Thursday, September 23, 2010

What Do You Want To Know About Psychiatry?



When you work in any setting, your view of it becomes distorted. Your vision becomes tunneled, and the world looks small. My husband came home one day upset because a client had burst into tears while they were talking. "Why does that bother you?" I asked. Apparently it's not something that happens a few times a day for him. And when I was a medical student on an oncology ward, one of the doctors came in for rounds late---on her to way to work she'd seen a young man get knocked off his bicycle by a automobile. She'd stopped to help, and her first question to the young man was, "Are you a smoker?" She quickly realized that it was not a particularly relevant question in that setting.

So do people in the real world have questions about psychiatry? What are they? What a time to ask: just as our book goes for it's final draft. I should have asked before-- What do you want to know? Maybe we're wrong about what we thought people want to know. Maybe we need to write a second book.

The good news is that after several requests, the jacket designer has agreed to add a duck. Bless our editor for asking--- no clue how she explained that one.

Why do I feel like we've been working on this book forever? Clink will tell you, "because we have."

So what questions do you think the general public has about psychiatry? Go for it.

24 comments:

tracy said...

Why do so few Psychiatrists do therapy? Is it because they can make so much more money in a much shorter time being "Drug Cowboys"?

Extra credit for knowing where i got the name! ;)

tracy said...

Yay for the duck!

Anonymous said...

Bloody obvious.
1)Is it a real science, aside from the dithering with the new drugs?
2)Can it help me?
3)How do I know what my child/friend/husband “needs a little help?”
4)Why do only the well-off, rich, and destitute receive care?
5)What are the objectives? What constitutes treatment?
6)When is enough is enough? When can I extracate myself from this clique?
7)What can I do that is preventative?
8)Do you or does anyone else know the answer to these questions; can they even be given in a book?

Imagine your worst reviewer. Now do everthing you can to avoid him/her using the word “facile” and "flippant" in the review.

Anonymous said...

That's FUNNY. Your husband comes home upset because someone cried and you're like, why is that upsetting--isn't that something you see every day, take a MAN PILL! You don't see me getting bent out of shape at all the criers I see!

Retriever said...

I would think that it must be frustrating having the insurance companies refuse to cover so many things. I know that many times relatives were discharged when they were still ill because insurance would not cover them, and I would imagine it is hard to send an ill patient back into the community. Because the stuff about care in the community is so much BS. THere is none: it all falls on harried families.

Then I would imagine it is frustrating that people assume that you just push pills. I would imagine that the most rewarding psychiatry would include doing therapy (brief and length) as well, even if the meds help some people. Because many people are ONLY helped by therapy, and by lengthy psychodynamic therapy, not just cookbook CBT type therapy.

I'm interested in the degree to which you think diagnostic categories may have become muddied by the need to assign a code on the chart to make sure the patient gets at least some reimbursement from insurance. Because nobody but the rich can afford psychiatric care without insurance, but so many conditions have limits or are not covered. Also, perhaps, by the desire not to alienate an increasingly clinically literate patient population. If someone asks you "What do I have?" and you tell them something vague, but they then look up the code that you put on their insurance form...a stigmatizing diagnosis may become an issue.

This may be a factor in the explosion of ADHD diagnoses for kids in my area (many of who are actually more likely to grow up to be bipolar like their hypomanic parents, or else just oppositional defiant or some other more dire diagnosis).

Mostly, I wonder what it's like to be so desperately needed by so many people who cannot afford your services. Or to know that the military are so desperate for shrinks, and can't recruit enough. Or that we can't persuade enough people to go into child psychiatry. You are very needed, but the meds are still so primitive and fail so many people. At the same time, the healing power of a therapeutic relationship has been so devalued by insurers and popular culture (perhaps simply because there aren't enough shrinks to spend the time with people?)

Sorry to ramble on.

Charlie said...

Do you "analyze" people in your head in social settings, like those who you converse with at a cocktail party?

tracy said...

i think most Psychiatrists just randomly assign a code for insurance companies, such as "Depression" or what not, as many conditions, such as the one i have, are considered by the majority of people, including Mental Health "Professionals" , as "Untreatable".
To find a good Psychiatrist who did therapy would be a joy. i would pay cash and we are far from "solvent". It would be well worth it.

tracy said...

Retriver "Well said...that was laid on with a trowel." What you wrote was excellent and filled with so much valuable information. Thank you!

The healing power of the therapeutic relationship is sooo very powerful!

Anonymous said...

What happens when a psychiatrist gets a mental illness? It's like that Latin saying, Quis custodiet ipsos custodes 'who will guard the guards?'

Dinah said...

Thanks, all, this is helpful.

We didn't really answer any of these questions, more we "addressed them""

Psychiatrists and therapy: yup, we got it.

Who needs help? Well, sort of: why people seek treatment. I think that also clarifies objectives.
When to stop: please call me when you get that answer...usually when the treatment goals are met. For people who continue on meds for years, some contact usually occurs for a very long time.

Retriever: Clinically diagnosis matters if there is a prognostic difference--so it's good to think about bipolar disorder in someone with depression because you may not want to prescribe antidepressants (or only with a mood stabilizer)...but often, clinically it's not that urgent...if is being treated appropriately with psychotherapy, it doesn't matter so much what it's labeled, and clinicians often use NOS (not otherwise specified) codes and they get reimbursed.

Anon: editor already kabashed all the flippant everythings!

Charlie: not usually, unless a diagnosis SCREAMS at us...

We talked a fair amount about the money and insurance issues and we addressed the question of "Are Psychiatrists Crazy" and should they all get care.

Tracy: I agree: Yay for the duck!

Dinah said...

Thanks, all, this is helpful.

We didn't really answer any of these questions, more we "addressed them""

Psychiatrists and therapy: yup, we got it.

Who needs help? Well, sort of: why people seek treatment. I think that also clarifies objectives.
When to stop: please call me when you get that answer...usually when the treatment goals are met. For people who continue on meds for years, some contact usually occurs for a very long time.

Retriever: Clinically diagnosis matters if there is a prognostic difference--so it's good to think about bipolar disorder in someone with depression because you may not want to prescribe antidepressants (or only with a mood stabilizer)...but often, clinically it's not that urgent...if is being treated appropriately with psychotherapy, it doesn't matter so much what it's labeled, and clinicians often use NOS (not otherwise specified) codes and they get reimbursed.

Anon: editor already kabashed all the flippant everythings!

Charlie: not usually, unless a diagnosis SCREAMS at us...

We talked a fair amount about the money and insurance issues and we addressed the question of "Are Psychiatrists Crazy" and should they all get care.

Tracy: I agree: Yay for the duck!

Anonymous said...

Why does taking anti-depressants help with anxiety, too? How do you think these medications work on our biology?

Do you think a mental illness is crippling? Do you see your patients as 'sick'?

How is your understanding of mental disorders changing?

Rach said...

What about people who are anti-psychiatry? What's your response to them?
(Don't mean to make waves, just thought of this as I make my way through academic reading)

Hi to all! Long time no speak!
~Rach

Anonymous said...

Can you really "retrain your brain" or is this just "the power of positive thinking" in a post-modern context?

Sunny CA said...

I have a question regarding the stance that a patient must "take medications for the rest of his/her life". That's what I was told following a breakdown at age 55, with no prior history of mental illness. Once I finally found my current talk-therapy psychiatrist he disagreed with the diagnosis and urged me to go off the medications, which I did and it's been fine (much better actually!!) without them. HE says that many people have a single incident of having a breakdown when under unusually stressful circumstances. Why do other psychiatrists slap people on meds and refuse to consider taking them off? (and simultaneously refuse to listen to the patient and come up with their own narrative, different from the patient's reality).

Karen said...

I would like to know how you determine if a seizure is "real" or a psychogenic nonepileptic seizure.

Website Designing Company USA said...

Hey, I'm a medical student and I have bipolar disorder. While I don't know the rules exactly, I think having a psychological illness would not disqualify you from being a doctor. You would need to apply to a medical school first, but the thing is, they have no access to your medical/psychiatric record. However, for the patients' sake, you need to look beyond the rules and ask yourself whether your condition would possibly put them at danger. If you truly believe you won't, then I say go for it. Getting into med school and getting through it takes forever though (Total of 4 years before you're even a Psychiatrist, then 2 years after that before you're certified), so if you wanna do it, start now.

snoring solutions said...

I know that many times relatives were discharged when they were still ill because insurance would not cover them, and I would imagine it is hard to send an ill patient back into the community.To find a good Psychiatrist who did therapy would be a joy.

Anonymous said...

I have bipolar disorder. Can I become a psychiatrist?

Maggie said...

The #1 question in my mind as soon as seeing a book on this topic is "How consistent is this? How much information is a book by three psychiatrists who are friends going to give me about psychiatrists in general?"
This is a question that comes to mind an awful lot when I read your blog, too. You say a lot of things that seem to be inconsistent with my experiences, which makes it even more difficult to sort out how applicable anything you say might be in regards to any other psychiatrist. Three psychiatrists who blog about psychiatry and are particularly interested in how people in general and patients (and family members of patients, etc.) view psychiatry seem like a very skewed sample from which to draw any conclusions about the profession in general.
(Okay, maybe that's not the first thing that would occur to "the general public" as I seem to be fairly alone in my insistence on representative samples. It's so difficult to apply logic and objectivity to this topic that I cling to what I can.)

Ladyk73 said...

Oh.....
we got our support ducks! When does the book go on sale?

My questions would be about personality disorders. You take on the treatment of the severe cases (borderline)

I would also want to know if my current mental fog is from the illness or the meds. It seems like my memory and cognitive abilities have suffered alot since I "breakdown."

Anonymous said...

Do you think it's helpful or harming to label a patient with a mental illness, and refer to that label often? Do labels help the person separate themselves from the illness? Or do they create a self-fulling prophecy or an "excuses"?

InLuv said...

How do you handle erotic-transference? What do you do when a patient actually thinks/feels that they love you? And is this response always due to previous sexualabuse?

Dinah said...

Let's see if I can remember all the comments

Anon: Do we see our patients as "Sick" great question. I think of them as people.

Rach: We do mention the anti-psychiatry movement.

Anon: I don't know if you can retrain your brain but I'm all in favor of all positive efforts. Let me know if it works.

Sunny CA: meds for the rest of your life is a matter of risk calculation. There's no precise answer for an individual, but it generally felt that the risk of relapse is higher for certain disorders, for people who've had recurrent episodes, and for some disorders, for folks over 50. If someone has a had a particularly bad episode and it may be felt that it's not worth any risk of relapse, especially if the meds are well-tolerated. There's risk either way (of relapse, of dysfunction, of meds causing health problems) and often our knowledge of what will happen is limited to populations and isn't about what will happen to the individual.
Stuff like this is in the book.

Karen, in difficult cases people are sometimes hooked up to video EEGs and monitored in the hospital. Other times the symptoms either do or don't jive with a diagnosis of seizures, and many with pseudo seizures also have seizures. It's not in the book.

Snoring solutions: we talk a lot about insurance issues.

Maggie: well we think our book has a lot to say about psychiatry in general! What do we say that isn't consistent with your experiences.

Lady AK47 (oh, I hope you don't mind my sense of humor): May 2011. We do talk about personality disorders. And we talk about adverse reactions to meds, but not specifically about mental fogs.

Anon: labels....I'm not a fan unless they guide treatment. Some people find it a relief to have a label that offers some explanation.
We talk a lot about the issue of accommodation versus excuse.

InLuv: I have not dealt with a patient's profession of love or attraction. It would make me uncomfortable.