First, your mother should NOT have said that, and second, the meme that mental illness isn’t “real suffering” is wrong.
:rolleyes:
And finally, I hope she never said that to his face, because telling someone already in the throes of depression that they should be ashamed because there are other people out there with “real problems” is only going to make one’s depression even worse.
A little professional honesty would be nice. When was the last time you heard of a psychiatrist, psychologist or other mental health professional say, “I am sorry, I don’t think I can help you with your illness,” instead of stringing someone along until their insurance or personal finances are exhausted. That would be refreshing.
But no doctor can rightfully say that until all availiable treatments have failed. And even then, destroying the hope of a cure might make things even worse for the patient.
And telling someone in deep depression that they’ll never recover is pretty much advocating suicide.
Anyway, while I also wish the cure rate was higher, I’m not sure a low cure rate is a condemnation of teh discipline altogether. After all, it’s not so long ago that you’d just as soon see an undertaker as an oncologist or neurosurgeon. Medicine improves. I’m not saying that current psychology models are 100% correct, they can’t be or we’d be seeing better results in treating mental illness, but treatment will improve as our understanding of neurobiology and human cognition increases.
You would like me, then. 
My usual way of working is to see a potential client once (or twice, if need be) then tell them what I think (usually a diagnosis), what that means (if they don’t know) and what I think the client and I should work on together and how. I tell them that there are no guarantees, and that a lot is dependent on how much they want to change and how hard they are willing to work. Then I ask if they want to work with me.
If it is someone I don’t think I can help, I tell them that. For example, I recently saw two men who were dragged to my office by females (a wife in one case, a mom in the other). These guys HATED talking to me. Therapy was not going to help them. I told them, got permission to tell the people who had dragged them in, and then told those people, “I am sorry, but I don’t think your guy is a good candidate for therapy. He hates the process too much. I think meds might be the way to go with him.”
Now (speaking as a physician) I’m confused. In your OP, you referred to “pathologists and cytologists”. Now you’re talking about “cancer doctors”, which to my mind suggests clinical hematologist-oncologists. Can you please clarify?
Well, try and look at it from the pathologist’s side. Someone gives you a tiny scrap of tissue from some mass, and you’re asked to tell them not only whether it’s benign or malignant, but also what kind of tumor it is. You look at it under the microscope and the cells look unusual, but not flat-out malignant.
You could take the conservative approach and say, “If it’s not knock-my-socks-off malignant, I’m not going to call it cancer.” Fine, then the patient comes back in a year with metastatic disease and you get sued for delay of diagnosis.
You could take the aggressive approach and say, “It doesn’t look right; I’m going to call it cancer so they take it out.” Fine, then the thing comes out and turns out to be benign, and the patient gets a postsurgical complication and you get sued for issuing a report that led to unnecessary surgery.
You could take the cautious approach and say, “It doesn’t look right, and I’m suspicious, but it’s not enough to call for sure, so let’s get a bigger sample.” Well, that’s the “trial and error tinkering” you’re complaining about, not to mention potential delay in diagnosis and/or surgical complication from a larger biopsy.
These problems are magnified ten-fold in cytology.
This is a vastly oversimplified summary of the decision algorithm I (at least) face daily, and believe me, a large amount of hand-wringing and hair-pulling goes into it, in no small part because I’m thinking about how people react when they’re told “You have cancer” or “You might have cancer” or “I don’t know if you have cancer or not”. Believe me, it would be a lot easier on my mental health if I did think patients were just machines to be fixed.
Well, rather than try to tar entire subspecialties with a single large brush, I’ll only speak for myself (as a practicing pathologist). I personally don’t have any problem, conceptual or functional, with psychiatrists. I think they do the best they can in a field that’s inherently murky. Granted, some of the psychiatrists I met during my rotation were a little peculiar, but then I went into pathology, so who’s the bigger freak here? A lot of the psychiatrists I worked with were quite bright and very perceptive of subtle nonverbal cues when interviewing patients.
Let’s face it: much as every specialty likes to pretend that it’s the one doing “real medicine”, the fact is that we’re all doing a particular part in the big picture of “real medicine”.
Something else–Two calls yesterday–one for a adoption parental eval, one for ADHD therapy. “Sorry, I am not trained to do those. Can I refer you to someone?” was my reply. Don’t get me wrong–I need the business. But professional ethics dictate that you don’t see someone who you aren’t trained to help, or don’t think you can help. Sometimes we are wrong, of course, and someone I think I can help, I can’t.
By the way, I am not saying I am the only one who acts in this way. I think most psychologists do–and all of us are supposed to.
I am sorry if you have not been helped. You may want to look into treatment for “treatment-resistant” depression (if, in fact, that is your diagnosis).
Well, since you profit from the whining of these people who don’t know how good they have it, then no. Not saying that’s what I think, necessarily, just that if you’re a person who doesn’t believe in an institution then you’re sure not going to take the word of someone who profits from that institution.
Yes, but even dinosaurs can be right.
I guess if you don’t believe mental illness exists then saying that wouldn’t make it worse, because it doesn’t exist to be made worse.
My childhood was really complex in its dysfunctionality. I think my mom’s objection (and maybe these doctors’, I don’t know) to psychiatry is that the diseases it tries to fix aren’t lethal on their own. Nobody dies from depression or bipolar disorder, they die as the result of things they do under the influence of those things, whereas cancer victims die of cancer itself. So it seems a little frivolous, like something people with too much time on their hands do. And also, it costs a lot of money.
Believe me, I would like to believe that she is wrong but I just can’t. Because doing so would align myself with my crazy dad, and I don’t want to do that. Like I said, it’s complex, and I have a lot of guilt. I don’t even go to the doctor when I’m physically sick because I know there’s people worse off than me. So I guess I take it one step beyond what she does.
But this thread isn’t about me, it’s about doctors and opinions and stealth research for a book.
And good psychologists, while not medical doctors themselves, know when to refer clients out when they need drugs or other therapy that only an MD can provide, and generally have working relations with one or more MDs.
[del]I’m not a psychologist but I did stay at a Holiday Inn Express[/del] 
OK, seriously, my wife is a psychologist, so there you go.
I’ve heard that before. So those who are “treatment resistant” have one more thing to beat themselves up about?
They are cytologists and pathologists who work with cancer specimens. So no, I guess they’re not cancer doctors in the strictest sense of the word, but they deal with cancer pretty exclusively so I think of them as being such.
That makes sense. I guess most people do that with their professions. But in this instance, what they said kinda played into what I’ve always been raised to think. It’s like if you were raised by piano players who always taught you that clarinets suck and then you move away from home and start thinking that maybe clarinets don’t suck but then you get told by another, professional piano player who says that yes, they really do. But this thread isn’t about me. Or clarinets.
Well, I know if I were a doctor I’d hate all psychiatrists with a passion. Then again, I do already: I can thank psychiatry for drugging me against my will in elementary school and God only knows how many of the problems I’ve had in the last few years stem from that. If my former psychiatrist and a flesh-eating monster tarantula were drowning, I’d save the tarantula.
First, I’m genuinely glad that you had a much better experience with psychiatry than I did. Psychiatry almost killed me, but mileage varies. Secondly, there are lots of other things that differentiate psychiatrists and psychologists. Granted, they pretty much all stem from the MD, but they can’t be written off, regardless; a psychiatrist and a psychologist will tend to have much different ways of viewing someone’s various problems, and much different ways of “treating” them. On each side, some work and some don’t.
I’m not an expert by any stretch of the imagination. But every single person I know who’s been diagnosed with depression is either (a) currently on a long roller coaster of medication and, although they have their ups, there’s no indication that they’ll ever get “better” with or without medication; or (b) used to be on said roller coaster, jumped off out of frustration, and are now both depressed and angry at the Man.
The concept of mental health is great, but shrinks don’t seem to ever know what they are looking for or if and when they’ve found it. They seem quite happy to keep people on the hook forever. I’ve known many people who went in expecting quick help, got slow help then could never get the doc to let go and had to feel guilty quitting. Trading one problem for another.
I work at a mental health facility. Most of the patients I work with are schizophrenic. The doctors who treat them are most assuredly REAL, and I dare anyone to come out here and hang around long enough to see the effects that medication has on these people. Some of them, with lots of help, are able to hold part time jobs, earn their own money, even move out into the community. Improve their lives.
Most of them started out homeless, hearing voices, getting picked up by the cops at Penn Station for being generally weird and inappropriate. There are still bad days, but you have to remember–there are all kinds of psych patients out there, not just Joe Unhappy who wants a prescription from something he saw on TV.
Also, I know plenty of people who claim that therapists have made them worse or “didn’t help” or whatever. Some of these people (not all, but some) are obviously just not willing to put in the effort and be accountable. And it’s easy to blame the shrink. Depression is not your fault (been there myself), but people really do expect that they can go into the office, get a miracle cure, and move on. I blame those awful TV ads.
Thanks for the clarification.
Well, I think partly it’s an unfortunate sociological side effect of American medical education, which I think propagates a certain machismo and “humorous” denigration of other specialties during residency training. No matter what (US) medical school or residency you go to, the same stereotypes seem to crop up. I can’t count the number of times an internist has seen me leaving the hospital at 7 or 8 pm and said, “Wow, late night for a pathologist.” I think every surgical resident across the country knows what a “dog collar” is (referring to the stethoscope which is worn around the neck by internists, but kept in the pocket by surgeons). I’m sure every internist has told the joke about how surgeons value their hands so much, when they need to stop an elevator door from closing, they stick their heads in instead.
Some MDs probably take this stuff seriously. Personally, I think a lot of it is funny, but I don’t really believe it.
No response to the rest of my post?
In psychological treatment, a great deal rests on the client. I can therapize* all I want, but if the client doesn’t participate, it doesn’t work. Period. Now sometimes clients are too depressed to fully participate, sometimes there are other factors, but the fact remains that the client has to work at it. It isn’t a matter of blaming, it is just a matter of fact. So, no, don’t beat yourself up about it, but stamping your metaphorical feet and blaming psychology/psychiatry doesn’t help, either.
By the by, ignoring the good (as you seemed to do with my post) and jumping on the blame bandwagon are two things one might work on in therapy. A big part of what I do is to get people to look at their thoughts, consider how their way of thinking is contributing to their depression, and try to change these thoughts. Can you imagine doing that without cooperation and hard work on the part of the client? So when I say it depends on how hard they work, it isn’t to blame them, but rather to warn them that it will be hard work.
Treatment-resistant depression, IMHO, is best treated with a combination of meds and psychotherapy–and in these cases, I think the meds are more effective. One’s brain not responding to medication is hardly a situation in which I would assign blame. You will note that I wasn’t referring to treatment-resistant depression in my initial post. If someone came to me with what seemed to be treatment-resistant depression, I would certainly discuss consulting a psychiatrist with him/her.
*used for comic effect, but damn I love that word.
It’s a sight better than surgerize, which I’ve had to hear quite a few times.
For some reason, my mind insists on linking both words with rhapsodize, which leads to some rather amusing mental images.
Well, you don’t know me, of course, but I’ve been diagnosed numerous times in my life with major depression, and neither (a) nor (b) apply to me. I am currently doing very well, with the help of a number of things: mood-stabilizing meds, talk therapy, self-examination, support of friends & loved ones, learning to make better choices in life, etc. I haven’t had a major depressive episode in quite a long time; I haven’t been dysthymic in months, which is a first for me in, well probably my entire life! If that’s not a mental-health success story, I don’t know what is.
And I’ve had some MD’s whose treatment of me for chronic pain, hypothyroidism, and other conditions has made them look much less competent than my psych doc!
Imagine, if you will, the following people:
Patrick is having a crisis of faith; raised conservative Christian, he’s having major doubts about the whole God thing but is upset, along the lines of “I don’t think there’s a God but I sure wish there was”, upset to the point that he doesn’t get anything done, blows off appointments and tasks, sometimes thinks of suicide, and even when not suicidal often says “What’s the use, what’s the purpose of anything anyhow?”
Suzanne was originally happy with her life; she’d left her good job to move with her husband and was fine with a non-careerpath part-time job while she raised the three kids and make a real home from the nice ranch house they got a good mortgage on. When husband started drinking and becoming abusive, she worked on him to get him to agree to couples’ counseling, and she found other interests & hobbies as the kids got older, but then he lost his job and become intermittently violent, and now she feels like she made bad life choices, feels stuck with a bad husband and, in light of probably impending divorce, a high mortgage and a sense that except for her kids everything she’s put energy into in the last 12 years is going down the tubes. Her cheerful persona has been punctured, she’s upset and cries a lot, has contemplated suicide on occasion, and even when not suicidal often says “What’s the use, what’s the purpose of anything anyhow?”
Melinda was raped four months ago by someone she knows, not a boyfriend or relative but someone who was a regular acquaintance. She believes that he has bragged about ‘getting’ her to their mutual acquaintances. She hasn’t reported the event to the police, although she’s been on the verge many times. She also hasn’t confronted any of the folks who are among their circle of acquaintances at times when she’s picked up on insinuations & innuendos to set them straight about what really went down, although she’s almost choked on her anger & was about to several times, but got scared that they might not take her side. She doesn’t feel safe with anyone any more. She distrusts her own ‘trustometer’ and often feels stupid. For days on end she doesn’t feel like leaving the apartment or even getting out of bed, she’s thought of suicide and made actual plans, and in her journal she writes “What’s the use, what’s the purpose of anything anyhow?”
Ahmed has a good job and good friends but as the Iraq war has dragged on finds himself increasingly distracted by the need to puzzle out things that previously did not seem to be in conflict — his American patriotism, his pride in his Iraqi heritage, the peaceful comfort of being able to practice Islam in a pluralistic society, his heartfelt desire to see dictator Saddam Hussein deposted. Everything somehow seems to have gone to hell in a handbasket. He has a cousin who is believed to be held at Guantanamo Bay. The American attitude towards Islam has gotten scary and so has the tone of lots of Islamic culture itself. Perhaps worst of all, his friends and coworkers just seem so unfazed and unbothered and somehow shallow and vapid and he has to either not talk to them or put on a false front of easy bland cheer. Lately he’s called in sick quite a bit and has said to his concerned girlfriend “Sometimes I think nothing matters, what’s the use, what’s the purpose of anything anyhow?”
Rhonda has no discernable events of situations in her life that I am aware of to tell you about. I mean, it is possible that something is going on with her that would make sense of how she acts and feels lately, but if so, it’s nothing that she can put her finger on, or nothing she can tell me about. She is here saying she’s miserable all the time, and all her friends are worried about her always being miserable and she is scared that everyone will leave her and she’ll be alone if she doesn’t get over it. It feels like nothing matters, what’s the use of anything, what’s the purpose of anything, why not just die and get it all over with?
Now, does anyone seriously want to suggest that that if we sent each of these folks, in turn, to a spiritual counselor, a feminist therapist, a psychiatrist, a psychologist of the behavior-mod school, a marxist social worker, a hippie guru, a nutritionist, an endocrinologist, a career counselor, and a holistic massage therapist, that each expert would consider the same possibilities in the same order? Of course not.
In choosing to go to a psychiatrist, you are framing your problems in a certain way. (Just as you are framing them in a different certain way by going to one of the others).
If our sample patient-people go to psychiatrists, chances are that all of them will have what they are feeling and the associated behaviors assessed as probable symptoms of the mental illness called “depression”, which the psychiatrists have been taught to conceptualize as a serotonin deficiency disorder best treated with antidepressant pharmaceuticals. This is particularly true for Rhonda, who doesn’t have a backstory of events and circumstances that point towards other ways of understanding these presenting symptoms, but it would not be at all unusual for all of the above people to have their problems assessed from that standpoint.
Regardless of how you may feel about spiritual counselors, feminist therapists, psychologists, marxist social workers, hippie gurus, and career counselors, their starting point differs from that of the psychiatrist in one critical aspect: they aren’t likely to start off considering the emotional state to be an artifact of a physiological pathology. They will mostly likely assume that the emotional state, like most emotional states, is a valid reaction to something that needs to be dealt with.
You could say that they differ also from endocrinologists, nutritionists, and massage therapists, who also will tend to think the feelings have a physical cause — but (in descending & consecutive order) they will generally test, with established, rigorously scientifically based panels for conditions with known etiologies which are addressed with hormones identical to those naturally produced in the healthy human body , or they will assess, with tables based on established metabolic processes and nutritional needs, for dietary insufficiencies that, if they exist, can usually be addressed without introducing into the body anything more medically intrusive than different foods, or they will assess, based on the somewhat esoteric and scientifically underevaluated protocols and traditions of the profession, for tensions and conditions and bottled-up chi that they will then address without introducing into the body anything at all, just prompting the body to release its own little chemicals and whatnot as a consequence of proper manual stimulation of muscles, nerves, and bones.
I don’t know that the counselors, gurus, MSW’s, endos, and whatnot would necessarily, upon finding no evidence of the kinds of problems that they specialize in, recommend to the patient that they see the others each in turn, including the psychiatrist. Some will, some won’t.
Point is, the treatments provided by the psychiatrists, by their very nature, are going to mask the symptoms that may be symptoms of a wide range of other problems instead of this mental illness called clinical depression, at least to a significant extent. There is zero evidence that any psychiatric pharmaceutical will only work on the constellation of feelings and behaviors when those are due to an actual brain-based, medical-model mental illness.
The profession lacks any means of distinguishing between a person with the symptoms due to something different and a person with the symptoms due to true mental illness. In practice, if not in theory, the symptom is the disease. They also don’t have any protocol for determining that, insofar as what they are treating you with isn’t working, you must have something else and should go see a different kind of doctor or therapist. They don’t do that. It just ain’t done. Nope, you get tagged with “treatment-resistant <mental-illness-name>” and they try a different psychiatric pharmaceutical, or eventually perhaps ECT. But because they don’t have any good “rule-out” protocols for eliminating mental illness as a possible cause of your symptoms, they are not prone to refer out. (They do, of course, refer out if you break your arm, get a ruptured appendix while on the psych ward, need a tooth extracted, etc, that’s not what I mean. I mean they don’t refer out for the presenting causes. Folks with symptoms of mental illness that they aren’t able to address with success aren’t sent on to the endos or nutritionists or marriage counselors as a general rule)
And that’s a good reason to rule out everything else first.
You keep saying “this thread isn’t about you,”, and yet, you keep bringing up YOUR experiences, and your biases are really coloring it. I’m not trying to bash or flame you, but I think you need to get a larger perspective.
And quite frankly, if someone IS suffering from mental illness, why should they just suffer rather than get treatment because of some notion of how someone else has it worse? It may make you feel noble, but does it make you happy?
I’m going to bring in MY biases, if you will. For some of us, the constant refrain of “it’s not real, the pills are a crutch, you just need to change your diet/suck it up/find Jesus/suffer because that’s what God intends/just snap out of it/blah blah blah fishcakes”, gets really old and really annoying. I’m not saying YOU are doing that, but I feel like I’m constantly having to DEFEND the way I treat my disorder, and that pisses me off.
Why should I have to defend and feel guilty for getting treatment? I’m a HELL of a lot happier since I gave in to my “weakness”, I don’t feel the need to constantly drink glass after glass of soda pop so I can belch and therefore, I won’t have to throw up, or go over and over the reasons in my head why I shouldn’t be afraid that somehow God is going to punish me unless I become a religious fanatic. It’s a HUGE burden lifted from me, and I am tired of having to justify it all the freaking time.
BTW, davenportavenger, HAVE you ever talked to a counselor? Not necessarily a psychiatrist-a therapist, a social worker, a psychologist, etc. Just wondering if you had any experience with them. You’ve talked about how you’re constantly on the verge of a nervous breakdown, always stressed out and exhausted-do you honestly feel good about that? I guess it all boils down to-does it make you happy?
AHunter3, most psychiatrists I talked to didn’t just say, “Oh, it’s a chemical thing-here’s some happy pills!” Mine also encouraged me to deal with the things in my life that were stressing me out (btw, my depression WAS situational, but my anxiety disorder was not, just that it got worse in stressful situations, naturally). To say they don’t rule these things out is bullshit. Some of them were like that, but not the profession at large.
That’s good. MMV, and in this case I’m glad it does. You’re obviously doing positive things and using the field of medicine to your advantage.
You haven’t seen incompetent medical care until you’ve been in the military. I’ve had some pretty incompetent care in the civilian world as well. I hate to paint with such a wide brush, but I haven’t found a single exception to this: MDs don’t believe that I experience chronic pain. A lot of people claim that doctors hand out dope (in various forms) like candy, but I have always had the opposite problem: doctors don’t believe my pain. It’s not that I want mind-bending opiates (although, to tell you the truth, I wouldn’t turn them down), I just wouldn’t mind some medical attention. I’ve pretty much given up on that. I did some posture exercises last year that were a miracle and really helped, but I still pretty much hurt everywhere. I deal.