet you didn’t actually explain where it falls apart. Valid malpractice claims are reasonably common in other much more measurable types of medicine. It’s often a good idea to get a second or third opinion when you see a normal doctor. To be wary of a branch of medicine like psychiatry with its far fewer checks and balances seems prudent.
- matt4077 8y ago
  Malpractice is mostly about errors of negligence. The accusation here was about intentional behaviour, which would actually be criminal.
  - sheepmullet 8y ago
    > The accusation here was about intentional behaviour, which would actually be criminal. Is that the accusation? My understanding is the parent was trying to say that incentives can bias a professionals decision making.
btilly 8y ago
You are providing an example of why people wind up reasonably overreacting to when they reject experts. The fact that someone is an expert makes them an authority figure. Whether or not they are effective is an independent question. In some areas it does. In others it doesn't. As long as that person follows the standards of practice for their profession. Believe it or not, a significant fraction of medical treatments offered have no quantifiable evidence saying whether or not they work. Admittedly a lot fewer than used to be the case since the movement towards insisting on evidence-based approaches in medicine started in the 1990s. But it has not reached all areas of medicine yet. In particular there is no evidence that talk-based therapy is better than a placebo (such as acupuncture) at treating basic conditions like depression. See http://theconversation.com/counselling-doesnt-work-in-the-long-term-86446 http://theconversation.com/counselling-doesnt-work-in-the-lo... for a random link verifying this. Now if this shocks you, then reflect on the fact that within my lifetime, therapy gave large numbers of people false memory of abuse that didn't happen, psychiatry subjected large numbers of people to electroshock therapy despite a lack of evidence that it worked. If you go back just a little further, to my parent's lifetime, tens of thousands of people had their brains very literally scrambled in frontal lobotomies (usually with an ice pick inserted through the eye socket). So here is the problem. There are lots of experts who you really should listen to. If you have cancer, don't be like Steve Jobs. But there are also plenty of professions whose practitioners who can be safely disregarded even though by all outwards appearances they are are just as expert. In a situation like this, can you blame people for identifying the wrong professions as ignorable? Unfortunately for your argument, available experimental evidence indicates that the example that you're responding to is one of the ones that actually IS ignorable.

DoreenMichele 8y ago

A psychiatrist that behaves as you describe is literally engaging in malpractice. Not if he is giving the standard advice everyone in the industry gives. There are lots of conditions where the standard expectation is that "people like you don't really get well" and "symptom management is the name of the game." It would be considered malpractice to even tell people with certain diagnoses that you will shoot for curing them. But if you don't even try to get someone well, if you only shoot for muddling through, don't you think that has bearing on the kind of results you get? If actually getting them well isn't even a goal, no, of course, you won't get them well.

criley2 8y ago
Not if he is giving the standard advice everyone in the industry gives. There are lots of conditions where the standard expectation is that "people like you don't really get well" and "symptom management is the name of the game." It would be considered malpractice to even tell people with certain diagnoses that you will shoot for curing them. This is not a fair summary of your previous point. You previously implied that a psychiatrist will maliciously give information they know to be against the patient's interests purely to continue a financial relationship. In this second post, you have walked back your irrational and ridiculous claim from "a psychiatrist will give you bad advice so you pay them forever to" "a psychiatrist will offer you evidence and science based advice that doesn't lie to you about your condition or future and instead seeks to give you the best options or advice that evidence teaches us can help" Sure, that sounds great to me. That's why you trust an expert. Now you seem to be mostly upset that a specific mental illness or condition isn't curable and may be permanent as the result of damage or pathology, and are blaming humanity's best experts for not having a panacea for your troubles.
- DoreenMichele 8y ago
  I haven't walked anything back. An awful lot of people are woefully misreading what I said in a much more negative light than I intended, then acting like I changed my story when I try to communicate about the issue. It's probably best for me to walk away at this point. Most of the remarks here do not strike me as good faith engagement.
  - deleted 8y ago
    [deleted]
  - jestgrade 8y ago
    If lots of people are simultaneously misunderstanding you in the exact same way, it's probably not that they're all stupid and malicious. Cf. https://xkcd.com/1984/ https://xkcd.com/1984/
    - DoreenMichele 8y ago
      No, but remarks like this essentially are malicious, regardless of whatever else is going on here. It's basically a personal attack that in no way tries to engage me about whatever point I was trying to make. The fact that you created an account just moments before taking a dig at me only reinforces the idea that this is absolutely not a good faith comment by you. There are lots of things that can cause a conversation to go sideways. It's really common for the group to then blame the person at the center. It only serves to compound and entrench the problem.
    - slededit 8y ago
      Its a malicious rhetorical tool to use attempts at clarification as evidence of retreat. That's what politicians do. People here are not professional communicators, you can't expect them to say things perfectly the first time.
      - jestgrade 8y ago
        I think you meant to reply to criley above; this has nothing to do with what I said. I did not accuse anyone of "retreat"; I replied to a complaint about being misunderstood.

jjoonathan 8y ago

> A psychiatrist that behaves as you describe is literally engaging in malpractice. That's only a deterrent to the extent you can prove it, which is zero. > frankly it's ludacris! Nearly every professional I've ever been in a position to independently assess has "rounded in their own favor," often quite heavily, frequently egregiously, and always with a firm rationalization in hand. Psychiatry has especially blurry lines to round -- but you expect me to believe that psychiatrists buck this trend? Frankly, that's ludicrous.

sheepmullet 8y ago

> but upon closer examination it falls apart as quite simply an irrational fear Yet you didn’t actually explain where it falls apart. Valid malpractice claims are reasonably common in other much more measurable types of medicine. It’s often a good idea to get a second or third opinion when you see a normal doctor. To be wary of a branch of medicine like psychiatry with its far fewer checks and balances seems prudent.

matt4077 8y ago
Malpractice is mostly about errors of negligence. The accusation here was about intentional behaviour, which would actually be criminal.
- sheepmullet 8y ago
  > The accusation here was about intentional behaviour, which would actually be criminal. Is that the accusation? My understanding is the parent was trying to say that incentives can bias a professionals decision making.

btilly 8y ago

You are providing an example of why people wind up reasonably overreacting to when they reject experts. The fact that someone is an expert makes them an authority figure. Whether or not they are effective is an independent question. In some areas it does. In others it doesn't. As long as that person follows the standards of practice for their profession. Believe it or not, a significant fraction of medical treatments offered have no quantifiable evidence saying whether or not they work. Admittedly a lot fewer than used to be the case since the movement towards insisting on evidence-based approaches in medicine started in the 1990s. But it has not reached all areas of medicine yet. In particular there is no evidence that talk-based therapy is better than a placebo (such as acupuncture) at treating basic conditions like depression. See http://theconversation.com/counselling-doesnt-work-in-the-long-term-86446 http://theconversation.com/counselling-doesnt-work-in-the-lo... for a random link verifying this. Now if this shocks you, then reflect on the fact that within my lifetime, therapy gave large numbers of people false memory of abuse that didn't happen, psychiatry subjected large numbers of people to electroshock therapy despite a lack of evidence that it worked. If you go back just a little further, to my parent's lifetime, tens of thousands of people had their brains very literally scrambled in frontal lobotomies (usually with an ice pick inserted through the eye socket). So here is the problem. There are lots of experts who you really should listen to. If you have cancer, don't be like Steve Jobs. But there are also plenty of professions whose practitioners who can be safely disregarded even though by all outwards appearances they are are just as expert. In a situation like this, can you blame people for identifying the wrong professions as ignorable? Unfortunately for your argument, available experimental evidence indicates that the example that you're responding to is one of the ones that actually IS ignorable.