How much talk therapy do psychiatrists do nowadays!?

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What is the first treatment? Remember on tests it isn't medication... but lifestyle changes.

It's the first treatment because nobody expects it to work, and anticipates the second treatment...

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We definitely should learn these things. These are essential. Ideally, it should be our aspiration to shift from a core of well progressed disease diagnosis and management to focusing on earlier stages of disease.

Diabetes, obesity, and heart disease are greatly linked to diet and exercise. We should be able to fluently discuss how to eat and how to exercise to prevent diseases. What is the first treatment? Remember on tests it isn't medication... but lifestyle changes.

I would classify it more as prevention and not as treatment, although it remains a vital component once treatment is initiated.
 
diet, exercise, and even psychotherapy, is vital for prevention, but should also be a cornerstone of treatment and disease progression.

As an example, I've got multilevel disc disease, spinal arthritis, and nerve damage throughout my right arm, thanks to a Hep B shot gone awry. I've stayed off pain pills and muscle relaxants by becoming a devoted student of mindfulness, biofeedback, and breathing-relaxation, successfully continued rehab gains and likely prevented depression (70+% comorbidity with my ailment, for obvious reasons) through self-administered cognitive-behavioral techniques, and, although the nerve damage hasn't gone away, and the osteophytes still drastically narrow both my spinal canal and neural foraminae, MRI surveillance has actually shown improvement in my posture as well as in impingement and thecal sac area due to the extreme exercise protocols I follow. Proper attention to diet and supplementation have also improved my exercise yields and limited adverse stress-endocrine changes (can actually prove that one), decreasing my chances of inflammation-stress related disease like htn, diabetes, and CAD, and improving my sleep.

On the rare occasion I'm forced to use the help of a specialist, their first reaction is 'No. Can't be that severe.' And then they see the MRIs and EMGs. Their second reaction is 'wow, you've done amazing.' And when I explain them the lengths I've gone to, they say 'you should stop lifting, protein and creatine kill your kidneys, and supplements are dangerous'. And then they go ahead keeping sticking needles in people, hooking them on opioids and soma, and performing back surgeries, watching as these chronic NMSK patients continue their absurd rates of decline in functional status and quality of life. Pathetic.

Our limited expectation of patients and limited expectation of lifestyle is part of the problem. As psychiatrists, certainly we should recognize the danger of this kind of negative thinking.
 
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Psychiatry is not about "happiness". It is about diagnosing and treating mental illness.

...Really!? Don't you find that sad? Shouldn't it be? I mean, really, isn't the point of all medical specialties "happiness"? Isn't the point of all this time you doctors spend learning to diagnose and treat diseases to give your patients a better chance at happiness? Or has it just become a high-paying game of incredible skill?

...What is the point of diagnosing and treating mental illness? Ultimately, to give your patients a better chance at happiness, right? Well, in that regard, the brain is unlike any other area of the body. If you're trying to adjust any other bone or organ, there is a simple, 'right' way that it should work, and getting from point a to point b is a relatively simple goal-oriented process. A better functioning organ or bone = less pain = higher functionality = a better chance at happiness. That's true to some extent in the brain as well. There are things that aren't working right that great psychiatrists and neurologists over the years have learned to identify and correct. A better functioning brain = less pain = higher functionality = a better chance at happiness.

...The reason I am most interested in the brain...as opposed to any other organ...is that the process of what makes us happy itself occurs in the brain. I'm not going to pretend I know much about neurology, but I know that there are certain synaptic responses, channels, etc. that lead to the feeling of happiness. For me, it's all about learning to connect the outer world to the inner world. What happens out there that makes us happy in there. What happens out there that channels this synaptic response that leads to happiness, and what happens out there that channels this synaptic response that leads to sadness.

...In my thesis, I did a lot of work on the evolutionary aspect of positive emotion, of which very little is known. The evolutionary aspect of negative emotions, on the other hand, is very well known. Sadness, Fear, Aggresiveness, etc...these are all signals of danger. If someone or some thing, for example, is trespassing against you, threatening you, you feel fear. Our 'caveman' ancestors that had the strongest negative emotion of fear, were the ones who were most likely to escape danger, and to go on to produce.

...The evolutionary aspect of positive emotions is somewhat similar. As human beings became more advanced, social creatures, there were advantages to living and cooperating in groups. Thus, positive emotions such as joy, tolerance, friendliness, etc. began to be naturally selected. Barbara Fredrickson of the University of Michigan has even shown that a positive mood moves us into an entirely different frame of neurological processing...one that is more open, inviting, accepting, and creative...as opposed to defensive, protective, seek-and-destroy. Problem solving has been shown to be better in subjects that are first put into a good mood by something like rekindling fond memories, or playing with puppies beforehand. There is very little that we know about anything in the grand scheme of EVERYTHING...but I find the argument that positive emotions are better than negative emotions quite convincing, lol. A person that has more positive emotions, and less negative emotions, is going to have a higher quality of life.

...Psychology, Psychiatry, Neurology, etc...it should be about more than correcting problems, shouldn't it!? It should be about finding out which triggers in the brain lead to happiness...and how the outside world can trigger those triggers. I want to be a master of both the inside and outside worlds. I want to learn as much as possible about what triggers positive emotions inside the brain. And I want to learn as much as possible about what sets off those triggers in the outside world.

...I am very well aware that I am just some idiot outsider...but that's what I'm interested in. But are you really telling me that there is no place for this kind of research in psychiatry??

Tell a neurologist you're interested in his field since you're pursuing the study of happiness. Curious to see his reaction.

...I can't tell if you're being sarcastic or not. What do you think he or she will say?
 
...Really!? Don't you find that sad? Shouldn't it be? I mean, really, isn't the point of all medical specialties "happiness"? Isn't the point of all this time you doctors spend learning to diagnose and treat diseases to give your patients a better chance at happiness? Or has it just become a high-paying game of incredible skill?

No--the point is "health". "Happiness" is not guaranteed. And it's a fairly large leap of illogic to "therefore, it has just become a high-paying game of incredible skill", btw.


...In my thesis, I did a lot of work on the evolutionary aspect of positive emotion, of which very little is known. The evolutionary aspect of negative emotions, on the other hand, is very well known. Sadness, Fear, Aggresiveness, etc...these are all signals of danger. If someone or some thing, for example, is trespassing against you, threatening you, you feel fear. Our 'caveman' ancestors that had the strongest negative emotion of fear, were the ones who were most likely to escape danger, and to go on to produce.

...The evolutionary aspect of positive emotions is somewhat similar. As human beings became more advanced, social creatures, there were advantages to living and cooperating in groups. Thus, positive emotions such as joy, tolerance, friendliness, etc. began to be naturally selected. Barbara Fredrickson of the University of Michigan has even shown that a positive mood moves us into an entirely different frame of neurological processing...one that is more open, inviting, accepting, and creative...as opposed to defensive, protective, seek-and-destroy. ...A person that has more positive emotions, and less negative emotions, is going to have a higher quality of life.

Albeit a potentially shorter one... ;)

(Yes, yes I know that positive emotions are better for cardiovascular health , etc. etc. I just feel the need to point out that even as "advanced social creatures", a sensitivity to danger signals remains adaptive, and may very well increase one's reproductive fitness, longevity, and quality of life.)
 
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The research and career you are wanting are pointing towards psychology.

We exist because disease exists. Medicine (psychiatry) is about preserving life, relieving pain, and improving function from disease. Being unhappy is not a disease but at worst a risk factor for illness. We can encourage happiness but we can't give it, provide it, or make it for patients.

Happiness is largely attitude. Anyone can be happy. You can be a happy billionaire, you can be a happy death row inmate, you can be a happy surgery intern, you can be a happy hospice patient, you can be happy at any time.

There is a reason why our declaration of independence describes it as the "pursuit of happiness". It is a goal that an individual must choose to pursue, and cannot be given by others.
 
The research and career you are wanting are pointing towards psychology.

We exist because disease exists. Medicine (psychiatry) is about preserving life, relieving pain, and improving function from disease. Being unhappy is not a disease but at worst a risk factor for illness. We can encourage happiness but we can't give it, provide it, or make it for patients.

Happiness is largely attitude. Anyone can be happy. You can be a happy billionaire, you can be a happy death row inmate, you can be a happy surgery intern, you can be a happy hospice patient, you can be happy at any time.

There is a reason why our declaration of independence describes it as the "pursuit of happiness". It is a goal that an individual must choose to pursue, and cannot be given by others.

But isn't there much we can learn about what it is (functionally, in the brain) that makes us happy, and apply it?
 
Shouldn't mental health = happiness?

No, unfortunately, it does not.

I just met with a lady who is perfectly happy being manic. Restoring her mental health means making her less happy.

Restoring addicts and alcoholics to sobreity often involves grappling with a lot of personal unhappiness. Sobreity is not a guarantee of happiness either, although I would argue that it is a state of mental health.

There are also plenty of very unhappy people in the world who do not meet criteria for a diagnosable mental disorder.
 
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But isn't there much we can learn about what it is (functionally, in the brain) that makes us happy, and apply it?

Absolutely! :) But this isn't the purview of psychiatry or medicine. This is the domain of psychology.
 
No, unfortunately, it does not.

I just met with a lady who is perfectly happy being manic. Restoring her mental health means making her less happy.

Restoring addicts and alcoholics to sobreity often involves grappling with a lot of personal unhappiness. Sobreity is not a guarantee of happiness either, although I would argue that it is a state of mental health.

There are also plenty of very unhappy people in the world who do not meet criteria for a diagnosable mental disorder.

Maybe we should be starting with ground zero then. Taking a perfectly healthy person (by psychiatrist and neurologist standards), and studying what makes them happy. Then, after you do your job and get a mentally unhealthy person mentally healthy, we can have a plan in place for them to become happy?
 
Absolutely! :) But this isn't the purview of psychiatry or medicine. This is the domain of psychology.

So, you're saying that I should be looking at academic PhD programs instead of Medical programs?

The problem there is that research would be work to me, even if it was very interesting. I have no problem going to school for another eight or so years to become a master of happiness studies. But at some point, I would like to perform therapy. For me, that wouldn't be work. That would be something I absolutely LOVE.
 
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But isn't there much we can learn about what it is (functionally, in the brain) that makes us happy, and apply it?

It's called cocaine, and as Rick James would say, "it's a hell of a drug!"

Like I said at the beginning of this thread, you need to read. Start with researching the basics: what is psychology, psychiatry, therapy, etc. A discussion on SDN isn't going to help because you don't know anything. This is the third time I've suggested it to you, so you probably aren't listening, but have you tried wikipedia or the stickies in the top of the psychiatry forum?

Without any background knowledge this conversation will continue to deteriorate into meaningless back-and-forths that have no point.

you're saying that I should be looking at academic PhD programs instead of Medical programs?

No, you should be looking at books to read! One step at a time :)
 
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So, you're saying that I should be looking at academic PhD programs instead of Medical programs?

The problem there is that research would be work to me, even if it was very interesting. I have no problem going to school for another eight or so years to become a master of happiness studies. But at some point, I would like to perform therapy. For me, that wouldn't be work. That would be something I absolutely LOVE.

There is always clinical psychology. It's very competitve, some would argue more so than medical school, but it sounds more in line with your dream. But you should really read and delve further. As I said above--you've fallen in love with one explanatory tool in the great human behavior toolbox. There are MANY more tools that you will certainly at least want to know something about, if not also become skilled at using.
 
Cocaine wouldn't do ---- if it weren't for DOPAMINE--The real happiness chemical! :love:

My students (and this may be tipping my hand in terms of my secret alter ego if any of them are reading this) hear me loudly declare at least once daily (usually in the middle of a busy ICU): "Behold the power of dopamine!"
 
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Why is mental health more important than happiness (let's assume the person's happiness isn't at the cost of others)?

If we're all high, who's going to make the dope?

I'm done with this thread. Have fun fellas
 
When would it not be at the cost of others?
 
#1) Most of my knowledge in psychology/psychiatry/neurology is limited to the courses I have taken - bio1+2/chem1+2/orgo1/intro psych/developmental psych/social psych/cultural psych/stats for psych majors and the thesis paper I wrote on positive psych. Every time someone brings up something new in this thread, I go straight to google and look it up. I'm trying my best to keep up with the conversation.

#2) This drug - dopamine, it sparks some sort of happiness trigger I take it? I'm guessing that it's impact lessens with continued usage...like most drugs...is that correct? Is there much known about non-pharmaceutical treatments that spark this kind of response? That is the sort of thing I am interested in. And it sounds like at least some of you are looking into it!
 
#2) This drug - dopamine, it sparks some sort of happiness trigger I take it? I'm guessing that it's impact lessens with continued usage...like most drugs...is that correct? Is there much known about non-pharmaceutical treatments that spark this kind of response? That is the sort of thing I am interested in. And it sounds like at least some of you are looking into it!

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I'm sure, somewhere, that your Intro Psych professor is crying him/herself to sleep. Dopamine is a naturally occurring neurotransmitter, not a drug manufactured by the pharmaceutical industry.

http://en.wikipedia.org/wiki/Dopamine

This is just a joke? Maybe? I'm still an undergrad, yet even I know the function of dopamine. Probably the most well known neurotransmitter, even to the laity, besides perhaps serotonin. Both play large roles in mental illness, and also in the maintenance of happiness (There's some positive psychology for you).
 
#1) Most of my knowledge in psychology/psychiatry/neurology is limited to the courses I have taken - bio1+2/chem1+2/orgo1/intro psych/developmental psych/social psych/cultural psych/stats for psych majors and the thesis paper I wrote on positive psych. Every time someone brings up something new in this thread, I go straight to google and look it up. I'm trying my best to keep up with the conversation.

#2) This drug - dopamine, it sparks some sort of happiness trigger I take it? I'm guessing that it's impact lessens with continued usage...like most drugs...is that correct? Is there much known about non-pharmaceutical treatments that spark this kind of response? That is the sort of thing I am interested in. And it sounds like at least some of you are looking into it!

Neurobiology of Addiction: Cocaine
 
diet, exercise, and even psychotherapy, is vital for prevention, but should also be a cornerstone of treatment and disease progression.

As an example, I've got multilevel disc disease, spinal arthritis, .

I feel your agony. I love my Artrodar, Lyrica, glucosaime, chrondroitin...and mountain bike...
 
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I'm sure, somewhere, that your Intro Psych professor is crying him/herself to sleep. Dopamine is a naturally occurring neurotransmitter, not a drug manufactured by the pharmaceutical industry.

But Dopamine Hydrochloride is and you'll find it hanging on patients in ICUs everywhere.
 
But Dopamine Hydrochloride is and you'll find it hanging on patients in ICUs everywhere.

I think that's the fundamental divide in this thread. There are people who have hung vasopressor drips on people in acute shock, and there are people who haven't. If you haven't, well, your opinions have an asterisk beside them. That's not always true, but it's true in this thread.
 
But Dopamine Hydrochloride is and you'll find it hanging on patients in ICUs everywhere.

Yes, but hardly as a psychotropic, correct?

Blueadams - the comment about neurology was a joke. Neurology is generally seen as a 'depressing' (read palliative) field, where most of the treatments aren't curative.

Also, just something to consider, take it how you will. I support Frankl's idea that the ultimate goal is to find a meaning in your life, which doesn't necessarily mean finding happiness, although the two are generally related to an extent. However, I would say happiness without meaning behind it is pretty valueless. I feel like you don't see it the same way, which is why you were so excited about dopamine. It seems like you'd support a Brave New World-esque place.
 
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I think that's the fundamental divide in this thread. There are people who have hung vasopressor drips on people in acute shock, and there are people who haven't. If you haven't, well, your opinions have an asterisk beside them. That's not always true, but it's true in this thread.

I will freely grant you this, and would never pretend otherwise. My medical expertise is obviously limited, so my knowledge of pharmacology is not up to the standard of many on this thread.

However, anyone who has ever taken any course relating to psychology or the brain should know what dopamine is. As loveofarganic mentioned, we generally do not hand out dopamine like candy for psychiatric illness. I was referring to the OP's seeming conviction that dopamine is a "drug" used to induce happiness. Which dopamine is related to happiness, and as the more distinguished posters on this thread have pointed out it is a drug, it seems highly unlikely that we give it to people in acute shock in order to make them happier. Its usage is not psychotropic, correct?

Medication can affect dopamine levels, psychotherapy can affect dopamine levels, but dopamine itself is not some sort of psychoactive medication.
 
...Really!? Don't you find that sad? Shouldn't it be? I mean, really, isn't the point of all medical specialties "happiness"? Isn't the point of all this time you doctors spend learning to diagnose and treat diseases to give your patients a better chance at happiness?

As a pre-med with bipolar disorder, I don't think it's about happiness. It's about functioning. Am I well enough to get my coursework completed?
 
I'm starting to play more by managed care's rules so-to-speak, not because I agree with it, but because I can get the greatest amount of good to the patient in the least amount of time. In doing that I can get to more patients.

I work in a few places where psychotherapy is offered by non-psychiatrists. I still do psychotherapy, in fact I've been able to make headway that the other psychotherapists could not (e.g. figuring out an object-relations problem, getting the patient off of a course of psychotherapy that was not working and getting that person into DBT which worked very well, etc). I also am very proud of myself when I get a patient better by not just giving a med or when I diagnose a disorder where medication is not the answer (e.g. borderline PD or adjustment DO). It allows me to at least hope I'm not falling into the trap of being a psychiatrist that throws a pill at every problem without addressing the psycho-social.

But my point is, due to the fact that there are more people who can do psychotherapy and less people who can prescribe, I need to make myself more open to everyone who needs medication checks, and I need to make referrals to others for the psychotherapy where the person really needs to be seen often, and for extended periods of time.

Psychiatrists should still learn as much as possible concerning psychotherapy, but market forces are what they are. I would not be doing the most amount of good in the places I work if I demanded time for extended psychotherapy sessions.

I also suggest don't lock yourself into a position where there's little opportunity to provide psychotherapy yourself or at least a referral. I've seen too many psychiatrist throw a pill at every problem, and bias their diagnosis to disorders that are only treatable with meds..e.g. classic case of a borderline patient diagnosed with bipolar, or a patient with a dissociative DO diagnosed as psychotic. If you know psychotherapy, you can work with those giving it and understand and better orchestrate the handling of it.
 
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blueadams, this is really quite a welcoming place and people here tend to be very helpful. Don't get put off by a couple of snide remarks.

I was in your situation not so long ago myself.

Yes psychiatrists do talk therapy. And you can make a very decent living (100k+) taking insurance and doing talk therapy.

http://www.usnews.com/health/family...iatrists-talk-therapy-falling-by-wayside.html

Recent survey for some info.

Here's a short, but far from exhaustive list of reasons for why talk therapy is falling by the wayside. The pharma push and the medicalization of psychiatry. Increased incidence of psychiatric disorders. Increased symptomatic management of same by PCPs who are not trained in psych. Increase in number of psychiatry programs without a strong psychotherapist faculty contingent. Decline in quality of individuals entering psychiatry. Adverse compensation (thank you medicare!). Sociocultural issues regarding psych stigma (if its a biochemical issue you need a pill for, that's not really your fault. If it's a biopsychosocial problem at least partially rooted in your experiences, and reaction to them, and requires work on your part to correct, then it's your fault, you weak person!)

30% is nothing to sneeze at. And I daresay there's no reason the number couldn't be higher. It's just that there's a combination of training programs who don't care about psychotherapy as well as residents who don't care to learn it to go along with societal and economic pressures.

Myself, I still plan on becoming a psychiatrist who thinks of himself as a psychotherapist. I can take a small economic hit, or supplement with some high-paying clients. If I were in it for the money, I wouldn't have gone into psych in the first place lol.

But I will say that a funny thing has happened since I started residency (i'm an intern right now). Namely that I've got a reputation for knowing my psychopharm. Which I actually got annoyed with for a while. Because psychotherapy and lifestyle intervention have been what I wanted to do since I was 15 or so. And then i wasn't so annoyed. Psychiatric disorders after all are BioPsychoSocial, and thus treatment needs to hit all of these areas. It's now become a goal of mine to become as good at psychopharm as possible, because that'll only make me a better clinician.

I'll also say that on the inpatient wards, every patient with insight gets the psychotherapy available in my at the moment limited armamentarium. Whether supportive, motivational interviewing, cognitive-behavioral chunks, or mindfulness exercises.

In short, there is plenty of opportunity for a psychiatry resident to learn plenty of psychotherapy and to do it.
I just wanted to say I thought this was a really well put and thoughtful post. btw, good job on the pharma
 
I've been clear about where I am as a student. If you want to be a dick and ignore all of the points I made...citing nothing but your education in relation to mine as proof...go ahead. No skin off my back. But your ignoral of the opinions of those 'regular non-MD people' (or as you probably consider them, *****s) from outside the profession, its not going to help you in the long-run.

Actually, apart from being one of the most knowledgeable members on here, and a thoroughly fascinating member to speak to/read, OldPsychDoc has never treated me with anything other than respect, and I'm about as far from a 'regular non MD person' as you can get on here - being that I'm actually a psych patient. Perhaps it might behoove you to look at how you're coming across with your own attitude towards others on here, before you accuse a highly respected, senior member of the forum of considering non MD people as being '*****s'.

And seeing as you seem to be so determined in your view that medication should be a last resort, over talk therapy which you seem to consider vastly superior in getting to the root of the problem (what problem and what root, exactly, I have no idea. You seem to be using that like a catch all phrase), then consider this. My Psychiatrist treats me with a combined pharmacological and pyschotherapeutic approach, but owing to my particular symptomology he recommended medication before we commenced with any sort of talk therapy. Not because he's one of these Psychiatrists you seem to be talking about who just throws pills at problems and ignores the talk aspects of treatment, but because without medication I wouldn't have been able to have effectively participated in talk therapy owing to the fact that one of my symptoms when I'm not medicated properly can include a litany of language processing issues, including Broca's Aphasia, Alogia, and my all time favourite, word salad. How do you think I manage to participate in Psychotherapy in the first place when I go through (very frustrating) periods of not being able to hold even a simple conversation. How is my Psychiatrist supposed to get to the 'root' cause of my 'problem' (FYI we don't actually work like that, and he's trained in numerous talk therapies, I don't think you actually understand what is meant by talk therapy with a patient) if I can't even speak properly in the first place.
 
Actually, apart from being one of the most knowledgeable members on here, and a thoroughly fascinating member to speak to/read, OldPsychDoc has never treated me with anything other than respect, and I'm about as far from a 'regular non MD person' as you can get on here - being that I'm actually a psych patient. Perhaps it might behoove you to look at how you're coming across with your own attitude towards others on here, before you accuse a highly respected, senior member of the forum of considering non MD people as being '*****s'.
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Much as I appreciate the vote of confidence, Ceke, you're dredging up an argument from 4 years ago--and "blueadams" was last seen on SDN in 2011. ;)
 
Much as I appreciate the vote of confidence, Ceke, you're dredging up an argument from 4 years ago--and "blueadams" was last seen on SDN in 2011. ;)

Oops, sorry, I just see a topic on the front page and assume it's new. :shy:
 
Even though this is an old thread, I was wondering, do pediatric specialists practice talk therapy with younger kids? Like pre-adolescent young'ns.
 
These are very interesting and good points you are making, but I often wonder if the point of neuroscience is to make psychiatry more like neurology. Is there a fundamental chasm between mental processes and the substrate that psychiatry will always be inextricably tied down to "physician-patient alliance"? In an ideal world, wouldn't we like all medical specialties to be somewhat "robotic" and as "evidence-based" as possible? I have very mixed feelings for both sides of the argument.

Also, I wonder perhaps with the emergence of more brain-based/procedures in psychiatry, the specialty will eventually split, with one specializing in biological psychiatry and the other truly focusing on the psychosocial side of medicine, which should really in itself be its own specialty. But perhaps such split will NEVER happen. In any case, these are very deep questions that currently have no good answers. It's kind of exciting in the field at this time for this reason also I think, since I get the feeling that we are at some cusp that the coming 30 years will be as transformative as the past 30 years in psychiatry.

I don't think it is that bad of an idea.. I mean psychiatry has largely done away with psychotherapy anyway... I would like to see psychiatry become integrated with neurology and be more "brain based" since we know now a days that the brain and mind are not seperate entities... so maybe all of psychiatry can go in the direction of neuropsychiatry.

As far as fostering therapeutic alliances, well thats what he have psychologists, social workers and mental health occupational therapists for... so let the psychiatrists the "brain" experts and continue to study more about how the brain biologically influences the mind and do the prescribing since they have med degrees and are the psychopharmacology experts.... and then let the therapies, behavioral and psychosocial aspects be handles by psychologists, LCSW's, etc.

And since there is a desire for many for integrated care and more combined treatment... I think it is too much for any one professional to be an expert in all areas of mental health (ie, biological, psychopharm, psychosocial, extensive talk therapy, testing, etc), so I think the solution would be to see more integrated practices where there is both a psychologist and psychiatrist working together to provide a patient with their meds and therapy all in the same place at the same appointment.

In the future I think brain/ mind divide should be eliminated and no longer treated as seperate entities, we will see how they are connected and how the brain impacts the mind and how experiences impact the brain, etc... and therefore as a result, mental health can be viewed more on a continuum... where a mental health issue is seen on a scale as either more neurological based (ie schizophrenia) or more psychosocial (ie. GAD) with influence from the other and then the appropriate professionals who are working together can intervene with necessary treatment ( ie just meds, just therapy or a combo. of both).
 
I don't think it is that bad of an idea.. I mean psychiatry has largely done away with psychotherapy anyway... I would like to see psychiatry become integrated with neurology and be more "brain based" since we know now a days that the brain and mind are not seperate entities... so maybe all of psychiatry can go in the direction of neuropsychiatry.

As far as fostering therapeutic alliances, well thats what he have psychologists, social workers and mental health occupational therapists for... so let the psychiatrists the "brain" experts and continue to study more about how the brain biologically influences the mind and do the prescribing since they have med degrees and are the psychopharmacology experts.... and then let the therapies, behavioral and psychosocial aspects be handles by psychologists, LCSW's, etc.

And since there is a desire for many for integrated care and more combined treatment... I think it is too much for any one professional to be an expert in all areas of mental health (ie, biological, psychopharm, psychosocial, extensive talk therapy, testing, etc), so I think the solution would be to see more integrated practices where there is both a psychologist and psychiatrist working together to provide a patient with their meds and therapy all in the same place at the same appointment.

In the future I think brain/ mind divide should be eliminated and no longer treated as seperate entities, we will see how they are connected and how the brain impacts the mind and how experiences impact the brain, etc... and therefore as a result, mental health can be viewed more on a continuum... where a mental health issue is seen on a scale as either more neurological based (ie schizophrenia) or more psychosocial (ie. GAD) with influence from the other and then the appropriate professionals who are working together can intervene with necessary treatment ( ie just meds, just therapy or a combo. of both).
It is a bad idea to separate out the psychological or social from the biological. Leads to really poor treatment. A psychiatrist doesn't necessarily have to have as much expertise in the conceptualization and delivery of psychological interventions as myself, just as I don't need to have the same level of knowledge of the pharmacological aspects of treatment as they should (when I do know more, that can be scary). Nevertheless, it needs to be a part of their skill set just as I need to be able to understand aspects of pharmacology and definitely neurobiology. The psychiatrists who post frequently here are constantly providing examples of how knowledge of the psychological is beneficial or even essential to the care of their patients. As an expert in the psychological myself, maybe I am just better at recognizing when they do and have seen the bad examples in the real world when people who are prescribing psychotropics don't. Some of the docs here would probably just call it good psychiatry with the implicit understanding that the psychological is included in that.
 
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It is a bad idea to separate out the psychological or social from the biological. Leads to really poor treatment. A psychiatrist doesn't necessarily have to have as much expertise in the conceptualization and delivery of psychological interventions as myself, just as I don't need to have the same level of knowledge of the pharmacological aspects of treatment as they should (when I do know more, that can be scary). Nevertheless, it needs to be a part of their skill set just as I need to be able to understand aspects of pharmacology and definitely neurobiology. The psychiatrists who post frequently here are constantly providing examples of how knowledge of the psychological is beneficial or even essential to the care of their patients. As an expert in the psychological myself, maybe I am just better at recognizing when they do and have seen the bad examples in the real world when people who are prescribing psychotropics don't. Some of the docs here would probably just call it good psychiatry with the implicit understanding that the psychological is included in that.

Oh absolutely, I'm not saying that they should remove psychosocial knowledge totally, because if that was the case then they might as well just hand it all overy to neurologists. That's why I said I think it should all be integrated together in neuropsychiatry.

I just think that since we have a better understanding of the brain/ mind relationship that psychiatrists should become more neurological (and still some behavioral too) and include more applications in clinical neuroscience and such. Reason being because out of all mental health professionals, they have the most medical/ biological understanding and integrating this knowledge into practice would help their diagnostics and applications of medication, ETC, TMS become more evidence based and empiracle.

And psychologists, although they should continue to have some biological training should continue to be the experts in Psychosocial, behavioral and cognitive knowledge.

It just seems like modern day psychiatry has a leg in the psychosocial world and another in the biomedical world but without a good, strong or solid foothold in either.
 
I just think that since we have a better understanding of the brain/ mind relationship that psychiatrists should become more neurological (and still some behavioral too) and include more applications in clinical neuroscience and such. Reason being because out of all mental health professionals, they have the most medical/ biological understanding and integrating this knowledge into practice would help their diagnostics and applications of medication, ETC, TMS become more evidence based and empiracle.
I don't know that using a more biological lens allows psychiatrists to better treat mental illness or better use medications and ECT. We're just not at the point yet, if such a point even exists, where we can get such a detailed understanding of the biological dysfunction and targeted brain treatment of psychiatric disorders.
 
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Please excuse the barely coherent tirade that follows.

It is time for the completely inane mind-brain dualism to die a fast, painless death. I am so sick of hearing about biological psychiatry vs. psychotherapy.

One of my greatest laments is that basic sciences in medical education is biased toward memorization rather than theory formulation and concept recognition. I majored in neuroscience in undergrad, knowing I wanted to go on to do psychotherapy. Why? Because if psychotherapy makes a difference (and it does, with equivalent efficacy and arguably superior relapse rates), then it does so through changing the brain.

Nerves that fire together wire together. The Hebbian synapse. A core principle of basic neuroscience. And a principle that can inform the way we think about how thought patterns arise, are maintained, and extinguished.

What is cognitive-behavioral therapy if not identifying a maladaptive thought pattern, showing it to be false, and then forcibly extinguishing it? Stopping the nerves that wrongly fire together from doing so. What is DBT if it isn't helping the patient to gain awareness over their destructive behavioral responses to emotional distress? And in doing so, extinguish the strength of this synaptic connection?

Furthermore, while a lot of different psychotherapies have been shown to be about as effective as each other for a number of different disorders, and it's been argued that the therapeutic alliance is the common bond, it can also be argued that one thing all of these modalities share is that they teach the patient insight. One could argue since that's a central goal of all psychotherapies, it shouldn't be terribly surprising that they all work.

Psychotherapies ultimately work on the substrate of the brain, and produce their therapeutic benefits through changes in long-term potentiation and synaptic networks. They do this by changing thoughts and improving behavioral/emotional control. Which are products of the brain and its neurons. This should be the null hypothesis, to be disproven, rather than proven. To hold any other position is to essentially invoke Cartesian dualism. Which I am for various reasons not OK with.

Another thing to consider is that most DSM diagnoses are syndromes. I.e. collections of symptoms. Not diseases in and of themselves. Our treatments have been designed to target the relief of these symptoms rather than at specific underlying etiologies. A reduction in symptoms, whether measured by DSM criteria or the GAF (bleh), thus reveals to us nothing but how effective the medication is at relieving symptoms. You can take enough morphine to not feel any pain after you've herniated a disc. Doesn't change the fact that you herniated a disc...

The point I'm trying to make is that while psychopharm works, and psychotherapy works, that in and of itself does not make a very good case for which one is actually fixing the underlying pathophysiology.

As I mentioned earlier, psychotherapies do appear to have better relapse rates than medications alone for depression and anxiety, and we all know that the combination of both is superior. Could the superior relapse rate have to do with therapies, by the development of insight and prevention of maladaptive behaviors, thoughts, and emotional responses, reduce the likelihood of the long-term potentiation and synaptic network changes associated with mood and anxiety disorders? Could it be that combination therapy is beneficial because antidepressants provide symptomatic relief and thus de-stress the brain enough to heal?

What this whole issue shows is a silly bias in the medical profession. If it's delivered through pill or needle, if we physically cut into you and rearrange things, then, it's biological. If it happens through a change in behavior, action, or thought, then it's not. It's that kind of thinking that leads to the loss of empowerment and the medicalization of everyday life.

And to conclude my nonsensical rant, one final thought experiment. If psychotherapy is not a biologic treatment, and it works, then is the illness not biological?
May I just say that I have thoroughly enjoyed all that you have been posting masterofmonkeys! You seem to have a deep and insightful understanding of the human condition, and have not eschewed the philosophical metaphysical aspects of people. I love your wholistic approach!
 
Please excuse the barely coherent tirade that follows.

It is time for the completely inane mind-brain dualism to die a fast, painless death. I am so sick of hearing about biological psychiatry vs. psychotherapy.

One of my greatest laments is that basic sciences in medical education is biased toward memorization rather than theory formulation and concept recognition. I majored in neuroscience in undergrad, knowing I wanted to go on to do psychotherapy. Why? Because if psychotherapy makes a difference (and it does, with equivalent efficacy and arguably superior relapse rates), then it does so through changing the brain.

Nerves that fire together wire together. The Hebbian synapse. A core principle of basic neuroscience. And a principle that can inform the way we think about how thought patterns arise, are maintained, and extinguished.

What is cognitive-behavioral therapy if not identifying a maladaptive thought pattern, showing it to be false, and then forcibly extinguishing it? Stopping the nerves that wrongly fire together from doing so. What is DBT if it isn't helping the patient to gain awareness over their destructive behavioral responses to emotional distress? And in doing so, extinguish the strength of this synaptic connection?

Furthermore, while a lot of different psychotherapies have been shown to be about as effective as each other for a number of different disorders, and it's been argued that the therapeutic alliance is the common bond, it can also be argued that one thing all of these modalities share is that they teach the patient insight. One could argue since that's a central goal of all psychotherapies, it shouldn't be terribly surprising that they all work.

Psychotherapies ultimately work on the substrate of the brain, and produce their therapeutic benefits through changes in long-term potentiation and synaptic networks. They do this by changing thoughts and improving behavioral/emotional control. Which are products of the brain and its neurons. This should be the null hypothesis, to be disproven, rather than proven. To hold any other position is to essentially invoke Cartesian dualism. Which I am for various reasons not OK with.

Another thing to consider is that most DSM diagnoses are syndromes. I.e. collections of symptoms. Not diseases in and of themselves. Our treatments have been designed to target the relief of these symptoms rather than at specific underlying etiologies. A reduction in symptoms, whether measured by DSM criteria or the GAF (bleh), thus reveals to us nothing but how effective the medication is at relieving symptoms. You can take enough morphine to not feel any pain after you've herniated a disc. Doesn't change the fact that you herniated a disc...

The point I'm trying to make is that while psychopharm works, and psychotherapy works, that in and of itself does not make a very good case for which one is actually fixing the underlying pathophysiology.

As I mentioned earlier, psychotherapies do appear to have better relapse rates than medications alone for depression and anxiety, and we all know that the combination of both is superior. Could the superior relapse rate have to do with therapies, by the development of insight and prevention of maladaptive behaviors, thoughts, and emotional responses, reduce the likelihood of the long-term potentiation and synaptic network changes associated with mood and anxiety disorders? Could it be that combination therapy is beneficial because antidepressants provide symptomatic relief and thus de-stress the brain enough to heal?

What this whole issue shows is a silly bias in the medical profession. If it's delivered through pill or needle, if we physically cut into you and rearrange things, then, it's biological. If it happens through a change in behavior, action, or thought, then it's not. It's that kind of thinking that leads to the loss of empowerment and the medicalization of everyday life.

And to conclude my nonsensical rant, one final thought experiment. If psychotherapy is not a biologic treatment, and it works, then is the illness not biological?
Great rant. Just wanted to add that I very much conceptualize my treatments as neurobiological. One brain in the room affecting another brain. Lou Cozolino refers to it as the social synapse in his book. All people with good interpersonal skills can help others regulate themselves and shift perspectives. I used to do it myself before I was trained. I am just much better at it now.

A good read for any interested in the intersection between the biological and the social.
Amazon product
 
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Hi, I'm new to this forum... a proud psychiatry resident.

Patients come to us for a therapeutic alliance. They may not recognize it as such, but the desire is there that may be realized later in therapy. One brain affecting another I agree is definitely in action. Just want to add that one heart affecting another is also happening in that there are emotional frequencies resonating in the room. The psychiatrist can be as stoic as he or she likes, but there are what I call emotional frequencies. Do they cancel out or harmonize with each other is the question.

Our purpose goes far beyond prescribing medications.
 
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Hi, I'm new to this forum... a proud psychiatry resident.

Patients come to us for a therapeutic alliance. They may not recognize it as such, but the desire is there that may be realized later in therapy. One brain affecting another I agree is definitely in action. Just want to add that one heart affecting another is also happening in that there are emotional frequencies resonating in the room. The psychiatrist can be as stoic as he or she likes, but there are what I call emotional frequencies. Do they cancel out or harmonize with each other is the question.

Our purpose goes far beyond prescribing medications.
When I refer to brain, I am very much including the emotions. You don't want to mix metaphors with neuroscience too much, it can get confusing. :)
Oh and I am also including the endocrine system and other types of intracellular communications and pupil dilation, heart rate, breathing, so in a way, I'm using brain in a bit of an oversimplification myself when I am actually referring to the psyche which is not complete contained in the brain.
 
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Please excuse the barely coherent tirade that follows.

It is time for the completely inane mind-brain dualism to die a fast, painless death. I am so sick of hearing about biological psychiatry vs. psychotherapy.

One of my greatest laments is that basic sciences in medical education is biased toward memorization rather than theory formulation and concept recognition. I majored in neuroscience in undergrad, knowing I wanted to go on to do psychotherapy. Why? Because if psychotherapy makes a difference (and it does, with equivalent efficacy and arguably superior relapse rates), then it does so through changing the brain.

Nerves that fire together wire together. The Hebbian synapse. A core principle of basic neuroscience. And a principle that can inform the way we think about how thought patterns arise, are maintained, and extinguished.

What is cognitive-behavioral therapy if not identifying a maladaptive thought pattern, showing it to be false, and then forcibly extinguishing it? Stopping the nerves that wrongly fire together from doing so. What is DBT if it isn't helping the patient to gain awareness over their destructive behavioral responses to emotional distress? And in doing so, extinguish the strength of this synaptic connection?

Furthermore, while a lot of different psychotherapies have been shown to be about as effective as each other for a number of different disorders, and it's been argued that the therapeutic alliance is the common bond, it can also be argued that one thing all of these modalities share is that they teach the patient insight. One could argue since that's a central goal of all psychotherapies, it shouldn't be terribly surprising that they all work.

Psychotherapies ultimately work on the substrate of the brain, and produce their therapeutic benefits through changes in long-term potentiation and synaptic networks. They do this by changing thoughts and improving behavioral/emotional control. Which are products of the brain and its neurons. This should be the null hypothesis, to be disproven, rather than proven. To hold any other position is to essentially invoke Cartesian dualism. Which I am for various reasons not OK with.

Another thing to consider is that most DSM diagnoses are syndromes. I.e. collections of symptoms. Not diseases in and of themselves. Our treatments have been designed to target the relief of these symptoms rather than at specific underlying etiologies. A reduction in symptoms, whether measured by DSM criteria or the GAF (bleh), thus reveals to us nothing but how effective the medication is at relieving symptoms. You can take enough morphine to not feel any pain after you've herniated a disc. Doesn't change the fact that you herniated a disc...

The point I'm trying to make is that while psychopharm works, and psychotherapy works, that in and of itself does not make a very good case for which one is actually fixing the underlying pathophysiology.

As I mentioned earlier, psychotherapies do appear to have better relapse rates than medications alone for depression and anxiety, and we all know that the combination of both is superior. Could the superior relapse rate have to do with therapies, by the development of insight and prevention of maladaptive behaviors, thoughts, and emotional responses, reduce the likelihood of the long-term potentiation and synaptic network changes associated with mood and anxiety disorders? Could it be that combination therapy is beneficial because antidepressants provide symptomatic relief and thus de-stress the brain enough to heal?

What this whole issue shows is a silly bias in the medical profession. If it's delivered through pill or needle, if we physically cut into you and rearrange things, then, it's biological. If it happens through a change in behavior, action, or thought, then it's not. It's that kind of thinking that leads to the loss of empowerment and the medicalization of everyday life.

And to conclude my nonsensical rant, one final thought experiment. If psychotherapy is not a biologic treatment, and it works, then is the illness not biological?


THIS!!!!! This is where Psych needs to be moving towards, and where many Psychiatrists and Psychologists fall short. I've heard so many therapists doing talk-therapy or "CBT" and it's literally just patients talking about their feelings, crying, and going home and paying for it with very little insight. (BTW I'm talking in the context of treating mental disorders like Anxiety, Depression, OCD, Etc.) Clinicians need to be targeting the "trigger points" that lead to patients feeling these states, THEN looking for various modalities to help treat the patient.

Too many times clinicians just start by saying "what's going on" week after week, OR just entering the patient in their room and the patient just starts talking about their lives or how they've been feeling again. There doesn't seem to be that targeted approach to looking for the underlying cause of the problems, rather just providing temporary relief in exchange for your time to listening to them. It's disturbing and this is why many patients lose faith in therapy or only see its benefits while they see a therapist-- because it's actually not doing anything for them.

Another point: Psychologists and Psychiatrists need to understand that although we do have a cortex and engage in conscious thoughts, this is only a PART of our brain. There are various parts of our brain such as the Amygdala that contain their own sets of memories, experiences, control our emotional states, and can ultimately affect our behaviors ABOVE conscious control.

I know my statements aren't exactly clear b/c i'm just learning about this stuff, but it's just ridiculous seeing how little therapists actually utilize the science we know of today.
 
THIS!!!!! This is where Psych needs to be moving towards, and where many Psychiatrists and Psychologists fall short. I've heard so many therapists doing talk-therapy or "CBT" and it's literally just patients talking about their feelings, crying, and going home and paying for it with very little insight. (BTW I'm talking in the context of treating mental disorders like Anxiety, Depression, OCD, Etc.) Clinicians need to be targeting the "trigger points" that lead to patients feeling these states, THEN looking for various modalities to help treat the patient.

Ah, the old classical I'm doing differently from what I bill.

BTW, it's called NEST - Never ending supportive therapy.
 
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I've heard so many therapists doing talk-therapy or "CBT" and it's literally just patients talking about their feelings, crying, and going home and paying for it with very little insight.

There is some validity to this, but just out of curiosity, from what experience have you made all these observations?

Depending on the patient's functioning at the beginning of therapy, a willingness to talk about their feelings may represent meaningful progress. But sure, it's as easy to throw around a term like "CBT" as anything else. It's not hard to see through.

Another point: Psychologists and Psychiatrists need to understand that although we do have a cortex and engage in conscious thoughts, this is only a PART of our brain. There are various parts of our brain such as the Amygdala that contain their own sets of memories, experiences, control our emotional states, and can ultimately affect our behaviors ABOVE conscious control.

I know my statements aren't exactly clear b/c i'm just learning about this stuff

Yes.

mt-stupid.png
 
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There is some validity to this, but just out of curiosity, from what experience have you made all these observations?

Depending on the patient's functioning at the beginning of therapy, a willingness to talk about their feelings may represent meaningful progress. But sure, it's as easy to throw around a term like "CBT" as anything else. It's not hard to see through.





Yes.

mt-stupid.png

Loll you lost me on the meaning of the picture.
 
Ah, the old classical I'm doing differently from what I bill.

BTW, it's called NEST - Never ending supportive therapy.

I'm new to this.... soon to be first year medical student. But currently read books regarding the nature and neuroscience of anxiety and OCD. When you look at it from a neuroscience perspective, it makes me think so much of the behavioral aspects of therapy are flawed because they only focus on cortex-based treatment, when the actual illness could be arising from other areas of the brain!
 
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