No, I’m saying that there’s no difference between a GP prescribing Prozac and a GP prescribing Flomax.
They are certainly able to do it, and they may in fact be the best treatment strategies for the presenting problems. On the other hand, they are treatment strategies for fairly specialized problems, so you would likely be better off if you went to a specialist to make sure that your problems had been diagnosed correctly and the treatment was in fact appropriate.
I’ve seen some atrocious diagnostic efforts from primary care physicians over the years in regards to psychiatric diagnosis. Oftentimes, they’ve delayed the beginning of appropriate treatment strategies by months or years.
So, there is just as much differentiation between psychiatry and general practice as there is between general practice and any other specialization.
If I may pipe up with an opinion (and I am pretty largely discredited from having valid opinions in this thread, given that my original ideas have been soundly rejected!) it sounds as if you’re drawing a distinction between medication and talk therapy. But classically, both are aspects of psychiatry.
I wish that talk therapy, especially with its insights into the unconscious, were more effective at treating mental illnesses. Such counselling has done a little help for a lot of people. (One might say, “Yes, and gentle massage might relieve some of the pain associated with appendicitis!”)
Well…yes! I’ve been asked the standard series of questions regarding depression by a psychiatrist…by a G.P…and even by an insurance screener! The tools are fairly well established by now.
It’s hard to do objective assessment of subjective things. How bad is one’s pain? How do you put the pain in, say, your broken ankle, on a level from one to ten? And yet, that’s exactly what they do. They even have a non-verbal chart, with little frowny faces, for very young children to point to, to indicate the level of their pain.
What objective indicators would you use to assess lethargy? How about headaches? Abdominal pain? Heartburn? Numbness? Erectile dysfunction? Loss of appetite? Bitter taste in the mouth? Angina? Painful urination? Tinnitus? Tingling in the extremities? Shooting pain through the arm? Vertigo?
If there aren’t objective indicators of these things then are they not valid symptoms of medical conditions?
Furthermore, what particular markers in the blood would you use to determine if schizophrenia was present? How about autism?
What’s that? There aren’t any? Then I suppose that a general practitioner would be just as good at determining if they were present or absent as anyone else.
Great boards here! I’m brand new to them and I love the debates I’ve read so far.
I’m extremely late to this party but I have important, new (well not that new), information regarding the psychaitry theme. Excuse me if I’m repeating any posts.
Dr. Frances Allen, leading psychiatric researcher and chair of the DSM-IV ( the psychiatric diagnostic bible) Task Force, had this to say in a 2010 interview with Wired:
“there is no definition of a mental disorder. It’s bullshit. I mean, you just can’t define it.” Then an odd, reflective look crosses his face, as if he’s taking in the strangeness of this scene: Allen Frances, lead editor of the fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (universally known as the DSM-IV), the guy who wrote the book on mental illness, confessing that “these concepts are virtually impossible to define precisely with bright lines at the boundaries.”
WTF? Did he just blow the whistle on himself and the psuedo-science of psychaitry? If you can’t define a “mental disorder” how do you diagnose one? Furthermore, even in cases where the model seems to match the data , i.e.* clinical trials* (“even a broken clock is right twice a day”), it still can’t be scientifically accepted because there is no proof of causality. Do different rules apply to the “science” of psychaitry? Scientific method is generally used to explain and unify concepts and data not confuse them.
I recognize that the field psychaitry appears to be a relevent field of study to further understanding and knowledge of an organ that is probably the most problematic and complex subject of study humans have ever attempted. Unfortunately, current data seems to suggest that psychaitry has been corrupted into a vehicle to expand diagnosis ad infinitum, with the main purpose of feeding insurance companies and big pharma - who will make a lot of money selling drugs for an ever expanding universe of “mental problems”.
“Woe to you, my Princess, when I come… you shall see who is the stronger, a gentle girl who doesn’t eat enough or a big wild man who has cocaine in his body.”
pungi: Howdy, and welcome. This was my thread originally, but my opinions got pretty roundly demolished… Still…
I would say that such expressions of mental illness as depression, obsession, uncontrolled anger, etc., all very obviously exist. That they cannot be defined exactly doesn’t mean they don’t exist. It’s a classic conundrum: can you define “chair” so very exactly that the definition covers all chairs, and excludes all non-chairs? This is why we have “fuzzy logic.” Some things, while definitely existing, are still not amenable to a precise definition. Only in mathematics!
This is why legal psychiatry is so subjective. You can put a guy on trial for a major crime, and ask ten court-appointed psychiatrists if he is “sane,” and easily get five saying yes, and five saying no. But, that said, we know that there are some criminal defendants who are unquestionably insane. (And…a few people running around in our social circles, too…)
Meanwhile, as I noted above, there are standard checklists for clinical depression; the expert asks a sequence of questions – “Do you have feelings of sadness or hopelessness?” “Do you think about suicide?” – and if the respondent says “yes” to a certain number, depression is the likely diagnosis.
It is scientific. It isn’t exact. This isn’t electronics…
Thank you Trinopus! I wouldn’t say they were demolished…
I hope I didn’t suggest that people don’t have depression, delusions etc… What I want to suggest is that there is a philosophic disconnect in science and particularly in the field of psychaitry among others. What it seems you are suggesting is that we must accept these Platonic “forms”/archetypes of different illness as definitions even though these archetypes are by definition subjective and actually do not exist in the “real” universe. For example, the Greeks believed that planets moved in perfect circular orbits. This entrenched belief lead to a lot of creative concepts (but wrong) for explaining anomolies that didn’t fit into the archetypal-perfect-circle theory and kept astronomy away from real knowledge for a millenia. Newton explained, very precisely, these planetary movements with the unifying theory of gravitation (a feat as great as any) - because he adhered rigorously to the demands of causality and proof. Psychaitry must do the same to be valid, whether it seems impossible or not, researchers must not abandon the rigors of science. Besides, what good is knowledge if it isn’t precisely correct? It’s not really knowledge.
I think this might be happening in the emerging field of clinical neuroscience which takes a more rigorous approach to science and is looking to make the DSM approach obsolete. We’ll see. Maybe it will even make the current field of psychaitry obsolete. Maybe we will define mental process in mathmatical terms (could happen with the right genious and the right tool) and stay out of the reach of corruption.
In my view, if it was arrived at through scientific method then it must be exact.
Diagnostic criteria for disorders aren’t always accurate or well defined. Take atypical depression for example. A study of the various criteria listed found that no group ever satisfied all of them and I think several were inconsistent depending on the patient.
Bipolar is another good example. It took decades before the full range of sub-classifications was recognized and that process may still not be finished.
The list goes on and on and the reason is that we still have no clear understanding of the biochemical basis for virtually any major mental illness. Even depression, which was widely believed to be due to a deficit in the serotonergic pathways in the brain now seems to instead relate more to neurogenesis in the hypocampus.
One big clue to that is the fact that low levels of ketamine, a drug that stimulate BDNF (brain derived neurotropic factor) seems to produce dramatic improvement in people with treatment resistant depression and it does so in hours to days rather than weeks to months.
However the attempt at classification still has to be made since even if your categories are wrong, they at least give you a language and short hand that facilitates communication, if nothing else. The only reason it becomes a problem is when professionals in the field become too invested in the labels.
I just googled both spellings, and the word “Scientology” wasn’t on the first page of either.
I well aware that google results are highly tailored to the recipient, so I wouldn’t expect our search results to be the same, but I wonder if what you are observing is ads for Scientology mixed with the non-commercial data for psych-whatever. I have noticed this phenomenon on YouTube (and yes, I am aware that YouTube tailors results in a similar manner according to past views). If I search for “atheist”, the first 1 or 2 videos that pop up are ads for Scientology. And since I am not reinforcing them by watching the ads, it seems that Scientology is paying heavily for product placement, either generally or specifically.
Unless you mean something idiosyncratic by “exact”, such a requirement would cut off a great deal of scientific practice. Fields of medicine outside of psychiatry would not be immune: where’s that tumor? Is it a tumor at all? That creme didn’t work for your rash — here, try another! Oops, you took the flu vaccine but got the flu anyway.
Scientists make models, test them, use them, but no model can account for all possibly relevant facets of reality; a model in quantum mechanics (or economics) might well make predictions with uncertainty. That’s not unscientific, that’s a recognition of current limits.
Frankly I wouldn’t call what medical practitioners usually do science anyway — physician is an applied vocation, not a research career. But there’s nothing in principle special about psychiatry. Yes, psychiatrists may not easily be able to point to specific physical correlates to a diagnosis, but that’s not a hard requirement.
That’s remarkable. I know all sorts of things that aren’t precisely correct: there are about seven billion people in the world; it’s cold today; my electricity probably won’t go out …
I believe Heisenberg would disagree with you. In fact, out side of trauma, most medicine has error bars of varying size. Even pregnancy test are not 100% accurate. And often many of the symptoms of medical conditions can only be self reported.
Does that prove your thesis? Consider this: multiple randomized trials (as well as controlled studies using observational data) have found that a combination of cognitive behavioral therapy and psychiatric medication are effective at treating depression. Did the researchers in charge of such studies use different, unsound statistical methods from researchers in other fields of medicine? Or what?
I would agree that “current limits” of our understanding and tools effect accuracy 100%. But consider this: In the previous millennium, it was accepted as “fact” that Mars moved backwards.. sometimes. Ptolemy’s models correctly calculated this observation but his assumptions were wrong – Mars obviously doesn’t move backwards. How do we know? Because of the inductive scientific method which requires causality and proof to move forward - becoming more and more accurate. Psychiatrists vote (DSM process) based on subjective assumptions, since there is no objective test to determine anything – ok, so they ask questions, is that considered an objective test? I mean, the person being questioned could be lying.
I admit the language I used paints a black and white picture which I regret . Allow me to rephrase - the usefulness of knowledge is directly proportional to its accuracy, no?
Also, there is a hidden assertion which I keep sensing, maybe I’m wrong but here it is: “Our lack of understanding and tools combined with the complexity of the subject is proof that there is no proof.”
