interesting clinical hypothetical......

[vistaril]

Which is why you won't be discouraged from not actually practicing psychiatry.

I'd rather be not practicing than be a MH provider who is neutral towards one of my patients doing those kinds of things. Again, this is not exotic dancing or whatever. They are oceans apart. Heck this isn't even your father's adult movies from the 80s.

And it's not about my disgust for people who do those kinds of things. Someone from that background doing those kinds of things almost certainly has issues.

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[Jorje286]

Need to return to the biopsychosocial model. It's not unethical to inquire about abuse and other threats to her life. Very appropriate to inquire how her line of work is/has affected her ability in living her life and the meaning.

This is all on the supposition you have more than 15-20 mins, asking her to open her mouth and throwing meds into it - what ever sticks is the dosage. (Yes, flagrently stolen).

But this is besides the point. If she visited my clinic then of course I need to inquire about all aspects of her social environment and psychological well being. What's unethical is discussing a public specific person on a public messageboard while at the same presupposing ("hypothetical") that they have this or that because of their job. Even more so that it's coming from MD holders.

 

[Shikima]

Not sure what the real issue is. Sounds as if there are a lot of presumptive ideas flying about due to employment as a sex worker. If said person was pushing crack, I don't think anyone would have a problem in discussing the case. I believe the root of the issue is that the discussion could be of a sexual nature - which is good if used in a therapeutic context rather than for getting one's "rocks off" and personal pleasure.

 

[erg923]

I would also add that, if your major objection to pornogrpahy is that fact that is "degrading".... I would imagine that the origin of that emotion is the objectification of the person, no? If so, what the difference, in your mind, between stripping and having coitus filmed?

From a Christian perspective, I think both are not in the image of God. However, I fully recognize that does not necessarily translate to psychological harm that need to be treated medically by me. To assume such is quite insulting and does not take into account individual differences, not to mention respect for individual choices and freedoms.

oh I just don't agree with your approach to this scenario at all.

Uh, which part? The part about the acceptance of other peoples choices when in a professional context/role?

I also noticed your didn't answer my question.

I get the feeling you really, really, really want to treat something that may not be there, or that the person has no interest in treating. What do you think this is about?

 

[erg923]

I'd rather be not practicing than be a MH provider who is neutral towards one of my patients doing those kinds of things. Again, this is not exotic dancing or whatever. They are oceans apart. Heck this isn't even your father's adult movies from the 80s.
And it's not about my disgust for people who do those kinds of things. Someone from that background doing those kinds of things almost certainly has issues. [/quote]

1. Again, why? You have not responded to my question about this.

2. Do you have any empirical evidence of such? Vistaril, do understand that suppositions such as these could be deterimental to a therapuetic relationship? Certainly you have had some psychotherapy training somewhere along the line, no? How have you managed to avoid education regarding these issues throughout your clinical supervision, especially with your therapy cases? I am actually curious about this one, because its coming across as if you have had almost NO clinical training at all?

 

[notdeadyet]

I'd rather be not practicing than be a MH provider who is neutral towards one of my patients doing those kinds of things.

Then good luck with the property management gig. Seriously. If you're unable to separate your personal beliefs from your clinical ones, the appointment length is the least of the issues impacting good care.

If your partner is going to make the huge money you predicted with GI and is willing to invest in your career with some start-up properties for you to manage, you could easily do just that and wouldn't have these issues at all. You've made your thoughts about psychiatry and medicine pretty clear from the jump and your desire for a profitable side business vs. exit strategy. Now might be the time.

 

[erg923]

Well, the issue here is that, even on the side where this IS judged in terms of its "rightness" or "wrongfullness", the response is still is not one of "taking a stand," assumptions of pathology, and forceful change talk. The literature is quite clear that the latter does not work well and we have known that for 30 years now (Proachaska and Norcross, folks). Compassion, catechesis, and working to have the person understand their value, their innate humanity and goodness would be the way pastoral/religious counseling would deal with such a thing-at least in the Catholic church. Quite a bit more gentle and tactful in approach than what Vistaril seems to be wanting to do based on his moral objections to such activities.

 

[erg923]

Then good luck with the property management gig. Seriously. If you're unable to separate your personal beliefs from your clinical ones, the appointment length is the least of the issues impacting good care.

If your partner is going to make the huge money you predicted with GI and is willing to invest in your career with some start-up properties for you to manage, you could easily do just that and wouldn't have these issues at all. You've made your thoughts about psychiatry and medicine pretty clear from the jump and your desire for a profitable side business vs. exit strategy. Now might be the time.

Is that partner also simultaneously supportive and scornful of the sex entertainment industry? lol

 

[nancysinatra]

1. Those are subjective emotional experiences and judgments, not facts. This isnt high cholestorol here (objective fact), pal. For goodness sakes, if someone doesnt actually have low mood or anhedonia, then they dont need treatment for depression.
2. "Taking a stance?" Is that your job?

Vistaril, these are basics. BASICS! How do you get to 4th year and not have the basics down?

If these are in fact basics, then why do I see so many patients who have been "told" by varius self-righteous providers they HAVE depression, anxiety, or bipolar disorder who don't, in fact, have any of the symptoms of those conditions? Are you saying we should be unbiased and objective when it comes to people in the sex trade? If so then why doesn't our profession take the same unbiased appraoch toward the rest of the population?

The reason this sex worker will get misdiagnosed is the same reason everyone in America gets misdiagnosed. Our field doesn't know what the heck it's doing most of the time.

 

[erg923]

If these are in fact basics, then why do I see so many patients who have been "told" by varius self-righteous providers they HAVE depression, anxiety, or bipolar disorder who don't, in fact, have any of the symptoms of those conditions? Are you saying we should be unbiased and objective when it comes to people in the sex trade? If so then why doesn't our profession take the same unbiased appraoch toward the rest of the population?

The reason this sex worker will get misdiagnosed is the same reason everyone in America gets misdiagnosed. Our field doesn't know what the heck it's doing most of the time.

I think it pretty basic clinical training to 1.) know your job description and the boundaries of it. 2). self-awareness at least to the point of knowing that you do have biases that would adversely affect your ability to act as a healthcare professional rather than as a friend/father/priest/moral authority figure, etc.

And yes, of course we should treat sex workers as we would any other patient. Session content/explorations might be quite different than when seeing a wallstreet banker though.

 

[shan564]

This discussion needs to end.

 

[nancysinatra]

I think it pretty basic clinical training to 1.) know your job description and the boundaries of it. 2). self-awareness at least to the point of knowing that you do have biases that would adversely affect your ability to act as a healthcare professional rather than as a friend/father/priest/moral authority figure, etc.

And yes, of course we should treat sex workers as we would any other patient. Session content/explorations might be quite different than when seeing a wallstreet banker though.

Although I'm glad to hear that you think it's basic to know one's job description, I was actually being ironic. You didn't address my point, which is that if every other psychiatric patient in this country is being misdiagnosed, why does it bother you that a sex worker would be misdiagnosed? Why should the reason for the misdiagnosis matter?

 

[erg923]

I don't know how to answer that question other than to say all patients deserve quality treatment, including accurate diagnosis in a "safe" environment that is free of preconceived judgements and/or biases that will impair quality of care.

 

[hamstergang]

You didn't address my point, which is that if every other psychiatric patient in this country is being misdiagnosed, why does it bother you that a sex worker would be misdiagnosed? Why should the reason for the misdiagnosis matter?

Firstly, hyperbole doesn't win arguments.

Secondly, who is upset only about this "patient" being misdiagnosed?

Thirdly, the problem is more with the whole approach here, not just the diagnosis.

 

[st2205]

How do you keep up with the copious amounts of drivel?

I think OPD is compensating for once recommending vistaril apply to his program, back when he was a med student (true story).

 

[vistaril]

Then good luck with the property management gig. Seriously. If you're unable to separate your personal beliefs from your clinical ones.

my personal beliefs regarding porn are not the issue here. My clinical belief is that someone in her situation who decides to do the kind of things she did(again, not exotic dancing or your father's porn) has some issues.

 

[vistaril]

1. Again, why? You have not responded to my question about this.

2. Do you have any empirical evidence of such? Vistaril, do understand that suppositions such as these could be deterimental to a therapuetic relationship? Certainly you have had some psychotherapy training somewhere along the line, no? How have you managed to avoid education regarding these issues throughout your clinical supervision, especially with your therapy cases? I am actually curious about this one, because its coming across as if you have had almost NO clinical training at all?

well although I appreciate your concern about such things, I feel good about my training.

Do I have any evidence of what exactly?(you bolded two things above)

 

[OldPsychDoc]

I think OPD is compensating for once recommending vistaril apply to his program, back when he was a med student (true story).

I can only hope that V was using a different user name then...or that you have me mistaken for a different PD. My first remembered encounter with the V was over the definition of recovery, 2-3 years ago, and before I became PD here.

 

[vistaril]

I think OPD is compensating for once recommending vistaril apply to his program, back when he was a med student (true story).

I'm sure I wouldn't mind training at his program...it's just too damn cold.

 

[st2205]

I can only hope that V was using a different user name then...or that you have me mistaken for a different PD. My first remembered encounter with the V was over the definition of recovery, 2-3 years ago, and before I became PD here.

It was under a different screen name. I stumbled on the thread a few months ago and had a chuckle.

 

[erg923]

Dude, lol. Does it matter what you think of your training and skill or what OTHERS think of it?

And I asked if you had evidence for your statement concerning the inevitably of psychopathology in those who perform in the industry. I think casual statements such as these without empirical backing highlight an existing bias (that you continue to deny) that would obviously hinder formation of a therapeutic relationship and/or treatment that is objective and patient centered.

 

[Trismegistus4]

Are you for real here? I don't support or condone drug abuse, either, but I khow that I am going to encounter a helluva lot of it in psychiatry - in all medicine for that matter. Same with obesity...be careful when you starting drawing lines on what you feel is morally acceptable behavior in patients - you mind end up in a very tight corner.

This is the problem I've been having with the cultural leftists in medicine since day 1 of medical school. I'm a doctor, and I'm not going to carry such a harsh, judgmental attitude into the exam room, but I'm not just a doctor going through life in a series of one-on-one patient encounters. I'm also a person living in a society--a society whose social pathology I would like to be kept to a minimum. Am I "ethically" bound by my MD not to act according to my convictions in my private conversations, in the voting booth, in raising my children? What cultural leftists--i.e., the type of people who refer to pornography and prostitution with the cold, clinical, morally netural term "sex work"--cannot accept is that taboos, stigma, shame, folkways, mores, all those relics of society they wanted to dispose of, believing they were fabricated out of whole cloth by a cabal of white males for the purpose of oppressing people, actually exist to keep social pathology to a minimum. Look at what's happened since we've gone soft on unwed motherhood: an explosion in bastardy. On similar grounds, I refuse to offer moral approbation of pornography and prostitution by calling them "sex work."

ETA: That said, I agree with the point others have made that there is no reason to think that a producer of pornography must, ipso facto, be experiencing depression or anxiety.

 

[birchswing]

This is the problem I've been having with the cultural leftists in medicine since day 1 of medical school. I'm a doctor, and I'm not going to carry such a harsh, judgmental attitude into the exam room, but I'm not just a doctor going through life in a series of one-on-one patient encounters. I'm also a person living in a society--a society whose social pathology I would like to be kept to a minimum. Am I "ethically" bound by my MD not to act according to my convictions in my private conversations, in the voting booth, in raising my children? What cultural leftists--i.e., the type of people who refer to pornography and prostitution with the cold, clinical, morally netural term "sex work"--cannot accept is that taboos, stigma, shame, folkways, mores, all those relics of society they wanted to dispose of, believing they were fabricated out of whole cloth by a cabal of white males for the purpose of oppressing people, actually exist to keep social pathology to a minimum. Look at what's happened since we've gone soft on unwed motherhood: an explosion in bastardy. On similar grounds, I refuse to offer moral approbation of pornography and prostitution by calling them "sex work."

ETA: That said, I agree with the point others have made that there is no reason to think that a producer of pornography must, ipso facto, be experiencing depression or anxiety.

What concerns me about knowing there are people like you practicing medicine is not that you have certain moral beliefs, but that you don't seem particularly intelligent. Your arguments are based on extreme strawmen and on an uproven idea that the unspecified past was more moral and humane than the present. You seem limited in your ability to realize how limited we all are in our ability assess the world.

Just the idea of cultural leftists is an imagined community, and that's your jumping off point.

 

[vistaril]

Dude, lol. Does it matter what you think of your training and skill or what OTHERS think of it?

And I asked if you had evidence for your statement concerning the inevitably of psychopathology in those who perform in the industry. I think casual statements such as these without empirical backing highlight an existing bias (that you continue to deny) that would obviously hinder formation of a therapeutic relationship and/or treatment that is objective and patient centered.

1st question- both, but obviously it depends on who the other people are. People I work with and like or people I work with and whose opinions/work I respect I would care what they think. Other people not so much.

2nd- yes, there is psychopathology in middle class girls going to good colleges who do *that sort* of porn(perhaps not the industry in general in all cases). Of course I don't have evidence- that is such unusual behavior in that demo(which is why it was a story in the first place) that it wouldn't be possible.

 

[vistaril]

This is the problem I've been having with the cultural leftists in medicine since day 1 of medical school. I'm a doctor, and I'm not going to carry such a harsh, judgmental attitude into the exam room, but I'm not just a doctor going through life in a series of one-on-one patient encounters. I'm also a person living in a society--a society whose social pathology I would like to be kept to a minimum. Am I "ethically" bound by my MD not to act according to my convictions in my private conversations, in the voting booth, in raising my children? What cultural leftists--i.e., the type of people who refer to pornography and prostitution with the cold, clinical, morally netural term "sex work"--cannot accept is that taboos, stigma, shame, folkways, mores, all those relics of society they wanted to dispose of, believing they were fabricated out of whole cloth by a cabal of white males for the purpose of oppressing people, actually exist to keep social pathology to a minimum. Look at what's happened since we've gone soft on unwed motherhood: an explosion in bastardy. On similar grounds, I refuse to offer moral approbation of pornography and prostitution by calling them "sex work."

ETA: That said, I agree with the point others have made that there is no reason to think that a producer of pornography must, ipso facto, be experiencing depression or anxiety.

I don't believe the last point has to be true either. What I do believe(and wrote) is that the person in this case has some issues. What those may be I'm not sure....I just threw in depression or anxiety to omply there was some reason for the referral.

 

[Jorje286]

This is the problem I've been having with the cultural leftists in medicine since day 1 of medical school. I'm a doctor, and I'm not going to carry such a harsh, judgmental attitude into the exam room, but I'm not just a doctor going through life in a series of one-on-one patient encounters. I'm also a person living in a society--a society whose social pathology I would like to be kept to a minimum. Am I "ethically" bound by my MD not to act according to my convictions in my private conversations, in the voting booth, in raising my children? What cultural leftists--i.e., the type of people who refer to pornography and prostitution with the cold, clinical, morally netural term "sex work"--cannot accept is that taboos, stigma, shame, folkways, mores, all those relics of society they wanted to dispose of, believing they were fabricated out of whole cloth by a cabal of white males for the purpose of oppressing people, actually exist to keep social pathology to a minimum. Look at what's happened since we've gone soft on unwed motherhood: an explosion in bastardy. On similar grounds, I refuse to offer moral approbation of pornography and prostitution by calling them "sex work."

ETA: That said, I agree with the point others have made that there is no reason to think that a producer of pornography must, ipso facto, be experiencing depression or anxiety.

Feminists tend to be right wing now? And they are probably the most vocal opponents of pornography. Regardless, western medicine operates through evidence not left or right wing theory. What's your evidence that sex work in itself underlies a psychiatric pathology? Doctors are not there to moralize or act as moral crusaders. They are there to help the patient. Point blank.

Also, lol @ Vistaril's "issues" comment. What does that even mean? There's nothing in psychiatry called "you have issues, you need treatment". There are symptoms that are distressing for either the patient or the people around him/her and that need to be addressed and treated. This thread is ah so amateurish, it's laughable.

 

[vistaril]

Also, lol @ Vistaril's "issues" comment. What does that even mean? There's nothing in psychiatry called "you have issues, you need treatment". There are symptoms that are distressing for either the patient or the people around him/her and that need to be addressed and treated. This thread is ah so amateurish, it's laughable.

yes, and I call those issues. Sorry the thread is too 'amateurish' for you.

 

[OldPsychDoc]

It was under a different screen name. I stumbled on the thread a few months ago and had a chuckle.

Oh all right...think I figured it out--and definitely the style is the same. And it sheds some light on subsequent attitudes. Kind of sad, really...

 

[PikminOC]

I think OPD is compensating for once recommending vistaril apply to his program, back when he was a med student (true story).

Dodged that bullet? Or not?

 

[earl of lemon]

I've been a long time lurker here on SDN, and I've seen far too many threads where one group ends up arguing against another group (or just against vistaril). I think if we just ignore the vast majority of vistaril's posts we would all be happier. And please just let this thread die.

 

[Shikima]

If these are in fact basics, then why do I see so many patients who have been "told" by varius self-righteous providers they HAVE depression, anxiety, or bipolar disorder who don't, in fact, have any of the symptoms of those conditions? Are you saying we should be unbiased and objective when it comes to people in the sex trade? If so then why doesn't our profession take the same unbiased appraoch toward the rest of the population?

The reason this sex worker will get misdiagnosed is the same reason everyone in America gets misdiagnosed. Our field doesn't know what the heck it's doing most of the time.

I'll further elaborate my 2 cents - during residency, invariably we would see common patients who show up in the ER under some kind of crisis. They will have been recently discharged from local private (UHS) psychiatric hospital and leave with a diagnosis of bipolar (when there are obvious and strong cluster B traits). The reason has to do with billing. Goes to an earlier discussion that Axis II can/cannot be billed, thus a lot of misdiagnosis out of convience and/or laziness IMO - which equally frustrates me because I want them to get better, to know their diagnosis and give them the vocabulary to express themselves so they do get the treatment they need.

On a side note, I try to minimize the anxiety by looking at the depression symptoms, particularly helplessness/hopelessness driving the flight or flight adrenergic system creating the anxiety and panic symptoms - once I explain this to them, tell them that xanax has a quick on/off function and functions similarly to ETOH, about 97% of the time I get the return question, "How do I fix this?". Typically I respond saying that medications that treat depression will also treat your anxiety and that they need to go get talk therapy. The medications will only stabilize the symptoms but the real curative value comes with talk therapy.

 

[erg923]

This is the problem I've been having with the cultural leftists in medicine since day 1 of medical school. I'm a doctor, and I'm not going to carry such a harsh, judgmental attitude into the exam room, but I'm not just a doctor going through life in a series of one-on-one patient encounters. I'm also a person living in a society--a society whose social pathology I would like to be kept to a minimum. Am I "ethically" bound by my MD not to act according to my convictions in my private conversations, in the voting booth, in raising my children? What cultural leftists--i.e., the type of people who refer to pornography and prostitution with the cold, clinical, morally netural term "sex work"--cannot accept is that taboos, stigma, shame, folkways, mores, all those relics of society they wanted to dispose of, believing they were fabricated out of whole cloth by a cabal of white males for the purpose of oppressing people, actually exist to keep social pathology to a minimum. Look at what's happened since we've gone soft on unwed motherhood: an explosion in bastardy. On similar grounds, I refuse to offer moral approbation of pornography and prostitution by calling them "sex work."

ETA: That said, I agree with the point others have made that there is no reason to think that a producer of pornography must, ipso facto, be experiencing depression or anxiety.

I am not sure what about compassion, unconditional positive regard while in the room, and respect for patients makes one a "cultural leftist." I presume this would make one "Carl Rogers?" And perhaps I might call this, living the Gospel? If "cultural leftism" means embracing and serving (both with money and my time) those who arent looked upon all that favorably by society, then I suppose thats what I am. Fiscally, I tend to be pretty conservative, I suppose. For example, I am not big fan of ACA, but that really just has to with the math, not the fact that we want to make healthcare a more accessible/affordable service.

Seriously though, I haven't seen anyone support pornogrpahy really, as you you seem to think. Moreover, others, including myself have aknowlegded that, outside our roles as mental health professionals, we view this as sinful behavior/action. But, thats not really my job, nor yours, in the office is it? Your job is to show compassion, respect and we must make our peace with other peoples choices, even if they may not be in the best interest of "society" or their own mental health. I dont think there is a lot of wiggle room with this, so I am pretty shocked to hear a physician actively object to this philosophy of practice.

Again, and for the last time (I promise), I think the issue here was not how he might personally view the patients actions, but that he seemed to want to change the entire plan of care based on this issue and his objection to it. And, I think most of us said: "Um no. Please return to evidence based practice and run through your interventions as usual. There is no need for this to cloud your agenda and judgment." I certainly think its fair to work with the patient on how the consequeces of that career choice could impact her mental health/quality of life, but we aren't "life coaches" or mentors, right?" Friends can do what Vistiral seems to want to do without charging a dime.

 

[Trismegistus4]

Just the idea of cultural leftists is an imagined community, and that's your jumping off point.

This is just the classic left-wing way of looking at the world. Leftists are so far left that they think leftism is "moderate."

Feminists tend to be right wing now? And they are probably the most vocal opponents of pornography.

You're about 30 years behind the times. Betty Friedan, Gloria Steinem, and other feminists of their generation opposed pornography because they believe it "objectifies women." Feminism has caught up and is now vehemently pro-pornography, because they realize, correctly, it is a means for women to exert their sexual power over men. The young harlot in question in the OP, for example, is a "women's studies" major at Duke University. And look at that open letter to her from another porno slut, this one a UCLA "student," in which the tart declares that "I love what I do and feel empowered by it."

Regardless, western medicine operates through evidence not left or right wing theory. What's your evidence that sex work in itself underlies a psychiatric pathology?

Duh, I just said that I don't think it does.

 

[erg923]

This is just the classic left-wing way of looking at the world. Leftists are so far left that they think leftism is "moderate."


You're about 30 years behind the times. Betty Friedan, Gloria Steinem, and other feminists of their generation opposed pornography because they believe it "objectifies women." Feminism has caught up and is now vehemently pro-pornography, because they realize, correctly, it is a means for women to exert their sexual power over men. The young harlot in question in the OP, for example, is a "women's studies" major at Duke University. And look at that open letter to her from another porno slut, this one a UCLA "student," in which the tart declares that "I love what I do and feel empowered by it."

If you truely label people in such a black and white and deragotory way, do you think patients feel safe in the room with you? Patients are perceptive, you know.

On a seperate note, is your approach to interacting with patients congruent with your faith, if you have one?

I am also curious if you percieve Pope Francis to be "left wing?" Whatever that actually means...

Trismegistus4, it is very easy for us to only see a gang member as a "thug" or a homeless drug abuser as a "hobo." or ""tramp." But, if you look a little deeper, you might find a person inside there. A person, maybe even just like you. A person worthy of being viewed as a whole person, even if they dont even view themselves in that manner. From one mental health profesional to another, I would emplore you to redefine and practice the act of compassion. Its does NOT mean you condone the behavior.