A patient's right to self-discovery

[chiron89]

I want to preface this by saying that, in my opinion, psychology is an invaluable science and profession. I think the importance of the field will only grow over the years, and I hope that one day mental health classes are considered standard curriculum.

The APA has a code of ethics regarding clinical care. Principle E in the general principles protects the patient's right to self-determination. I think this makes diagnosis a bit of a slippery slope. How can you give someone a diagnosis while respecting their right to self-discovery?

This right of the patient is made clear to clinicians in the code of ethics. But patients don't always read the APA code of ethics. How is this right made clear to patients? Is it easy for patients to exercise this right when the clinician has experience and authority?

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[MLT2MT2DO]

Wrong forum, my friend

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[sunlioness]

Is my PCP denying my right to self discovery in diagnosing my hypertension?

I mean, they've got blood pressure stations at most pharmacies and grocery stores these days. If I were invested in my self discovery maybe I should be using those.

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[chiron89]

Is my PCP denying my right to self discovery in diagnosing my hypertension?


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I expected this. I think that the diagnosis of mental disorders, as well as what behaviors are healthy or unhealthy, do more to influence a person's idea of who they are, than most diagnoses that come from your primary care doctor.

 

[sunlioness]

Probably true. And that can be explored in therapy.

Doesn't change the relevant diagnosis.

Indeed you'd be denying this person the opportunity to explore the intersection of X diagnosis and identity if you refused to diagnose them.


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[hamstergang]

I want to preface this by saying that, in my opinion, psychology is an invaluable science and profession.

You posted this in the psychiatry section, not the psychology section. That being said:

Principle E in the general principles protects the patient's right to self-determination. I think this makes diagnosis a bit of a slippery slope. How can you give someone a diagnosis while respecting their right to self-discovery?

Where is this self-discovery coming from? It's not the same as self-determination, which is the actual principle. Giving a diagnosis doesn't impede on self-determination. It doesn't force someone to do anything.

 

[Shikima]

Is my PCP denying my right to self discovery in diagnosing my hypertension?

I mean, they've got blood pressure stations at most pharmacies and grocery stores these days. If I were invested in my self discovery maybe I should be using those.

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[chiron89]

Probably true. And that can be explored in therapy.

Doesn't change the relevant diagnosis.

Indeed you'd be denying this person the opportunity to explore the intersection of X diagnosis and identity if you refused to diagnose them.


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I agree, and I'm not opposed to diagnosis. I just wonder if it would be helpful to write these principles into a consent form. That way all parties have equal knowledge about the code of ethics.

Social theory tells us that power needs to be shared equally in happy relationships. I think a lot of clinicians take this into account by emphasizing the importance of collaboration.

But I don't think that an emphasis on collaboration is always the case. When this value is underemphasized, I think the patient can often give undue authority to a clinician, and that this unhealthy dynamic can go unnoticed.

 

[deleted343839]

How can you give someone a diagnosis while respecting their right to self-discovery?

*self-determination

Setting that aside, self-discovery can include seeking expertise and guidance from others. Seeking the help of a mental health professional may result in a diagnosis, interpretation, opinion, etc. For the most part (unless you're incapacitated to the extent that you're a threat to yourself or others), you can take or leave that professional's opinion as you see fit. Many choose to leave it.

 

[chiron89]

You posted this in the psychiatry section, not the psychology section. That being said:


Where is this self-discovery coming from? It's not the same as self-determination, which is the actual principle. Giving a diagnosis doesn't impede on self-determination. It doesn't force someone to do anything.

That's a good point. The two words mean different things. But shouldn't the field of psychology (and psychiatry) value both?

 

[chiron89]

*self-determination

Setting that aside, self-discovery can include seeking expertise and guidance from others. Seeking the help of a mental health professional may result in a diagnosis, interpretation, opinion, etc. For the most part (unless you're incapacitated to the extent that you're a threat to yourself or others), you can take or leave that professional's opinion as you see fit. Many choose to leave it.

I would argue that it can be hard for people who are vulnerable, have low self esteem, or have trouble setting boundaries to leave that opinion. Especially considering the implications of power and authority.

I don't think this takes away from the value of the psychologist, but only adds to their responsibilities. I think this responsibility could have a clearer description in the code of ethics.

 

[Bartelby]

I think self-determination and self-discovery are much different concepts. Self-determination is "the process by which a person controls their own life" and speaks to valuing autonomy in interactions with patients.

To speak to your question about self discovery and diagnosis, however, assigning a diagnostic label and giving feedback about your thoughts on etiology of the problem, what sustains the problem, what might help with the problem, and what course you expect it to run with and without treatment is an essential part of treatment by either a psychologist or psychiatrist. To abstain from any and all of these things would allow for the patient to "self-discover" without any influence, but such an interaction would be worthless. They could do that without you.

I think you will also learn that truly assimilated insights from psychotherapy are self-discovery. Whether an idea seems to have originated with the patient or the therapist it is of real value when the patient internalizes and acts on it; until then its utility is quite limited in any voluntary treatment.

 

[chiron89]

I think self-determination and self-discovery are much different concepts. Self-determination is "the process by which a person controls their own life" and speaks to valuing autonomy in interactions with patients.

To speak to your question about self discovery and diagnosis, however, assigning a diagnostic label and giving feedback about your thoughts on etiology of the problem, what sustains the problem, what might help with the problem, and what course you expect it to run with and without treatment is an essential part of treatment by either a psychologist or psychiatrist. To abstain from any and all of these things would allow for the patient to "self-discover" without any influence, but such an interaction would be worthless. They could do that without you.

I think you will also learn that truly assimilated insights from psychotherapy are self-discovery. Whether an idea seems to have originated with the patient or the therapist it is of real value when the patient internalizes and acts on it; until then its utility is quite limited in any voluntary treatment.

I really like your response. I agree that insights become useful when a patient internalizes them and acts on them. Before that, as you point out, they are just words. I also agree that a clinician is of no use if they were to completely abstain from influencing the patient.

But I think that influence itself has many flavors. It can be more collaborative or dictatorial. It can involve the power of suggestion. What are the ethical guidelines regarding the power of suggestion? If a clinician tells a patient they are angry at their spouse, they might just well become angry at their spouse.

I think that the power to influence comes with a lot of responsibilities. I honestly think the number one responsibility is to relinquish power to the person being influenced. Asking someone if they are angry at their spouse has different consequences than telling them. It involves a different appreciation of authority.

 

[deleted343839]

I would argue that it can be hard for people who are vulnerable, have low self esteem, or have trouble setting boundaries to leave that opinion. Especially considering the implications of power and authority.

I don't think this takes away from the value of the psychologist, but only adds to their responsibilities. I think this responsibility could have a clearer description in the code of ethics.

I agree that we need to approach our patients with humility, an appreciation of our own stimulus value, and respect for the patient's autonomy. While we can do our best to write out our ethical principles on paper, most of us gain a real appreciation for ethics in our clinical training, and even more so in independent practice.

Since you've only mentioned the general principles, I'm not sure whether you're familiar with the ethics code as a whole. The general principles are written broadly. The main sections of the ethics code (esp. 3, 9, and 10) address many of the issues you've raised in greater detail. The whole document can be found here: http://www.apa.org/ethics/code/

 

[splik]

it is only in recent years that psychologists have become more medicalized and have jumped on to the diagnosis bandwagon, but many psychologists do not really believe in psychiatric diagnosis, and psychologists have their own models of explaining human behavior. It is less common for psychiatrists, but some psychiatrists (myself included) reject labeling people and do not believe in psychiatric diagnosis other than mad/bad/sad (not including the very important role of identifying whether another medical or substance/toxic cause of the patient's problems can be identified) and instead use formulation. Formulation is a more comprehensive, shared, and collaborative understanding of the problems and strengths the patient has, trying to understand why they have the problems they do, and why now. And for me it is the fun of psychiatry.

And you don't have a right to self-discovery. It's somewhat meaningless to claims "rights" for everything which cannot be enshrined and it's not in any of the ethical guidelines because self-discovery has nothing to do with ethics (unlike self-determination or autonomy which is a governing principle and is many ways as suppressed by psychiatric intervention). As much as find psychiatric diagnosis distasteful I don't see how it would shroud self-discovery anymore than anything else does. The very systems we live in seek to ensure we do not know ourselves, and how would we know if we did? One of the reasons people seek psychotherapy is for "self-discovery" but who's to say that the self one discovers is really who they are. Many of my patients have a perception of who their true selves are that are more fantasy than anything else and they may commit suicide if they discovered themselves. Don't we also have the right to not discover ourselves? Assuming this is an ethical isssue, do we in the helping professions have a duty to secure someone's "right to self-discovery" when to do so would harm the individual?

Some further readings on different approaches to formulation:

Cabaniss DL, Cherry S, Douglas CJ, Graver R, Schwartz AR. Psychodynamic Formulation. Chichester: John Wiley & Sons, 2013

Campbell WH,, Rohrbaugh RM. The Biopsychosocial Formulation Manual: A guide for mental health professionals. New York: Routledge, 2006

Chisholm MS, Lyketsos CG. Systematic Psychiatric Evaluation: A Step-by-Step Guide to Applying the Perspectives of Psychiatry. Baltimore: Johns Hopkins University Press, 2012

Johnson L, Dallos R. (Eds.) Formulation in Psychology and Psychotherapy: Making Sense of People’s Problems. New York: Routledge, 2014

McHugh PR, Slavney PR. The Perspectives of Psychiatry 2nd ed. Baltimore: Johns Hopkins University Press, 1998

McWilliams N. Psychoanalytic Case Formulation. New York: Guildford Press, 1999

Persons JB. The Case Formulation Approach to Cognitive-Behavior Therapy. New York: Guildford Press, 2008

 

[chiron89]

And you don't have a right to self-discovery. It's somewhat meaningless to claims "rights" for everything which cannot be enshrined and it's not in any of the ethical guidelines because self-discovery has nothing to do with ethics (unlike self-determination or autonomy which is a governing principle and is many ways as suppressed by psychiatric intervention). As much as find psychiatric diagnosis distasteful I don't see how it would shroud self-discovery anymore than anything else does. The very systems we live in seek to ensure we do not know ourselves, and how would we know if we did? One of the reasons people seek psychotherapy is for "self-discovery" but who's to say that the self one discovers is really who they are. Many of my patients have a perception of who their true selves are that are more fantasy than anything else and they may commit suicide if they discovered themselves. Don't we also have the right to not discover ourselves? Assuming this is an ethical isssue, do we in the helping professions have a duty to secure someone's "right to self-discovery" when to do so would harm the individual?

I think we first have to define self-discovery. Merriam Webster gives a good definition: The process of understanding our abilities, character, and feelings. I think that African-Americans were taught during the segregation era that their character was less than other people's. And that gay people were taught up to a few decades ago that their feelings weren't as legitimate as other people's feelings.

I think this idea is useful, in addition to self-determination, because while self-determination deals with a person's freedom to make choices, self-discovery deals with how people think about themselves on a fundamental level. I'm gay... Is that okay? Should I be ashamed? I'm transgender... How should I feel about that? If we had protected this right thirty years ago, we would have had a lot less discrimination.

I find it hubristic for anyone to claim how another person should behave, feel, or appraise their abilities. But I think that people often lack this humility. A good analogy would be parenting. Many parents think they know their child's abilities better than their children. They might push them into medical school when they want to be engineers. Or push them into a marriage that they don't feel is right. Better to let people discover and encourage, in my mind.

 

[chiron89]

it is only in recent years that psychologists have become more medicalized and have jumped on to the diagnosis bandwagon, but many psychologists do not really believe in psychiatric diagnosis, and psychologists have their own models of explaining human behavior. It is less common for psychiatrists, but some psychiatrists (myself included) reject labeling people and do not believe in psychiatric diagnosis other than mad/bad/sad (not including the very important role of identifying whether another medical or substance/toxic cause of the patient's problems can be identified) and instead use formulation. Formulation is a more comprehensive, shared, and collaborative understanding of the problems and strengths the patient has, trying to understand why they have the problems they do, and why now. And for me it is the fun of psychiatry.

I like your approach.

 

[chiron89]

I agree that we need to approach our patients with humility, an appreciation of our own stimulus value, and respect for the patient's autonomy. While we can do our best to write out our ethical principles on paper, most of us gain a real appreciation for ethics in our clinical training, and even more so in independent practice.

Since you've only mentioned the general principles, I'm not sure whether you're familiar with the ethics code as a whole. The general principles are written broadly. The main sections of the ethics code (esp. 3, 9, and 10) address many of the issues you've raised in greater detail. The whole document can be found here: http://www.apa.org/ethics/code/

Thanks for your response. I enjoyed reading your words, and really admire your values. I think it can sometimes be hard for patients to find therapists with the same values. I wonder if attitudes that exist in the field might exacerbate this problem. For example, perhaps a psychiatrist isn't open with a patient about other forms of therapy. The one experience discourages the patient, and makes them give up their search for a therapist.

 

[deleted343839]

Thanks for your response. I enjoyed reading your words, and really admire your values. I think it can sometimes be hard for patients to find therapists with the same values. I wonder if attitudes that exist in the field might exacerbate this problem. For example, perhaps a psychiatrist isn't open with a patient about other forms of therapy. The one experience discourages the patient, and makes them give up their search for a therapist.

Sure, that does happen. I always ask new patients about prior experiences with mental health services, and what did or didn't go well, what was or wasn't helpful to them. Though some patients report negative or harmful effects, the majority seem about evenly split between those who perceived benefit and those who say that it wasn't particularly helpful or unhelpful. Depending on one's area of practice, you might see different patterns of opinions.

I genuinely believe that most mental health professionals have good intentions, but we are all vulnerable to being less than our best professional selves due to burnout, biases we may not be aware of, our own illnesses and problems, etc. Another important aspect of the ethics code deals with how we address those limitations in ourselves. I wish I could say I had a perfect solution, but self-awareness and willingness to use feedback are important.

 

[Shikima]

Thanks for your response. I enjoyed reading your words, and really admire your values. I think it can sometimes be hard for patients to find therapists with the same values. I wonder if attitudes that exist in the field might exacerbate this problem. For example, perhaps a psychiatrist isn't open with a patient about other forms of therapy. The one experience discourages the patient, and makes them give up their search for a therapist.

You forgot the golden rule - can't please 100%, 100% of the time.

And finding a therapist is a lot like dating.

 

[erg923]

I dont understand how concluding a dx hinders "self-discovery."

 

[Ceke2002]

I dont understand how concluding a dx hinders "self-discovery."

Neither do I, and if my Psychiatrist had handed me some sort of a pamphlet that explained how to understand the concept of diagnosis in regards to the non hindrance of self-discovery I would have looked at him like he'd just descended from another planet and grown an extra head. This to me just comes under the category of 'you don't need to explain it to me like I'm five'.

 

[hamstergang]

That's a good point. The two words mean different things. But shouldn't the field of psychology (and psychiatry) value both?

Sure we can value them, but that doesn't mean we shouldn't diagnose patients, especially as they come to us for help.

Could you explain where this is coming from? What is your connection to psychology, and what led you to signing up for this site today?

 

[birchswing]

I think it's a very interesting idea. A diagnosis can very much color the way a person sees himself. It seems there's an acknowledgement of that as diagnoses now tend to be more conditional or even avoided. They are often described as being something for insurance purposes. When I was diagnosed with anxiety, I took the diagnosis very unquestioningly and ran with it as an identity. The word now seems so soluble, but at the time it was somewhat foreign to me. At the time I had an idea that I knew what it meant, but I only had an idea in that I thought it described what my experience was. I wasn't given any sort of ideas outside outside my experience about what anxiety is. I can recall after getting this diagnosis telling two good friends that I had something important to tell them. I told them I had been diagnosed with anxiety disorder. They both laughed as they were assuming I was going to tell them I had something like cancer. This was in 10th grade. For some reason, I really did take the diagnosis differently than you would expect someone to. If someone had told me I was nervous, I think it would have seemed self obvious. But the word anxiety became a thing in and of itself. I do also believe it precluded looking into the causes of distress I was having. If you can make a case, as my psychiatrist implicitly did, that anxiety is a free-standing disorder, I came to the conclusion that I simply had a disease called anxiety. And as was explained to me, it was the same as a person having diabetes. To me, Ativan became like life-saving insulin. When I had what was diagnosed as anxiety, I felt like I couldn't breathe and was suffocating. Ativan made that go away. And that formed a very unhealthy and uninformed view of what was going on in my body.

But I think putting a name on the distress and suggesting it was a stand-alone biological disorder also precluded the psychiatrist from thinking about what could have been causing distress. To this day, I am not unconvinced that I am a very high-achieving person with ADHD, as it was when I began college courses the summer after ninth grade that my "anxiety" came on. It was as if, in my opinion, my strong abilities had been able to correct for ADHD until I reached a level of material that was too difficult for me to compensate for. It's a theory only of course. And there were also social and psychological factors at play, including my sexuality, harassment in school over my perceived sexuality, and my parents being neglectful that certainly all played a role. Yet this was all reduced to a biological disease and treatment with Ativan.

I do think once you suppose you know something with certainty it does limit your ability to find true answers. I should say that since that initial diagnosis, doctors have been more reluctant to assign me diagnoses, especially psychologists, who seem to usually say that the diagnosis isn't important.

 

[hamstergang]

But I think putting a name on the distress and suggesting it was a stand-alone biological disorder also precluded the psychiatrist from thinking about what could have been causing distress.

That's just bad psychiatry, not a problem with giving a diagnosis and prescribing medications.

 

[nitemagi]

This is a bit reductionistic, but you're just calling out the observer effect as if it itself causes harm. It's the most extreme of political correctness. "How dare you effect me by forming an opinion about me." In the context of a patient seeking treatment, they are in fact asking to be effected. In the context of a patient being pressured/forced into evaluation/treatment (brought in involuntarily on a hold), the opinions that something is "abnormal" begins far before the consultation (the police officer, the neighbors, etc). It's near impossible to not form an opinion and thus have an effect. We live in an intimately interconnected world, like it or not, where we will be affected by things. No way to hide from that.

 

[birchswing]

That's just bad psychiatry, not a problem with giving a diagnosis and prescribing medications.

That's true. I think that the conceptualization of psychiatric illness being like any other illness (often through marketing and changes in insurance reimbursements) and having that diagnosis/treatment modality in a way enables people to be bad at psychiatry. The psychiatrist I saw could have been better, but I think there are ways that both enabled and encouraged him to practice the way he did. I'm not absolving him of bad practice, but I think you have to look at in the aggregate a bit when looking at why people do what they do.

 

[chiron89]

This is a bit reductionistic, but you're just calling out the observer effect as if it itself causes harm. It's the most extreme of political correctness. "How dare you effect me by forming an opinion about me." In the context of a patient seeking treatment, they are in fact asking to be effected. In the context of a patient being pressured/forced into evaluation/treatment (brought in involuntarily on a hold), the opinions that something is "abnormal" begins far before the consultation (the police officer, the neighbors, etc). It's near impossible to not form an opinion and thus have an effect. We live in an intimately interconnected world, like it or not, where we will be affected by things. No way to hide from that.

I don't think you can reduce it to the observer effect. I think that influence is a spectrum. One end of the spectrum is being a complete observer. The extreme end is being a controller. I think we all fall somewhere along this spectrum in every relationship that we have. This includes the relationships that therapists have with their clients. I'm not saying that there should be guidelines on where to place yourself on this spectrum. But I do think it's important to be aware of where you stand on this spectrum in your important relationships.

I guess what I'm saying is, we all know what it's like to have a friend or parent boss us around. They're still good people, but we have to learn to assert ourselves so mom doesn't force our hand in graduate school the way she did in college. In the same way, therapists are good people but they too can be bossy. Because they're people as well as therapists. Just like a brother is a person as well as a brother. I think we put therapists on a pedestal. They don't have all the answers. They disagree among themselves as much as they disagree with us.

 

[PikminOC]

No one wants a label or diagnosis until they find out their insurance wont pay without one...

 

[PikminOC]

That's just bad psychiatry, not a problem with giving a diagnosis and prescribing medications.

It's not bad psychiatry not to diagnose someone with what they want especially if they are drug seeking...and they don't have the condition...no matter how much they may think they do...

 

[PikminOC]

I agree that we need to approach our patients with humility, an appreciation of our own stimulus value, and respect for the patient's autonomy. While we can do our best to write out our ethical principles on paper, most of us gain a real appreciation for ethics in our clinical training, and even more so in independent practice.

Since you've only mentioned the general principles, I'm not sure whether you're familiar with the ethics code as a whole. The general principles are written broadly. The main sections of the ethics code (esp. 3, 9, and 10) address many of the issues you've raised in greater detail. The whole document can be found here: http://www.apa.org/ethics/code/

Where's that autonomy when they do something and then sue the Psychiatrist?

 

[PikminOC]

I expected this. I think that the diagnosis of mental disorders, as well as what behaviors are healthy or unhealthy, do more to influence a person's idea of who they are, than most diagnoses that come from your primary care doctor.

So no diagnosis for my psychotic inpatient? He can self determine it as well as his treatment?

 

[Shikima]

So no diagnosis for my psychotic inpatient? He can self determine it as well as his treatment?

"It's my bipolar acting up...."

 

[hamstergang]

I think we put therapists on a pedestal. They don't have all the answers. They disagree among themselves as much as they disagree with us.

Who is 'we?' This sounds like it's about you.

It's not bad psychiatry not to diagnose someone with what they want especially if they are drug seeking...and they don't have the condition...no matter how much they may think they do...

I don't know why you're saying this to me.

 

[deleted343839]

Where's that autonomy when they do something and then sue the Psychiatrist?

Sounds pretty autonomous to me.

 

[erg923]

I want to preface this by saying that, in my opinion, psychology is an invaluable science and profession. I think the importance of the field will only grow over the years, and I hope that one day mental health classes are considered standard curriculum.

The APA has a code of ethics regarding clinical care. Principle E in the general principles protects the patient's right to self-determination. I think this makes diagnosis a bit of a slippery slope. How can you give someone a diagnosis while respecting their right to self-discovery?

This right of the patient is made clear to clinicians in the code of ethics. But patients don't always read the APA code of ethics. How is this right made clear to patients? Is it easy for patients to exercise this right when the clinician has experience and authority?

Person dx with MDD. He/she then self-discovers in the course of therapy (via discussion of core and intermediary beliefs, corrective emotional experience, psychological insight, changing life priorities, or whatever.....) fill in the blank.

I still don't get how these (dx and self discovery) are at all related.

 

[thoffen]

Firstly, you are referencing the American Psychological Association's code of ethics rather than Psychiatric, which is our professional organization. Nonetheless, it does not make your question invalid.

There is an assumption that people make when it comes to, well, everything, and that assumption is that we work in a world where situations can be summed as right or wrong, and there is a guiding principle which will wholly elucidate the rightness or wrongness of an action.

This is utter fallacy, and this is the principle on which ethics decisions are made. The medicine versions of ethical principles are Autonomy, Beneficence, Non-maleficence, and Justice. Our brains want to assume that all decisions come down to finding which principle matches our situation and therefore makes clear the delineation between ethical and unethical.

What is accurate instead is that, in any given situation, there lies conflict between 2 or more ethical principles, and we must weigh the situation according to these principles and choose our actions accordingly. For instance, when choosing a medication, there is an ethical decision involved because we must weigh the benefit of a treatment against the risks (beneficence vs. non-maleficence). Most of the time we make these decisions without any conscious consideration of ethical principles. Still, it is important to define these principles not because they can always be honored, but because it guides us to looking at the ethical considerations of our choices and the conflicts that we must weigh.

 

[PikminOC]

Sounds pretty autonomous to me.

Not when they don't take responsibility for their own actions and blame someone else instead.

 

[PikminOC]

Wrong forum, my friend

Sent from my SM-G900V using SDN mobile

Actually, thank you for posting in here. This explains why I'm butting heads with a psychologist right now. While she waxes poetic, I'm trying to prevent a hospitalization

 

[chiron89]

Who is 'we?' This sounds like it's about you.


I don't know why you're saying this to me.

That's your hubris speaking. No one's problems are unique. Maybe it does come from my experiences. But other people have had the same experiences. To say that no one in history has had my experiences, is not only deluded and foolish, but also detrimental to understanding the strengths and weaknesses of a field.

 

[chiron89]

OK. I'm going to take a step and speak with some authority.

Psychology is a wonderful, beautiful, and valuable science. But until it heals its own divisions, there are patients who will be hurt and burned by those divisions.

The system in America whereby CBT and pharmacotherapy are given almost exclusive authority over the field, actually hurts a lot of people. Mostly patients. But also psychologists whose opinions differ.

 

[Shikima]

No one problem is alike but the emotional responses are pretty much the same. Treatment plan is pretty much the same save for nuances on a theme.

Don't like it - take it up with your shrink and therapist. If you need an existential explanation, talk to your priest.

 

[hamstergang]

That's your hubris speaking. No one's problems are unique. Maybe it does come from my experiences. But other people have had the same experiences. To say that no one in history has had my experiences, is not only deluded and foolish, but also detrimental to understanding the strengths and weaknesses of a field.

This is just nonsensical and has nothing to do with my post.

OK. I'm going to take a step and speak with some authority.

What authority do you have?

Your post is just filled with assertions with nothing to back then up as something real.

 

[erg923]

OK. I'm going to take a step and speak with some authority.

Psychology is a wonderful, beautiful, and valuable science. But until it heals its own divisions, there are patients who will be hurt and burned by those divisions.

The system in America whereby CBT and pharmacotherapy are given almost exclusive authority over the field, actually hurts a lot of people. Mostly patients. But also psychologists whose opinions differ.

Your posts are becoming increasingly tangential to the topic, and seemingly based on some type of personal experience or grudge. And you still haven't addressed the very basic question I have asked twice on this thread.

I think if you want to be taken seriously, you will need to stop speaking in such vagaries about "harm," "self-discovery, (whatever the **** that even means), and demonstrate some actual knowledge of the professional practice of psychology/psychiatry. And being a patient doesn't qualify someone for the later, no mater how much they may think it does.

 

[thoffen]

Chiron, it seems that you posted this with an intent to expose a problem that has emotionally affected you. There are aspects of what I think your position is that I empathize with a great deal, and there are people whose voices are not being heard as a result. However, I think we are missing an opportunity to hear each other. I suggest that it will be easier to tell us how you feel and why and what you are concerned about without notions that it is a singular correct perspective and give us an opportunity to hear it. I can't speak for others, but I will endeavor to do the same in response.

 

[chiron89]

Your posts are becoming increasingly tangential to the topic, and seemingly based on some type of personal experience or grudge. And you still haven't addressed the very basic question I have asked twice on this thread.

I think if you want to be taken seriously, you will need to stop speaking in such vagaries about "harm," "self-discovery, (whatever the **** that even means), and demonstrate some actual knowledge of the professional practice of psychology/psychiatry. And being a patient doesn't qualify someone for the later, no mater how much they may think it does.

What I'm protesting is a lack of humility in the field which is evident in this thread. A good physician has a willingness to receive and empathize with feedback. I don't see that willingness reflected in some of the physicians here. Fifty years from now psychiatrists will be rolling their eyes at how many psychiatrists of today treated their patients. In the same way that psychiatrists of today roll their eyes at how the psychiatrists of fifty years ago treated their patients. This basic insight is what engenders humility among the best of the field. It takes the best of the field to realize the limits of the field. And that's why the best practitioners have humility, but not the rest.

 

[chiron89]

So no diagnosis for my psychotic inpatient? He can self determine it as well as his treatment?

Madness is madness. The names we give to demons are political. The treatment is often also political. When the politics interfere with effective treatment, we have an ethical issue.

I do agree that in practice diagnoses are often necessary. Especially to facilitate insurance. It's really less to do with the diagnosis, and more to do with the diagnostician.

If you could send your troubled daughter to meet with Gandhi every week (let's say we could bring him back to life) she probably would become a healthier and more balanced person.

But the weekly meetings with Gandhi wouldn't be CBT or pharmacotherapy. What's less important is the name we give to the treatment, and what's more important is the wisdom, humanity and compassion of the mentor or physician.

We test our drugs to make sure they aren't toxic but we do not test our practitioners to make sure they aren't arrogant.

 

[chiron89]

Chiron, it seems that you posted this with an intent to expose a problem that has emotionally affected you. There are aspects of what I think your position is that I empathize with a great deal, and there are people whose voices are not being heard as a result. However, I think we are missing an opportunity to hear each other. I suggest that it will be easier to tell us how you feel and why and what you are concerned about without notions that it is a singular correct perspective and give us an opportunity to hear it. I can't speak for others, but I will endeavor to do the same in response.

I admire your response. Your even tone and understanding. I'll respond later today.

 

[nitemagi]

We test our drugs to make sure they aren't toxic but we do not test our practitioners to make sure they aren't arrogant.

The best way to get respect is to give respect. That goes both ways.

 

[erg923]

What I'm protesting is a lack of humility in the field which is evident in this thread. A good physician has a willingness to receive and empathize with feedback. I don't see that willingness reflected in some of the physicians here. Fifty years from now psychiatrists will be rolling their eyes at how many psychiatrists of today treated their patients. In the same way that psychiatrists of today roll their eyes at how the psychiatrists of fifty years ago treated their patients. This basic insight is what engenders humility among the best of the field. It takes the best of the field to realize the limits of the field. And that's why the best practitioners have humility, but not the rest.

I don't know what the "feedback" is? You don't want a diagnosis? Is that it?