Saturday, June 18, 2011

The Top Ten or More Things That Annoy Me About Psychiatry Haters

I'm trying to heat things up a little in anticipation of our "Hot Grand Rounds."

The Top 10 (or more) Things That Annoy Me About Psychiatry Haters

10.  Repetitive posting to the same anti-psychiatry links on Shrink Rap comments.
  9.  Insults directed by psychiatry haters at the Shrink Rap bloggers.  Disagreement is one thing, insults are another.
  8.  Insults directed at other commenters on Shrink Rap. 
  7.  The implication that all (or even the majority) of psychiatrists are purposefully evil and have mean intentions when treatment has bad outcomes.  Most of us don't have personal relationships with the devil. At least I don't think so.
   6.  The implication that we can foresee that medications will cause side effects, adverse effects, or be ineffective, or that we're using them with the intent to control people.  Our knowledge is limited by a lack of  research in our field, a limited number of available treatments, and the fact that people respond differently and unpredictably to the same the treatment.
   5.5 The implication that psychiatrists uniformly push medications on unwilling patients.  In the outpatient setting, patients often come requesting medications, or requesting to continue medications that they have found to be helpful.
   5.  Statements that someone was perfectly fine until they took psychotropic medications.  People generally seek psychiatric care and medications because something is wrong.  This is not to say that medications don't have side effects that might be worse than the problem they were treating.
   4.  Statements that psychiatrists personally benefit by keeping patients in the hospital and  "incarcerating" people who are well for prolonged periods of time.  Psychiatrists are under tremendous pressure to keep lengths of stay as short as possible, they have to personally call and argue with insurance companies to justify each day of inpatient care--this is not fun.  
    3.  Statements that psychiatry "incarcerates" people without due process.  There is due process, but it takes time, and it is true that someone can be kept on a hospital unit for days until 1) the psychiatrist is able to make a reasonable evaluation and 2) the legal system is put in motion-- most hospitals have a specific day of the week where a judge comes to hear both sides.  In any system that employs due process, there is the possibility of miscommunication, misinformation, misunderstanding, lying, or mistakes. 
     2.  The implication that the average practicing psychiatrist had some way of personally knowing that Big Pharma manipulated research and withheld side effects and adverse effects of medications and they should have not prescribed those medications.
    1.5.   Sensationalism by the media on the all of the above in an unbalanced way.  For example, there was a recent news story about how atypical anti-psychotic medications are prescribed for agitation to patients with dementia when they do not have a FDA approval for this indication.  The article did not mention that there is no medication that has FDA approval for agitation in dementia.  The article also does not give any examples of things such as patients who are miserable in their agitation, who strike their caregivers, who repeatedly end up injuring themselves.  (This isn't to say that I believe that it is always appropriate to give patients with dementia antipsychotic medications, or that giving these patients a better environment or improved care wouldn't allow them to manage without them, it's simply to say that I would want journalists to present a balanced view with a number of scenarios).
  1.25  Implications that psychiatry as a field is inflexible, finds itself above reproach and is unwilling to listen to criticism.  We still have a long way to go to reach perfection, but every year things change:  we've come a long way from the days when someone could be committed to a hospital for years for trivial reasons, we look at treatment more as a partnership, and we have more (albeit imperfect) treatments to offer.   There are too many ways to list how care has changed over the last 50 years.  My gripe is not with criticism or with a desire to change the way things are done, it's with a particular form of delivery of the message.

And the number one thing that psychiatry haters say that annoys me:

 1.  The implied statement, "This psychiatric medication harmed me so it should be illegal for anyone else to take any psychiatric medication."   It's disrespectful to those who find medications to be beneficial.

To read many of the comments on our Shrink Rap posts, one might think the psychiatrist-patient relationship is an adversarial one.  I just haven't found that to be true.

Comment away, and please don't forget to submit your Grand Rounds posts by Sunday night!