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!












  

63 comments:

rob lindeman said...

Dinah, is there any criticism of psychiatry that's true? Just askin'.

Anonymous said...

You mean, you aren't intentionally evil, only accidentally? You can't see the future??? What?? And, you aren't getting rich off of hospitalizing patients for years on end? Blows my mind...

:-) One thing I am learning from your blog is the tremendous number of factors you have to balance, not just with the patient him/herself, but with the system and available resources. Apparently you don't get a magic wand when you get your medical license.

Aqua said...

I would like to expand on the number one reason chosen from my ( a psychiatric patient) point of view.

Anti - Pychiatrist posts often trigger huge feelings of shame in me. If I do not have a psychiatric illness, ie. A medical illness, then the implication is that I am the one perpetuating all my symptoms.

If that is true then I am not trying hard enough to get well. I have let everyone I love down, because if I tried harder, if I really cared about my family and friends I could change.

I do try, I have always tried to be a better daughter, sister and friend, but all my thoughts tell me I am bad, useless, worthless and not worthy of existing in this world.

Thank god I have the best psychiatrist I can ever imagine having. Without him I literally would not be here. His caring and empathy, his knowledge of medications and his non-dogmatic use of various therapy techniques, medications for my symptoms and making himself available for weekly therapy, coupled with his not giving up on me despite my illnesses' unrelenting treatment resistance upon me has provided me with the tools to help myself live through all my hellish symptoms.

If you don' like psychiatry, then please, for both our sakes, move on to something you do like, or you will end up like the many of us who really need psychiatry to help us

Sunny CA said...

I understand your desire to not be abused on your blog and I also dislike the hate message, but this comes across as though you do not believe that there are people who have been treated poorly within the mental health system. I am one of them. My in-patient experience was a nightmare. I now have a psychiatrist I love, but this does not mean that I have forgotten how I was abused. If you could experience just one of my in-patient days, you might understand why some people become angry at the practices that do, in fact, exist today in your field.

Anonymous said...

As a patient, what most annoys me about the haters is the rudeness. They think it's somehow OK to butt in to other peoples' business because they're "passionate" or "caring" or somehow "smarter" than the rest of us.

BS -- they're proselytizers. They're like the guy with the bullhorn that's on every college campus (with a poor dog in tow) shouting "Repent!" "You're Doomed!"

And the idea that I would give up my own thoughts about medical treatment to follow the musings of some arm-chair expert? Absurd!

But, hey, they do provide some amusement.

Anonymous said...

Agreed with Sunny CA. I suspect most(!) psychiatrists cannot comprehend the humiliation and terror that comes along with psychiatric misconduct, because you would not have believed it possible. I also would have assumed such stories were mostly drama or revenge-seeking...until I experienced bad psychiatric care masquaerading as the best in the field.

That said, there is another unquantifiable factor that comes with vulnerability and shame in psychiatry. If I have a lousy experience with a dentist who performs unneeded procedures, makes bad clinical choices and is overall cruel, I don't blame dentistry as a whole. That said, the next dentist I see will likely be able to recognize the truth of what happened from the state of my mouth, whereas with psychiatry, the next psychiatrist is thoroughly conditioned to take whatever truths I say as false - after all, I am seeking help for mental illness, and after all, the crappy psychiatric treater is a colleague.

You three perhaps may put yourselves in that camp; however, 1) I suspect on some level you do, and 2) if perchance you truly don't as a general rule, you are fooling yourselves to think that you are the rule and not part of an exception.

I understand it is frustrated to hear so much anti-psychiatry, however I think most comments I've read here are trying to get you to acknowledge reality, even if you three believe you are - or perhaps truly are - above it yourselves. In that case, I count your patients lucky...and part of the exception.

Anonymous said...

I have to agree with Sunny CA. I have a good doctor. I am not anti-psychiatry. I don't need to add to Sunny CA's comment-it was well put.
Number one reason I like my psychiatrist is the recognition on their part that a lot of harm has been done by the mental health system and that people suffer as a result.
I am sorry that you suffer so much from some people who are anti-psychiatry. There are worse things to focus on.

Anonymous said...

I think the nasty posts you doctors get are nothing compared to the abuses heaped on patients in state hospitals, which happened to me.

I have made it clear that I was hoping to function better, but instead I was lied to and doped up on high doses of antipsychotics, reducing functioning.

Many psychiatrists are willing to completely sacrifice a patients psyche if they think it will save the patient from suicide. To a doctor, apparently a living death on high doses of antipsychotics is better than a risk of suicide.

Some people have terrific recovery (but would they have gotten better anyway?), but for those of us with serious mental illness, the system is dishonest and coercive. I would leave the mental health system if I could, but I am not able to work and need to have my ongoing problems documented.

I find it difficult to believe that antipsychotics could help restore functioning in anyone. Heck, I couldn't even go to the bathroom no matter how much Miralax and Milk of Magnesia I took. Agony.

It is really something special to be inpatient and realize your psychiatrist has more issues than you do, and this doc has control over you.

Anyway, I think the problem is this biological model of mental problems got pushed way way way before its time and it was a lie that mental health treatment is as effective as for other health problems.

Anonymous said...

i think your spam filters may be overworking again. i left a post that i doubt you would have deleted deliberately.

Anonymous said...

1. "Psychiatry hater" is itself a generalization of critics of psychiatry. Surely there is a middle ground? Some firmly grounded criticism? You have done what you accuse "haters" of doing. You can and should do better.

2. Yes, psychiatrists should know more about the effectiveness and risks of the medications they prescribe. They should let patients know the limits of their knowledge. And they should take some responsibility for the damage they do.

3. Yes, many psychiatrists do overprescribe, and do pressure patients to take drugs.

4. I don't hate psychiatry or psychiatrists, but I have permanent damage (severe tinnitus) from a psychiatric drug (Wellbutrin), and based on my experience, psychiatry--with its recklessness, ignorance, and irresponsibility, is just too dangerous to take chances on.

Sarebear said...

As I've said once before, I think the negative stories that have happened to people tend to lead to such things coming up in blog comments much more than positive experiences would, because people who had a positive experience don't have an urge to try and bring their experiences to light, as those who've had bad experiences do.

I've had my own bad experiences with psychiatrists, so I'm not completely clueless in that regard; I've had positive ones as well.

I do not say any of the above to diminish, demean, or invalidate any experience that anyone has had, positive or negative. I just say it to point out that there really isn't a segment of people out there going around and posting or commenting about their great experiences, nearly as much as the segment of people who've had bad ones.

Do people who have had negative experiences have plenty of reason to voice their troubles and hopefully try to bring some change? Sure. But to always expect the shrink rappers here to acknowledge EVERY FACET there is to every issue of treating patients every time they post, is a bit too much.

I don't think their post implied that negative experiences don't happen. I just think it wasn't on the list of annoyances. It is likely a deep concern to them that the flaws in the system and the flawed practitioners out there end up mistreating people, sometimes horrifically.

At the same time I think it would be ridiculous to expect them to mention these things every time they post.

And I don't think the title of this post is Dinah doing the same thing to psychiatry critics that she says they do to psychiatry. I think it fits the theme of the grand rounds, and I think it is one way to describe SOME of what SOME critics do/believe/say/espouse. Whether or not it's the BEST way I'm not going to judge; there's far too much judging that goes on around here, and I wish people would lighten up on that.

rob lindeman said...

There is due process, but sometimes it takes time? In other words: incarcerate first, apply due process later. That's not due process. That's Newspeak.

Imagine search warrants issued after a home is invaded and ransacked. Do you call it a "reasonable search and seizure"?

Sarebear said...

I believe that due process that sometimes takes far too long is the best an often overloaded system can do.

Whether or not I'd like to be on the receiving end of that due process is kind of beside the point, because I'd rather that if I was wanting to kill myself and refusing to admit myself, as has happened recently, that if I'm trying to pull my plan together and do it, that I would rather be alive and railing against everyone who's involuntarily committing me (at least, when I returned to a more healthy state of mind, at the time I'd probably still want to die, but that's why they'd be putting me in there in the first place), than be DEAD and leave my daughter without a mother and husband without his wife.

Hrmm, I oughtta read that again and help it settle in . . . lol.

Since I suspect that those who have little regard for the reality of how due process works, and I suspect that those who have little regard for involuntary commitment, will never see my point of view, I am not sure why I am posting it.

Probably because I'm tired of being afraid to post an opposing viewpoint, which leads to less of my type of viewpoint being heard.

I disagree with the harshly negative views of the processes involving involuntary treatment.

In fact, my oldest brother benefited greatly from his time in prison. He came out of prison on meds (I don't think he was forced to take them, I think he was happy to finally have someone trying to figure out what was wrong with him, why he kept behaving the way he did), and working on changing his life. It was slow, especially in the beginning, being not sure where one was headed but being sure that you wanted to improve; after a year or two of processing the fact of what he had done as well as having been in prison, he really started to turn his life around even more after he had his feet back under him. I can say that he is MUCH, MUCH better because he finally received treatment (though I suspect he was glad for the treatment, though it happened behind bars at the beginning). I am not saying he is better off for having committed a crime; it would have been better had he not done that. BUT since his behavior DID land him in jail, it resulted in the best one could hope for out of that situation, the kind of positive outcome that I suspect Clink hopes for and has hopefully had with some of her patients.

I've probably put my foot in it somewhere in here, but since he DID do what he did, you'll not EVER get me to believe that being treated in prison wasn't the best thing that could have happened to him, given what had happened.

Dinah said...

All: The 'hater' reference is to the delivery, not the content. And hater is a facetious term, borrowed from the kids--


Aqua: thanks, next time around I will include the implication that those with illness should be able to snap out of it or pull up those bootstraps.

Anon: I'm not so sure about the concept that psychiatrists are conditioned to hear what patients say as false... I'm not sure what to say to that. Shrinks don't all like each other and there are some pretty bad shrink stories out there.

SunnyCA: You are definitely not a hater! : )

Sarebear: Exactly! Also : )

Rob: Perhaps we can just agree to disagree?

jesse said...

I don't think we are conditioned to hear every patient complaint as false. The psychiatrists I know are good at telling good treatment from bad treatment. One can't tell all the time, of course, but the more you know about a field the better you may be in discerning whether it is being practiced well or not.

It has, though, been a surprise to me to hear all the complaints about involuntary, etc, and I'm grateful to those who have thoughtfully explained what went wrong. Thoughtfully. I hear better when people are thoughtful and moderate.

Lisa said...

Sarebear is so right about many not knowing the good aspects of psychiatry because those people have found a way to manage their illness, have generally good experiences with their care team, and have no reason to talk about their experiences.

I do genuinely believe that psychiatry helps to treat illnesses and helps people learn to live with their disabilities. I do not think that psychiatrists are inherently evil. I think psychiatrists generally take on that profession out of a sincere desire to help people.

Still, it's often hard to remember this as I never hear from those who've had overwhelmingly good experiences with the mental health field. Blogs, support groups and anecdotes by friends and family are ones that scream out "I was screwed by a psychiatrist!" I tried searching out self-help memoirs to find people who had an overall good experience and I haven't found anything.

It's even harder to remember that psychiatry is helpful when I look back on my own experiences. Everything from involuntary lock-up/treatment when I admitted that I had homicidal and suicidal thoughts (though no plan or history of acting on these thoughts), to not being allowed to see my doctor (though being billed for the missed session) simply because my card had expired and I forgot the new one, to spending a year trying out various medications and then suddenly being told at the end of one session not to return since I was not doing well with the medication he felt comfortable prescribing, to psychiatrists dissing on past doctors I have seen, to being ignored when I tell them that I have had severe episodes when prescribed particular anti-depressants. The list continues.

These experiences and what I hear and read from others tells me that people who hate on psychiatry don't know about the good that comes of it. I'd like to hear someone with an overwhelmingly positive story. It'd give me and others I know hope that there is hope in continuing to seek out treatment instead of succumbing to our paranoid, delusional, manic, depressive, miserable existences.

Zoe Brain said...

Are there incompetent psychiatrists? Yes.

Are there sociopathic psychiatrists?
Yes.

It's the proportions that are important.

I've come to the conclusion that anyone who wants to be a psychiatrist is crazy. You try to help some really suffering people, people whose psychic wounds bleed all over you, and much of the time you can't. There's so much about psychiatric science we don't know. So much of common practice is un-evidenced, superstition and conjecture that's taught as fact. Yet it's the best we have. If it works - who cares if the theory behind it is purest phlogiston?

Even the easy bits, where there's neuro-anatomical pathology, and there's medications that have objective proof of cure or amelioration, the side-effects can be severe.

It's a dirty job, but someone's got to do it. I hope the cases where you *have* made a difference, where you've done good and *know* you've done good make up for the times that you know you've been unable to help - yet empathise with the patient (and often, those around them) so feel echoes of their distress.

I truly don't know how you do as well as you do - even if that is a 30% improvement rate. It must take keen observation, intellect and ability to integrate that with past experience. A large dollop of human compassion too. Patience, dealing with the bureaucratic nonsense just to get paid. And a sense of humour too.

Did I mention Ducks?

All the best, Zoe

Anonymous said...

Also annoying (from a reader's perspective):

- when a few people use the comments as a stage to launch a battle of the egos about whether mental illnesses are ‘real’ or not.

- when commentors are more concerned with winning the game of debating than challenging themselves and their own thinking or genuinely engaging with the experiences of others.

- when heart-breaking personal stories are shared in order to discuss some point relevant to the post and they are completely ignored.

Sunny CA said...

This is somewhat off-topic, but it is a positive story for those looking for one. Since I was hospitalized (the only time) in late 2005 I have wondered how much stress I can handle (and fearful of pushing too hard), and I am much more cautious about the amount of stress I take on. I went through a career change in 2008-2009, earning my teaching credential in summer, 2009, but with layoffs in teaching I ended up as a substitute during the 2009-10 school year. In fall 2010 I was hired, finally, in a charter school as the only high school science teacher, teaching 4 sciences: Earth Science, Biology, Chemistry, and Physics (two Biology, so 5 periods total). It turns out this is NOT a low stress profession, but I made it through the year (last day was Thursday)! I made it with the help of my psychiatrist, who helped me sort the important obligations from those I could jettison or shortcut. He has always asked what I plan to do for recreation to keep me focused on spending some time relaxing and recuperating from each difficult week. He supported me emotionally and helped reassure me I was handling the stress level. He helped me explore my feelings and thoughts throughout the year. I feel that this first year of teaching is likely the hardest I will ever face because now I have a year's lesson plans for 4 sciences, and labs, tests, outlines, etc which should make my life easier. I never thought I could accomplish this post-breakdown, and could not have without my psychiatrist.

Anonymous said...

We love you, Dinah!
As Sarebear said, those who don't have an axe to grind are generally silent.
I am a doctor who has seen a number of psychiatrists. All tried to admit me to hospital but I was too scared of what might happen.
Even in my relatively privileged position, I found it hard to find a good psychiatrist. My earlier psychiatrists were bad to average, but I felt they were trying their best to help me. My experience has not made me hate psychiatry or psychiatrists.
Keep up the good work.

Anonymous said...

Dinah, I was greatly bothered by this blog entry but wanted to wait to respond until my thoughts were clearer. I finally had a light bulb moment regarding this comment:

"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."

That comment is very invalidating. That would be like telling someone who was raped by a policemen that most cops aren't bad.

And before anyone flames me for using the "r" word, I used it because in my opinion, being forced to take meds against your will as described by people on this blog is a chemical rape.

A woman who owns the blog. Raising Bipolar, about her son who has the disorder, writes that when he was hospitalized, he was over medicated as punishment. Definitely, not the writings of a crazy scientologist.

I am also bothered by this comment because the person I feel you are criticizing, particularly took a risk and revealed that one reason for his views was that his son was the victim of a false BP diagnosis and suffered horrific side effects from medication.

Not once did you acknowledge the pain he or his son experienced or even thank him for posting those comments. As you know, I have been critical of his tone but if you're going to empathize telling all sides of the story, I think you have to practice what you preach.

And I would love for you to meet that person I have mentioned on this blog who was forcibly committed against her will for daring to question her psychiatrist about a med side effects. Her crime was she got admittedly belligerent when he attributed her complaints to her mental illness. This was a person who has taken heavy duty meds for years without complaint.

And before you claim this is an isolated incident, it isn't and happens way too frequently.

Finally, you act like that if the anti psychiatry activists would shut up, everything would be fine and dandy.

But as I keep stressing on this blog, it is the folks who are in the mental health system who have a concern about abuses in psychiatry. You don't see them on these blogs either but they exist.

Claiming that everything is fine in your neck of the woods doesn't deny the reality that in many areas, psychiatry needs to be reformed big time.

AA

Anonymous said...

Anon 1:
My GP has a magic wand, every time I end up with a cold or flu (that was bad enough to need a note for time off work) I whinge that he can't "cure" me! He waves his magic wand and tells me I'll be well in 5-10 days! And I always am!

Anon 3: I totally agree.
I too have had many bad experiences with psychiatrists. What I think is different from other medical professionals is the nature of the problems themselves.
Not just how serious the illnesses can be, and the horrendous impact they have on peoples lives. There is also the factor of blame and shame on behalf of the patient. In addition the fact that often your opinions of symptoms or past treatment can be discounted purely due to the fact that you are mentally ill and therefore your perspective MUST be skewed.

Anon 5: Antipsychotics are the MOST AMAZING thing that has happened to me. So yes, there are people it works for. Admittedly it took a while to adapt and adjust dosages and timings but I got there and it's FANTASTIC!
And did you know... that person who just passed me in the street can't see inside my soul, and they don't want me dead. Who knew!!!!! :-)

I do have a few questions though;

- Why are there so many psychiatrists that either appear to have no social skills or are just inept? If they have interviews on intake to med school, why not interviews focusing on ability to communicate with psych residencies?

- As Sarebare said, why do we communicate hatred more readily than likes and loves? Why do we get more invested in communicating these? Is this a kind of evolutionary protective mechanism? If individuals in a society are more open about hates and problems then they will eventually be changed or 'fixed'. But we don't recapitulate good experiences as much because nothing needs changing?

Lisa: I don't know if this is overwhelmingly positive; but it has resulted in some very positive things.
I attempted suicide and after I was medically cleared I was an involuntary patient for around a month. In this hospital, I for the first time was treated with respect and care by the nursing staff. They really were there to take care of my and help me. They told my parents to leave when I wasn't able to do so myself. The 20 min checks, while annoying were actually very reassuring. In a sense I was able to sit back, not fight the suicidal feelings and let them take care of me. I didn't have to worry. The consultant was insensitive and had the empathy of a 'brick wall', but the resident was so caring and sensitive and she even had a sense of humor. We fiddled with meds, arranged for leave for me to continue with my psychologist and generally let me take a load off and have some respite. I know that the ward I was in, was not like your usual ward, but being forced into a psych ward for a month has ended up being one of the better things that has happened to me.

Dinah, you seem to be getting a bit down about all the haters. I hope that even if they have had negative experiences that they at least gain from reading your blog. After all that is why many of us read. To see what some psychs think and to learn a little more about the profession.

I would at least like to thank the three of you. (And quietapine.)
-Bec

John Allman said...

In reply to: "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."

I have never once witnessed a psychiatrist-patient relationship that was anything OTHER than adversarial.

My experience? Several decades ago, I was a student mental nurse for eight months, before being fired, but not for misconduct, nor for poor achievement academically.

Over 20 years later, and over ten years ago, I was sectioned in my own home. Since then, I have known many people deprived of their liberty and/or treated without consent, and attended their appeals against being sectioned.

At appeals against being sectioned, the idea that psychiatry was anything other than an exact science that enabled predictions of human behaviour did not appear to be an idea the psychiatrists we were fighting admitted that they were even capable of admitting, even under the sternest cross-examination.

Yes, there is "due process" of sorts. But this is within the framework of legislation at odds with international conventions on the rights of disabled people. (See "How mental health law discriminates unfairly against people with mental illness", by Prof George Szmukler.)

In the face of such routine perjury to the effect that psychiatry is a proper, experimental science, that enables predictions, it is not surprising that so few patients win their appeals, even when they aren't drugged senseless in court to make them look like dribbling, shuffling morons.

Anonymous said...

Sarabear,

It is not that every single experience is a bad one. There are cases in which due process is overlooked and those cases are more than a few. After you have been admitted involuntarily, you may find it will stick with you forever such that if you go to the hospital with some unrelated problem, even years later, you could find your psych diagnosis predisposes the staff to treat you as a crazy person. I am glad that prison helped your brother. I hope you never experience a psych hospital stay and that you stay well for your daughter. If you ever need the hospital, I hope you know your rights.

Anonymous said...

I am anon #5, I believe

I want to point out to those of us who had poor results with psychiatry or had our rights abused that it is FAR more effective to make a few effective arguments than to argue shrilly that psychiatry is a fraud and all psychiatrists are abusers etc. What you do by arguing in that manner is to turn off your potential "converts" to your point of view. In order to persuade people to listen to your message, that psychiatry often harms more than it helps, and that the system is coercive and often violates due process, it is better to be more moderate in tone, so people unfamiliar with the issues will listen to you, and those on the fence will be more likely to see your point of view also.

Nobody will listen to extremist positions unless they already agree with you, but then you are preaching to the choir, right? If your motive is to caution people against psychiatric treatment, or to persuade psychiatrists to be more empathic with patients, or for society to get rid of forced treatment, the extreme tone is counterproductive.

jesse said...

I have no doubt that the stories of the negative things that happened with patients are true, and they have been enlightening. How can the system can be improved? There are many safeguards put in place to protect patients, and they don't always work well. I'm sure that in certain hospitals, parts of the country, or for different economic groups those safeguards are woefully inadequate. But in other places they function well. Those doctors, nurses, administrators, etc. that have perpetrated the negative things described here never would read this blog.

One poster wrote about a joint replacement that was done when it was the femur that was fractured. Big mistake. Proveable on an xray. How often do we have definitive tests in our field?

No one goes into psychiatry or pediatrics to make a lot of money. Our work can be vastly more time intensive than needed for the other specialties. You saw a dermatologist? Five minutes. Most medical specialties work with quick visits, quick decisions, procedures, get on to the next thing. Our field deals with thinking and emotions. They don't show up on xrays or scans. It is very easy to miss what is most important. And to not know what to do even if you do see it. But I think our field is the most interesting medical field of all. And it is very gratifying when you help people.

Anonymous said...

Anon #5 here again.

I think that one problem is that psychiatrists don't realize that many of their patients with severe mental illness are afraid of their psychiatrist. They are afraid of forced treatment. Because psychiatrists have the ability to force treatment, they are authority figures like cops. Psychiatrists know many of their patients are afraid of the police or the hospital, but apparently don't realize these patients will therefore probably be afraid of the doctor.

It's not just me, my community support workers in the past have said that some of their clients are terrified to speak up about problems with symptoms or with their treatment, for fear of another forced hospitalization or commitment.

Remember, about half of patients with severe psychiatric illness have a sexual abuse history and many of the rest were victimized in other ways. Psychiatrists must avoid accidentally putting themselves in the role of a new kind of authoritative abuser by being aware that they are authority figures and some patients fear them. Perceptions are everything.

It doesn't help that a few docs get off on bullying patients. Just a few, but then it is difficult for a patient to trust another doctor.

jesse said...

Actually, Anon#5, most psychiatrists who also do therapy know that even patients without severe mental illness are afraid - they are afraid they will be judged, that there problems will be seen as their "fault," and so on. They are afraid we will take their symptoms away - many people want to hold on to their symptoms and even though they might be very much crippled by them they cannot imagine how they could be otherwise (I don't mean anxiety in itself here, but the thing that the patient thinks might be the cause of the anxiety).

A good example of this is that frequently a person who is very depressed wants to hold on to the feelings he has. They seem right. They may seem like just punishment for something he thinks. Or a connection to someone he lost or who died.

But your point is right on. Psychiatrists may be seen as police. And what you said about abuse histories is right on, too.

Anonymous said...

No clue who Jesse is but I like him.

moviedoc said...

This could be a wiki, Dinah. We could expand that list. I'll just add that there are many psychiatry critics within the profession -- like me, and I don't get the sense that the Shrinkrappers believe psychiatry is perfect either. Don't take all those attacks too seriously, Dinah; I don't. And I believe most people who read them can see through them.

rob lindeman said...

Thanks to Jesse for reminding me that pediatrics is a lousy way to make money - particularly if you try to do it on your own!

With respect to involuntary treatment, pediatrics and psychiatry share a lot in common. This is one of the reasons I find these discussions compelling - and personally challenging.

Every day, I physically overpower a defenseless child, usually several, in the name of doing something "for his own good". Except it's virtually never good for him. VIRTUALLY NEVER. How much more so (a fortiori for you students of logic; kal va'chomer for you students of Talmud) for adults who you claim do not know what's in their own best interest, thereby justifying the most heinous violations of Liberty.

Shrink2B said...

It seems like most psychiatry haters are "Borderline" anyway. They are like politicians - they split everything into absolute good and absolute evil. If one friend got a bad side effect - then the medication that caused it is the devil - and so is the doctor who prescribed it. This doesn't apply when the same patient gets an amoxicillin rash, or a dry cough with an ACE inhibitor - no, the ridicule is reserved for psychiatry. - Gotta love it.

moviedoc said...

One thing that annoys me is stereotyping, especially with regard to a psychiatric classification, especially "borderline" which IMO is a questionable label to being with.

Shrink2B said...

Oh - there are many people who walk the borderline between psychosis and neurosis. I don't know if they need a diagnosis in the DSM, but the label is certainly applicable.
And what is everything in evidence based medicine if not stereotyping? We say "93.2% of people with your symptoms have "X" disease and so I will treat you with "X" medication. Oh, and if I try to treat you differently because you are an individual, I can lose my license for unsafe and unproven practices."
We label people everyday - we must, or we can never get anything done. It's like labeling people as "Psychiatry haters" - are they all the same? No. Do we clump them together in order to write a blog post and have something to talk about? Yes.

Anonymous said...

The borderline analogies and put downs tick me the heck off, also. I got that borderline label for years, in addition to the bipolar, when it was actually the medications (like ativan) that were causing my outrageous behaviors. I never met the criteria for the disorder anyhow.

People have borderline behaviors for a reason, often due to terrible abuse as children. I get it that the behaviors are frustrating, but quit kicking people when they are down, ok? They already have no friends.

This labeling is another psychiatric abuse. My brother had a university doctor that did not believe in diagnosis which was great, except my brother needed his disability paperwork filled out, and I dunno how the heck the doc got reimbursed by the insurance company.

borderline is a nasty label. Psychiatry creates some more psychiatry haters, with that labeling and the crappy treatment that results from the label from some providers, i bet.

Anonymous said...

"Do we clump them together in order to write a blog post and have something to talk about? Yes"

At least the psychiatry hater that I believe Dinah is referring to posted with a real name.

Nothing like lobbing insults with a pseudonym.

I am not sure Dinah how this is any different than what you accuse psychiatry haters of doing.

Movie Doc, thanks for speaking up about this.

AA

moviedoc said...

Classification and categorization are natural human activities practiced in every culture. (Read Lakoff's Women, Fire and Dangerous Things.) Stereotyping is generally perjorative. The notion of "borderline psychosis" is archaic as far as I know. See the film The Caretakers which seems to use the term the old way.

rob lindeman said...

re: moviedoc's comment about classification. Unfortunately, MIS-classification is also a common feature to all cultures at all times. Thus, a whale looks like a fish and swims in the water, but it is not a fish. And mental illness feels like bodily illness and drugs make (some) people feel better, but... (I better stop there, lest I become mis-classified as a 'hater')

Anonymous said...

Rob: kal vachomer. LOL, who knew? Oy, oy, oy.

Dinah said...

I am not a fan of the "borderline" thing-- it feels like hurling insults-- Please see:

http://psychiatrist-blog.blogspot.com/search/label/personality%20styles
and
http://psychiatrist-blog.blogspot.com/2008/09/borderline-or-bipolar.html

The "hater" post was absolutely not directed at one person. We've had haters since the beginning---in fact, I had some vague sense of an anti-psychiatry movement of people who picket the APA, and I've certainly had patients who complained about their former psychiatrists, but until Shrink Rap, I had no idea of the venom people have towards psychiatry. One of the people in our publishing house was reading Shrink Rap and said to me, "I thought psychiatry was just a medical sub-specialty." Yeah, me too, until Shrink Rap. It's been an education, and I'm still here blogging.

Shrink2B: welcome to Shrink Rap. May I make a gentle suggestion? In psychiatry we don't say things like "Seems to me that psychiatry haters are all borderline." For a whole slew of reasons, this will not make you a popular shrink.

I did not mean to offend anyone with this post, though I did mean to stir and heat things up. And the fact that I don't perceive my relationships with patients as being adversarial (...hmmm, who wants an adversarial shrink?...I thought I was supposed to be kind, non-judgmental, listen and be helpful), does not mean that I discount or invalidate the bad experiences others have had with shrinks.

Zoe Brain said...

Personal, non-confabulated story:

I had a most disorientating experience in 2005. A change of sex.

Anyone who perceives this to be happening should obviously seek psychiatric help (and I did).

It turns out to be 3-beta-hydroxysteroid-dehydrogenase deficiency (3BHDD), we think now. All the symptoms match anyway, and such changes are *far* more common than I'd appreciated at the time. Rare, but they happen.

I thought they were plain impossible, hence my perceptions had to be askew with reality. Having others confirm that they saw the changes too just meant my delusion was more extensive than I thought... until even I couldn't believe that, not without doubting all perceptions whatsoever.

I've since found out the scope of the neurological changes that must have occurred over that time, due to the hormonal chaos. 3BHD is the necessary catalyst that aromatises cholesterol and a few other precursors into (eventually) cortisol, estrogen, testosterone, progesterone, mineralocorticoids etc etc so if 3BHD is deficient, the body's whole endocrine system is out of whack. The natural feedback systems try to cope, and keep the patient alive, but in the meantime pretty much anything can happen. I lost 1/3 my body mass for example before HRT stabilised things.

Anyway... given the chaos, any drug intervention at all was inadvisable. I had to ride it out, somehow keep functional. My feelings were untrustworthy, I had to ignore them and think "OK, now what would a *sane* person do in this situation"?

It helped that I'd been Gender Dysphoric all my life, so the change was a massive relief (though of course that provided extra evidence to me that I'd gone off my rocker in some kind of delusional wish-fulfilment psychotic episode, and increased my disorientation).

My attitude towards my psychiatrist was absolute honesty. I reported what I felt, trying to be as dispassionately objective as I could, figuring that without honest data, they couldn't arrive at a good diagnosis, let alone prescribe good treatment. I put myself totally in their hands.

Had I known then what I know now about psychiatry... I'd still have done the same, but been far less confident of their ability to diagnose, let alone help.

I have a lot of sympathy too for the first psych I saw (who blew it completely). This kind of thing is rare, he would have been completely out of his depth. I didn't know that at the time.

Anyway, I'm too busy living now to mull over it. There's exams to mark, a thesis to write up, my son wants to play a game with me.... though I do wonder how anyone could go through an experience like that and retain any semblance of sanity. Others do though.

Anonymous said...

your spam filter is eating posts, again. Also, shrink2b - are you really a person studying to be a shrink who just labeled a whole population as borderline? I sincerely hope you have many more years of training and life lessons before you are qualified to work with psychiatric patients.

Roy said...

Thumbs up to anon#5, re comment: "Psychiatrists must avoid accidentally putting themselves in the role of a new kind of authoritative abuser by being aware that they are authority figures and some patients fear them. Perceptions are everything."

Definitely agree.

BTW, I suggested the "hater" term, rather than anti - psychiatry, to differentiate critics of psychiatry (and the three of us have criticisms, as well; we recognize many imperfections) from the "haters", ie, those who sees no positive aspects whatsoever, think that all psych meds should be banned despite benefiting some people, and always steer the conversation to the same points... the extremist views that another commenter referred to.

jesse said...

Whoaa! Shrink2be put "borderline" in quotes, as "borderline." That was not making a diagnosis but rather noting that many of the Haters characterize things in a black and white way - she said "like politicians" and we all know that is the most pejorative comparison one can make.

Let's go back to Aqua, the third poster.

Aqua has "bought in" (and I'm not saying from Shrink Rap) to the idea that only symptoms and suffering that result from absolutely provable brain changes are not her fault; others are her fault, her responsibility, and any suffering she has results from her not having tried hard enough to change. And she's working hard to rid herself of these attitudes. 

Aren't psychiatric patients burdened enough by guilt that we should try not to increase it? So to Dinah's list I would add number 0.5, "Psychiatry is not a valid discipline."

At times anti-psychiatric positions are touted that in effect are denials that our field has any validity, and these strike me as quasi-religious stances masquerading as scientific. These are harder for others to address as they are not what they purport to be. This seems to me much worse than using "borderline" in a tongue-in-cheek way.

jesse said...
This comment has been removed by the author.
Shrink2B said...

Jesse - thank you for taking my comment in the way it was intended. I was referring to the trait of splitting black and white, as I tried to explain by the example. I was not making a diagnosis, or attempting to label all anti-psychiatry people as having Borderline Personality Disorder.

Alexis said...

The implication that we can foresee that medications will cause side effects, adverse effects, or be ineffective...

I would say that this is an exaggeration with some basis in fact, though I would also say that psychiatrists are far from the only medical specialty with this problem. I have felt like I was not warned of side effects which, though not necessarily foreseeable in my specific case, were common enough to deserve a mention. I have also felt like I wasn't taken seriously when I complained about some of those side effects (weight gain is my particular problem).

I feel like there is a culture where we tend to believe that the benefits of medication outweigh the side effects, even if they are not life threatening, and doctors do not always understand a patient who does not find the trade-off acceptable.

jesse said...

Zoe, you wrote "I put myself totally in their hands" in regard to the psychiatrists. Others have written somewhat similar words in other posts.

You yourself have become expert in an area of life most people know nothing about; it is easy to see how, faced with the changes in your body and feelings you described, you would be baffled, frightened and feel a need to put yourself totally in their hands.

What I think all of us psychiatrists would agree with is that our work with our patients is more a joint exploration than trusting someone with complete knowledge. A good part of the anger expressed in these blogs results from the fact that knowledge in psychiatry is anything but absolute; at times the people in authority are aware of their limitations, at other times they are not.

Even for the best of us we do things which don't go as intended. We can only do what we can with the knowledge we have.

Anonymous said...

This post was so ludicrous it's beyond rational fathoming...

This Psychology Today shill is a glaring example of exactly why psychiatry is once again being viewed with growing skepticism by the general public as the pseudo medical snake oil salespersons they are.

Just another bait post...I assume you're going to take the responses to your next APA meeting as another cheap stunt & unscientific paid presentation.

Can hardly wait for the profitable misleading drug ads to begin appearing on this site...

If nothing else, Miller has validated & strengthened the evidenced criticisms of the psychiatric practices today.

Thank you once again...

Anonymous said...

Jesse,

You said,

""At times anti-psychiatric positions are touted that in effect are denials that our field has any validity, and these strike me as quasi-religious stances masquerading as scientific. These are harder for others to address as they are not what they purport to be. This seems to me much worse than using "borderline" in a tongue-in-cheek way.""

As someone who has greatly appreciated alot of your posts, I have to take issue with this one.

I feel that with the stigma that people with borderline personality disorder already experience in the medical field, that using something even in a tongue-in-cheek way by someone in psychiatry is offensive. Thankfully, Dinah and Movie Doc recognized that.

If this person had compared psychiatry haters to people with schizophrenia in a tongue and cheek way, I don't think you would have found that acceptable. So why is this situation any different?

Regarding people questioning your field, critics of the upcoming DSM have been psychiatrists who are concerned that you are labeling every human experience as mental illness. So in a sense, they are questioning the validity of your profession.

"The public needs to know that psychiatry is a field in its infancy, and as such, skepticism is warranted"

http://www.psychologytoday.com/blog/learning-play/200912/dsm-v-plea-skepticism

By the way, I find this discussion of the black and white issue ironic. As I keep pointing out in my posts, you (generically) make it seem like psychiatry haters are the only folks who are criticizing psychiatry. I keep pointing out that with various examples that isn't the case.

So who really has the problem with black and white thinking?

AA

Carolyn Cummings said...

I believe part of what feeds this kind of negative thought toward psychiatry is that many people taking psychiatric medications stay very quiet about it, due to the stigma related to taking these medications. I am always surprised by how many people around me have taken or are taking a mild antidepressant or mild anti-anxiety medication to maintain functionality during difficult times in their lives. But these folks aren't going to announce it to the world, so the only public voices we hear are the ones of people who have had a real problem in their system of care. I know many people who have found psychiatric medications to be a Godsend- it helps them get better faster and maintain a higher quality of life. I even took notes in my psychopharmacology class in grad school so I could remember which medications sounded good to me in case I ever found myself in extreme personal need and needed to talk to a psychiatrist myself.

As far as involuntary care goes, I find it ironic that this is an issue because in my own backyard, working with minors with severe symptoms, its hard to even get them admitted and once they are, its hard to let them stay there as long as they need to. For as many people have been involuntarily admitted, there is another group of people clamoring at the doors to be let in who are turned away because they don't have the knife to their wrists right then. This is due to our state's huge budget problems. I am not trying to deny this issue, just saying I have seen more of my clients turned away than I have sent to the hospital against their will. Also, and I work only with minors, so bear with me, most of them report it as a pleasant experience, even vacation-esque, because they get to be in a quiet place where they feel calm, watch movies and play video games, and nice people come and check up on them on a constant basis, which is way better than the environment in their actual homes.

I am likely biased because the psychiatrist I work with (in fact all the psychiatrists I've worked with) have held therapy as the primary mode of treatment and medication as the secondary, and they have worked closely with me to be sure my clients get appropriate services. Many parents ask for a psychiatric evaluation, and my psychiatrist denies then due to a lack of evidence, or evidence that the child's problems have more to do with environment than a biological mental illness, and they get referred back to me. I have referred children as young as 3 to our psychiatrist (not because I thought they needed it, but because parents have a right to request a psychiatric evaluation whether I agree or not) and I know I can trust my psychiatrist to deny medicating any children under 6 years old unless there are some kind of extenuating circumstances.

I am sorry for the folks who have had bad experiences with inpatient and outpatient care, or have come across uncaring, unfeeling mental health professionals. Narcissism, anti-social behaviors, and ignorance are not absent from our professions just because we have graduate degrees. I recommend you read up on your rights as a patient/client and take advantage of those rights, because you have A LOT of them. Malpractice is a huge deal and you have the power to threaten the licensure of a mental health professional who has acted unprofessionally. All mental health professionals answer to a board for ethical and best practice decisions, and many lose their licenses or certifications every year for infractions. There are watchdogs on us to keep us honest. For MFTS and Social Workers in CA, we answer to the BBS. Every state and profession answers to somebody. I recommend taking complaints to a higher authority; you might be surprised at the results.

Lastly, thank you for being a psychiatrist who continues to learn and perfect her craft in order to provide best practice. I sure there are many silent, grateful voices who simply don't feel comfortable with a public forum.

Dinah said...

It's interesting that the idea that I am Annoyed (which is not a terribly strong word) by insults, or one-sided sensationist views, then gets interpreted as being unwilling to hear criticism of the any area of our field.

Anonymous said...

Unfortunately the part about psychiatrists benefiting from prolonged hospital stays is true in my experience. The hospitals view patients as heards of cattle. They get paid per patient per day and want patients to stay as long as possible. There are some psychiatrists who work hand and hand with these hospital administrators to maximize hospital stays and profits. One example might be a malingerer they could easily stay in the hospital 2 weeks or more if not confronted. My buddy walked into a situation like this. He greatly improved the quality of care but the administrators were frustrated because he cut the bed days. Go figure.

Anonymous said...

I don't think people are harmed by meds but there is definitely an over reliance on them. A patient comes in, says they want a med. They might benefit from a med but what they really need is therapy. For whatever reason the patient can't access therapy so they just cycle through monthly 15 minute med check type appointments. The sad state of psychiatry and our health system is embarrassing.

Anonymous said...

I'm sorry I'm on a roll here. Psychiatrists do benefit by over prescribing meds. They get paid. If a psychiatrist tells a patient they don't need meds they need therapy they lose business. Psychiatrists are under a tremendous amount pressure to make money just like anyone else. Also if a patient isn't sick enough to need a med, then insurance companies probably won't pay for them to see a psychiatrist. It's crazy how screwed up our health system is.

Alexis said...

Anonymous, I think the mental health system is so broken that singling out hospitals and psychiatrists for extending stays misses the point. The insurance company wants you out. Preferably, they don't want you in at all. Many hospitals aren't even set up for lengthy stays. It's all "crisis stabilization." Sometimes, the MDs are fighting for a longer stay because the patient needs it. I don't think this system can be said to have been designed for anyone's benefit.

Anonymous said...

If you're hospitalized against your will, you're probably best off if you have health insurance because they will help get you discharged quickly.

But, if you've got Medicare you could be in for a much more difficult fight to get out. They can keep you a long time and take your social security check, too, while they're at it. e.g. if you followed the Elizabeth Ellis forced ect situation in Minnesota - they have posted the bill per day by the hospital and it's almost $1000/day or approx $30,000/month to treat her against her will. Big bucks, and to help pay it they took her social security check and I imagine the rest is via Medicare. I suspect if she had had health insurance her stay would have been much shorter.

Roy said...

[warning: gratuitous book plug coming...]

This issue of extending stays, etc, is interesting. In Maryland, hospitals generally get paid for an episode of care (DRG), not by the day. So, we get paid a flat rate whether someone is in the hospital for 3 days or 23 days. This incentivizes efficient care. But no matter how long or short the stay, I suppose some would criticize us for kicking people out too early or for keeping them in too long. The reality is that we try to keep the stay as short as possible while providing safe and effective care. Most of us care and always try to do our best. I am sorry that not all have a good experience.

We do address these money issues in our book, btw. We discuss incentives and billing and DRGs and such... chapters 9 & 10.

Anonymous said...

I hope this doesn't annoy you ;-)
I don't believe psychiatrists, as a whole,would have had reason to know that pharma was deceiving them. However, I do question why so many were willing to take what were, in effect, bribes to change their prescribing practices.

Anonymous said...

Carolyn, I disagree with your statement that people who have good experiences with medication treatment are quieter than those with bad experiences because of stigma. People who have poor results are also afraid of stigma. I only posted on here as an anonymous about my poor results with psychiatry because of stigma.

I only know people who had poor results with meds because I hang out with people who all need social workers, so by definition, we're the ones who failed treatment (if the pills worked, we wouldn't need a social worker, right?)

I post about my bad experiences on meds to counterbalance the billions of dollars in advertising and the costant mantra that "you can live a normal life with (insert severe mental illness here) if you take your meds." Unless normal means you can't hold down a job or clean your house and you can't have kids or the state will take them away because you can't take care of them.

I am absolutely appalled that antipsychotics are being handed out to so many people. I had the worst time with those drugs, but at least I actually have severe mental illness so the risk was worth it, if they had worked.

Anyway, people who dislike the meds probably post more on blogs and such, but people who don't like their Net10 cell phone service also post more than those who do like it.

Good to know that there is an emphasis on therapy where you are. In my area, the psychiatrists are mostly 15 min med checkers pushing the latest and greatest antipsychotic.

Tawny said...

Roy, I have to take issue with what you say about how hospitals are paid in Maryland. I have been inpatient at Sheppard Pratt several times and have insurance through Carefirst. They have ALWAYS paid by the day and, interestingly enough, since I have always had 21 days of inpatient coverage, I have always been "cured" on day 20. It's amazing. Am I missing something?

Anonymous said...

"I have been inpatient at Sheppard Pratt several times and have insurance through Carefirst. They have ALWAYS paid by the day and, interestingly enough, since I have always had 21 days of inpatient coverage, I have always been "cured" on day 20. It's amazing. Am I missing something?"

Sydney Walker III MD makes this claim in "A Dose of Sanity". He said patients were held for as long as they had medical insurance and then "cured" just before it ran out.

moviedoc said...

Anon, does Walker imply that the patient was happy to enjoy hospitalization as long as he didn't have to pay for it himself, and miraculous got better when he could no longer use other peoples' money?