One thing “wrong” with it is that even more so than with most types of medical care, diagnosis and treatment are based almost exclusively on information provided by the patient (or in the case of a child, the parents) rather than relying on any objective test. And as anyone who’s watched “House” knows, patients lie—if not outright fabrication, then exaggeration or lies of omission—to give the doctor what they think they want to hear, or to help steer the diagnosis toward their own preconceived expectation.
I am confident that I could walk into almost any psychiatrist’s office, give the obvious answers to a list of boilerplate questions, and walk out with a prescription for medication for depression, anxiety, ADD, and/or insomnia. (I know because I’ve done so.) In the future it may be simpler to employ a brain scan or some other test that can confirm the existence of the disorder before treatment is prescribed, but at present it’s almost fully based on a patient’s own word, and many doctors are reduced to the role of pill vendor if they want to keep their patients from going elsewhere.
This is not to say that psychiatric drugs are not beneficial to many, or that everyone who receives medication does so inappropriately. But a patient seeking psychiatric treatment for a disorder may actually have the disorder, or may just be seeking out that cool-sounding pill they keep seeing commercials for, or may be looking for some biological abnormality upon which to blame their (or their child’s) irresponsibility or bad behavior. Until more objective tests are developed, your average psychiatrist has neither the means nor the motivation to determine which of these may be the case, and standard procedure of “throw another drug at the problem and see if it sticks” will remain in force.
My reading comprehension is fine, thank you. I’ll go over it again. You are dismissive of chemical imbalances by putting it in quotes, implying that these are less than real. You say they are “alleged” to exist as if there were no clinical basis for diagnosis and treatment. You similarly dismiss “mentally ill” as if it were some sort of hoax. You refer to people who have concluded that there is a chemical basis for mental illness as “all too credulous.” Your final paragraph implies that you think someone might by trying to foist unwanted treatment upon you in order to change your brain chemistry. Unless you’re a danger to others, or even to yourself, I don’t think anyone’s likely to do so.
There is no one simple answer to mental illness, no one size fits all solution. In my experience people are more likely to dismiss mental illness as some sort of weakness, self-indulgent behavior, or character flaw. I have seen few if any situations such as you describe of people being “all to credulous” about the physical and chemical basis for mental illness.
Would you scoff at “such chemical imbalances” if we were discussing diabetes and insulin? I would presume not.
Well, stupid idiots that they are, they assume, I guess, that people might want to be - oh, you know, honest - when it comes to matters of their own health. :rolleyes:
Not ‘in the future’. The future is now.
Huh? Who would do that? And would you not consider that in itself a symptom of faulty mental functioning?
Because that allows them to feel superior to people. It’s unjust to condemn someone’s behaviour if it’s caused by something beyond their control. So in order to justify righteous indigantion and moral approbation, you have to believe that people with mental ailments are just malingerers.
Schizophrenia is not a prolixin-deficiency disease.
Bipolar disorder is not a lithium-deficiency disease.
Clinical depresson is not a prozac-deficiency disease.
That any of the three consist of, are caused by, or even necessary correlate with a neurotransmitter chemistry state that can be reasonably described as “imbalanced” is a theory not as of yet solidly supported by any physical evidence.
People with diabetes can have blood drawn and it can be shown to be true beyond a reasonable doubt that their bodies’ pancreas’ are not producing insulin, and that the insulin provided for them to inject themselves is for all intents and purposes identical to the insulin that would be produced by the pancreas if this were not so.
Believe what you want about “clinical depression” or whatever you’ve been diagnosed with, and if the pills prescribed for you help you, by all means take them.
The quotation marks are, as explained in my first post in this thread, due to the fact that they don’t have a very solid working definition of what the fuck “clinical depression” is as contrasted with any of the other handful of psychiatric labels they hand out. Their inter-rater reliability quotient is lousy (i.e., if a psychiatrist doesn’t already know what diagnoses you’ve received previously, your chances of getting the same one are not as high as the standards of inter-rater reliability in the other branches of medicine would hold that they should be in order for those categories to continue to be in use).
The fact is that in the real world, many people are not completely honest. And these are drugs whose effects, and side-effects, are not always fully benign, particularly in long-term use (not to mention how unpleasant and severe the withdrawal symptoms can be). It would behoove both the doctor and patient to make sure the problem exists, and is identified accurately before treating it with drugs. Much as you wouldn’t start someone on insulin before confirming they are diabetic, rather than relying on their say-so.
Cite? In none of my ten years of treatment for depression and anxiety was I ever once subjected to a brain scan. And to be perfectly clear, I am asking you for a cite that psychiatrists, as a matter of course, currently employ brain scans (or other test that can show a positive or negative result) for a psychiatric condition such as depression, anxiety, ADD, etc., before prescribing drugs. (So please do not paste that same link to the clinical ADD study from the “punctuality” thread. I’m talking about current, common practice.)
You’re actually proposing that if someone (for example) exaggerates the severity of his anxiety because he wants a prescription for Xanax, that proves he’s crazy, therefore he needs the drug after all? Fan of Joseph Heller, by any chance? (Substitute “depression/Prozac” or “attention deficit/Ritalin” if you wish.)
AHunter3, we will simply continue to disagree on this.
I’ve seen very specific descriptions of clinical depression and other mental illnesses. If you have not, then we have different experiences and resources.
With bolding added, my point is made, depending on your definition of “solidly.” Clinical depression may not be prozac- or paxil-deficiency disease. But serotonin reuptake inhibitors have been clinically shown to assist in the appropriate balance of serotonin, an important brain chemical.
Bipolar disorder may not be lithium-deficiency, but it has been clinically documented that its use helps in moderating the extreme mood swings of the disease.
I have never heard anyone say he or she understood the basis for schizophrenia. It may be that it is not a single disorder but any one of a set of malfunctions resulting in similar effects, like cancer.
I agree that we have a very, very long way to go toward understanding exactly how and why many of these chemicals work, both in health and in disease. Heck, has the medical profession yet figured out exactly how aspirin works? Nevertheless, it eases many a headache.
The medical profession has, in my opinion, just barely begun to scratch the surface of the biological basis for brain function and dysfunction. The fact that there is much to learn does not mean nothing has been learned. The fact that there are poor clinicians does not mean that the practice is worthless.
For some reason this reminds me of how, until recently, stomach ulcers were believed to be caused by stress and/or dietary habits. The first person to suggest a purely biological ailment caused by a bacteria was scoffed at, yet that is widely believed today to be the basis most of the time.
Yes, and the accepted practice guides do require differential diagnosis be done.
Now, if you want to discuss the state of training/regulation of medical practitioners, that’s a whole other issue. It doesn’t make psychiatry bad science because people don’t do it right.
Why not that link? But here’s another if you like, and if you do a search on ‘brain scan diagnose’ (w/o quotes) and then add ‘bipolar’, ‘schizophrenia’, etc. you’ll find plenty of quotes. Me, I want to get out of this house soon and don’t want to spend another hour hunting sites when your fingers appear to work just fine. But here’s one for starters: http://www.brainplace.com/bp/atlas/
Dr. Amen regularly uses SPECT scans in his practice and has been made a Distinguihsed Fellow of the APA.
Again, it’s to the physician to do the differential diagnosis. Addiction/drug abuse should be something the physician should be watching for.
The central ethical issues of psychiatry, as I see it, is how much alteration of a person’s mind is acceptable and where the range of “normal” behavior is set. Because psychiatrists are forced to work with these issues on a regular basis while there is no consensus on the answers, their profession will continue to controversial.
Thanks. For future reference, the one making a claim (as you did by claiming “the future is now,” implying that brain scans are used by psychiatrists as a matter of common practice) is the one who is expected to provide evidence for the claim, so “go look it up yourself” is not a particularly useful response.
I appreciate your going out of your way in this case to actually dig up a cite, but as I feared, the one you give does not provide what I asked you for. It shows that one clinic (and one doctor in particular, Dr. Amen) uses SPECT scans in his practice. I did use my well-functioning fingers to do a Google search on SPECT scans, though, and found that every link related to the use of SPECT scans for psychiatric conditions referred back to Dr. Amen.
It may be that SPECT scans are adopted as a diagnostic tool commonly used by psychiatrists across the board one day, but I contend that today they are not, and that you have (once again) provided an isolated example as evidence to support a general claim.
I think psychiatry is often so messed up because the people who go into it and later become psychiatrist are often trying to figure out their own problems. It’s like the blind helping the blind. Just a theory from my personal experiences. The psych majors at my school are often the most messed up people I’ve encountered.
Not to be defending shrinks (trust me on that!), but the folks at university who are majoring in psych are not the future psychiatrists. You want to see the future psychiatrists, you’ll find them amongst the pre-med students. Psychiatrists are medical doctors.
Actually, they did try to change his brain chemistry. You’ll find a wealth of information on The Dark Side of Psychiatry if you search some of AHunter’s threads on the subject.
Personally, I think he’s a peach just the way he is.
Mr. Kalhoun, please have a seat. Was there a time when you became convinced that your associate AHunter3 was a peach? Or have you believed AHunter3 to be a peach all along? Has it ever seemed to you that AHunter3 was an apricot, or perhaps a nectarine? Only a peach, mm. Does anyone else seem to you to be a peach?
Maybe so. But his experience was not my experience, and vice versa. He shouldn’t judge ALL psychiatrist by his own encounters. There are some of us who have had negative experiences, and some of us who have had positive ones.
I’ve learned that as a consequence of being on this board. Whatever the state of the science underpinning psychiatry, I’m convinced at this point that there are strongly caring & professional doctors in the profession and that, furthermore, whatever the precision of medications available to us today, there are people who credit those meds with saving their lives and allowing them to move on and function as non-incapacitated people.
Friendly neighborhood psychiatrist checking in here. I don’t know if my experience is typical, though:
I worked in academia for about five years after residency. Our program (which, interestingly enough, was considered very psychopharmacologically based) focused a great deal on providing both individual and group psychotherapy experiences for our residents. I also had a fair-sized private practice, in which I had the good fortune to provide short- and long-term psychotherapy.
I take a conservative position on medications; I don’t like prescribing medication just for medication’s sake. I am a BIG believer in psychotherapy for those who want it. I see my job as collaborator and provider of what information we know (also acknowledging that there is a lot we DON’T know); I believe that, with certain exceptions, clients should make their own choices based on current research and their goals/wishes/desires.
Two problems (there are more) are two sides of the same coin:
Psychiatry has unfortunately devolved to psychopharmacology for a great many of us. I was able to engage in psychotherapy because of being in an academic position; my colleagues in private practice (unless they’re cash-pay only and have a talent for it) do not have that luxury. A dear colleague of mine feared that a vital skill was being lost by modern psychiatrists not having substantial therapeutic cases; I share his view.
The other problem is that people who come to me and do want treatment frequently WANT a psychopharmacologic solution. While I am happy that more people are willing to seek treatment, frequently I get “fine, but just give me a pill and make it go away” when I start talking about therapy. When you couple that with reimbursement problems, it’s hard to keep fighting that fight.
By the way, we don’t have good scan data yet so as to make it part of standard clinical practice. Psychiatrists have been holding out for the “Holy Grail” of imaging studies that demonstrate functional differences, partly to legitimize psychiatry to insurance companies and other medical colleagues. While I have ordered EEGs and such, I’ve never ordered any “functional” scans such as a SPECT. As an interesting counterpoint, I have met physicians in other professions that lament the inability of new docs to diagnose based on a history and physical because of “worshipping at the shrine of lab tests”. While I look forward to whatever tools we can make use of for diagnostic clarity, they’re not going to replace the tool we have now - a careful (and ongoing) dignostic assessment through interview.
(reclines on couch) It came to me in a dream. The room was full of people who looked like artichokes and kiwi fruit. Then this peach walked in. It identified itself as AHunter3. What does this mean?
I had heard (at university, many years ago) that [ul][li]there is very little evidence that talk therapy has much effect on most mental illness, []that there is very little evidence that talk therapy is any more effective conducted by a psychologist than by a moderately trained layman[]that nothing Freud said was backed up by any real evidence, and that his theories were almost entirely abandoned.[/ul]Which of these are wrong, in your view?[/li]
It strikes me as similar to the threads about the efficacy of AA and other chemical dependency treatment programs that kick around the SDMB periodicially. Is there hard evidence that they “work*”? Is there evidence that talk therapy and other forms of non-drug treatment “work”?
If, by “psychotherapy” you didn’t mean talk therapy, then what non-drug treatments did you mean?
Regards,
Shodan
*“Work” in this context means better outcomes than otherwise, fewer relapses, faster return to normal functioning, IMO. Unless you mean something else.
