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With respect, most psychiatrists I know generally pay lip service to the idea of psychological counseling, but when the rubber meets the road end up relying on

With respect, most psychiatrists I know generally pay lip service to the idea of psychological counseling, but when the rubber meets the road end up relying on meds. I mean think about it. If you actually believed the root cause was psychological, you would become a clinical psychologist instead of going to med school just so you could have the title of Doctor and prescribe meds. If you are one of the “other” kinds of psychiatrists, who deeply believe in psychological trauma recovery and are trying to fix the system from the inside, then I sincerely commend you for your work.

phren0logy 8y ago
I probably know more psychiatrists than you do, so I'll offer a counterpoint: Outside of starting your own practice, nobody will pay psychiatrists to do talk therapy when they can pay somebody who didn't go to medical school to do it. For this reason, we end up doing mostly medication management, but at a good clinic this is as part of a team of social workers, psychologists, occupational therapists, etc. Ironically, most US readers of HN will never have seen such a clinic, as the only places actually staffed this way are things like county mental health departments in states where they can get funded. So, anyway, psychiatry training REQUIRES that each of us provide many hours of supervised psychotherapy. Some training programs are better than others, but we all graduate with a working knowledge of psychotherapy. Many of us have less opportunity to use it than we would like. Which brings me to my final point: it's not either / or. That's a false dichotomy. It's about the right tool (or combination of tools) for the job. There are plenty of problems that there is no pill for, and a few problems that no amount of talking about it is going to fix. Horses for courses, and all that. edit: I'm sorry to see you are getting downvoted. I think many people arrive at the same conclusion you have, based on their experiences. I can totally understand how you arrived at that opinion.
- mindgam3 8y ago
  I don’t mind the downvotes. What concerns me more is the obvious logical circles you are spinning in order to make a weak argument in defense of psychiatry. Your parent comment: “I have never worked at any addiction program where psychological and behavioral interventions weren't the primary mode of treatment.“ Your latest comment: “Nobody will pay psychiatrists to do talk therapy... for this reason we end up doing mostly medication management...” So let me get this straight. You are currently doing mostly meds, and you’re presumably working at “one of the good places” where psychological methods are the primary mode of treatment. So either you are completely okay with being relegated to a secondary role in treatment (unlikely, given how psychiatrists tend to dominate the conversation thanks to that Dr. title), or, more likely, you are not being sincere when you state your belief that psychological methods are primary. Which is exactly my point. Psychiatrists by their nature and training don’t believe non-pharma methods are the primary solution. Most really try to pretend that they care, but end up prescribing meds in the end. Which was my original point.
  - phren0logy 8y ago
    I have friends who are in orthopedics, and they work with lots of physical therapists. They don't do the physical therapy themselves. Similarly, I'm the medical part of a team, and I'm cool with that. I do the parts that other people can't. It's a pretty standard arrangement and most psychiatrists who treat addiction work this way without much issue.
    - loceng 8y ago
      I think we understand those comparisons. The comparison that is missing, and where experience seems to be lacking with practitioners due to its how it has become structured, is doing therapies without harmful medications - that for many people have extremely negative side-effects, withdrawal symptoms - that some would argue cause more permanent problems/changes.
  - deleted 8y ago
    [deleted]
  - dang 8y ago
    You've crossed into incivility in multiple places here. That's not ok on HN. Please review https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html and refrain from posting like this, even when you feel strongly. I've spent years working with past trauma and many hours in therapeutic circles with traumatized people, so I completely get where you're coming from and our views are probably sympatico. But there's a risk, when one's opinions come from the same intense experiences as one's feelings do, of not leaving enough space for other people. On HN, other people means other commenters, especially ones who are coming from an opposite position. Forum comments tell us very little about who we each are, and inevitably we sketch in the gaps from material of our own past experience. This leaves exchanges fraught with misunderstanding, especially when feelings are strong. We're all responsible for guarding against that.
    - mindgam3 8y ago
      dang, I appreciate your efforts to maintain civility and I sincerely apologize if my tone came across as disrespectful towards any member of the HN community. I also appreciate you mentioning your experience with past trauma. Looking back on this comment, I agree that I could have worded this more respectfully. I will strive to do so better moving forward. I would hope that HN is a space where you can call out illogical ideas, which is what I was trying to do. I reacted emotionally because I felt like I was being trolled, which is extremely common for anyone who exposes themselves by speaking about trauma. I can see now that the intent may not have been to troll me. However, I do feel like I’m being singled out a bit unfairly here. Again, not excusing the tone of my own comment, but I’ve received a few replies that feel at least as aggressive as my own. There’s one in particular referring to the “stench” of my comment that felt a bit harsh. All I would ask is for the same standards of civility to be applied to all members. If you see that comment and legitimately believe that mine was noticeably more over the line, please let me know.
- mjevans 8y ago
  Would you also say that complex jobs require a whole toolbox, rather than just a hammer, wrench, or driver of some sort?
_carl_jung 8y ago
> going to med school just so you could have the title of Doctor and prescribe meds Your comment really isn't with respect when you make this assumption about someone's profession based off no knowledge of that person's chosen career path. I'm not sure what kind of a person knows many psychiatrists but doesn't understand that the boundary between psychiatry and psychology isn't some high garden wall whereby a psychologist tosses the ball over when they can't figure out the case.
- mindgam3 8y ago
  Undoubtedly there are some psychiatrists who pursue the title for reasons other than the fact that psychiatrists have the vast majority of the power and funding in western medicine as compared to psychologists. Surely there are some who are genuinely motivated to solve the problem of human psychological suffering. To those I have a serious question: why did you choose psychiatry over for example a PsyD degree? And: what are the key data points that make you believe that the pharma-centric approach is the one worth devoting your career to?
  - docbrown 8y ago
    >why did you choose psychiatry over for example a PsyD degree? And: what are the key data points that make you believe that the pharma-centric approach is the one worth devoting your career to? The patronizing stench of this comment aside, you’re attempting to wedge these two careers into the same hole when they are apples to oranges. At their foundation, the curriculums between the two are nowhere comparable. My psychologist has been taught to conduct _psychotherapy_ at an expert level. My psychiatrist is trained to be a _medical doctor_ on all bases with additional expert knowledge in their sub field. While you may have a certain disdain for the field of psychiatry, attempting to devalue the importance of the balance they maintain for a patient stems from ignorance of what they do.
    - dang 8y ago
      > patronizing stench That falls under what the site guidelines refer to as name-calling and ask you not to do. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html

phren0logy 8y ago

I probably know more psychiatrists than you do, so I'll offer a counterpoint: Outside of starting your own practice, nobody will pay psychiatrists to do talk therapy when they can pay somebody who didn't go to medical school to do it. For this reason, we end up doing mostly medication management, but at a good clinic this is as part of a team of social workers, psychologists, occupational therapists, etc. Ironically, most US readers of HN will never have seen such a clinic, as the only places actually staffed this way are things like county mental health departments in states where they can get funded. So, anyway, psychiatry training REQUIRES that each of us provide many hours of supervised psychotherapy. Some training programs are better than others, but we all graduate with a working knowledge of psychotherapy. Many of us have less opportunity to use it than we would like. Which brings me to my final point: it's not either / or. That's a false dichotomy. It's about the right tool (or combination of tools) for the job. There are plenty of problems that there is no pill for, and a few problems that no amount of talking about it is going to fix. Horses for courses, and all that. edit: I'm sorry to see you are getting downvoted. I think many people arrive at the same conclusion you have, based on their experiences. I can totally understand how you arrived at that opinion.

mindgam3 8y ago
I don’t mind the downvotes. What concerns me more is the obvious logical circles you are spinning in order to make a weak argument in defense of psychiatry. Your parent comment: “I have never worked at any addiction program where psychological and behavioral interventions weren't the primary mode of treatment.“ Your latest comment: “Nobody will pay psychiatrists to do talk therapy... for this reason we end up doing mostly medication management...” So let me get this straight. You are currently doing mostly meds, and you’re presumably working at “one of the good places” where psychological methods are the primary mode of treatment. So either you are completely okay with being relegated to a secondary role in treatment (unlikely, given how psychiatrists tend to dominate the conversation thanks to that Dr. title), or, more likely, you are not being sincere when you state your belief that psychological methods are primary. Which is exactly my point. Psychiatrists by their nature and training don’t believe non-pharma methods are the primary solution. Most really try to pretend that they care, but end up prescribing meds in the end. Which was my original point.
- phren0logy 8y ago
  I have friends who are in orthopedics, and they work with lots of physical therapists. They don't do the physical therapy themselves. Similarly, I'm the medical part of a team, and I'm cool with that. I do the parts that other people can't. It's a pretty standard arrangement and most psychiatrists who treat addiction work this way without much issue.
  - loceng 8y ago
    I think we understand those comparisons. The comparison that is missing, and where experience seems to be lacking with practitioners due to its how it has become structured, is doing therapies without harmful medications - that for many people have extremely negative side-effects, withdrawal symptoms - that some would argue cause more permanent problems/changes.
- deleted 8y ago
  [deleted]
- dang 8y ago
  You've crossed into incivility in multiple places here. That's not ok on HN. Please review https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html and refrain from posting like this, even when you feel strongly. I've spent years working with past trauma and many hours in therapeutic circles with traumatized people, so I completely get where you're coming from and our views are probably sympatico. But there's a risk, when one's opinions come from the same intense experiences as one's feelings do, of not leaving enough space for other people. On HN, other people means other commenters, especially ones who are coming from an opposite position. Forum comments tell us very little about who we each are, and inevitably we sketch in the gaps from material of our own past experience. This leaves exchanges fraught with misunderstanding, especially when feelings are strong. We're all responsible for guarding against that.
  - mindgam3 8y ago
    dang, I appreciate your efforts to maintain civility and I sincerely apologize if my tone came across as disrespectful towards any member of the HN community. I also appreciate you mentioning your experience with past trauma. Looking back on this comment, I agree that I could have worded this more respectfully. I will strive to do so better moving forward. I would hope that HN is a space where you can call out illogical ideas, which is what I was trying to do. I reacted emotionally because I felt like I was being trolled, which is extremely common for anyone who exposes themselves by speaking about trauma. I can see now that the intent may not have been to troll me. However, I do feel like I’m being singled out a bit unfairly here. Again, not excusing the tone of my own comment, but I’ve received a few replies that feel at least as aggressive as my own. There’s one in particular referring to the “stench” of my comment that felt a bit harsh. All I would ask is for the same standards of civility to be applied to all members. If you see that comment and legitimately believe that mine was noticeably more over the line, please let me know.
mjevans 8y ago
Would you also say that complex jobs require a whole toolbox, rather than just a hammer, wrench, or driver of some sort?

_carl_jung 8y ago

> going to med school just so you could have the title of Doctor and prescribe meds Your comment really isn't with respect when you make this assumption about someone's profession based off no knowledge of that person's chosen career path. I'm not sure what kind of a person knows many psychiatrists but doesn't understand that the boundary between psychiatry and psychology isn't some high garden wall whereby a psychologist tosses the ball over when they can't figure out the case.

mindgam3 8y ago
Undoubtedly there are some psychiatrists who pursue the title for reasons other than the fact that psychiatrists have the vast majority of the power and funding in western medicine as compared to psychologists. Surely there are some who are genuinely motivated to solve the problem of human psychological suffering. To those I have a serious question: why did you choose psychiatry over for example a PsyD degree? And: what are the key data points that make you believe that the pharma-centric approach is the one worth devoting your career to?
- docbrown 8y ago
  >why did you choose psychiatry over for example a PsyD degree? And: what are the key data points that make you believe that the pharma-centric approach is the one worth devoting your career to? The patronizing stench of this comment aside, you’re attempting to wedge these two careers into the same hole when they are apples to oranges. At their foundation, the curriculums between the two are nowhere comparable. My psychologist has been taught to conduct _psychotherapy_ at an expert level. My psychiatrist is trained to be a _medical doctor_ on all bases with additional expert knowledge in their sub field. While you may have a certain disdain for the field of psychiatry, attempting to devalue the importance of the balance they maintain for a patient stems from ignorance of what they do.
  - dang 8y ago
    > patronizing stench That falls under what the site guidelines refer to as name-calling and ask you not to do. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html