What's wrong with psychiatry?

Great Debates
61

[QUOTE=AHunter3]
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.
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And that’s all I ask-thank you. I also do understand that there are some REAL assholes in the profession as well, and a bad psychiatrist/psychologist can really fuck you up.

But isn’t that true of any field?

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Maybe not any field, or not in the same ways… a bad policeman can fuck you up, but generally won’t do so while earnestly believing those actions are good and proper actions to take and are in your own best interests; a bad social worker could screw with your head and/or steer you wrong while earnestly believing in the propriety and benefit of the actions taken, but is generally not in a position to do as much damage.

Point taken, though.

Truce?

63

Fine with me.

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[QUOTE=Shodan]
If, by “psychotherapy” you didn’t mean talk therapy, then what non-drug treatments did you mean?
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“Talk therapy” encompasses a number of modalities; I worked in psychodynamic psychotherapy. It was usually expressive, where defenses and transference issues are partly examined), but occasionally supportive, where defenses are shored up and transference issues are left alone.

Other “talk therapies” (in which I am not formally trained) include psychoanalysis, cognitive-behavioral therapy, dielectical behavioral therapy (DBT), psychodrama, group therapies, family therapy, etc.

[QUOTE=Shodan]
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][/QUOTE]

For the first point, it depends on the diagnosis and the therapy used. Unfortunately, my current set of reference books are in boxes, so I have to rely on Kaplan and Sadock (Synopsis of Psychiatry): For depression (with interpersonal or cognitive-behavioral therapy), combined worked best (partly because medications work on physical symptoms, and therapy works on mood and drive). Bipolar patients may not have their illness managed per se by therapy, but it can help with social functioning once the illness has been treated. Therapy has also been shown effective (in relatively limited studies) for panic disorder, and may be the treatment of choice (particularly cognitive-behavioral therapy) for mild to moderate obsessive-compulsive disorder.

There is an interesting study (Project MATCH, for the Googlers out there) that looked at therapeutic interventions for alcohol abuse. It compared a Twelve-Step Facilication, cognitive-behavioral, and another therapy called motivational enhancement. They were hoping to demonstrate that one worked best; what they found is that they all worked better than no treatment. There are other relatively recent studies about AA that suggest that the program works better than placebo; I can get the basic references for you if you like.
For the second point, I think it depends on severity. I do think that a person with aptitute and some training could provide at least supportive therapy to a mild-to-moderately afflicted patient; that’s one of the reasons I entered psychiatry was some basic ability to work with other’s problems. The challenge is that mild-to-moderate case don’t always stay mild-to-moderate (for example, a patient remembers previous sexual assault that had been repressed), which may put the lay therapist - or even the non-practiced psychiatrist, for that matter - rapidly out of his/her depth.
For the third point, there are no scientific studies that have evaluated Freud’s work to my knowledge. Except perhaps to the analysts, most of us hear little about Freud in psychiatric training (it may be different for psychologists - I don’t know). However, he opened the door for others to take a look at the functioning of the mind in a new way, which stimulated a lot of other bright people to come out with their own theories and expanded the field of “mind medicine”. Further, there is much terminology and theory that he introduced that is in use today (such as defense mechanisms) So, I think that your average modern psychiatrist doesn’t believe Freud to the letter, but recognizes that he made a considerable contribution to the attempt to understand the mind’s functioning.

Hope this helps :slight_smile:

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[QUOTE=Shodan]
I had heard (at university, many years ago)
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Things have changed quite a bit since ‘many years ago’.

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Lets face it you’d have to be mad to go to a psychiatrist for some sort of cure.

67

This is what my professor said after years of researching whether pschotherapy and/or drug therapies helped people with mental problems- “Some therapies can help some people some of the time.”
He meant that only some therapies actually work. They only work on certain people (not all people with problems). They only work on said people at certian points in their life.
His conclusion was that the world would be a better place without any of the therapies - drug or psychotheries.

68

[QUOTE=blinkingblinking]
His conclusion was that the world would be a better place without any of the therapies - drug or psychotheries.
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My conclusion would be that the world would be a better place with all psychiatric treatment being strictly on the basis of fully informed consent. I’m not at all opposed to prospective pysch patients hearing all the anecdotal success stories from the folks who have benefitted from treatment, I just want to make sure they also hear the stories from people whose experiences have been neutral-to-horrible.

There’s a lot of advertising budget going towards giving most of the public the impression that they’ve got this stuff nailed and that their Wonder Drugs will fix them right up, easy as Maalox for a tummy-ache and nothing to lose even if it doesn’t work, etc., so I tend to shout out the negative side to even things up.

But if you made the therapies unavailable, people like Guin would suffer. Why take away from them something that works for them?

69

[QUOTE=Freudian_Slip]
“Talk therapy” encompasses a number of modalities; I worked in psychodynamic psychotherapy. It was usually expressive, where defenses and transference issues are partly examined), but occasionally supportive, where defenses are shored up and transference issues are left alone.

Other “talk therapies” (in which I am not formally trained) include psychoanalysis, cognitive-behavioral therapy, dielectical behavioral therapy (DBT), psychodrama, group therapies, family therapy, etc.

[/quote]
Is “psychoanalysis” what Freud developed? And is there anything online that demonstrates the value of what you do in particular? I am talking about double-blind studies and so forth, where patients are randomly assigned to talk-therapy only, talk therapy plus medication, medication alone, or nothing.

Thanks for your response - this is the sort of thing I was thinking about.

Now that’s interesting! Wasn’t there a thread asking if AA worked better than nothing recently? Methinks it is time for some Googling.

Yes it does, thank you for your response.

Regards,
Shodan

70

[QUOTE=blinkingblinking]
This is what my professor said after years of researching whether pschotherapy and/or drug therapies helped people with mental problems- “Some therapies can help some people some of the time.”
He meant that only some therapies actually work. They only work on certain people (not all people with problems). They only work on said people at certian points in their life.
His conclusion was that the world would be a better place without any of the therapies - drug or psychotheries.
[/QUOTE]

This makes no sense to me. IANAD, but I can’t think of a single therapy for any disease or ailment that always works for everyone. Does that mean we should do nothing?

Examples: Amoxicillin therapy works for a goodly number of infections, but certainly not all of them. For some people, like me, it causes an allergic reaction. Does that mean no one should be given Amoxicillin? Of course not.

I also find that Tylenol does not generally relieve my headaches; I find that Advil or Aleve work better. But some people get good results from Tylenol and get stomach aches from Advil. Should no person ever take an analgesic?

For some folks, having a therapist to talk with helps them find coping strategies and to deal with their mental illnesses. For others they could talk all day and still feel awful. For some people, Paxil or lithium helps. For others, it doesn’t. Why would the uncontroverted fact that nothing works for everyone lead to no one should use any treatment? :confused:

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Probably someone has mentioned this, but most psychiatric drugs have godsawful side effects: from the 100 lb weight gain and diabetes type II of some of the newer antipsychotics to the involuntary facial movements from older ones to erectile dysfunction and anorgasmia from the SSRIs. I see this as symptomatic of society’s marginalization of mentally ill people since these horrible effects are seen as somehow okay. I realize that depression, bipolar disorder and psychosis are very serious illlnesses, but come on. We sent people to the moon and can’t come up with a safe therapy for mental problems?

besides that, in my opinion if poverty were eliminated, so would be 90% of so-called “mental illness”, but that’s another thread

72

[QUOTE=olivesmarch4th]
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.
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I’m not familiar with the Australian medical system, but in Spain once a patient is deemed to be “stable for medication” (not just in psych but in any speciality), he moves to seeing the specialist much less frequently and to getting most prescriptions from the GP. In Spain statistics do not differentiate “first prescription”, “prescription that got changed two days later due to severe secondary effects requiring hospitalization” and “refills”. The last time Mom got #2 it was when the trauma doc decided to change a painkiller she’d been on for years, which leads to the question of “why try to fix it if it ain’t broken.”

Also, if the waiting time for a specialist is long, a GP may give some ultra-mild treatment while you wait for the specialist to treat you. They give painkillers to people who need to see trauma about rheumatism and low-dose antidepressants or sleeping aids to people who need psych. “Press here while I apply a bandage”, if you wish.

73

[QUOTE=AHunter3]
Bipolar disorder is not a lithium-deficiency disease.
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We don’t know in which chemical(s) is lithium deficient in the body of many patients with bipolar disorder. But we know that lithium helps, to the extent of many people self-medicating with foods that are naturally high in lithium, so we figure there is probably a lithium defficiency somewhere*. We just don’t know where yet.

*A study published in Nature-I-think-it-was in the early 90s and wildly misreported in many newspapers’ Science sections showed that bananas, which Freud had said were seeked by depressed patients because of “the phallic symbolism”, have a high Li content and have it in a form that’s particularly easy to digest (specifically, a protein containing the same prosthetic group as hemogoblin and chlorophyll, with the Li as its metal atom).

There was no machine diagnosis for Multiple Sclerosis until a few decades ago. Even nowadays, patients with relatively-mild cases need multiple scans, to verify whether there are changes over time. Does that mean that nobody had MS before CATs were invented, or that before CATs were invented MS had no physical root?

74

[QUOTE=Oregon sunshine]
Probably someone has mentioned this, but most psychiatric drugs have godsawful side effects: from the 100 lb weight gain and diabetes type II of some of the newer antipsychotics to the involuntary facial movements from older ones to erectile dysfunction and anorgasmia from the SSRIs. I see this as symptomatic of society’s marginalization of mentally ill people since these horrible effects are seen as somehow okay. I realize that depression, bipolar disorder and psychosis are very serious illlnesses, but come on. We sent people to the moon and can’t come up with a safe therapy for mental problems?

besides that, in my opinion if poverty were eliminated, so would be 90% of so-called “mental illness”, but that’s another thread
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Many drugs (not just psychiatric ones) have the POTENTIAL for godawful side effect for SOME people. Even aspirin can cause stomach bleeding in some people. Most heavy-duty cancer drugs have double godawful side effects, as I’m sure you know. Only the sufferer can decide if those side effects are worth the results. A person close to me deals with the weight gain thusly: “I’d rather have my sanity than be thin.”

I really get annoyed at the “if we can send a man to the moon, why can’t we…” meme. That was a technological problem. Biology is much more complicated.

Did you know that there are rich people with mental illness? Yes, really. Lots of them. Poverty can certainly make it difficult to get treatment, though.

75

[QUOTE=Nava]
We don’t know in which chemical(s) is lithium deficient in the body of many patients with bipolar disorder. But we know that lithium helps, to the extent of many people self-medicating with foods that are naturally high in lithium, so we figure there is probably a lithium defficiency somewhere*. We just don’t know where yet.
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Lithium mimics sodium, or so I’ve been told. If I were convinced that folks with bipolar disorder were suffering from a specific metabolic disorder which was directly ameliorated by lithium salts, I’d look into what the heck their bodies are doing with sodium such that tricking the body via lithium into not utilizing so much sodium stops that process.

But I think all that lithium does is dampen complex mental processes. The human mind in one possible state has a tendency to make connections between concepts and idea rather loosely and fluidly; the upside of that is creativity, “thinking outside the box”, etc; the price of it is scattered thinking & excitability, a tendency to follow links between concepts that aren’t really usefully related, and to do the mental equivalent of going way out on limbs that won’t support your weight instead of sticking close to the solid branches close to the tree trunk.

Everyone I’ve ever known who has been on lithium agrees with that or something close to it, and agrees that what lithium does is (depending on subjective experience) ground your thinking or stick your brain in a linear rut: to cause the mind to make fewer connections between concepts and generally only the most compelling ones that are already closely linked in many known ways. There is less emotional intensity attached to thoughts and ideas.

I haven’t held the dx and had lithum thrust at me since the days when the malady was known as “manic depressive”, but no, I don’t think it’s a lithium deficiency disease.

That’s not the same as saying “Godawmighty, don’t take that awful stuff!”

[QUOTE=oregon sunshine]
obably someone has mentioned this, but most psychiatric drugs have godsawful side effects: from the 100 lb weight gain and diabetes type II of some of the newer antipsychotics to the involuntary facial movements from older ones to erectile dysfunction and anorgasmia from the SSRIs. I see this as symptomatic of society’s marginalization of mentally ill people since these horrible effects are seen as somehow okay.
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Agreed. Hence the demand for fully informed consent.

To those of you who consider yourselves to have benefitted from psychiatric meds: you lose nothing from people like me demanding that people like you hear about the full range of patient experiences with the meds that have been prescribed for you.

76

[QUOTE=Shodan]
Is “psychoanalysis” what Freud developed?
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Freud is considered the father of psychoanalysis, ayup :slight_smile:

[QUOTE=Shodan]
And is there anything online that demonstrates the value of what you do in particular? I am talking about double-blind studies and so forth, where patients are randomly assigned to talk-therapy only, talk therapy plus medication, medication alone, or nothing. Thanks for your response - this is the sort of thing I was thinking about.
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Hmmm … I’m certain there are, but it’s not a field I’ve kept up (in terms of journal articles) in a while.

I did a little Google-fu; I found this website which appears to be very well sourced. It might be a good one to look at? (And I’m saving it too … it looks intriguing):

APA article

FS