I often find myself in the unenviable position of defending psychiatry. This, in spite of the fact that I am not a psychiatrist nor do I even play one on TV.
Nevertheless, I feel compelled to speak on psychiatry’s behalf. Maybe it’s because when left to their own devices, psychiatrists aren’t very good at it. Or more likely it’s simply because an unreasonable number of people attack psychiatry unreasonably and I think someone ought to bring the concept of reason into the discussion.
Antipsychiatry
There is a faction of folks out there who are antipsychiatry and every time I mention them I get hate mail. But here I am again. Antipsychiatry. Antipsychiatry. Antipsychiatry.
Rather than give you my definition, which people hate and argue with, here are the central points of antipsychiatry according to Wikipedia:
- The specific definitions of, or criteria for, hundreds of current psychiatric diagnoses or disorders are vague and arbitrary, leaving too much room for opinions and interpretations to meet basic scientific standards.
- Prevailing psychiatric treatments are ultimately far more damaging than helpful to patients.
Some of antipsychiatry’s other opinions, according to Wikipedia, include:
- Inappropriate and overuse of medical concepts and tools to understand the mind and society, including the miscategorization of normal reactions to extreme situations as psychiatric disorders
- Unwillingness to develop and use objective tests (such as intelligence/cognitive tests) to determine patients’ state (such as strong psychosis)
- Unexamined abuse or misuse of power over patients who are too often treated against their will
- Relation of power between patients and psychiatrists, as well as the institutional environment, is too often experienced by patients as demeaning and controlling
- Forced use of government (both civilian and military) psychiatric treatment prevents the patient from choosing private psychiatric or alternative treatment thereby denying the patient of his or her basic rights
I have dealt with many of these claims on occasion, but for now, let’s just say that while criticisms are a valid and useful agent of change, the approach taken by these groups leaves something to be desired.
Psychiatry is Perfect. I Love Psychiatry.
See, here’s the thing, psychiatry is neither perfect nor do I love it. Psychiatry is just a branch of medicine like oncology or cardiology. No branch of medicine is perfect nor do I have emotional attachment to any of them. They are just what they are. They are just areas of medicine where doctors try to make the best decisions they can based on the information they have available.
It’s pretty simple actually. No great conspiracy. No great cover-up. Just people doing the best they can.
Psychiatry is Imperfect
Psychiatry then, naturally, is imperfect. Wildly so. I have had encounters with psychiatrists that would curl your hair and make you turn your head around 360 degrees. Psychiatrists can be absolute assholes.
Among other things, psychiatrists tend to appear cold, unfeeling, callous, uninterested, uncaring, indignant and self-righteous to say nothing of poor bedside manner and a general lackadaisical attitude towards the concerns of the patient. Why so many of them are like this, I don’t know, but I suspect it has little to do with psychiatry and much to do with medicine in general.
But I digress.
Why Fight for Psychiatry?
[push]For every asshole psychiatrist, there are people with the opposite characteristics. Some psychiatrists do care, do listen and do take patient concerns seriously. These people deserve recognition.[/push]
That’s easy. Because for every psychiatrist that shows the characteristics above, there are people with the opposite characteristics. Some psychiatrists do care, do listen and do take patient concerns seriously. And even those who appear not to, they get the benefit of the doubt in my mind as doing the best they can. Like most human beings.
And to be clear, doctors went to school for more than a decade to be in a position to help you. Maybe they’re burned out, jaded and cynical at times but likely down there somewhere is a kernel of trying to help. Really. They are.
Psychiatrists Help People
And they do. Psychiatrists help people every day. Every day they save lives. Every day they make lives better. Every day they make it possible for people to get jobs, have families and relationships. Every day they make it possible for a person to get out of the hospital, be safe and get better from an illness that would otherwise destroy them. Every day they make it possible for me to get out of bed in the morning.
So you see, it’s not that I love psychiatry. I don’t. I think they offer too many meds, not enough psychotherapy and allow insurance companies to dictate too many decisions. They’re not perfect. But no system is. Any medical specialty could be accused of the same.
But they’re worth standing up for because they are the last line of defense between the mentally ill and, well, often death, just like oncology is the last line of defense between cancer and death. They do an important job and fill and important role for people with a mental illness and don’t deserve to be demonized simply for being imperfect. Because not one of us meets that bar at work or anywhere else in life.
This is a very good explanation. I personally have had terrible psychiatrists and great ones. But I’ve also had bad doctors and good ones. I had terrible teachers and terrific ones. Psychiatry doesn’t have a monopoly on people who don’t do their jobs well.
Honestly, I would like to never see a psychiatrist or a prescription again. But my reality is that I know the consequences of not seeing a psychiatrist.
I think it’s the confidentiality issue that prevents more understanding and appreciation of psychiatry. Of course, it’s essential but for some people therapy is just a scary black hole still.
My first Psychiatrist diagnosed me with multiple personality disorder, I suppose Bipolar is a mix of intense opposite emotions. She didn’t take a lot of time with me to come to that conclusion. Planting a seed like that in someone who is mentally ill isn’t going to help matters at all. I do have a lot of respect for those that are in this profession. It’s not an easy one.
Thank you for writing this. I have experienced both positives and negatives of psychiatry, and I absolutely could not have said it better.
Psychiatry is evil. I detest it, it should be banned.
I’m readying a lot of comments from people who get their diagnosis and meds from their GP. I don’t understand that. Why would you trust someone who has only taken one or two psychiatry classes with your mental health? I can understand getting a referral but if you had a heart condition, would not go to a cardiologist? I think this may be part of the problem. Also, if you are diagnosed with something. Research the condition, see if that sounds like what is happening with you. I am bipolar and so is my now teen son. He was originally diagnosed, by his pediatrician as ADHD and prescribed medication to treat it. I bought books and researched as much as possible. While he had many of the symptoms, it just didn’t fit and the meds weren’t resolving many of his symptoms so I spoke up and took him to an actual psychiatrist. He was then diagnosed with depression and anxiety as well as ADHD and prescribed more meds and therapy. While these things helped a little also, it still did not seem to be the answer. I changed his doctor 3 times before finding one that actually LISTENED to what my son and myself had to say and he was given a diagnosis of Early Onset Bipolar Disorder. Again, I researched and read everything I could get my hands on. This was it. He fit this diagnosis to a T. We moved across the country and I now had to find a new psychiatrist for him. The first one we went to, told me that he was misdiagnosed and was merely immature, impulsive and OCD and wanted to take him off mood stabilizers. While all this may be true, I knew it was not the only thing going on with him and insisted that he write the scrip for them anyway. I left his office and immediately started searching for another doctor. The next one I found, spent over the allotted hour asking questions and said that there was no doubt that the diagnosis of bipolar was correct. We continued to see her for several years until he “outgrew” her. He now sees a neurological psychiatrist. My point is that you have to educate yourself, you have to speak up when it doesn’t feel right and if your doctor won’t listen to you, find one who will. I am currently not being treated because the only doctor available to me did not listen, put me on meds that made me feel sick and did not help me. I manage my disorder with self awareness, which I don’t recommend for anyone, but it is working for me. Be smart, doctors only know what you tell them, so speak up!
As a member of Psychiatry, I alternatingly feel appreciation for and weariness of such a piece as this. Throwing the baby out with the bathwater is what antipsychiatrists typically amount to, yet there is no question there are many systemic problems needing to be addressed.
I hope readers here are aware that there has been a long running false epidemic of Bipolar (NOS). That is a fact to which even APA and DSM staff have admitted, it is no longer a debate. Yet sadly and for reasons I cannot fathom, the public in general do not seem to be aware of it. “Bipolar Advocates” who truly want to help others and make a difference would do well to keep reporting on this fact so that the many many people (mostly youths) who were misdiagnosed and needlessly given psychotropic drugs can find better alternatives.
Hi Natasha,
What provoked this? It is much more ranty than usual and constructing the argument in binary terms: love/hate, psychiatry/anti-psychiatry. I’ve had various different psychiatrists over the year and found them to be complex, diverse humans. However psychiatry is something else, a cultural tradition which begins from the premise that non-normative = pathological. This is a difficult philosophical position to sustain as it encourages a focus on symptoms rather than causes and where causes are concerned they are unduly restricted to biological causes; because most psychiatrists gave up on the psychosocial aspects of the biopsychosocial model years age.
Defending psychiatry is like defending anti-psychiatry – there’s always some room for critical analsysi – and Kraeplin’s been calling the shots for too long.
Psychiatric abuses of human rights is O.K just use victim blaming !
Victim blaming occurs when the victim(s) of a crime, an accident, or any type of abusive maltreatment are held entirely or partially responsible for the transgressions committed against them .
But People familiar with victimology are much less likely to see the victim as responsible.
You don’t just get tied down for nothing, unless you’re acting dangerously. If you’re psychotic and dangerous to either yourself or the staff, you’ll be put in restraints.
I’m sorry you’ve been through a lot, but don’t act like they just tie people up and drug them. Be honest with yourself. Don’t blame psychiatrists for the fact that you were psychotic.
Psychiatry needs defending because a lot of its patients are crazy.
Sandy wrote : “Don’t blame psychiatrists for the fact that you were psychotic”
Its always Blame-the-victim when it comes to psychiatric abuse of people.
Define “psychotic” . I was having panic attacks I never had before caused by the psychiatric drugs I was taking. The hospital setting wasn’t helping I was starting to feel better and just wanted to leave like any other patient would. I didnt know yet that “psychiatric patients” are stripped of all there rights as a human being and that the nurses (bouncers) would put there hands on me (violence) if decided to just leave and get some fresh air. I had no idea, I didn’t even know I was a “psychiatric patient” meaning Im trash with less rights than common criminals.
My reation to this is taken as proof I needed more abuse.
Victim blaming occurs when the victim(s) of a crime, an accident, or any type of abusive maltreatment are held entirely or partially responsible for the transgressions committed against them
Once you have been a victim of them with there locked doors, tie down beds and neuroletiptic brain poisons , your feelings towards them will change forever. After there drugs gave me panic attacks I never had before and went to the hospital for this, It was blame the victim and coerce more psychiatric poisons (nueroleptics) with the standard threats of forced injection and the state hospital (prison).
My reaction to this discusting treatment is then called “a symptom of the illness” requiring more of the same mistreatment.
Psychiatry woulden’t need defending if they would clean up there act and also tell the truth about the drugs the push.
It’s refreshing to read something like this. When you put “Psychiatry” in YouTube’s searchbox, NOTHING positive comes up. It’s video after video of psychiatry being pseudoscience, locking people away, destroying lives, poisoning children.
It’s too bad the field is so maligned.
When my wife died, my whole world fell apart. I tried to kill myself and failed… now that’s depressing… to be a failure even at that.
Psychiatrists and psych meds got me back on my feet. They didn’t cure me, but they gave me what I needed to get back on my feet again. Even now, 6 and a half years later, I still cannot talk about my wife without crying, but I’m ok. I have a job. I have a life.
There are definitely messed up things in psyche, like the DSM, but docs need to be all on the same page about mental disorders. It’s not perfect, and yes, it is a book of billing codes as well…. but my psychiatrist wasn’t treating the the code in the DSM. He was treating me, and I have to say that without him, I would have eventually succeeded in killing myself.
Hi Mike,
Believe it or not, I believe most people who interact with psychiatry (or with meds through their GP) have a story like yours. The person had a problem and psychiatry came in and gave them the strength/tools/opportunity to fight that problem and after some time, they felt better. The trouble is, those people are the ones motivated to create videos on YouTube because those people are just off happily living their lives. They’re not looking up psychiatric information on the web.
No, psychiatry isn’t perfect, but it’s a lot better than many people give them credit for. Thanks for your comment.
– Natasha Tracy
It has been my experience that psychiatrists often diagnose people on the basis of what they will be able to get from the insurance companies, some disorders are not considered to be “curable”, so the insurance companies won’t provide coverage. What this means is that psychiartic treatment is useless for someone like me. Actually is there any cure for any mental illness? I think the most psychiatrists can hope to do for anyone is teaching them how to manage the symptoms.
Hi Joanne,
Psychiatrists are stuck with dealing with insurance companies, yes, and sometimes, I have no doubt that involves playing certain paperwork games. I have yet to see this dictate a diagnosis, however.
And you are correct, there is no cure for mental illness but there is effective treatment to get people back to where they were before the illness or to allow them to handle their symptoms.
– Natasha Tracy
Regards for helping out, excellent info .
Dear Natasha,
Couldn’t agree with you more, I am of the belief that without the psychiatrist, doctor and psychologist, who have been my carer’s these last six months, I wouldn’t be here today, you KNOW what I mean. I am and will be forever grateful to them.
Teresa
Hi Teresa,
I absolutely know what you mean and I think many people would say something similar. I credit psychiatry for saving my life, and making it worth living, too.
– Natasha Tracy
I am sure this is not typical but when I first got “into The System”, when I had my first mental health encounter, the psychiatrist told my family doctor I was just clinically depressed. So, around 5 years ago, when I felt a big depression starting to kick in again, I asked the family doctor for a change in medicine, from a Prozac to something else. He did he on the Friday: I flipped BIG time Saturday morning! (Still not fully functional even after 5 years, so no work, which is a bummer with two kids to clothe and feed, but we plod on anyway.) I retained just enough presence of sanity to realise what was happening was a reaction to the new medication and, if I stopped taking them and locked myself away, I could survive the weekend and get an emergency appointment with my family doctor on the Monday. In fact, got an emergency appointment with a psychiatrist instead, who said, “Oh, you shouldn’t have been given THOSE tablets – they should never be given to someone who is Bipolar – it makes you hypER manic …” Bipolar? Who said I was bipolar? “It’s in your hospital notes from 12 year ago, Graham – diagnosis: bipolar. Didn’t you know?” No one had told me and, worse still, no one told my family doctor! So, he wasn’t to know what he could or could not use to treat me. Therefore, having once nearly killed me, I think the medical system owes ME a life! :o) But as I say, I presume mine was an isolated case, a rare error – at least, I hope so. Whatever, I survived yet again, and I reckon THAT is something to be pleased about and even proud of because too many never make it. That’s why I love the term “Bipolar Survivors”: It’s our own exclusive club!
Hi Graham,
Well, it’s sort of common and it sort of isn’t.
I have heard of doctors not telling their patients their official diagnosis for philosophical reasons. Which I think is rather silly and dangerous, but that’s me.
People with bipolar are often mistakenly given antidepressants inappropriately for a variety of reasons. That, I’m afraid, is pretty common.
– Natasha Tracy
With regard to antidepressants, indeed, I note there is debate about the use of the tricyclics, as Prozac, which I gather some pDocs believe can actually cause hypomanic episodes. Indeed, some have given such allegedly anti-depressant resultant hypomania’s the unofficial title of Bipolar Type 3!! I also noted a study I found posted on the web – you may have seen it – that suggests there MAY be a link between long-term use of tricyclics and Ultradian BP, and that the effect may be irreversible. I would like to see the data replicated before accepting it as True. Nevertheless, I didn’t have issues with such rapid changes before I began a continuous 12+ years spell on Prozac and Cipramil; but you know how it is with this illness – things sometimes happen for the better or worse because of or in spite of the medication! As you say, treating BP (or any mental illness?) seems much more a form of art than it is a science.
Hi Graham,
I think the evidence is clear that antidepressants cause cycling and switching in bipolar disorder when they’re used without a mood stabilizing agent. As for tricyclics causing cycling, I don’t believe this is the case unless the person has bipolar disorder.
The problem is detecting both: 1. who has bipolar and 2. who will switch or cycle and I think we have a ways to go on both counts.
– Natasha Tracy
Natasha,
You have to assume that psychiatrists enter the profession because they actually do want to help people and believe that through psychiatry they can accomplish their goal. What happens from there depends on the person and their experiences in life and in their careers. Just assuming. I do know that one particularly not egotistical, kind, and insightful psychiatrist gave my life back to me after I had been agoraphobic for six years. He recognized that I had Pure O OCD which had not been treated and that it was the source of the anxiety and panic attacks that resulted in my barely leaving the house for all those years. Love that man. And he had a gracious soul. On the other hand, went to one arrogant and cold psychiatrist (after agoraphobia) who told me that there was nothing wrong with me and I did not need meds at all. So from one end of the spectrum to another. Unsettling that it is the luck of the draw but that is reality.
Psychiatrists come in all sizes, shapes and forms just as do doctors in all other specialties. Some are noble and some are ignoble. Some are kind and others very unkind. Some are remarkably skilled and some remarkably ill-equipped to provide care. An excellent doctor practicing in any branch of medicine is worthy of being held in the highest regard. A bad psysician practicing in any branch of medicine can prove harmful both to the body and the human spirit. I would ask that these words be pondered before passing judgment on a discipline which I have practiced for three decades and cherish.
In its purest form psychiatry is an art involving the interweaving of applied science and and a capacity to form interpersonal relationship based on mutual trust and respect. However, this is true of all branches of medicine in which the doctor/patient relationship is long-standing.
Hi Steven,
Thank-you for coming by and sharing your thoughts. I’m sure it’s challenging to be a psychiatrist in this time where the profession seems to be so maligned.
“In its purest form psychiatry is an art involving the interweaving of applied science and and a capacity to form interpersonal relationship based on mutual trust and respect. However, this is true of all branches of medicine in which the doctor/patient relationship is long-standing.”
I would tend to agree, but as in all things art, it is subjective and there’s where I think much of the issues lie.
My doctor is always very clear with me that he will do what he can but that remission isn’t likely for me. He never promises miracles nor suggests that he has all the answers. And this, I think, helps our relationship a lot. Many people, I think, feel betrayed by doctors who either promised too much or whom patients just had unrealistic expectations of.
I think realism and acknowledgement on both sides improves relationships.
– Natasha Tracy
Well said! My doctor has also tried to be realistic, telling me that the medication will not stop the Ultradian cycling but ought to snap off the extremes of each pole. Can’t say I was too pleased to hear that, of course, because it’s the rapid change, and the mixed moments in the middle, that can be so debilitating (as well you know). But I know where I stand.
Hi Graham,
It’s interesting he says he can’t stop the cycling because to the best of my knowledge, that is the number one priority. (That being said, everyone’s treatment plan is different.)
And yes, we often don’t want to hear the truth but it’s often the best medicine.
– Natasha Tracy
(More on stopping cycling here:http://www.psycheducation.org/depression/ADwithoutAD.htm more on rapid-cycling here: http://psycheducation.org/depression/Waves.htm )
Hi Natasha,
As always, compliments to you on your stimulating topics and more rational approach to discussing these very difficult mental health issues, in my opinion.
After so many years of participation on the Internet I’ve also come to realize that many of these message forums are more a safe harbor for those not benefitting from treatments or worse yet encountering serious side-effects to often commiserate about their ills. This does not preclude that Psychiatry and its treatments are not working or that many aren’t benefitting as they simply don’t take the time to share the other side of the story. There are very few forums, in my opinion, that do maintain a balanced perspective as you endeavor to establish here.
There are far more forums inhabited by those sharing the negatives of almost each and every therapy and worse yet often calling for the demise or withdrawal of numerous therapies that quite frankly would leave no therapies and we’d be back to the Middle Ages warehousing many of these same folks.
It is refreshing to have someone of your intelligence and writing capabilities carrying the torch of reason and balanced perspective. Just recently I wrote to someone, somewhat surprised at her statements, fear mongering and disseminating misinformation about ECT. Worse yet was her advocating for doing away with the treatment when I thought knowledge wise she would be more understanding rather than what I consider, emotional. Then again as you stated, you’ve gone through similar discussions on this forum as I recall; ECT in particular.
Those who obtain efficacy from Psychiatry will most often continue on in their lives absent the need to frequent and/or participate in these forums leaving the other side of the story unheard.
As always, I wish you wellness and all the good you’d wish for yourself.
Warmly,
Herb
vnsdepression@gmail.com
http://www.vnstherapy-herb.blogspot.com/
Hi Herb,
Yes, I agree, many forums do tend to foster wallowing in treatment problems rather than solutions. But unhappy people speak out more than happy people. Me too when I’m unhappy. It’s hard to achieve balance that way, as you’ve said.
And yes, ECT is a hot topic. Always has been and seems destined always to be.
– Natasha
She said she enjoyed “leveling the neurotransmitters in the brain”- Sara, yes that does sound aweful however, it’s exactly what I needed when I showed up in the ER. Isn’t it really the same as the Dr saying, ” I really enjoy clearing that blockage in the valve”. If we are truly to accept mental health issues as nothing other than health issues we will have to move past the political correctness. Not that the Dr needs to be projecting that onto the patient.
If I say to a co-worker “yes I was in the hospital leveling my neurotransmitters this weekend, and am feeling much better”, hopefully (in my perfect world) we will see mental illness unmasked and see it for what it is and she can respond, “yes, my heart valve replacement went well too, pass the salt”.
The one quote I made was part of a longer conversation about her enjoyment of her placement in the emergency psychiatric services. I don’t find issue with the leveling of neurotransmitters, and I am not at all concerned about whether such a statement is politically correct or not.
My concern rests with her clear lack of empathy or compassion for the people that she was helping – demonstrated by her referring to the person as a body part and the manner in which she discussed the people she encountered on her placement. She showed no concern whatsoever about the severity of the illnesses, the long and difficult recovery these people would have, or the losses, trauma and pain her patients suffered. In fact, I’m not sure she even thought about these things. To her, and I am sure to many others in her class, recovery was simply a matter of leveling neurotransmitters, and she saw these patients not as real people with real struggles but as experiments.
Of course, this doesn’t apply to all psychiatrists, or medical doctors. It was just an interesting observation I made at the time, which led me to wonder how many people do see us as just brains and don’t give a rats ass about us as people.
@ Sara, your right and I still find subjecting myself to the Drs scary at times. I still find a power difference, despite my educational and work experience in the field, they can still “put me in a box”, with one look, so to speak when I am not at my best. Sometimes this is just my own feelings, but sometimes it is reality, as it is for many of the patients I work with too.
I don’t have any real physical illnesses, however I recently had a neck injury and went into a medicentre where I was quickly dismissed, untreated (medically) aside from being treated coldly. Two months later I am still in physicial pain. I also had asked for a refill of my antipsychotic at the same time…..so I wonder, should I have made two seperate apts or did I just hit the pot of gold with Mr. I know better than you medicentre Dr?
Not that I want a physical illness, but as I age the liklihood will increase, will be interesting to see how I will be treated physcially in comparison to psych, however the reality is once they see one, it will take a real good Dr. to put that in a box, to clearly see the other.
Hi Ryan,
You’re absolutely right about psych patients being given short shrift often on mental and physical issues. We are assumed to be “drug-seeking” or “attention-seeking” or any number of other things that invalidate our very real complaint. It’s incredibly frustrating and incredibly difficult to fight, especially when we’re not well.
Hopefully you find a doctor, if you ever need one, that can look past one disorder in other to see the other clearly. But yes, that could be difficult to find.
– Natasha Tracy
Hi Sara,
See, the thing is, it’s really hard to see patients as full, 3-dimensional people and still maintain the clinical distance necessary in order to treat effectively. If every doctor were to really get wrapped up in a person’s life, loss, pain and suffering, they would become paralysed over one patient and unable to help them or anyone else.
So it’s a balancing act. There has to be clinical distance and yet recognition of the person as a human being. But some distance and objectivity is always going to be necessary.
– Natasha Tracy
I agree. I don’t want a doctor who is wrapped up in it at all, and that is not what I am suggesting is necessary. It’s the lack of any concern or interest that worries me. I would expect at least some degree of concern regarding the challenges ahead as opposed to absolutely none. If doctors are unable to do this, then how can they really work in line with the patients best interests?
Well, you’re right about that, _no_ concern definitely isn’t appropriate. You can’t make a good decision for the patient if you don’t consider their whole life.
– Natasha
As one who sits on both sides of the table, I see good reasons why some Dr’s are reluctant to describe in depth the “black box” warnings to a person who may for example be psychotic, or have limited insight or limited education on the subject. it is hard enough to convince people to finish their antibiotics let alone start a medication that yeah, saves your life but gives you an extra 50lbs, which leads to your diagnosis of diabeties 5 years later. It’s a relationship though like anything else. A good Dr will discuss the side effects more in depth as the persons mental illness starts to be brought under control. That is the better time in many cases to look at doses, switches etc. Some patient’s, including me have too often jumped to the side effects (hard to blame us) and minimizing the benefits (forgetful arn’t we of that week in vegas). Patient’s in recovery need to advocate for, and have good advocacy (from Drs, from treatment teams, from awesome blog writers) to be more involved in treatment decision making. Patient’s who are acute may need a listening ear, but may also really need that injection, for better or worse-It’s a bit like a marriage.
It’s a difficult balancing act you have to face – I don’t envy you that! It is, nevertheless, a decision that, ultimately, must go back to the patient. For example, if the choice is between, say, poor functioning due to unstable moods (which may have fatal consequences) or diabetes due to weight gain … the choice isn’t straight forward. When in one of those traumatic states of mood swings (I’m Ultradian, so I know it only too well how bad it can get!) the first instinct is to get rid of that “pain” and I would swallow anything to take it away – medicines, poison, whatever it takes! But as you say, when the worst is over, these things need to be discussed because, given the example of Diabetes, the long term outcome isn’t a bed of roses. High risk of heart attacks and strokes – a quick fatal heart attack would be a blessing compared to being fully aware of living inside a body that cannot move and a tongue that will not speak, or descending into the wrecked mind of someone with cerebral vascular dementia. I think such things need to be truthfully discussed so an informed choice about the risks and consequences can be made.
I don’t believe patients should be lied to or denied information “for their own good”. If one decides that screwing up their metabolism (which may in the end screw up your moods) is not a good trade-off, well it is their choice. If somebody thinks it is worth it for them… well, they can go ahead and proceed with the treatment.
But people should be told all available info. “lack of insight”… why don’t they just call us retarded and be done with it? Implications are the same. We need to be good little complaint patients and take our pills because we are ill. If we feel we don’t want to take ’em, it is because we are ill and we need to take the pills. Vicious cycle, ain’t it?
Hi VenusH,
When people say “lack of insight” they don’t mean _retarded_ or unintelligent, they mean that at that particular time the patient doesn’t understand their own illness. Most patients do not lack this insight, but people who are severely sick, for example, psychotic, do.
If a person is psychotic and believes that the FBI can hear their thoughts, it might not be the right time for a full evaluation of every scrap of information available. It’s only once the illness has been brought under control that some people can even appreciate side effect information.
I’m not for lying to patients, but I do think it’s important to choose the correct time to impart certain knowledge. But, of course, if the patient asks, then the doctor is always on the hook to provide an honest answer.
– Natasha Tracy
I agree 100% . I have had a line of psychiatrists, some good some in different and some … dreadful. But I think they were all well-meaning.
But one negative thing they all had in common, however, is they like to prescribe medicines without telling you the side effects. Now, in nearly every other area of medicine I’ve come into contact with, they spell out the risks (perhaps too much so in some cases!) Not these guys! Of course, when one is raving one is not necessarily in the right frame of mind to make an informed decision about such matters! But we ain’t always raving … in fact, I never have been. (Ok, may be once or twice!)
One other thing … I wish they wouldn’t try to front themselves as medical psychologists. Guys, medical psychology is the province of medical psychologists; how would you like it if psychologists started diagnosing specific mental illnesses or prescribing drugs? Psychiatrists, you have your area of expertise and it isn’t psychology – leave that to …. the psychologists. Except, of course, over here it’s damned hard to get a psychologist without having to hire one privately…
Hi Graham,
I agree, psychiatrists are _notoriously_ bad at talking about side effects. It seems like they do it for the first two or three drugs and then don’t bother any more. It’s very frustrating but I’ve learned the way around it is just to ask. True, we shouldn’t have to, but we do. Meh.
And to be fair, all doctors (at least in North America) get training in psychotherapy and are qualified to do psychotherapy if they choose to do so. Granted, most of them don’t, but they could. I just met a psychiatrist who determined her area of interest was psychotherapy and that was what she planned on practising, predominantly. So they aren’t lying when they say they do it.
– Natasha Tracy
I agree, Natasha. But you and I have the knowledge and confidence to enquire about the side effects of medicines. Many will not, especially when their level of confidence may be shot because of the effects of the illness. We are strong enough to do that. Many will not be. The easy way will be not to engage them in such a discussion because they might find it difficult to understand or come to a decision, but the issue should, I think, be brought to the patient as a priority, not the other way about. Do you agree?
Hi Graham,
I do agree. Side effects should be a priority discussion for psychiatrists. I also agree whole-heartedly that many people can’t start that conversation for a variety of reasons. It does need to be started by doctors, ideally, unfortunately we can’t count on that.
– Natasha Tracy
I have to confess that I ere on the side of anti-psychiatry but I recognise that it has helped many people. I have a firm foot in both camps. The fact that it is so difficult for many people to find a “good” psychiatrist suggests to me that there is something amiss in the profession that needs attention. As Sara said there is good and bad in every profession but if a good psychiatrist is the exception and not the norm (?) then something is not right. My research has involves examining flawed psychoanalysis so I am probably biased.. all I hear about is the bad stories rather than the good ones.
Just a note on why some psychiatrists tend to appear cold and unfeeling… my understanding is that it is a method some psychiatrists use to be a neutral, impartial figure. As humans are social creatures… we rely on social interaction with others in order to have a sense of self. So if we see ourselves through the eyes of other people, other people are effectively “mirrors” that reflect our self image back to us. Some psychiatrists deliberately attempt to limit what they mirror back so the patient is more in tune with his/her own thoughts and how she/he genuinely sees him/herself (if you get what I mean!). Some psychiatrists are skilled at doing this while others come off as arrogant and uncaring. I’ve had experiences with both. The one that was skilled in this area was frightfully expensive!!
Hi Skully,
I agree, it’s hard to find a good psychiatrist, but it’s hard to find a good GP or a good mechanic or a good software developer (trust me) too. All that proves is that too many people suck at their job. Or, too many people can’t manage relationships with others. Regardless, it’s not just psychiatry, it’s really just humanity. Not that psychiatry can’t and shouldn’t do better – they should, but it’s not really systemic to them alone.
Yes, there are several reasons why doctors appear cold and unfeeling, which is why I said “appear” and not “actually” cold and unfeeling. Not that I think that difference helps patients all that much.
It’s too bad that skill is expensive but it often is. It is with mechanics and software developers too.
– Natasha Tracy
I appreciate the comparison but I think the key difference between something like a car mechanic and psychiatry is that the theories and conventions that make up the psychiatric profession are problematic which in turn breeds poor psychiatrists. The foundations of the profession are suspect (such as the sexism and homophobia inherent in some of its key theories), not sure the same can be said for mechanics. Yes, it’s a human problem but it’s definitely an institutional one too in my view.
You’re right, though, it is equally difficult to find a good mechanic :)
I think it’s also important to point out here that just as there are good and bad psychiatrists, there are different kinds of “anti-psychiatrists”… some of whom, are psychiatrists themselves! (such as Thomas Szasz). Unfortunately most folks have probably been exposed to the more dogmatic types of anti-psychiatrists than the more conciliatory ones.
Hi Skully,
See, I’m not sure that the foundations of psychiatry are suspect. I think that psychiatry tries to deal with human behaviour and that’s a lot more complicated than anything else out there so it does the best it can, but it’s wrong, or out of date, more often then the simpler ideas like how a car works.
And there’s a delay behind research and knowledge and official recognition of diagnoses. Like PTSD, for example, it didn’t come into being until 1980 (I think) but, of course, it has always existed. But it takes time for research to happen and for the scientific communities to agree.
Moreover, there is a difference between how people practice and the specific diagnoses as written. There are some arcane diagnoses out there, to be sure, but people don’t generally receive them.
And while psychiatry _was_ homophobic and gender bias, I would suggest it isn’t now. Again, it’s just another case of the policy having to catch up with the science. One can hardly blame psychiatry for being homophobic when the entire society was.
I agree with you that there are many kinds of people who identify with antipsychiatry. This is why when I talk about it, I specify the beliefs I am addressing as not everyone in any group can agree on any set of beliefs. Nevertheless, if you’re going to call yourself antipsychiatry, then you should probably be on board with the central tenants of the movement.
And yes, I get exposed to the nasty, small-minded, argumentative and dogmatic ones. That’s the internet for you.
– Natasha Tracy
Sorry, I have to strongly disagree that there is no homophobia and gender bias in psychiatry now. I see evidence of it in my work every day, especially for young queer kids. I know we’ve all had bad experiences with psychiatrists but some of the things these kids are subjected to is truly appalling. And it’s happening right now, not 20 years ago…. and by “good” reputable therapists, not rogues. The APA may have declassified homosexuality as a mental illness in the late 70s, but there is yet to be a “sexual revolution”, so to speak, in the theories and practice that underwrite the discipline. This has happened in psychology and sociology, but psychiatry continues to lag behind in this regard, especially in developmental psychiatry. There are some great progressive psychiatrists like Ken Corbett who are leading the way but the mainstream establishment of psychiatry continues to resist change.
Hi Skully,
Well I guess all I can say is that I’ve never seen it and I’m sorry if you have. I’m openly bisexual and I’ve never had a doctor even blink at it. Of course, I have always lived on the West Coast and that probably doesn’t hurt.
– Natasha
This is critical stuff. I’ve seen 6 shrinks over the course of my life – 3 did absolutely nothing, demonstrating a lack of understanding of very basic symptoms of OCD, but 2 helped save my life.
It’s medicine, and there are good doctors and bad. But until we start a conversation about the field, fight the stigma against mental illness, push for greater education and accountability of professionals- it’ll never get any better. And that would be a genuine tragedy, because as I said psychiatric treatment saved my life, and it’s discouraging to think how many other sufferers could be helped but refuse treatment, either because of negative past experiences or antipsychiatry bias.
Hi Fletcher,
I agree, we need to have a conversation and, in fact, we are having one. Many people are having one. But I hope we can do it with respect because that’s what is so often missing.
And oh yes, I weep for the people who have had bad experiences or are unduly influenced by antipsychiatry and so now suffer in silence. All I can say is that the more that we talk and the more that we educate, the more I hope people will get professional help. And hopefully, the better professional help will actually be.
– Natasha Tracy
I’ve had good doctors and bad doctors. One doctor I referred to (My GP) when I was particularly low told me as long as I was crying then I was OK. When I changed GP’s, my next one took me seriously and made a diagnosis, referred me for counselling etc. When I changed countries (I live in Switzerland) I saw both of my excellent GP’s who both took me seriously and recommended I see a Psychiatrist. My psychiatrist is AWESOME. He’s reassuring when the shit is hitting the fan, I have confidence in his diagnosis and knowledge, he is always there for an appointment or an email conversation or a telephone call. When he is on holiday he makes sure there is someone available for me. And my GP’s – well, if I am in between psych appointments then they are on hand and will spend a lot of time with me EVERY day if I need it. I know the system is slightly different over here, but I will never forget the brushoff from that GP in Sussex when I knew, I KNEW that I wasn’t right. I don’t care what reasons the antipsychiatry movement comes up with, I feel much better, not perfectly happy all the time but better than I have been in ages because I am taken seriously and have excellent support. It doesn’t matter to me whether its neurotransmitters or whether that isn’t true or whether the meds have turned me into a zombie or whatever they claim – I don’t care. I CAN FUNCTION (at times very well) and that’s all that matters. All antipsychiatry does for me is in my more paranoid moments believe I am a freak. And no, you can’t do a blood test to show emotion. Thanks for speaking out about this.
Hi Scilly,
Thanks for sharing that. It’s good to remember that even after a really _bad_ experience, better ones can be around the corner. And good on you for not giving up.
“All antipsychiatry does for me is in my more paranoid moments believe I am a freak.”
I agree completely. It’s amazing how destructive their rhetoric can be.
– Natasha Tracy
Hi Sara,
Thanks.
I think a lot of people owe much to psychiatry, but these people are the silent majority. There’s no reason to talk about a positive outcome, especially when you get attacked for that sort of thing.
I sort of wrap up perspectives and understanding patient challenges into “bedside manner” because the whole issue is very complex. That being said, I know doctors in Canada get training in bedside manner (although, I don’t know how recently that started).
And you’re right, the whole world should get signed up for a “perspective taking” class :)
In all of medicine it’s a problem that people are seen as diseases (just brains, hearts, tumors, etc) and not people. I think it hits people pretty hard but it’s something we can work to change and I believe many doctors also want to see that change.
– Natasha Tracy
Fantastic post Natasha!
I agree that there are good and bad psychiatrists (to make it a simple dichotomy), but that goes for every single profession on this planet. My primary psychiatrist is an absolutely amazing psychiatrist and an amazing woman. I owe a lot to her.
On the other hand, I am concerned that there are psychiatrists and other medical practitioners who have little understanding or concern of their patients challenges. Like you said, this is more a general problem in medicine, as opposed to psychiatry alone, and I would love to see better training in perspective taking and empathy a part of med school (only talking for my country here, not the rest of the world as I don’t really know what goes on outside of NZ). In fact, almost every person in this world could do with a lesson in perspective taking – but particularly those in helping professions.
One of my friends is a doctor. During her training she did her placement in the emergency psychiatric ward. She said she enjoyed “leveling the neurotransmitters in the brain”. I think that statement sums of the sort of position some medical practitioners might be taking i.e., it’s a brain, separate from a body, and not a person.
Sara