Assuming that it is not perfect, what specifically is wrong with it?
It does not work and often does harm.
It’s a dartboard at best. You basically try medications until you get the desired result. Lather, rinse, repeat.
Paging Tom Cruise. Paging Tom Cruise.
So it’s just like other kinds of medicine. Not sure I see the problem.
Primary problem:
Psychiatry - solve with meds
Psychology - solve with talking therapy
MDs in Psychiatry are trained to solve mental problems with drugs. PhDs in Psychology are trained to solve mental problems with various forms of non-drug therapy.
Psychiatrists look down on Psychologists. Psychologists want to have the right to dispense drugs. Psychologists have minimal to no training in drugs. Psychiatrists have minimal training in non-drug therapy. Both groups do NOT get along.
Now, the efficacy of many drugs is in question, especially across the population. When it works, it is GREAT. When it does not, there are other issues.
The efficacy of therapy is greatly dependent on both the patient, the therapist, and the type of therapy used. Some folks have to search until they find a good one - which often means one that fits both their problem AND their personality.
Finally, life sucks. Your happiness is at a set point, and will not move much from it. Accepting that is often one of the first steps. Some of us are born happy, others are born sad. Take a happy person, chop off their leg, and within a couple of years they are happy again. Take a sad person, let them win the lotto, and within a few years they are back to their original level of sadness.
Well, I’m a psychologist, so I have some issues with psychiatry, but I have to argue that gonzomax is quite wrong in saying that it does not work, and I think it easily does more good than harm.
I would also clarify Fear Itself’s observation to say that it isn’t that they try any medication with any disorder. There are classes or sets of medications that work well for some disorders. They may go through several different medications within a set of them, but they aren’t just randomly grabbing meds off the shelf.
Many psychiatric drugs and prescribed recklessly, without proper regard to possible side effects, and without adequate oversight. At least in the USA, many public schools bully certain students into taking drugs without. Lastly, relying on psychiatric drugs can divert a patient from tackling underlying behavior issues.
For almost all psychiatric illnesses there’s virtually no real understanding of the pathophysiology of the illness, therefore diagnosis and treatment is almost entirely based on guesswork and trial and error.
I apologize if I gave that impression. My point was that even among classes of drugs commonly prescribed for depression, only about one third of patients receiving them will show any improvement. The efficacy rate for psychiatric drugs is much lower than drugs prescribed for other medical problems. It is not unusual for patients to try dozens of antidepressants without positive results.
The same thing that was wrong with medicine up until the late 19th Century: It’s still in its infancy.
I studied neuroscience academically and then became a bipolar patient myself a little later. The brain is enormously complex even within one person. When we take into account variability across people and it becomes unworkable. Throw in poor theoretical understanding of even most basic brain processes and you can see the problems involved.
Psychiatry literally almost killed me a few times before it made me better. It really was the drugs that made me better if you can call the main one a drug. Lithium is an element and it was discovered to work on bipolar people by chance. It would be considered a dietary supplement if it weren’t for some dangerous side-effects.
The main problem with psychiatry is that it is dealing with the most complex subject matter available and using the most non-cooperative lab animals (people) to figure out what works and what does not.
It has made huge strides since Freud, lobotomies, asylums, routine electroshock etc. However, now we are left with a whole slew of drugs being pumped out without being well understood. There is a whole menu of drugs under the SSRI category for example. They are touted as rather benign antidepressant but one of them many triggers mania in one person, suicidal thought in another, and just causes another person to gain weight. OTOH, another SSRI that is thought to act in nearly the same way can get rid of depression in some of the ones that failed before.
Psychiarty has made great progress but it is still one of the areas of medicine awaiting the most improvement.
As a doc friend of mine says, we haven’t had any real progress since we learned to wash our hands.
I agree with this.
I know this is a popular meme, but do you have any evidence of this? Anecdotally, this is not the case for the children I see (often it is more difficult to get the school to regard the problems that disrupt classes most as anything like a mental health problem).
Behavioral problems are primary manifestations of mental health problems. ADHD in children can be particularly difficult to address without medication. There’s no underlying behavioral problem there - it is front and center.
I don’t want to hijack, but public schools don’t have the right to practice medicine. They do have the right to enforce rules of conduct.
I’m surprised to hear that only 1/3 of psychiatric patients improve with medication. That is the same percentage that I was quoted in 1971 – prior to the use of SSRIs. But perhaps that number was wrong then.
I don’t want people to have the impression that psychiatrists don’t do any talk therapy now. Some may not, but some do.
Psychologists advocating for limited prescription rights include a requirement for specialized training, typically a post-doctoral master’s degree or approved equivalent in psychopharmacology. Studies of psychologists who have been trained and allowed to prescribe demonstrate that they prescribed at a lower rate than psychiatrists.
I don’t want to hijack either, but I’ll simply point to Laparoscopic surgery, and say that I think your doc friend is wrong.
Funny line though.
Also: I know a number of psychiatrists with excellent talk therapy skills, but under managed care they have become extremely restricted in the amount of time they can spend with a patient. I hope that with the collapse of managed care and the introduction of mental health insurance parity in many states we’ll see psychiatrists being able to engage in a wider range of treatment options.
I’m living proof that the latter fate is avoidable.
It is all very simple, really. Sigmund Freud founded psychiatry on the belief that we all have Oedipal urges. Oedipus was a Greek King who killed his father, married his mother and poked his eyes out.
No matter what you think you really want, no matter what you figure is really bothering you, it all comes back to your Oedipal urges. So why waste all that money and time on a shirink’s couch? Go straight to the pay dirt. Kill your father, screw your mother and poke your eyes out. You will be as happy as a clam! 