doctors

People Spend More Time Picking Out a Hairstylist than a Doctor?

→ November 19, 2012 - 18 Comments

People Spend More Time Picking Out a Hairstylist than a Doctor?

How Does One Choose a Psychiatrist?

The other day I was searching for a hairstylist. My hair is hard to keep up, very challenging for a stylist and thus, very expensive, so if I leave the salon with anything but exactly what I want, I’m more than a little peeved. I’m the client and I want what I paid for.

And as I was looking at various salons and considering which stylists might do a good job, it occurred to me, I’m spending more time on this than most people spend on finding a psychiatrist.

So how does one choose a psychiatrist anyway?

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Mental Illness Stigma Affects Psychiatrists Too – Who Wants to be a Psychiatrist?

→ October 9, 2011 - 39 Comments

Recently I read Invisible Tattoos: The stigma of psychiatry by Dr. Henry A. Nasrallah in Current Psychiatry. Invisible Tattoos is an editorial piece on how the stigma of mental illness affects psychiatrists just like it affects the mentally ill. And my reaction?

Oh cry me a freaking river.

I thought the piece was a little whiny and navel-gazing. I mean seriously, these people are respected professionals making lots of money – they don’t have an illness threatening to kill them every day.

But then I got a comment from a medical student and I reconsidered my position. Maybe antipsychiatry poster-boy Tom Cruise doesn’t just fuck around with the way people look at me, maybe he fucks around with the way people look at psychiatrists too. And maybe stigma is difficult for psychiatrists too.

Antipsychiatry vs. Psychiatry

People, mostly antipsychiatrists, tell me I’m evil because I’m a pharma-shill as evidenced by this site. And perhaps more insidiously, others insist I’m really just caught up in a giant web of pharmacology conspiracy and I’m just too stupid and naive to know any better – thus writing me and my opinions off nicely.

This is all falderal, naturally, but the antipsychiatry folks have to have some hatred to hurl at me, I suppose.

But consider for the moment, if I am evil for what I do, how despicable a doctor – someone who prescribes the evil for others – must be.

Psychiatry and Stigma

According to Invisible Tattoos psychiatrists face stigma from their family and friends, just like the mentally ill.

  • Stigma: Psychiatrists aren’t “real” doctors.
  • Reality: Psychiatrists are not only medical doctors who attended the same medical schools but they attended additional schooling to become a psychiatrist as psychiatry is a further specialty.
  • Stigma: Psychiatrists are only money-driven.
  • Reality: Psychiatrists make less money than many other specialties and in the US, health insurance companies reimburse at lower rates for psychiatric services than other medical specialties.
  • Stigma: Psychiatry treatment is considered a failure.
  • Reality: The success rates in psychiatry are virtually the same, and in some cases higher, than other specialties.

Medical Students and Antipsychiatry

And not only do all these ridiculous antipsychiatry statements affect practicing doctors but they also affect medical students considering going into the field of psychiatry as this medical students expresses:

. . . in medical school and in society I keep picking up a negative perception towards mental illness. My family members keep trying to persuade me to pick internal medicine and do cardiology or GI . . . They feel that the good pay is worth it and at least I get respect from society. Even within medicine, other students tell me not to pick Psychiatry as I won’t be paid nearly as much as the more lucrative specialties such as Gastroenterology. And I won’t have to put up with society’s bullshit and demonization.

This makes becoming a psychiatrist a very difficult proposition. Do you willingly become a pariah among your family, friends and colleagues or do you go with a branch of medicine that pays more and people respect?

It’s a wonder anyone becomes a psychiatrist at all.

Why Do People Become Psychiatrists?

Well, as I’m not a psychiatrist, I can’t say for sure, but I believe, hold onto your hats, they do it to help people. That’s right, the evil-pill-pushing monsters are really trying to help people with very severe, possibly lethal, illnesses. Imagine that.

Again, this medical student expresses his reasons,

I came into medical school wanting to do Psychiatry because I particularly enjoyed working closely with patients and people, and personally feel that Mental Illness can be far more devastating than other types of illness . . . some patients may also have heart disease and diabetes, but the schizophrenia when uncontrolled leads to them not taking their pills and a downward spiral culminating in disaster. Then when I see how most patients with mental illness get ripped on by family members and society in general I feel like helping them all the more.

Ah. Evil.

Psychiatrists and AntipsychiatryPlease Become a Psychiatrist

I don’t know the person who left these comments here, but what I do know is we need more people like that in psychiatry. What I know is it’s hard to stand up against antipsychiatry, intolerance and hatred. What I know is there are more sick people than doctors can handle and one more with a good heart can save lives.

And while I have my problems with doctors, medicine, psychiatry and psychiatrists, I will stand behind their work and always say they are doing the best they can to help people that the rest of society would happily write off.

I will never stand behind those who are not good psychiatrists, those who would abuse their power or who don’t care about their patients. But these are not the average psychiatrist. The average psychiatrist is a caring person who sees psychotic patients not because it’s lucrative or fun, but because they honestly want to help better the lives of others.

So please become a psychiatrist and I will stand with you against the hate. You deserve to be respected every bit as much as I do.

No Hospitalization after a Suicide Attempt?

→ July 13, 2011 - 167 Comments

No Hospitalization after a Suicide Attempt?

As I mentioned, a friend of mine attempted suicide last Friday. His life was saved by his friends, the police and hospital staff. I’m grateful his suicide attempt was not successful.

But one of the oddest things about this scenario is after the suicide attempt he was not hospitalized. The hospital stabilized and released him. Just like that. No psychiatric hold. No psychiatric treatment. Nothing.

What the hell is up with that?

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Share Your Tips on Talking to Doctors / Psychiatrists

→ July 8, 2011 - 22 Comments

Communication with Psychiatrists

I’m working on my first ebook. It’s going to be about building a relationship with your doctor. Essentially, it’s about getting what you, the patient, need from the person behind the prescription pad.

Why Write About Doctor-Patient Communication?

I’m writing this book because of the plethora of mental health questions I get on the subject. I believe people with bipolar disorder, depression and other mental illnesses don’t get optimal care due to dysfunctional medical relationships. This is not necessarily the fault of the doctor / psychiatrist or the patient. It just means the relationship isn’t as good as it could be. Think of it like couples counseling between doctor and patient.

So, I have some questions for you; please weigh in. (Oh, you don’t have to answer all the questions. Any that interest you would be great though.)

What Do You Wish You Had Asked Your Doctor When You Were Diagnosed?

Pre-diagnosis, before you understood your mental illness, what do you wish you had known? What do you wish you had asked your doctor about your diagnosis? What do you wish you had said to your family doctor or psychiatrist specifically?

Communication with Psychiatrists

What Do You Wish You Had Asked About Your First Treatment?

What do you wish you had known about treatment? What do you wish your doctor had told you? What do you think new patients should know? Who do you think should handle treatment?

What Do You Think Patients Should Ask About Treatments / Side Effects?

When you get a new treatment or change your treatment, what do you ask your doctor? What should people ask? What do you want to ask but always forget? What do you want to ask but are too afraid too? What do you wish your doctor would tell you?

What Should You Tell Your Doctor / Psychiatrist?

What is most important for a doctor / psychiatrist to know? What do you always tell your doctor? What are you too scared to tell your doctor? Is there something you think you shouldn’t tell a doctor/psychiatrist?

What Makes a Relationship with a Doctor / Psychiatrist Work?

After dealing with doctors for over a decade, I have my own ways of making the psychiatrist-patient relationship work. What are your tips for patients? What works with a doctor and what doesn’t?

What Other Questions Would You Like to See Addressed?

What else do you think I should put in the book?

Why Am I Asking?

I’m asking because I would like to represent the real voice of the real patient as much as possible. I know what I want to write and why, but I’d like to hear varying opinions. Every one of you is different and every one of you has a different insight to share. Whether you love or hate doctors, this book is designed to make your relationship with them work better for you, and maybe for them as well.

I look forward to hearing your thoughts.

Note

By responding here you agree to be quoted in the book should I choose to do so. I’ll only use aliases to identify people so you don’t have to worry about people identifying you. If you don’t want to be quoted, that’s no problem, just say so.

If you have something to add but wish to do so privately, contact me here.

Why Aren’t Doctors More Honest With Patients in the Hospital?

→ July 1, 2011 - 33 Comments

Inpatient Prescriptions of Antipsychotics

Yesterday I received this comment from Leah,

. . . At the mental health clinic [where] I stayed, they were really into prescribing low doses of Seroquel [quetiapine] for unipolar depression . . . after reading up on this stuff I became somewhat angry for the widely prescribed off-label use of these antipsychotics since side effects can be strong. Especially since I was not told. Do you maybe have any thoughts on this practice?

Thoughts? Yes. Far too many. Ask anyone.

I have, over and over, lamented about the lack of honesty and transparency in the doctor-patient relationship. Specifically, why is it doctors prescribe antipsychotics, often off label, without disclosing their risks? It’s happened to me many times. In the hospital may be a special case, however.

Prescribing Antipsychotics

Antipsychotics (by which I mean atypical antipsychotics) are being prescribed for all sorts of things these days. Traditionally schizophrenia, but now frequently bipolar disorder and major depressive disorder (MDD) too. There is considerable evidence for atypical antipsychotic treatment in all three disorders.

Antipsychotics and Risk

Antipsychotics are not pleasant medications. Antipsychotics turn down the dopamine and serotonin in your brain, those neurotransmitters typically considered to be “happy chemicals.” Why does that help depression? That is extraordinarily fuzzy, but we know they work for some people.*

Trouble is antipsychotics carry very serious risks. Risks like permanent movement disorders, weight gain and diabetes. I have had fits about such things.

Antipsychotics FDA-Approved for Treatment of Depression (Unipolar)

  • Aripiprazole (Abilify) is an antipsychotic “indicated for use as an adjunctive therapy to antidepressants for the treatment of major depressive disorder (MDD).”
  • Olanzapine (Zyprexa, antipsychotic) and fluoxetine (Prozac, antidepressant) come combined in one medication called Symbax. Olanzapine and fluoxetine, when used in combination is “indicated for the treatment of treatment resistant depression.” **
  • Quetiapine Fumarate Extended-Release (Seroquel XR) is an antipsychotic “indicated for use as adjunctive therapy to antidepressants for the treatment of MDD.” *** (Study of quetiapine monotherapy for MDD)

Prescribing of Antipsychotics

[push]Antipsychotics do work quite well for many.[/push]

Often when multiple antidepressants fail for depression, antipsychotics are up next, typically as an adjunct (like aripiprazole, above). And in all honesty, in a case of severe or treatment-resistant depression, in my opinion this practice is quite reasonable.

Antipsychotics in the Hospital

One of the places people are often introduced to antipsychotics is in the hospital. There are generally three reasons for this:

  1. Patients in the hospital are there because treatment has failed thus far
  2. Patients are in the hospital because they are in crisis
  3. Patients need something that will stabilize them so they can leave the hospital

Those are the realities of being in the hospital. Under these circumstances it’s quite reasonable to prescribe powerful, more risky medication as the person is in more danger. This doesn’t mean it’s pleasant. As I remarked after having been given quetiapine in the hospital:

Seroquel [quetiapine] is the new med . . . 50 fucking milligrams a day. That’s ridiculous. He had to know that would kill me. And yet, somehow he doesn’t care.

I will say though, he looked like I had punched him in the stomach when I saw him today. I don’t know what he was expecting but I did look pretty bad. His medication made me that way for fuck’s sake, where’s the surprise there?

Doctors and Honesty in a CrisisHospital Prescribing

Here’s the thing about hospital prescribing – doctors really, really want you to take the medication. No, they can’t make you (bearing legal exceptions) but they do want you to. And this is not for some dark, sinister reason, it’s because they want you to get better.

You’re sick. You don’t have the mental capacity to be considering antipsychotic study data comparisons. You don’t have cognitive ability to make good choices and assess risk. You’re already overwhelmed. You’re in a psych ward. It’s not the place to be discussing the nuances of treatment.

Skip the Messy Medication Details

So doctors often overlook things like telling patients a drug is being prescribed off label (if it is) and there may be serious side effects. They choose the treatment they feel gives you the best chance at recovery. (By the way, doctors do this all the time, not just in psychiatric cases.)

Because if you don’t accept treatment, how will you get better? And if you don’t get better how will you leave the hospital? And if you don’t leave the hospital, how will you get back to your life?

Doctors Have a Tough Call When Prescribing in a Hospital

That’s the choice. Do you tell the patient more information and run the risk of them refusing treatment and not getting better? Or do you tell the patient less information to increase the chance they will accept treatment?

Antipsychotic Prescription in the HospitalI feel for doctors in this scenario. From personal experience I can tell you, being in a psych ward is seriously unfun. And when I was there I was incapable of making good decisions. He could have given me heroin and I probably would have taken it. But that’s the game folks. Your brain isn’t working. Your brain is in crisis. That’s why you’re in the hospital. You can’t expect your brain to make good choices at that moment.

I understand the conundrum. I understand why doctors do it and I understand why patients get made about it. But what the heck else is the doctor supposed to do? ****

Antipsychotic Prescriptions after the Hospital

But, of course, then there’s the problem of what happens once you leave the hospital. You should be more stable and more able to make good decisions. So it’s time for the doctor to cough up whatever it is they skipped over while you were busy being crazy.

I find doctors tend not to do this. I can’t really say why. They don’t want to rock the boat if you’re doing well? They’re lazy? Who knows? I’m not a doctor and really couldn’t say. I consider it to be unprofessional, unethical and bad practice, but that’s me.

Honesty and Doctors

I’m sorry to say doctors are often only as honest as we make them. We have to question them. We have to get the information even if they don’t offer it. It’s our responsibility. Not because it should be but simply because we’re the ones with the most invested. Like I said, the time to do this isn’t likely going to be in a hospital ward, but at some point, the unpleasant information has to be dealt with. And it may only happen if you force the issue.

—————————————————————————————————-

Notes of the Foot

* I actually have a pet theory on this regarding depression and mild psychosis, but that’ll have to be another day.

** Treatment resistant depression is defined as “major depressive disorder in patients who do not respond to 2 separate trials of different antidepressants of adequate dose and duration in the current episode.”

*** Quetiapine fumarate (the non-extended-release form) is not FDA-approved for unipolar depression (making that information extremely hard to find).

**** An answer, by the way, might be to have a patient’s proxy or advocate make the decision, as they are not ill at the time. However, as time is an issue, and decisions have to be made extremely quickly, it’s unlikely a proxy could get up to speed on the treatment fast enough. Not to mention, many of us don’t have such people.

 

Are All Doctors, Psychiatrists and Scientists Lying All the Time?

→ April 28, 2011 - 91 Comments

One of the problems with the antipsychiatry movement is they assert all of psychiatry, all doctors, all science is lying, pretty much all of the time. Any biological evidence for mental illness must be wrong, because if it isn’t, then psychiatry might make sense. Any evidence antidepressants help a brain must be wrong, because otherwise antipsychiatry views might come into question.

But seriously, does any rational, thinking person really believe all of science, all over the world, is lying?

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Psychiatric Myths Dispelled by Doctor – Fighting Antipsychiatry

→ April 5, 2011 - 198 Comments

Or How Antipsychiatry Groups are Wrong

If you’ve been reading my writings here at the Bipolar Burble for a while, you’ve probably gathered that I don’t like antipsychiatry groups. These groups are often under the “mad pride” flag or “psychiatric survivors” or people for “human rights” or people fighting psychiatric abuses. Often the language they use is solely designed to convince you that psychiatry is evil, psychiatry should be stopped, no one should take psychiatric medication and in many cases, psychology is also evil. Many antipsychiatry groups are sneaky. Antipsychiatry groups sounds reasonable on first glance but it’s only once you dig into them that you see how insidious they are.

Psychiatry and Psychology are Not EvilAntipsychiatry groups are ridiculous.

I’ve tried to look into antipsychiatry groups to see if there’s something worth understanding but they have no evidence. Just ardent supporters that make wild claims without proof. And their tactics of cruel, personal, abusive attacks are not worth my time. It assures that their groups have no credibility whatsoever.

I Fight Antipsychiatry Groups

And sometimes I spend entire days fighting antipsychiatry people. Antipsychiatry shows up on the Bipolar Burble, antipsychiatry finds me on Twitter, antipsychiatry follows me to Facebook, antipsychiatry shows up on Breaking Bipolar. And these charming antipsychiatry folks, for whatever reason, read all about me and then use those personal details to ensure their personal attacked will be as nasty as possible.

Yes, antipsychiatry groups are ridiculous.

Who has Time to Scientifically Refute Every Cockamamie Antipsychiatry Argument?

I don’t have time to research every one of their outragous claims and make cogent counter-arguments. Because it’s endless. It can always be done but it’s more work than I have time for.

Myths About Psychiatry by Nada Logan Stotland M. D. – Huffington Post

Luckily for me and for you, Dr. Nada Logan Stotland M. D. has written the most amazing anti-antipsychiatry article I’ve ever read. (She doesn’t say she’s anti-antipsychiatry, but this piece is certainly a shot across the bow of antipsychiatry.)

Psychiatry Myths Dispelled by a Doctor

Aren’t mental health diagnoses randomly added to the Diagnostic and Statistical Manual (DSM) and applied to individuals?

When deciding what to include in the DSM, “. . . specialists have to look at the evidence and then make judgments about the criteria for medical diagnoses. The difference between a benign tumor and a cancer is a matter of how many sick cells appear under the microscope. “

“Differentiating them [psychiatric disorders] from normal is no different than deciding what level of blood pressure is ‘hypertension,’ how many pounds add up to ‘obesity,’. . . A condition rises to the level of disease when it handicaps a person, is associated with bad outcomes, and/or can be treated — in psychiatry just as in the rest of medicine.”

We don’t understand mental illness the way we understand other illnesses.

“We all know that diabetes is caused by the failure of the pancreas to secrete normal amounts of insulin. But what causes that? We say it’s an autoimmune condition — the body attacks its own insulin-secreting cells. Why does that happen? We don’t know.”

And, of course, we treat diabetes in spite of this lack of knowledge just like we treat mental illness.

Psychiatry illnesses aren’t real, don’t exist, because there are no diagnostic tests for mental illness.

“The substrate, the physical location, of thought, mood, and behavior, is the brain. That’s not a part of the body we like to biopsy without an extremely good reason . . . Using brain scans, however, we now can distinguish between the brain of a person with depression and a person who is not depressed — and make many, many other such observations.”

This is something antipsychiatry groups bring up all the time. But as Dr. Stotland points out, we can distinguish depressed brains from non-depressed brains in a brain scan. In fact, there are many illnesses that show on brain scans (and sometimes blood tests) but it is early days and brain scans aren’t the kind of thing people can afford (or necessarily even get access to).

Don’t psychiatrists have a vested interest in making everyone “sick” so they can make more money?

“There is a shortage of psychiatrists. I don’t know any psychiatrists with time on their hands. Our incomes are at the lower end of the medical totem pole, along with family medicine and pediatrics . . .”

No one is saying they don’t make oodles of money, they do. But the notion they are not trying to help people and they are trying to create more patients is ludicrous. It takes months to see my psychiatrist because he’s so busy. He doesn’t need any more sick people. Not to mention the fact that in Canada, many profit motivation arguments just don’t hold a lot of water.

There is no science behind psychiatry.

“The New England Journal of Medicine some years ago published a paper demonstrating that far fewer than half the treatments used for cardiovascular diseases are supported by good scientific evidence. Psychiatric treatments work about as well as other medical treatments.”

I’m kind of shocked about cardiovascular disease, but if you think about it, they are in the same position. They are trying to save people’s lives, just like psychiatry is, in the best way they know how.

Please read Dr. Stotland’s full article.

The Motives of Doctors, Psychiatrists and Psychologists

And as many problems as I have with psychiatry, psychiatrists, doctors and psychiatric medication, I believe that psychiatrists are trying to help. They’re not always successful, but their motive is not evil and it’s not money – it’s making people better.

 

What Happens When Your Doctor Gives Up On You?

→ July 19, 2010 - 8 Comments

I have had two doctors give up on my bipolar disorder (mostly depression) treatment. One almost a decade ago, and one just a couple of months ago. I didn’t take the most recent doctor abandonment all that well, as I’ve mentioned. In fact, if I saw the woman today, I’d still want to call her a cunt. An unfeeling, malpracticing, cold-hearted cunt. It seems I’m still a little upset about it.

A Doctor Giving Up on You is Unacceptable

But regardless as to my personal feelings about this woman, I feel that a doctor dismissing a patient without referral, medication, treatment or care, is unacceptable. It leaves the ill person with few visible options outside of suicide. A depression, suicidal person with no options. Peachy. These doctors are killing people through their own ignorance.

So, what should you do if your doctor gives up on your treatment? (You know, other than call them nasty names online, which I heartily recommend. It’s cathartic. HealthyPlace isn’t a fan of such things, however.)