Wow. I thought this was a place where ignorance was fought. There’s lots of battles in this field, I guess.
Um. That was psychology. Not psychiatry.
Not even close to true.
Things have been changing as neuroscience has been uncovering the biochemical basis for lots of mental ailments.
Wrong on all counts. Try to find cites (from actual reputable sites) to back you up. And good luck with that.
Well, the first thing that popped into my mind upon reading the OP is this:
By and large, the people doing the prescribing of psychotropic medications aren’t psychiatrists.
Though finding an online cite for the U.S. is damned hard without paying some money, I did find one Australian study here that found a whopping 86% of subsidized antidepressants are prescribed by General Practitioners. I know the cite for the U.S. number is around here somewhere, because it was recently published in a major newspaper, but from my recollection the number was very close to that of Australia. I’ve also seen studies that give similar numbers to the UK and Italy, so I don’t think it’s unsafe to say this is a widespread phenomenon.
I also found this study that indicates an increasing number of psychotropic medications are being prescribed to children by pediatricians and other GPs.
I am of the mind that GPs have no business prescribing psychotropic meds to ANYONE, barring they complete some kind of rigorous certification for it. There is also evidence to show that plenty of GPs prescribe psychotropic meds even when they don’t think it’s the best treatment, because other treatments for whatever reason aren’t readily available.
Anecdotally I can tell you some serious horror stories about GPs prescribing psychotropic meds. Anyone with a psychological disorder can probably explain how often GPs just don’t seem to understand what they are doing. My Aunt had been suffering some anxiety problems for several weeks. She went to her doctor, and her GP gave her Paxil and said, “Take this. If it doesn’t work, you’re probably bipolar.” My aunt has no knowledge of psychology or psychiatry whatsoever, she had no idea how ludicrous and outrageous this was until I told her.
So my gut response to the question is basically this: What’s wrong with psychiatry is that most of the people dispensing psychiatric meds aren’t psychiatrists.
Once that grievous problem gets taken care of, then we’ll have a better sense of where psychiatry is hitting the mark and where it’s failing. Though by and large I would have to agree that it’s a new science, and the brain is difficult to understand, therefore psychiatry is going to struggle on a certain level until we know more.
I can tell you a serious horror story about a psychiatrist (who still works) prescribing psychiatric meds but I’m not going to go into it.
I wasn’t claiming perfection within the field either, just that as long as GPs are prescribing it’s going to be a lot harder to sort out the problems that actual real psychiatry still faces.
ETA: I hope your story didn’t involve you. I know what a bitch that process can be, and there is incompetence everywhere, no question.
What about those of us who feel that we got a great deal from psychiatry? I would go so far as to say it saved my life-along with talk therapy.
No, you see. Here’s the problem. You don’t know the history of psychiatry. I do. :dubious:
In my case, my GP sent me to a psychiatrist to get me on a new antidepressant, and then wrote a prescription for the same medicine, to be refilled as I needed it. She told me that if I felt the need to try a new med, she wouldn’t change my prescription, I’d have to go back to see someone who knew more about antidepressants than she does, but she’d be happy to write refill prescriptions once I was on a more suitable medication.
I had a very hard time finding a psychiatrist who was accepting new adult patients in my city who also took my insurance. I don’t use an HMO, either. It’s a good thing that I wasn’t having a crisis.
Don’t you have a couch that needs jumping on?
It’s way too expensive for many of the people who need help. If you are fortunate enough to have medical insurance, the psychiatric benefits are usually limited.
I get irritated when I hear some expert say that people with psychiatric problems shouldn’t be given medication unless it’s temporary and integrated with talk therapy. That’s fine for the people who have lots of money and access to a psychiatrist. What about everyone else?
I second this. Most insurance companies only cover 15 sessions a year, if any. And the burden of proof for why you need the therapy is so high. Psychiatry will continue to suffer as long as it’s not treated as a legitimate medical field, and people will continue to suffer until they have fair access to health care regardless of their income.
I just got this. It was much more clever than what I would have come up with…
How is that any different from any other field of medicine?
Part of why that’s recommended is that the research from NIMH shows the combination of cognitive-behavioral therapy plus medication to be most effective for many disorders. I’ve been involved in the fight to get insurance to cover mentsl health issues in an equitable way (what’s odd is that it’s well-demonstrated that covering mental health needs decreases the company’s costs, but they don’t seem to believe it). I can’t speak for your community, but in mine there are a number of reputable clinics providing low-cost individual and group counseling, and a number of practitioners doing so as well. One way to find these services is to call the closest college or university counseling center to ask for low-cost communit5y referrals. Ditto the local crisis hotline.
There is a lot that is wrong with psychiatry but I’m not going to attempt to boil it down to a one-liner. Or even a one-paragraph’er.
a) Multiple, occasionally contradictory goals leads to muddy focus, and goals disguised as things other than what they are lead to distortions, falsehoods, and deliberate misrepresentations.
Psychiatry is, on the one hand, for the treatment of people who have the emotional and cognitive problems we call “mental illness” — for the benefit of those people; and, on the other hand, for the protection of society from people who have the emotional and cognitive problems we call “mental illness”, insofar as those people can be disruptive, unpredictable, and tend to be considered dangerous or incompetent (now), evil or immoral (then), and inconvenient (both then and now).
The latter practice is actually a police function, when you think about it, but this part of psychiatry’s role is commonly sugarcoated with the pretense that it’s merely an extension of the first role, that the removal, containment, and control of the lunatics and nutty people is for their own benefit, for their own good.
The role of such thinking is strongly manifested in the rationales for forced treatment, but above and beyond that, various treatment modalities that have been approved “for the mentally ill” are not earmarked as “only appropriate for subduing disruptive people or maintaining control over them in our police role, don’t use this when you’re genuinely trying to help people who have turned to psychiatry for help with their mental problems”.
So many treatment modalities that get greenlighted for their usefulness to psychiatry’s police role get turned on the people they are trying to help as well, even though many such treatments have been unsafe (ranging from “not adequately tested” to “tends to permanently maim and kill those who receive it”).
b) It’s historically been a medical-science ghetto; successes have been stolen away from psychiatry, leaving behind the unsolved problems, which may not even be medical.
Cast your mind back to the medical profession of 150 years ago. Rationality and scientific method were, in a very exciting way, revealing how diseases worked and what could be done about them. Even though (as discussed above) psychiatry had, from its origins onward, a police role, it was not with cynicism or duplicity that people originally believed that these human ailments would yield up their secrets to science.
Still, a stigma was attached to the profession just as to the sufferers, and no one who had a disease that could be comprehended as a biological process for which medical intervention was possible wanted to be treated by one of those doctors! I mean, people would think you were nuts, those doctors treat the nuts!
So one “dementia” came to be understood as the result of latter-stage syphilis (and ceased to be treated by psychiatrists), another as hypthyroidism (which got moved to the new field of endocrinology and again ceased to be treated by psychiatrists), yet another became known as epilepsy (several forms of it, actually, all of which were lifted and moved to another new field, neurology).
By the middle 1900s, psychiatry was mostly holding onto the ailments that had not proven so readily solvable. Depression, schizophrenia, bipolar disorder… these may in fact not be medical ailments at all, and there’s a sentiment that’s finally getting some airspace that says it’s most likely a constellation of factors, some intrinsic, some social or contextual, and some of it even consisting of coping mechanisms and/or coping mechanisms gone awry rather than merely pathology per se.
c) As an outgrowth of both of the above, lower standards within medicine as a whole.
I don’t mean lower standards of the quality of treatment, although that’s affected of course, but rather standards pertaining to the use of diagnostic category, for example: in other branches of medicine, there’s internal pressure and pressure from other branches of medicine to show that you diagnose people with a diagnosis that they would have obtained in a double-blind test, i.e., different doctors seeing the same patients and each set of doctors unaware of the other doctor’s diagnosis reaching, to a high degree of confidence, the same conclusion.
It’s a somewhat controversial claim I’m making here (some would defend psychiatry and say its reliability quotient is as good as any other branch of medicine’s) but I’ve heard many speakers say that in any other branch of medicine there would be more pressure to retire the existing categories of psychiatric diagnosis because they are too loosely defined, and inter-rater reliability is very low (meaning that you’d get one dx from one doctor and another from the next doctor to an unacceptable level of uncertainty).
To exacerbate the problem, preferred treatments for any of the existing categories are sufficiently muddy that there is no treatment that is ruled out for any category, nor any that is reserved for sole use within a single diagnostic category. People with bioplar disorder are prescribed prolixin; schizophrenics are subjected to ECT; people with clinical depression are given mellaril; etc. In short, beyond a surface appearance of pyschiatrists making precise diagnosis of a specific psychiatric ailment and treating it with a specific regimen, the practice is to stick a label on it, willy-nilly, then to throw a drug at it, then another if the first one didn’t work, and after trying a few alone with no success trying them in combo with each other.
I’m not saying other branches of medicine are not also horrifyingly vague in actual clinical practice about what they’re treating and how they’re treating it, but psychiatry is definitely a lot closer to trephination and stone knives and bearskins than endocrinology, gastroenterology, dermatology, cardiology, neurology et. al.; and while it may be nasty of them to say so, lots of doctors in the other branches of medicine still view psychiatry as where you go if you went to medical school and turned out to not be any good at any of the forms of real doctoring.
d) It’s lucrative for the pharmaceutical industry, and they’re trying to cast a wider net.
The combination of the fuzziness of diagnosis (meaning that given sufficient reason to do so, a higher percentage of any population can be found to exhibit symptoms of mental problems in need of treatment), the intertwining of it with coercive social response to disturbing behaviors (the police function), and the lower standards regulating the safety of the medications themselves means that it has proven mutually beneficial to the pharmaceutical industry and to various institutions that have a need to control a population they are in charge of — schools, prisons, elder care facilities, and others — to aggressively expand mental health screening, to use institutional pressure to require accepting treatment, and to deploy newly approved psychiatric pharmaceuticals on a large scale in such settings.
Meanwhile, again due in large part to the fuzziness of definition of what is and is not a psychiatric ailment (and what it means for something to be a psychiatric ailment), the entire target population of human beings who experience emotional and cognitive problems all the way down to “some distress” and “feeling stressed” (as more than one subway ad I’ve read has it) is a market to which new psychiatric pharmaceuticals are being advertised.
There are a lot of truly miserable people who consider themselves to have full-blown mental illnesses (and who may or may not credit psychiatrists with providing useful and necessary treatment, some certainly do), and many of them get severely annoyed when their condition is casually associated with that of people who are merely “a little stressed” or who have “a case of the blues”… well, they can blame the pharmaceutical industry for that, in large part. I
f they could convince us all that 3/4 of us need psychiatric treatment, they’d be happy to fill the supply chain with the pills, and lobby the insurance companies for full coverage, you can bet on that.
Despite all that, there are good people in the psychiatric profession. Most of them have, shall we say, drunk the Kool-Aid; they are way too inclined to believe their own profession’s bullshit, IMHO. But some of them are good listeners, supportive counselors, and are people who listen to their patients’ feedback after prescribing and work with the patient to find the best possible medicines.
And again, despite all that, human misery of the emotional/cognitive variety does exist, and at least some of the research done by or on behalf of the psychiatric profession has yielded things that help some of the people some of the time.
If you want hard evidence, I point you to the steady decline in suicide rates since the advent of Prozac in the late 80’s. If you want a cite, I can give it to you here:
http://www.cbsnews.com/stories/2005/02/02/health/webmd/main671167.shtml
Do you still question the value of psychiatry?
Dean.
wrong. Suicide rates have dropped steadily since the 60’s, because of psychiatry.
Dean.
Science lately has been skewing much more to the pathology. In fact, in my estimation, once people begin to understand that ‘mental illness’ is, generally, an organ malfunction, ‘psychiatric treatment’ will, as it properly should, be considered part of regular physical maintenance rather than some esoteric and specialized part-shamanistic rite used only by ‘wierdos’ and ‘nuts’.
The brain is a hunk of meat. Stuff goes wrong with it. That stuff can be fixed, as can with things that go wrong with any other of our organs.
Preach it.
I recognize that there are obviously many, many times when talk therapy in some form, whether formal or informal, can help a person with a problem. However, in my experience, reading, and observation there is a huge amount of chemical and basic organ malfunction involved in mental illness.
Obviously, like anything else, drugs can be misused, overused, and abused. Some people want a magic pill to erase all problems, which is impossible. Before we had any lithium or Prozac or Paxil, though, people just suffered, committed suicide, or if in bad enough shape were locked up “for their own good.”
I personally thank Paxil for changing my life. I’d reached a stage where I spent most of the day being afraid, taking a couple of breaks every day to go into the ladies’ room and cry quietly. I’d tried everything except talking to my doctor. When I finally did, and got the right med, it was like a dark gray fog was lifted from my brain. So don’t tell me it’s not chemical.
A person close to me who has bipolar disease is noticably improved as her psychopharmacologist fine-tunes her array of medicines. She’s also seeing a therapist twice a week. It’s expensive, but it’s less expensive than the trips to the ER and the in-patient treatment for attempted suicide.
The pity is that much if not most of society treats such things as shameful secrets that you don’t talk about, and people with such chemical imbalances as if they were somehow to be blamed.
Meanwhile, society is also well-populated with folks who are all too credulous about “such chemical imbalances” as they are alleged to exist in people who have been diagnosed as one form of “mentally ill” or another solely on the basis of behavior.
That would include me. I prefer my brain chemistry, however balanced imbalanced or unbalanced it might the fuck be, to remain as it is, thank you very much.
Well, nobody’s suggesting you change your brain chemistry. However, if you spent most of your time in a state of dispair for no particular reason, yunable to experience joy in anything, ever, you might feel otherwise.
I find your dismissiveness of the all too real pain and suffering of others disturbing.
Cite?
…and I would, of course, intuitively know that no particular reason existed…
Yes, I might. And if I thought it was in my best interests to go to a psychiatrist and, hopefully, obtain a prescription for a psychiatric med that might make my life tolerable to me, or better yet make the problem go away, I’d be massively pissed off if someone tried to stand in my way.
You see any inclination on my part to stand in your way?
I have said they pretend to a degree of knowledge they do not possess, that they prescribe medicines for which they understate the risks while overstating the specificity therof, and that in some cases they force people to accept treatments they do not want, which I have said is wrong. I have in fact said all of these things are wrong.
I have not, however, said that people should be barred from receiving psychiatric treatment, or psychiatrists barred from providing it, or pharmaceutical companies prevented from developing, producing, and distributing psychiatric medication.
I find your lack of reading comprehension disturbing.