If Psychiatry had half the proven scientific merit of dentristy and medicine I might buy this. As it is I’ll simply point out that I have the option of choosing which doctors examine my child and when.
It doesn’t? Well, what does it need to get there?
Hentor the Barbarian
The equivalent of teeth. Tangible, demonstrable, clearly delineated & definable maladies, etiologies, and other things that differentiate their subject matter from bad mojo, the status of being a witch, the “engrams” that Scientology attributes to its non-“clears”, violence-tinged auras, and other such things.
I’m not going to say there is absolutely no validity to the generalizations that psychiatry has made over the last century-and-change, nor am I going to deny that generalization, categorization, and the naming of those resultant categories is a valid and important part of how scientists (and, indeed, all thinking people) make sense out of observable phenomenae.
But they don’t have any real explanations for the general patterns they use as diagnostic criteria, they don’t know what these patterns mean, what causes them, whether they are entirely somatic in origin, partially so in conjunction with triggering events and situations in individual lives, loosely so in conjunction with societal norms and culture-specific interpretations, or entirely caused by events and situations (i.e., that they are not diseases of the brain or nervous system at all). And yet not only do psychiatrists have the power to impose forced treatment (making any assessment of one’s mental health an implicit threat), they also often operate within the framework of institutions and bureaucracies that can (as someone mentioned) get sued for failing to diagnose and impose treatment, so they have a structured impetus to err on the side of caution where “caution” means saying a mental health condition that should be treated appears to exist.
So, if you’ll pardon the expression, if it ducks like a quack…
I’m not sure where you’re getting this little fact, but:
-
Psychiatry is a scientific discipline and a medical specialty involved with the diagnosis of mental, emotional and behavioral disorders. A psychiatrist is a M.D.
-
A very short time ago, medicine was primitive compared to its current state, and there are still discoveries that have eluded it. Psychiatry is thousands of years younger a discipline. There are disorders it is good at diagnosing and treating, and a lot of things it cannot do, at least not yet. Do I shun internists because they can’t cure cancer? No, that there are limits to medical knowledge is not a reason to dismiss medicine as junk science. Same with psychiatry.
-
“Mental health care” is not synonymous with psychiatric treatment. A psychiatrist is an M.D. who can prescribe drugs. Much mental health care takes the form of counseling and social outreach to alleviate disconnects between the sufferer and the world at large.
Do you really? I don’t , much. I’m limited to the doctors listed on my insurance plan who work within a reasonable distance of my home and are willing to add my family to their list of patients. Moreover, I have to make this choice without much information that would help me choose between any two physicians, and an uninformed choice really isn’t much of a choice at all. Also, sometimes the doctor I’ve picked is busy or on vacation, and the kids’ll have to see someone else, or schedule another appointment. Of course, if it’s an emergency and I have to go to the hospital, I have no choice at all, except to see the doctor in front of me or not see one period. As far as when my kids see the doctor, I have no choices at all. Every few years I have to arrange for an examination or I can’t enrol them in school. I also have to take them to the doctor when they’re sick, and the little so-and-so’s never consult my schedule beforehand.
Thanks to AHunter3 for bringing this up and for generating a good discussion.
The part of the proposal that sounds less than great to me is the mention of setting up mental health screenings as part of the general medical assessment prior to kindergarten, fourth and ninth grades. Even with a voluntary basis, a lot of parents will wind up going with the flow and sending their kids in, in the process getting red-flagged for a lot of stuff that formerly would have been seen as the typical quirks of growing up.
The downside to catching problems that might save some children from later grief (or as I suppose the major goal was, potentially thwarting a future Columbine), is that a much larger group will get stigmatized by questionable diagnosis and dragged to therapy and/or treated with unnecessary meds.
There need to be people at these forums strongly resisting anything that smacks of urging routine mass screenings for schoolchildren.
**Jackmanii, you have raised two very good points. The first is the potential for “false positive” diagnoses of mental health disorders, and the second (closely allied with the first) is the stigma associated with a diagnosis of a mental/social/behavioral disorder. Taking the second first, if you believe (as I do) that such disorders actually exist, then the only moral course of action is not, imo, to refuse to diagnose and treat the illness, it’s to work to remove the stigma from the disorder. This can’t happen if people refuse to regard mental illness with the same rationality with which we think about any other disorder. Your first objection is a lot harder to answer, because I don’t have any statistics on the occurance of inaccurate psychiatric diagnoses. Getting back to the Illinois proposal, I think I’d insist that it be limited to diagnosing disorders with wide agreement on both diagnostic techniques and treatment. I’d also insist that a multitiered process be implemented, with more than one or two adverse evaluations necessary before any kind of compulsory process takes effect. I’d probably also agree that any medication or long-term treatment (say, more than six months) be contingent on the parents’ approval, because I’d have to to get the law passed. Jackmanii, why are you willing to have your child risk potentially unnecessary medical care but not possibly unnecessary psychological therapy?
So, let’s say your children are screened, and that the tired, bored, underpaid quack the state is using to “diagnose” these things, feels your child has ADHD. (And I don’t see the state using actual psychiatrists, probably re-trained social workers, or “clinicians”). So now your child is ADHD. That’s it, end of story, that label will now be on ALL your child’s records, and you will be required to give your child medication.
Ritalin, the drug commonly used to treat ADHD, has been know to cause death, and learing disabilities!
Also, if you look at the link to DSM-IV I posted earlier, you will note that almost all of the disorders require a certain amount of time during which the symptoms must be present. How many state paid doctors or clinicians or even psychiatrists are going to spend that much time on each case?
And if you want to compare psychiatry to dentists, should I bring up fluoride?
AHunter3 quoted:
The State of Illinois shall develop a Children’s Mental Health Plan containing
short-term and long-term recommendations to provide comprehensive,
coordinated mental health prevention, early intervention, and treatment
services for children from birth through age 18.
Bolding mine.
Is it just me, or is there someone else, also, who is puzzled as to why anyone would want to prevent mental health.
I think there’s a problem here—not even the law that creates this mental health “service” is very clear. How can there not be any abuse?
More unsupported assumptions than you can shake a stick at. No one is advocating that those involved in mental health screening be tired, bored, underpaid or unqualified. What evidence is there that this will be the case?
More nonsense. In the first place, which records exactly are you concerned about? The dreaded permanent one? Second, I know it’s difficult, but please read the actual proposal. Huge chunks of it are devoted to maintaining confidentiality and keeping the child’s family and educational status intact. Third, ongoing screening is the best defense against a diagnostic label “sticking” beyond its usefulness. Fourth, how could an accurate assessment of a medical condition possibly be more harmful to a child than an undiagnosed and untreated condition? Fifth, diagnoses entailing any drug therapy must be made by an M.D., not social workers, even the hypothetical tired, bored, incompetent variety.
[QUOTE=Killerkatt]
you will be required to give your child medication.
1)The ABC story you cite does not show this. It gives an example of one man in New Mexico, which is not Illinois, who says he was threatened by a police detective (not the state attorney’s office, which has the authority to do it) with prosecution for taking his child off prescribed Ritalin. So far as the article goes, there is no law under which he could be prosecuted.
- Even if this was a problem, it has nothing to do with the desirability of mental health screening. It’s an argument for allowing parents to cancel medical regimens
for their children, which may be defensible, but I hope that a second medical opinion would be involved somewhere.
This discussion isn’t about the merits of Ritalin, thank heavens, because I don’t have the expertise to evaluate that argument, and I’m guessing that you don’t either. I do know that frequent independent evaluations are more likely, not less, to prevent poor diagnoses and halt inappropriate treatment protocols. Under the present system, a single diagnosis might keep a child on Ritalin as long as his teachers and parents are happy with his docility. Why do you discount the possibility that a mental health evaluation can save a child from inappropriate drug therapy? At any rate, if Ritalin is a bad drug, that seems to me a matter for the FDA, not an indictment of mental health care.
Well, they’ll continue to take as much time as the protocol requires, I suppose. If Illinois decides to depart from that, they’re going to have a hard time implementing the law, because doctors and other mental health professionals will refuse to cooperate.
Absolutely. Please take as much time as you need to explain why fluoridation is an insidious communist plot to contaminate our vital bodily fluids. I will read it with great interest.
My apologies. In my last post, I clumsily managed to include my response to **KillerKatt ** in the same (third) box in which I quoted him. I think a careful reading makes it clear which words are his, and which mine.
Oh good lord. Will it ever stop?
Do you happen to have any sites that aren’t so blatantly biased and made up of junk science?
It’s nice to see that the law doesn’t call for mandatory screening, but it would quite a bit more comforting if it specifically said mandatory screening would not be used.
That’s a decent point, and while not many laws spend a lot of words defining what they don’t do, a clause like that could be useful for purposes of judicial review.
At any rate, the Childrens’ Mental Health Partnership has most of a year to digest the citizens’ input it has gathered (and will continue to gather) before it submits a proposal to the governor. My prediction is that there will be an opt-out provision included to satisfy the civil libertarian and psychiatry-is-witchcraft groups, that the mandatory screening for DCFS and Juvenile Justice cases will be left intact (because those demographics don’t have much of a political voice), that “social/emotional learning” will be integrated into school curriculums in defiance of the fact that apparently nobody knows what social/emotional learning actually is, and that, twenty years from now, someone will do a study on the incidence of mental illness among adults who were screened as children vs. those who opted out, and that it will show that screening was a pretty good idea.
There is a surprising amount of unsubstantiated hostility to the whole idea of mental health care. I can’t really argue against it, because it’s never clearly spelled out. I must say, a lot of it seems to stem from the assumption that mental illness carries a stigma that, say, broken bones don’t. I can only reassert my conviction that though I understand the visceral reaction to mental health screening (it is, at least sometimes, a prelude to interference with a human personality), I cannot intellectually defend the protection of mental illness on those grounds any more than I can insist on protecting a malignant tumor because it is technically part of my body. Honestly, do those people who hate psychiatry because they think it debases the “natural” personality think that mental illness* doesn’t*? If I had a choice as to whether a therapist messed with my child’s mind or clinical depression, obsessive-compulsive disorder or some other psychosis did, I’d not consider it a hard choice at all.
I’ve been in and out of therapy for 12 years. Zoloft saved my life in 1996. All in all it’s been good for me.
I’ve also seen a lot of bullshit passed off as medicine.
A lot of people get the same results from religion, and I tend to think of enforced mental screening as the equivalent as enforced spiritual advisement.
Good. There should be a better word, one that means I’m glad your life was saved and I hope you’re healthy and happy and thank you for sharing personal information for the sake of advancing the discussion. Does your experience lead you to agree that mental illness is real and that medical science can at least sometimes effectively treat it?
Me too. Laetrile and homeopathy, copper bracelets and the “healing touch” spring to mind. But I still go to the doctor if I’m sick, because he doesn’t subscribe to quack remedies either. I’ll allow that psychiatry, being a younger discipline, may be subject to more false starts and dead ends than other forms of medicine. I would agree that before a government imposes any mental-health program on its citizens, the types of illness it is allowed to diagnose, the criteria for evaluation and the treatments it offers should be limited to well-established clinical standards and should be constantly scrutinized as medical knowledge progresses.
Not always, certainly. You didn’t view your swallowing a Zoloft pill as a sacrament, did you? Or your therapist as a conduit to God? In fact I agree that religious instructors and psychologists can often perform the same function – as I said before, mental health care does not necessarily mean psychiatry. But I’m not sure you can make a case that mental health screening, especially as the Illinois proposal defines it, amounts to the enforcement of the service and worship of God.
Your post seems to imply that the mind is the same thing as the soul. I’m not prepared or qualified to debate that. But I’m still pretty sure that there are secular mental/social/behavioral conditions that can be treated without violating the first amandment.
Or even the first amendment. Good night, everyone.
The “visceral reaction” you refer to is (in my case) because of a few things.
1: These proposed laws call the establishment and funding of a large diagnostic apparatus that will seek to screen for mental health defects. Dealing with the diagnosis and treatment of mental health issues usually means medicating the problem the vast majority of the time. As a commercial real estate broker leasing space to several of these groups, I have dealt directly with state contracted service providers for children’s mental health services. Their clients are mainly the children of parents on public assistance, or with limited means. I have had extensive and candid conversations with them about diagnosis and treatment, and the nature of their business.
As a private service provider dispensing diagnostic and treatment services for children they are essentially doing what the state proposes setting up and institutionalizing in the OP’s example. 90% + of the children getting “treated” for perceived mental health issues are being medicated in one form or another. I’ve seen the kids they treat. The vast majority of the patients are not OCD, or bulimics, or depressed white females. They are primarily lower class and lower middle class male (mainly black) children who are loud, inattentive, disruptive, and won’t behave. They have some group meetings but the primary treatment tool is to medicate them, and medicate them, and medicate them.
You seem to have some interesting notion that a budget stressed program of this type when established, is going to be comprised of highly educated, intelligent, caring, perceptive individuals, who will have the skill and time to separate real mental issues from the normal emotional scrum of dealing with the stresses of everyday life. They will not be overloaded, haphazardly trained, or (like many school teachers are wont to do) ready to slap the ADD/ADHD label on every kid that won’t mind his manners and stop fidgeting and being disruptive.
2: The only real “science” part of psychiatry is the bio-chemical end. The notion that psychiatry has some kind of effective paradigmatic handle or effective methodology for treating acute mental illness sans drugs is absurd. In a high pressure and litigious environment, diagnostic labels will be slapped on quickly just out of defensive medicine concerns. Compared to other medical disciplines psychiatry is not even up to stone knives and bearskins level in terms of understanding how the brain works, and when it doesn’t how to effectively fix it.
It’s not because psychiatrists and other mental health workers are stupid or lazy or practice in bad faith, it’s that he task in front of them is vastly more complex than almost any other medical discipline. To pretend or imagine that psychiatric methodologies and mental health service providers implementing those methodologies, can possess the skills to quickly and accurately diagnose mental dysfunctions in formative minds and personalities in an assembly line environment, is ignorant hubris of the absolute highest order.
Okay, the issue here is the overmedication of state-referred psychiatric child patients in Maryland. Oh, wait. No it’s not.
For the moment, I’ll take your word that your position as a commercial real estate broker has given you an accurate and comprehensive understanding of your clients’ psych. diagnostic and treatment practices. I hope you found time to explain the lease to them as well. I’ll also assume for the present that when you say things like “90% +” of a certain group of patients are being medicated that that is an exact and accurate figure and could easily be substantiated if you chose to take the trouble. I will take issue with one thing. You suggest that many of these patients are being medicated in the absence of any medical, physical or behavioral condition that warrants it. Did your doctor clients really confess to you a felony and breach of their oath, opening themselves and the state up to a series of enormous lawsuits in the process? Taking the rest of your post as pure gold, however, I’ll answer.
-
One reason your clients have a high incidence of drug therapy may be that their patients have been pre-selected – they are, after all, psychiatric referrals. They’ve already been through a screening process of some sort and been designated for treatment. If all children were regularly evaluated, the 90% + figure would no longer apply.
-
You trot out the issue of medication as if the mere word mitigates against mental health care. Why? If we innoculated 90% + of these children against smallpox, we would consider that number unforgiveably low. The fact that these children are receiving medicine should, absent evidence to the contrary, be a good thing. Why isn’t it? If you have any evidence that children are being harmed by your clients’ practice, you should be talking to the state’s attorney, not to me. As far as your post goes, a lot of poor and minority clients are getting medical help for mental, emotional and behavioral disorders, and as far as you know they are being helped by this
-
I think I said before that regular mental health screening, like that proposed by Illinois and not done in Maryland, is the best defense against the sloppy, lazy process that leads from a frustrated teacher to an overworked and poorly trained public clinic to a label that may outlive its relevance. Still true.
-
I won’t debate the structure of the Illinois plan, the funding, the adequacy of training, the time spent with each patient, the inadequate protection against litigation or how much they plan to overwork their employees, because none of it exists yet. Next June, we can let the ignorant hubris out for a walk.
I’m acutely aware that I am talking too much in this thread, especially as I’m neither a doctor, public health professional, or even a realtor. But since astro addressed me specifically, I thought I owed him the courtesy of an answer
The King of Soup
If a sizeable portion of these children were found to be subject to physical pain and were subsequently shot up with morphine, would you have any problems with that?
Psych meds are like morphine: they don’t address the (unknown) causes of the various phenomena called “mental illness”, they do tend to ameliorate the most unpleasant symptoms, but they come with very heavy baggage of side effects, some of them permanent, and, like morphine, they tend to be addictive and incapacitating in their own right.
Oh, and they fuck with your head. That’s what they do. There’s nothing more personal than one’s mind. Bumping up the immune systems of a flock of 2nd graders via smallpox vaccinations may kill a tiny percentage of them and do physical damage to a few more, but the rest will experience as invasive only the pain of the vaccination event itself and will continue to be themselves in every way imaginable afterwards. Drugs that affect the mind, the personality, behavior, feelings, thoughts? If they aren’t taken voluntarily they are experienced as an assault.
I really try to avoid participating in these threads, but this post is so ill-informed it must be discussed. First, I am a psychologist. I practice clinically as well as being very involved in science. You appear to be confusing the concept of “science” with “medicine” or perhaps assuming that science must have a tangible object of study. Perhaps, alternately, you are making a comment specifically about psychiatry, and their tendency to be less well trained in scientific practices, but there are psychiatrists who do good science as well. As to conducting mental health treatment without medication, what is it that you suspect psychologists do? In fact, I recently completed treatment with a woman for OCD without using medications - no mean feat for those suffering with OCD, but an illustration of your erroneous assertion nonetheless.
So which other medical disciplines have a better understanding of how the brain works?
Part of the problem is that psychiatry and psychology will always be regarded as the domain for disorders for which we continue to lack handy biological indicators. Once they are present, and once a medical treatment is clear, that disorder becomes a “medical disorder.”
Here it appears you are half-right. The task before mental health professionals is vastly more complicated than other conditions. But there are reliable diagnostic methods that do not require extraordinary amounts of time. Generally, they are more time consuming than medical evaluations, yes. And they may be mishandled by the poorly trained. This does not mean that they will be.
As to the requirement that symptoms have been present for a certain amount of time for many of the DSM diagnostic criteria (raised in another post), this does not mean that they have to be observed by the evaluator for six months or for two years! This means that they have to be reported by the patient or other informant during the clinical assessment.