6 ms·

But that doesn't mesh with "start my own private practice." Either those concerns apply to his original job and his new practice, or neither. Something doesn't

But that doesn't mesh with "start my own private practice." Either those concerns apply to his original job and his new practice, or neither. Something doesn't seem to add up...

dmurray 6y ago
The full quote is > At some point, I may start my own private practice, where I’m my own boss and where I can focus on medication management – and not the kinds of psychotherapy that I’m most worried are ethically incompatible with being a public figure It seems believable to me that "medication management" (you've been diagnosed with a mental illness, we have an idea how to treat this chemically, but it's a really complex balance that needs constant professional intervention) is less sensitive to being a public figure than other aspects of psychiatry (lie on the couch and open up to me with your personal secrets). I'm sure this is a ridiculous simplification and as I said in another post here I'd like to hear SSC's take on it (but don't expect to). But it's uncharitable to say "something doesn't add up".
canjobear 6y ago
His new practice will be medication management, not psychotherapy.
- unityByFreedom 6y ago
  When people go this route, do they still see or talk to another therapist? I always figured people's chemical imbalances were influenced by behavior. If you just treat the chemical imbalance without addressing the behavior, isn't that rather risky?
  - acituan 6y ago
    They do. Psychotherapists cannot prescribe medication but are licensed to deliver psychotherapy. Psychiatrists, who are MDs, can prescribe medication but also can do psychotherapy if they choose to do so. I even know psychiatrists that only do psychotherapy and won't do medication management. To complicate further, non-psychiatrist MDs can also prescribe certain classes of psychotropic medication. Either way, pharmacotherapy is rarely administered alone, usually psychotherapists refer patients to psychiatrists if they believe pharmacotherapy can be beneficial, and with patient's consent they can share notes. He will be that therapist.
    - unityByFreedom 6y ago
      > pharmacotherapy is rarely administered alone, usually psychotherapists refer patients to psychiatrists if they believe pharmacotherapy can be beneficial, and with patient's consent they can share notes. He will be that therapist. I see, thank you for your reply.
  - deleted 6y ago
    [deleted]
  - dragonsngoblins 6y ago
    It is really a case by case thing. I have ADD but with chemical treatment I'm basically fine and don't need other intervention. I go in to see someone a few times a year to get another prescription but I didn't really need any cognitive psych stuff. All the "behavioral" problems I may have had were largely caused by the underlying imbalance and just stopped once I was on it. Or at least, stopped enough that they are no longer a problem for me, and I think really once a behavior isn't causing issues in your life it is probably hard to classify it as a "problem"
Barrin92 6y ago
my original thesis was, and I got quite a lot of flack for it at the time, that it's going to mightily piss his patients off if they ever figure out that he's blogging about them, if only in anonymized form. I think this really is the issue here with his employer, and I honestly always found it extremely weird, maybe unethical that he wants to avoid his patients figuring out that their stories may appear on a public blog.
- sillysaurusx 6y ago
  Ah. Thank you! That’s an entirely reasonable theory that fits the data. I didn’t realize he blogged about his patients. Do you happen to know of any examples of articles he published along those lines? Now I’m curious what he said...
  - Barrin92 6y ago
    https://slatestarcodex.com/2016/07/12/34/ https://slatestarcodex.com/2016/07/12/34/ here's one, I don't know if he put that preface on all of them, apparently he fictionalises them and mixes them up.
    - sillysaurusx 6y ago
      https://slatestarcodex.com/2014/08/31/radicalizing-the-romanceless/ https://slatestarcodex.com/2014/08/31/radicalizing-the-roman... is another. I think your theory is spot on.
    - searchableguy 6y ago
      > I know that if I don’t change the medication, he will probably be a zombie like this until such time as somebody else does change it, which may be never. But if I do change the medication…well, there must be some reason somebody put him on that, and the idea of somebody who needed that much medication not being on it is too horrible to imagine. Also, I’m only seeing him once, and then he gets transferred to someone else. What do I do? > The maxim is “do what lets you sleep at night”, so I punted. I kept him on his medications and turned him over to the next guy. I just hope the next guy gets my documentation instead of thinking “Dr. Alexander kept him on all this medication…I wonder what he knows that I don’t.” Oh man, I have noticed this same behaviour with doctors. I think how we portray doctors and hospitals as isn't aligned with practice. People really lack the skills to express their issues succinctly to doctors and expect them to figure out everything when they couldn't in months or years. The idea that a 30 min conversation is enough for doctors to know your entire life and medical history to prescribe you relevant medicine and diagnosis is flawed. Many people omit details out of fear and shame. Not that doctors are better at communicating that as a message. It's really like an interview.

But that doesn't mesh with "start my own private practice." Either those concerns apply to his original job and his new practice, or neither. Something doesn't seem to add up...

dmurray 6y ago

The full quote is > At some point, I may start my own private practice, where I’m my own boss and where I can focus on medication management – and not the kinds of psychotherapy that I’m most worried are ethically incompatible with being a public figure It seems believable to me that "medication management" (you've been diagnosed with a mental illness, we have an idea how to treat this chemically, but it's a really complex balance that needs constant professional intervention) is less sensitive to being a public figure than other aspects of psychiatry (lie on the couch and open up to me with your personal secrets). I'm sure this is a ridiculous simplification and as I said in another post here I'd like to hear SSC's take on it (but don't expect to). But it's uncharitable to say "something doesn't add up".

canjobear 6y ago

His new practice will be medication management, not psychotherapy.

unityByFreedom 6y ago
When people go this route, do they still see or talk to another therapist? I always figured people's chemical imbalances were influenced by behavior. If you just treat the chemical imbalance without addressing the behavior, isn't that rather risky?
- acituan 6y ago
  They do. Psychotherapists cannot prescribe medication but are licensed to deliver psychotherapy. Psychiatrists, who are MDs, can prescribe medication but also can do psychotherapy if they choose to do so. I even know psychiatrists that only do psychotherapy and won't do medication management. To complicate further, non-psychiatrist MDs can also prescribe certain classes of psychotropic medication. Either way, pharmacotherapy is rarely administered alone, usually psychotherapists refer patients to psychiatrists if they believe pharmacotherapy can be beneficial, and with patient's consent they can share notes. He will be that therapist.
  - unityByFreedom 6y ago
    > pharmacotherapy is rarely administered alone, usually psychotherapists refer patients to psychiatrists if they believe pharmacotherapy can be beneficial, and with patient's consent they can share notes. He will be that therapist. I see, thank you for your reply.
- deleted 6y ago
  [deleted]
- dragonsngoblins 6y ago
  It is really a case by case thing. I have ADD but with chemical treatment I'm basically fine and don't need other intervention. I go in to see someone a few times a year to get another prescription but I didn't really need any cognitive psych stuff. All the "behavioral" problems I may have had were largely caused by the underlying imbalance and just stopped once I was on it. Or at least, stopped enough that they are no longer a problem for me, and I think really once a behavior isn't causing issues in your life it is probably hard to classify it as a "problem"

Barrin92 6y ago

my original thesis was, and I got quite a lot of flack for it at the time, that it's going to mightily piss his patients off if they ever figure out that he's blogging about them, if only in anonymized form. I think this really is the issue here with his employer, and I honestly always found it extremely weird, maybe unethical that he wants to avoid his patients figuring out that their stories may appear on a public blog.

sillysaurusx 6y ago
Ah. Thank you! That’s an entirely reasonable theory that fits the data. I didn’t realize he blogged about his patients. Do you happen to know of any examples of articles he published along those lines? Now I’m curious what he said...
- Barrin92 6y ago
  https://slatestarcodex.com/2016/07/12/34/ https://slatestarcodex.com/2016/07/12/34/ here's one, I don't know if he put that preface on all of them, apparently he fictionalises them and mixes them up.
  - sillysaurusx 6y ago
    https://slatestarcodex.com/2014/08/31/radicalizing-the-romanceless/ https://slatestarcodex.com/2014/08/31/radicalizing-the-roman... is another. I think your theory is spot on.
  - searchableguy 6y ago
    > I know that if I don’t change the medication, he will probably be a zombie like this until such time as somebody else does change it, which may be never. But if I do change the medication…well, there must be some reason somebody put him on that, and the idea of somebody who needed that much medication not being on it is too horrible to imagine. Also, I’m only seeing him once, and then he gets transferred to someone else. What do I do? > The maxim is “do what lets you sleep at night”, so I punted. I kept him on his medications and turned him over to the next guy. I just hope the next guy gets my documentation instead of thinking “Dr. Alexander kept him on all this medication…I wonder what he knows that I don’t.” Oh man, I have noticed this same behaviour with doctors. I think how we portray doctors and hospitals as isn't aligned with practice. People really lack the skills to express their issues succinctly to doctors and expect them to figure out everything when they couldn't in months or years. The idea that a 30 min conversation is enough for doctors to know your entire life and medical history to prescribe you relevant medicine and diagnosis is flawed. Many people omit details out of fear and shame. Not that doctors are better at communicating that as a message. It's really like an interview.