psychiatrists are like prostitutes...?

[rkaz]

Apparently... according to this article:
http://www.naturalnews.com/038694_psychiatrists_prostitutes_getting_screwed.html

It's amazing how much vitriol this site puts out towards the medical profession. So many conspiracy theories, so much hatred... just keep attacking docs as being evil and greedy, and don't bother to propose any constructive solutions. Then the public reads these articles and hates on doctors without having any knowledge of our education and training, and thinks we have some devious plot against humanity.

If you want more back-sided attacks against your profession, you can check out more of these articles here: http://www.naturalnews.com/psychiatrist.html

---

Members don't see this ad.

 

[rkaz]

This article on the site is just awesome.... better than the article above I mentioned. Definitely a must read: http://www.naturalnews.com/038322_DSM-5_psychiatry_false_diagnosis.html

Edit: I just wanted to say that I do agree that nutrition, exercise and lifestyle is not given enough importance in psychiatry, and I think that needs to change. Just don't understand though how spewing hate against docs achieves anything constructive.

 

[rkaz]

.

 

[splik]

that article is so ridiculously contradictory. it starts of by claiming psychiatrists are medicalizing normalcy in order to drug everyone. it then goes on to agree that people do suffer from morbid mental states caused by nutritional imbalances that need chemical intervention in the form of.... nutriceuticals! go figure! the nutriceutical industry is a money-making industry no different than big pharma except in its scope. it is a multimillion dollar industry. the only difference is they are suggesting we abandon using drugs for which there is a tiny bit of evidence for and instead use vitamins and minerals for which there is absolutely no evidence for.

the final delicious irony is the article cause psychiatry a quack science, but is surrounded by ads for ads such as "make colloidal silver", "body detox", "thyroid helper" and "cancer cure forces doctors to eat crow". this irony appears to be lost on the architects of this website.

 

[Mad Jack]

NaturalNews. Not even once.

 

[happygilmore]

Rkaz, you just got trolled. Troll is successful!

Seriously, why even give such junk publicity, mental energy, or any critical analysis? You've been trolled hard.

I try to ignore most news, but this even supersedes traditional news in its stupidly, generalization, over-simplification, and general unworthiness to occupy our limited daily thoughts. It's equivalent to drinking 120 ounces of soda.

 

[rkaz]

Yes, Happygilmore, this is crap news. I am not trying to be the troll.... I just find it absolutely crazy the stuff that is put out. Probably I should not waste any mental energy on some ignorant person's vitriol, but I find it sad that people like this can sway the public so much. Mr. Adams has probably a million readers on his site (as he has over 800,000 on his facebook page).When lay people are constantly putting out these conspiracy theories, it's no wonder our patients also come to us with hesitation to use any kind of drugs. I see it in clinic all the time, that people are so much more willing to use supplements. And personally, I'm not opposed to supplements at all, as I take some supplements myself. I just think there should be more research done on these supplements.

I actually think he has some points which have merit (like improved nutrition). But the way he writes with so much negativity takes away any hope of constructive dialogue.

 

[Nasrudin]

I wonder what it is exactly about our enterprise that attracts such conspiratorial confidence. Tom cruise has done his research after all and instructs Matt Lauer to tighten up his--spoken with no irony whatsoever from one of the chief visionaries of a science fiction cult. Even when other fields were in our equivalent state of development and understanding it doesn't seem they attracted such public disgust and abhorrence from a variety of sources. Is it that we trample on the domain of religion? That we engage in manipulation of what people hold most dear--their identity and personal sovereignty?

I don't know. But the inability of the foundations of our knowledge to defend me against such vitriol is perhaps one of the reasons why I plan on doing the type of psychiatry that seems irrefutable to me--acute stabilization. Since nobody--not relatives, not the hippies or their gurus, or other doctors, or the public and it's shopkeepers and neighbors, or the cops, or anybody--wants to deal with acutely manic, psychotic or suicidal patients or to perform our role in ruling out medical causes. Chemically altering their mind state in such cases seems unimpeachable, if only out of necessity.

So even though I think psychiatry is vastly more interesting than other fields, I think it does bother me that my future profession occupies such a strange position in society and in the public imagination. Especially in regards to patients and advocacy for them. The field seems very murky to feel assured of proper service outside of acute stabilization.

The preponderance of psychoanalysis alone makes me uneasy about what train I'm on. And the leaders of programs everywhere are steeped in this wizard culture.

 

[rkaz]

the final delicious irony is the article cause psychiatry a quack science, but is surrounded by ads for ads such as "make colloidal silver", "body detox", "thyroid helper" and "cancer cure forces doctors to eat crow". this irony appears to be lost on the architects of this website.

Yes, I'm curious how much more he is making by selling supplements on the site, versus the greedy doctors he likes to write about. Never mind the fact that physicians went through years of training to get to their position, where all he has to do is use opinion articles and blogs as his 'sources' of reliable info.

 

[vistaril]

I didn't read the article you link, but I think it is important to separate criticism of medicine vs criticism of psychiatry. The vast majority of people skeptical of mental health care in this country(especially the way in which we see pts and use pharm) do not have those same feelings about medicine as a whole. Lumping them together as if they are the same is misleading. In all likelihood the mostly reasonable parent who doesn't believe his 6 year old needs to be on Adderall wouldn't object to his kid getting tubes put in his ears for chronic ear infections.

 

[SmallBird]

I don't know. But the inability of the foundations of our knowledge to defend me against such vitriol is perhaps one of the reasons why I plan on doing the type of psychiatry that seems irrefutable to me--acute stabilization.

That's interesting - I tend to find acute stabilization incredibly murky. I may agree that we deal with people that other people aren't interested in dealing with, but it's far from an ideal arrangement. I guess it's not the kind of work that's likely to be criticized as often (although when it comes to involuntary treatment there are groups that are very controversial) but it also feels (to me at least) quite unlike being a doctor at times, having little potential for quality relationships that are one of the things we are supposed to be good at.

 

[Nasrudin]

That's interesting - I tend to find acute stabilization incredibly murky. I may agree that we deal with people that other people aren't interested in dealing with, but it's far from an ideal arrangement. I guess it's not the kind of work that's likely to be criticized as often (although when it comes to involuntary treatment there are groups that are very controversial) but it also feels (to me at least) quite unlike being a doctor at times, having little potential for quality relationships that are one of the things we are supposed to be good at.

Morally and ethically murky, yes, I see your point. But I can wander in this darkness guided by lights of things I believe in--the rule of law and the rights of communities to address these problems with legislation and their ability to administer them by separation of powers--psychiatric and judicial. Nothing in this context that I've seen is done unilaterally and everything has a high level of scrutiny. And the real necessity of considering undifferentiated medical causes of AMS not the ones worked up to death by medical teams is very appealing to me.

I think that it is possible that if chronic outpatient care was as transparent in practice as emergency psychiatry it wouldn't be the forced admission that would be the murkier mode of practice.

 

[vistaril]

Morally and ethically murky, yes, I see your point. But I can wander in this darkness guided by lights of things I believe in--the rule of law and the rights of communities to address these problems with legislation and their ability to administer them by separation of powers--psychiatric and judicial. Nothing in this context that I've seen is done unilaterally and everything has a high level of scrutiny. And the real necessity of considering undifferentiated medical causes of AMS not the ones worked up to death by medical teams is very appealing to me.

I think that it is possible that if chronic outpatient care was as transparent in practice as emergency psychiatry it wouldn't be the forced admission that would be the murkier mode of practice.

I think(mostly based on a post earlier) you've somehow made inpatient acute stabilization to be 'more medical' and more evidence based than other things we do. I'm not so sure about that........when someone comes going a mile a minute, bouncing off walls, hearing voices, and proclaiming that he is jesus Christ jr, we probably shoot him up with a bunch of Geodon or Zyprexa and probably some Ativan. What do you think those are really doing when a few hours later he is zonked out in a room somewhere?

Also...what do you mean by 'the real necessity of considering undifferentiated medical causes of AMS not the ones worked up to death by medical teams'? House is a TV show, not real life. Someone could work as an inpatient psychiatrist at a high turnover unit for a decade(and be pretty solid) and not do what you described above. I don't think many people in medicine looks for us to be the ultimate detectives for AMS of unknown origin.

And I say that as someone who enjoys acute stabilization work more than most.

 

[notdeadyet]

when someone comes going a mile a minute, bouncing off walls, hearing voices, and proclaiming that he is jesus Christ jr, we probably shoot him up with a bunch of Geodon or Zyprexa and probably some Ativan.

Just pointing out to our impressionable younger students and residents that you should most definitely NOT shoot this patient up with both Zyprexa and Ativan...

 

[notdeadyet]

I think that it is possible that if chronic outpatient care was as transparent in practice as emergency psychiatry it wouldn't be the forced admission that would be the murkier mode of practice.

I love emergency psychiatry. I work it a lot at a great psych ER and find it fascinating. But in fairness, emergency psych is more transparent because it's just not very complicated. It can be hard work and very challenging, but it's just not as complex as outpatient care.

 

[vistaril]

Just pointing out to our impressionable younger students and residents that you should most definitely NOT shoot this patient up with both Zyprexa and Ativan...

I wouldn't do it, but the data on that is....weak at best. I asked an MICU attending with >20 years experience this, and he wasn't impressed either. The reality is that if some bottom out and die on Zyprexa and Ativan, it's not certain(or even likely) that it was that combination that did it. Zyprexa IM alone can cause such outcomes, so if one is terrified of using Zyprexa IM and Ativan IV/IM together, then they should probably also avoidusing Zyprexa IM period. That said, because there are so many other combinations to use it probably makes more sense to avoid it.

 

[vistaril]

I love emergency psychiatry. I work it a lot at a great psych ER and find it fascinating. But in fairness, emergency psych is more transparent because it's just not very complicated.

agree with this.

 

[Nasrudin]

I love emergency psychiatry. I work it a lot at a great psych ER and find it fascinating. But in fairness, emergency psych is more transparent because it's just not very complicated. It can be hard work and very challenging, but it's just not as complex as outpatient care.

What I meant was that what you're doing clinically is more visible to other professionals in an emergency setting. Not that it's more transparent to someone interested or learning it. Although I can see your point now that I think about it that way.

I guess in terms of murkiness and the original poster's query, we do a lot of things that are speculative evidence-wise, and I think this fuels conspiratorial critique. Also religiosity plays a huge role in casting aspersion on our venture in the population that my institution serves. And this is made devastating by the role of other physicians and professions who's perspective on human consciousness is influenced by these dogmas.

To me the psychoanalytic elements of our training that an alarming number of program leadership cling to despite the lack of evidence is another source of fuel for valid criticism that bothers me immensely. For instance why is it harder to get CBT training than psychodynamic training despite better evidence for it. If we can't answer that. How can we then go into the inherently murky habitat our field must go into and expect to convince people of what we're doing.

In this environment, I find the stronger clinical indications of emergency psychiatry appealing. But I can discover these things as I go.

What about the ferocity and variety of our critics? What fuels it?

 

[SmallBird]

To me the psychoanalytic elements of our training that an alarming number of program leadership cling to despite the lack of evidence is another source of fuel for valid criticism that bothers me immensely. For instance why is it harder to get CBT training than psychodynamic training despite better evidence for it. If we can't answer that. How can we then go into the inherently murky habitat our field must go into and expect to convince people of what we're doing.

You make a valid point, although I really feel it is important to distinguish between psychoanalytic training (Which is not a prominent feature of any residency); psychodynamic psychotherapy; and the broader concept of applying psychodynamic principles in patient interactions. The latter, in particular, is incredibly useful accross multiple contexts, where being able to form some understanding of a patients personality structure sets us apart from other clinicians trying to deal with complex individuals. It's the reason there is more to a C/L service than prescribing Haldol. A lot of these priniciples have there origins in psychoanalytic theory, and it is a good thing that program directors will cling to them whatever the state of outpatient psychoanalytic practise.

 

[notdeadyet]

To me the psychoanalytic elements of our training that an alarming number of program leadership cling to despite the lack of evidence is another source of fuel for valid criticism that bothers me immensely. For instance why is it harder to get CBT training than psychodynamic training despite better evidence for it. If we can't answer that. How can we then go into the inherently murky habitat our field must go into and expect to convince people of what we're doing.

Read SmallBird's comments. She has an excellent point about distinguishing between psychoanalytic and psychodynamic. Even programs that are more psychoanalytic than others (and I'm at one), mostly use psychoanalytic theories for metaphor and conceptualization. I don't know of any programs that require folks to do psychoanalytic therapy.

As for why psychodynamic gets more time/attention than CBT, it's because becoming proficient at psychodynamic therapy requires more training and has a steeper learning curve. CBT is extremely helpful. It's also fairly rote and algorithm based. It doesn't take long to learn how to do competently (how to do it exceptionally takes years of practice, like anything). Psychodynamic therapy takes a long time to do even adequately well. It also affects your approach to any other therapy you do. That's why you spend more time on it. Hope this helps.

You'll also find that a lot of this is false dichotomies. I actually note psychoanalytic principles when I'm doing any kind of therapy (particularly transference/countertransference), use CBT techniques in open-ended therapy cases, and apply psychodynamic therapy while doing CBT. You need to get decent training in all of them. Some just take longer.

 

[Ceke2002]

For instance why is it harder to get CBT training than psychodynamic training despite better evidence for it.

I don't know if it depends on where you train and/or on the individual Psychiatrist's desire for particular training, but the Psychiatrist I see is well versed in a variety of therapies - including Cognitive Behavioural, Metacognitive, Psychodynamic, Psychoanalytical, Interpersonal Neurobiology and Mindfulness. I can't speak for how hard the training itself is in each discipline, but he certainly hasn't seemed to have had all that much difficulty gaining access to a wide variety of modalities (or whatever the correct term is, sorry, 6.30 am here, I'm up early ). That kind of sucks if it's not the same elsewhere.

What about the ferocity and variety of our critics? What fuels it?

The people I've known who have gone full on anti psych have all been former patients who had either had very negative experiences within the mental health system (abuse, boundary violations, etc), or who basically walked into a Psychiatrist's office and expected to just be 'fixed' and when no magic wand was produced then proceeded to go apes**t and reject all Psychiatry as pseudoscience and useless, and blah blah blah. The funny thing is most of these people are still clinging onto the sorts of alternative therapies that Natural News seem to be pushing, and however many years on they're not really any better than when they started. The magic cure still hasn't appeared, but when you point out the irony of them turning their backs on Psychiatry, because they couldn't just be handed some sort of insta!cure on a silver platter, and yet they cling so desperately to an alternative that has basically produced the same results, it's like their brains just explode - queue the capslock of rage! As a patient (who utilises both traditional, for want of a better word, and complementary therapies in my treatment plan) I have previously tried to engage in meaningful dialogue with the anti psych brigade. It didn't take me long to give up.

 

[michaelrack]

xxxxxxx

 

[SmallBird]

Read SmallBird's comments. She has an excellent point about distinguishing between psychoanalytic and psychodynamic.

Although I am flattered, I must humbly acknowledge that I am, in fact, a man.

 

[birchswing]

I wonder what it is exactly about our enterprise that attracts such conspiratorial confidence. Tom cruise has done his research after all and instructs Matt Lauer to tighten up his--spoken with no irony whatsoever from one of the chief visionaries of a science fiction cult. Even when other fields were in our equivalent state of development and understanding it doesn't seem they attracted such public disgust and abhorrence from a variety of sources. Is it that we trample on the domain of religion? That we engage in manipulation of what people hold most dear--their identity and personal sovereignty?

I don't know. But the inability of the foundations of our knowledge to defend me against such vitriol is perhaps one of the reasons why I plan on doing the type of psychiatry that seems irrefutable to me--acute stabilization. Since nobody--not relatives, not the hippies or their gurus, or other doctors, or the public and it's shopkeepers and neighbors, or the cops, or anybody--wants to deal with acutely manic, psychotic or suicidal patients or to perform our role in ruling out medical causes. Chemically altering their mind state in such cases seems unimpeachable, if only out of necessity.

So even though I think psychiatry is vastly more interesting than other fields, I think it does bother me that my future profession occupies such a strange position in society and in the public imagination. Especially in regards to patients and advocacy for them. The field seems very murky to feel assured of proper service outside of acute stabilization.

The preponderance of psychoanalysis alone makes me uneasy about what train I'm on. And the leaders of programs everywhere are steeped in this wizard culture.

You answered it. People are pretty possessive about their minds, more so than most other body parts, I think. Also, people have more experience with psychiatrists than they do other specialists so it's more talked about. It's less mysterious than the world of cardiology to most people. People see psychiatrists in childhood or in the prime of their life, so they expect more. You don't tend to see other specialists until something is failing physically, which often happens later in life. And there are a lot of bad psychiatrists. The sketchy parts of psychiatry's history also seem to be more well known than the sketchy areas of other parts of medicine, whether that's proportionate or not, I don't know.

 

[Ceke2002]

And there are a lot of bad psychiatrists.

Agreed. I've come across a few myself, so have other people I know/have known, who are not necessarily confined to my country of origin (Australia). But the thing is none of us did a complete 180 and militantly rejected Psychiatry all together - sprouting the sorts of conspiracy theories that you read on some of these sites. So what is it about the psyche/psychopathology of those patients with bad psychiatric experiences that does make them go to that extreme? I wonder if anyone has done any studies on this?

 

[birchswing]

Agreed. I've come across a few myself, so have other people I know/have known, who are not necessarily confined to my country of origin (Australia). But the thing is none of us did a complete 180 and militantly rejected Psychiatry all together - sprouting the sorts of conspiracy theories that you read on some of these sites. So what is it about the psyche/psychopathology of those patients with bad psychiatric experiences that does make them go to that extreme? I wonder if anyone has done any studies on this?

I can only speak for my own experience, but before I found this forum, I had never encountered what I would call an intellectually curious, caring psychiatrist. It is my belief, which cannot be proven, that there are regional pockets that attract bad psychiatrists, by which I mean they are uncaring, not knowledgable, and prescribe recklessly. I was at one time someone who held great sentiment against psychiatry. If all that that existed in the world of psychiatry was what I had experienced across a range of doctors, I would still be against it. What is somewhat frustrating now is seeing psychiatrists on this board complain about patients, when I see them complaining about behaviors that are caused/informed by other bad psychiatrists (for example, using Xanax as first-line treatment for a mood disorder). It's easier to see psychiatry dispassionately when you see it as one more specialty where the main line of treatment happens to be drugs and that those drugs are prescribed judiciously. But that's not everyone's experience. And it doesn't take a lot of experiences to form an opinion, especially if you can't find a good experience. I believe there are what I call "twilight zones" of bad doctors. And I think I lived in one.

In terms of the conspiracy theories (not that I'm really familiar with any about the present), I think psychiatry lends itself to inspiring mystical thinking, when you consider that you literally are taking potions to change the mind. Then there is the history of psychiatry, parts of which form a more interesting narrative than say the field of dentistry. Psychiatry has specific foci, but human suffering has always been of great interest to people, and there were answers to it long before psychiatry. It's the stuff of religions, ancient traditions, literature, art, and part of the human experience. I guess that could inspire people to see psychiatry conspiratorially. The subject matter is definitely of greater interest to people than say, bones.

 

[splik]

As for why psychodynamic gets more time/attention than CBT, it's because becoming proficient at psychodynamic therapy requires more training and has a steeper learning curve. CBT is extremely helpful. It's also fairly rote and algorithm based. It doesn't take long to learn how to do competently (how to do it exceptionally takes years of practice, like anything). Psychodynamic therapy takes a long time to do even adequately well. It also affects your approach to any other therapy you do. That's why you spend more time on it. Hope this helps.

Although I agree that training in psychoanalytic/psychodynamic psychotherapy (the terms are interchangeable cf. psychoanalysis) is more labor intensive than CBT, there is only one reason why so much time is devoted to psychodynamics, and that is politics. American Psychiatry was entirely wedded to psychodynamics until the late 1970s when in no longer became tenable to hold onto that model, and by the 1980s, the American Psychoanalytic Association was forced to admit non-MDs as analytic candidates despite their objections. It is entirely political that programs in NYC and Boston in particular have a strong leaning towards psychodynamics. It is entirely political that the mid-atlantic programs like Hopkins, WashU and Iowa barely hide their contempt for psychodynamics. In your own department, as recent as 20 years the analysts revolted against the Chair as 'too biological' and he was forced to step down. CBT is for the psychologists, and actually clinical psychologists in PhD programs in the leading psychology departments don't learn psychodynamics. at all. and that's entirely political too.

In my program the psychologists have been battling to have equal time in the didactic curriculum for CBT as for psychodynamics (typically taught by psychiatrists), and they a fraction of it. and this is at a program that tends to more CBT-heavy than most. despite claims that the 'mind wars' are over, they still rage behind closed door. some people would like to see questions about psychodynamics eliminated from the PRITE but this area is very well represented. The reason? Politics.

I can tell you in other major developed countries psychiatric training is not so beholden to psychoanalytic theory or therapy. Given that most people would argue that it is not possible to become competent with this modality during psychiatry training, we could argue that this should not be a mandatory area for psychiatrists. Again 20 years ago the AADPRT produced minimum requirements for psychodynamic training and suggested residents should have their own personal therapy, and see at least one long-term patient twice weekly with at least 7 hours in PGY3 devoted to seeing psychodynamic psychotherapy patients. How many residents have their own personal psychotherapy or see patients 2+ times/week today? How many see a therapy patient for 30+ months during residency. The requirements have slowly eroded and it there is no good reason other than politics that so much emphasis at many places is on psychodynamics. One could easily spend more time learning about cognitive models of psychopathology (which most residents aren't really learning), and get in-depth training in motivational interviewing, DBT, social skills training, interpersonal therapy, family intervention, individual and group psychoeducation - things that psychiatrists practicing in the current climate are more likely to be able to incorporate into their practice.

[I am not anti-psychodynamics and in fact will be doing the psychoanalytic psychotherapy training at the local institute but I don't think there is any logical reason why it should remain a significant part of clinical training, when there is much more of practical value that one could reasonably achieve competence in during psychiatry residency.]

 

[michaelrack]

There was a time when a small minority of psychiatrists did very bad things- frontal lobotomies (only a few psychiatrists actually performed the procedure) and slept with patients (fortunately becoming much less frequent). And of course, the public is concerned about ECT (which unfortunately is also being performed less frequently)

 

[birchswing]

There was a time when a small minority of psychiatrists did very bad things- frontal lobotomies (only a few psychiatrists actually performed the procedure) and slept with patients (fortunately becoming much less frequent). And of course, the public is concerned about ECT (which unfortunately is also being performed less frequently)

I think ECT has actually gotten a better reputation lately. Carrie Fischer has spoken positively of it as did of all people Dr. Oz:

http://www.psychologytoday.com/blog/struck-living/201201/dr-oz-ventures-bravely-ect

 

[Ceke2002]

I can only speak for my own experience, but before I found this forum, I had never encountered what I would call an intellectually curious, caring psychiatrist. It is my belief, which cannot be proven, that there are regional pockets that attract bad psychiatrists, by which I mean they are uncaring, not knowledgable, and prescribe recklessly. I was at one time someone who held great sentiment against psychiatry. If all that that existed in the world of psychiatry was what I had experienced across a range of doctors, I would still be against it. What is somewhat frustrating now is seeing psychiatrists on this board complain about patients, when I see them complaining about behaviors that are caused/informed by other bad psychiatrists (for example, using Xanax as first-line treatment for a mood disorder). It's easier to see psychiatry dispassionately when you see it as one more specialty where the main line of treatment happens to be drugs and that those drugs are prescribed judiciously. But that's not everyone's experience. And it doesn't take a lot of experiences to form an opinion, especially if you can't find a good experience. I believe there are what I call "twilight zones" of bad doctors. And I think I lived in one.

I can definitely relate to that. Not necessarily to being frustrated about the Psychiatrist's on here blowing off steam about difficult or frustrating patients, because hey, at the end of the day this is their space and we are privileged to be allowed here as basically guests in someone else's 'home', which is how I see it at least (not saying you have to agree with that or anything, I do get where you're coming from as well), but yeah in terms of never encountering an 'intellectually curious, caring psychiatrist', I hadn't either until recently. I don't feel it's appropriate to go into too much detail on here, but let's just say back in the 90s I was psychologically harmed by the manipulation and coercion of a male Psychiatrist that I was in the care of at the time. I'd had other psychiatrist's before that that I either just didn't connect with, or who didn't really seem to know or care what they were doing as long as they were getting paid, but it was my experience with him that really left me with a very deep seated mistrust of Psychiatry that lasted for well over a decade. The thing was though I still knew people who were really being helped by Psychiatry, so my attitude was 'no thanks, don't trust any of them as far as I could throw them, but if you're happy and they're helping, keep it up, that's great'. Just because I had that level of mistrust and doubts within me, didn't mean I then projected it onto others.

And as you say, coming on here and meeting (in a manner of speaking) some of the fine Physicians on these forums, and reading how much they care about their patients, and wanting to improve services, and their drive for knowledge and understanding and intellectual debate, and so on, has been a real eye opener for me. Along with my own Psychiatrist, who I've been working with for (close to) a few years now (and who I hold in the absolute highest regard and have the utmost respect for) it has played a huge part in pretty much turning my attitude towards Psychiatry, and Psychiatrists, completely around. I suppose it's why I have tried to engage in what I hoped would have been mutually positive and open dialogues with certain members of the anti psychiatry brigade, because I do understand where some of them are coming from, and I figured (wrongly) that if we could just open a channel of communication we could somehow eventually agree to find the middle ground that benefits everyone. The responses I got, I could not have been more mistaken. Talk about YIKES!

Here's some interesting reading:

Open Forum: Evolution of the Antipsychiatry Movement Into Mental Health Consumerism (David J. Rissmiller, D.O.; Joshua H. Rissmiller)

http://journals.psychiatryonline.org/article.aspx?articleid=96788

Critics and dissenters: Reflections on “anti-psychiatry” in the United States (Norman Dain)

http://www.chronicstrangers.com/history documents/Anti-Psychiatry.pdf

 

[vistaril]

I can only speak for my own experience, but before I found this forum, I had never encountered what I would call an intellectually curious, caring psychiatrist. It is my belief, which cannot be proven, that there are regional pockets that attract bad psychiatrists, .

this is a ridiculous argument. There are very noncompetitive training programs all across the country, in every region of the country. Perhaps only california is spared, and then even then only partially. The psychiatry being practiced in Des moines isn't that much different than the typical practice model in Shreveport vs that in San Antonio vs Syracuse. And if it is, that is *not* a good thing for us btw.

A more reasonable argument is that there are small pockets where a minority of the MH care available is different....but that doesn't in any way represent the standard across the country(in every region).

 

[birchswing]

this is a ridiculous argument. There are very noncompetitive training programs all across the country, in every region of the country. Perhaps only california is spared, and then even then only partially. The psychiatry being practiced in Des moines isn't that much different than the typical practice model in Shreveport vs that in San Antonio vs Syracuse. And if it is, that is *not* a good thing for us btw.

A more reasonable argument is that there are small pockets where a minority of the MH care available is different....but that doesn't in any way represent the standard across the country(in every region).

Perhaps the standard of care is quite poor then. I might be optimistic or charitable in my thinking.

 

[vistaril]

Perhaps the standard of care is quite poor then. I might be optimistic or charitable in my thinking.

I didn't neccessarily imply that it is a poor standard of care. That's really another argument to be made(or not made) imo. The 'regional difference' argument I just don't buy. Sure there are small differences here and there for various reasons(such as ect being not popular in texas as one example). And in areas like Manhattan, there is obviously a much larger and very real cash pay therapy market. But the vast majority of psychiatrists are not seeing cash pts for an hour twice a week on the west side in an office overlooking the park. That's likely true(if I bothered to check some data) even for the great majority of psychiatrists in the nyc area.

 

[Nasrudin]

Although I agree that training in psychoanalytic/psychodynamic psychotherapy (the terms are interchangeable cf. psychoanalysis) is more labor intensive than CBT, there is only one reason why so much time is devoted to psychodynamics, and that is politics. American Psychiatry was entirely wedded to psychodynamics until the late 1970s when in no longer became tenable to hold onto that model, and by the 1980s, the American Psychoanalytic Association was forced to admit non-MDs as analytic candidates despite their objections. It is entirely political that programs in NYC and Boston in particular have a strong leaning towards psychodynamics. It is entirely political that the mid-atlantic programs like Hopkins, WashU and Iowa barely hide their contempt for psychodynamics. In your own department, as recent as 20 years the analysts revolted against the Chair as 'too biological' and he was forced to step down. CBT is for the psychologists, and actually clinical psychologists in PhD programs in the leading psychology departments don't learn psychodynamics. at all. and that's entirely political too.

In my program the psychologists have been battling to have equal time in the didactic curriculum for CBT as for psychodynamics (typically taught by psychiatrists), and they a fraction o

Good discussion. I hope you're going gonzo with that. Regardless good luck. Myself, when someone says they're really into psychoanalysis and can't wait to link up with the local wizard league, I can't help thinking they just told me they were really in Magic The Gathering. Kind of a funny little hobby. Except that, as you've said, its considered the higher art at many of my favorite programs. Which is disorienting. I don't have the personality structure to relinquish my instincts for bull**** detection under any circumstances. Whether I'm uninitiated or not. Like a kid who knows adults are BS'ing about a santa claus or whatever. I just trust myself like that. And in no way am I biologically or non-therapy oriented. So I'm confused by that binary association as well.

Combine that with my general unease about the pervasive lack of evidence for what we're doing and I guess you could say I have a solid case of cold feet before getting married to all this.

People earlier were dismissive about the simplicity of certain modes of practice. But what else should we be when moving blindly? Invented complexity is considerably worse than skeptical, conservative simplicity, is it not?

I think I would just be happier with this train I'm on if we had more tendencies toward acknowledging our ignorance than asking people about their sexual/metaphorical fetishes and writing novellas about it. It's bald-faced ridiculous that this is passed off as medical practice.

 

[Salpingo]

It is entirely political that programs in NYC and Boston in particular have a strong leaning towards psychodynamics. It is entirely political that the mid-atlantic programs like Hopkins, WashU and Iowa barely hide their contempt for psychodynamics.

Maybe I don't understand what you mean by political (I'm guessing by the context you mean partisanship/factionalism). But if you're saying that the Northeast has a more psychodynamics, then that seems cultural, and not political. It makes sense considering the demographics, with high density populations capable of paying out-of-pocket, filled with academics and worried well (both as patients and as treaters).

In my program the psychologists have been battling to have equal time in the didactic curriculum for CBT as for psychodynamics (typically taught by psychiatrists), and they a fraction of it. and this is at a program that tends to more CBT-heavy than most. despite claims that the 'mind wars' are over, they still rage behind closed door. some people would like to see questions about psychodynamics eliminated from the PRITE but this area is very well represented. The reason? Politics.

I think thats an oversimplification. One reason it is still tested and of academic/historical interest is that it is the most comprehensive model of the mind that we have in psychiatry, and some would argue cognitive science.

I can tell you in other major developed countries psychiatric training is not so beholden to psychoanalytic theory or therapy.

I can't think of any element of American psychiatry that's "beholden to psychoanalytic therapy". The only example I can think of in the world would be in France (that's developed, right?)

One could easily spend more time learning about cognitive models of psychopathology (which most residents aren't really learning), and get in-depth training in motivational interviewing, DBT, social skills training, interpersonal therapy, family intervention, individual and group psychoeducation - things that psychiatrists practicing in the current climate are more likely to be able to incorporate into their practice.

These are fantastic models of psychopathology (addiction, borderline personality, etc.) and will make you a better practitioner, but like I said above, they don't even come close to capturing the breadth of psychoanalysis or even really offer an explanatory model of the mind. Unless neuroscience can step up their explanatory models of consciousness, I don't really see anything that could replace psychoanalysis in the curriculum. And like notdeadyet already stated, psychodynamics informs so much of what we do in these other therapies (both historically and practically), while requiring the most time/discipline to learn. There are manuals/books for most other modalities (and hopefully psychoeducation is being taught at most residencies) written at a layperson level that I would take the exact opposite of your approach (i.e. make them elective, extracurricular pursuits). Yes, they will make you a better psychiatrist, but they would do the same for an internist, social worker, pediatrician, family practitioner, etc.

 

[whopper]

In any field there's good and bad. In certain fields where one has tremendous power over another, the bad could cause serious problems. There are bad psychiatrists out there just as there's bad judges, clergy, police officers, teachers, yada yada yada and people performing poorly in these fields can cause significant harm.

The writer of the article could complain about psychiatry all he wants. Maybe he had a bad psychiatrist, I don't know, but what I mentioned is not going to change, and this is true of bad people in any field.

Some specific trends that I believe could help the good/bad ratio of our field are 1-higher reimbursements to psychiatrists thus attracting more and better medstudents, 2-graduating more psychiatrists thust cutting into the shortage and preventing patients from being trapped into accepting a bad one

 

[st2205]

Stumbled upon this gem today...

 

[Shikima]

Good discussion. I hope you're going gonzo with that. Regardless good luck. Myself, when someone says they're really into psychoanalysis and can't wait to link up with the local wizard league, I can't help thinking they just told me they were really in Magic The Gathering. Kind of a funny little hobby.

Funny little game which has its own microculture and transactions.
Went to a conference recently and that was being played at the same time. Gone are the gaming conventions, hello comics and cards!