Psychiatry After Ferguson

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[jakeislove]

It's unlikely that Black people on Staten Island being wary of the police probably is a psychiatric issue. I get that an unfortunate accident made things worse, though.

Generally speaking: Black people have a different relationship with the police than the majority and are wary of them everywhere. They could have given him flowers (instead of a chokehold) and nothing would have changed, LOL!

 

[Psycholeptic]

All, forgive me for intervening—just wanted to say how very encouraged I am to read this terrific conversation. So many thoughtful, insightful points raised—on all sides of the debate. I recognize/respect that this is a student forum so I will bow out after this message—but reading the replies makes me very encouraged about the future of our profession. Also, in brief reply, I’ll add that the Ferguson/Psychiatry post came from a series of larger projects. For more info about drapetomania, race, or schizophrenia, see http://en.wikipedia.org/wiki/The_Protest_Psychosis. Also have a new piece just out about guns, race, and mental illness, at http://ajph.aphapublications.org/doi/pdfplus/10.2105/AJPH.2014.302242 and http://op-talk.blogs.nytimes.com/2014/12/16/can-psychiatrists-stop-gun-violence/?smid=tw-share.

Happy to talk more via email if anyone would like? My contact info can be found via www.vanderbilt.edu/mhs.
Very gratefully, JMM

 

[vistaril]

He looks like one of the good guys to me... but thats me....

after glancing at his web page and clicking on a few of the posted links, it seems his biggest goal is to restrict the rights of American citizens and shout down the bill of rights. I'll pass on such propaganda.

 

[Ibid]

after glancing at his web page and clicking on a few of the posted links, it seems his biggest goal is to restrict the rights of American citizens and shout down the bill of rights. I'll pass on such propaganda.

How did you get to that..... What I got from reading the links was mostly an arguement to decouple conversations about mental health and guns because getting a diagnosis is such a poor predictor of future violence....

Just interested....

 

[vistaril]

How did you get to that..... What I got from reading the links was mostly an arguement to decouple conversations about mental health and guns because getting a diagnosis is such a poor predictor of future violence....

Just interested....

well a few of the links were broken(for me...my computer is always borked though), so we may have been reading different stuff.

He just comes across as extremely hostile to gun rights in general I guess.

 

[Ibid]

All, forgive me for intervening—just wanted to say how very encouraged I am to read this terrific conversation. So many thoughtful, insightful points raised—on all sides of the debate. I recognize/respect that this is a student forum so I will bow out after this message—but reading the replies makes me very encouraged about the future of our profession. Also, in brief reply, I’ll add that the Ferguson/Psychiatry post came from a series of larger projects. For more info about drapetomania, race, or schizophrenia, see http://en.wikipedia.org/wiki/The_Protest_Psychosis. Also have a new piece just out about guns, race, and mental illness, at http://ajph.aphapublications.org/doi/pdfplus/10.2105/AJPH.2014.302242 and http://op-talk.blogs.nytimes.com/2014/12/16/can-psychiatrists-stop-gun-violence/?smid=tw-share.

Happy to talk more via email if anyone would like? My contact info can be found via www.vanderbilt.edu/mhs.
Very gratefully, JMM

How lovely that you have appeared!

I got the original link via a twitter feed belonging to a UK based psychologist....I think that was a retweet...

I have heard Szasz lay claim to "discovering" the story of drapetomania..... interested to know your view on that.... his influence seems to live on in so many ways.... its just no one ownes up to it when they use his ideas..... being a slightly toxic brand if that makes sense....

imo you should feel free to comment here.......

The issues in this thread are highly salient given the changing US demographic.... the US has had its first black president, shortly to have its first female president..... how long till the last white president puts in their appearance....? Not that it matters one spit as such in itself but just to say things are not going to stay the same... thats all.....

In our life time imo

Imagine a world where white people ended up being designated mad more often than black people and stuck on Community treatment orders..... I mean answers on a postcard for why that wouldn't happen.....

 

[Nasrudin]

Nvrmnd

 

[jakeislove]

How lovely that you have appeared!

I got the original link via a twitter feed belonging to a UK based psychologist....I think that was a retweet...

I have heard Szasz lay claim to "discovering" the story of drapetomania..... interested to know your view on that.... his influence seems to live on in so many ways.... its just no one ownes up to it when they use his ideas..... being a slightly toxic brand if that makes sense....

imo you should feel free to comment here.......

The issues in this thread are highly salient given the changing US demographic.... the US has had its first black president, shortly to have its first female president..... how long till the last white president puts in their appearance....? Not that it matters one spit as such in itself but just to say things are not going to stay the same... thats all.....

In our life time imo

Imagine a world where white people ended up being designated mad more often than black people and stuck on Community treatment orders..... I mean answers on a postcard for why that wouldn't happen.....

You're bordering on word salad, LOL!

 

[Ceke2002]

Ibid - If you have such strong ideas and convictions on how the mental health system should be working, why don't you put your money where your mouth is, actually become a Psychiatrist and help change the system for the better from the inside?

 

[smalltownpsych]

There are several aspects of psychiatry that negatively impact people on the lower end of the socioeconomic status. The overdiagnosis and underdiagnosis of mental illness are issues I'm seeing causing huge problems.

Two typical cases I see.
1-Young male with behavioral problems is diverted to a behavioral program designed to get such a person, in a demographic where the risk of becoming a criminal is significant, with resources. Turns out in many of these programs you can't get significant help unless you're dx'd. Some do-gooder social worker and psychiatrist dx the young man with bipolar disorder even though they don't even believe he has it.

Leads to 1-use of meds that aren't justified 2-Patient is now rewarded for bad behavior and in some of those cases the patient is given even more resources (e.g. monthly checks, more attention) when he commits more inappropriate behaviors such as beating up other kids 3-When these people show up to a forensic unit or ER, the doctor just continues the dx, furthering the inappropriate medication. 4-If someone like me comes along and stops all the meds and stops the dx, the family gets all ticked off, asking why another doctor dx'd them with a disorder and that they need the monthly check.

I've had cases of the above where I even talked to people at the program and they even told me over the phone they didn't think the person had bipolar disorder but they gave him a dx for more services. This would, of course, put me in a situation where if I went to court, I had to divulge what was told to me.

I had one case where literally about a dozen psychiatrists wrote a patient had schizoaffective, schizophrenia, or bipolar disorder, and the guy didn't have it. I took him off all of his meds and he was stable for 16 months. About half of the doctors even admitted to me they never saw enough sx on the guy to justify the above dx but were just continuing a prior dx. Some of them even didn't believe in the dx they wrote on paper but put it anyway.

While I was in Cincinnati, I think a reason why the local probate court liked me was because I just told what I thought was going on as-is. I would state that I didn't think the person had a disorder despite that they had several dx the person with such, or there wasn't enough to dx. Other doctors would try to be diplomatic and side-step the real issue.

I'm on a soapbox because I think a truly pathetic aspect of our field that we all see but do not talk much about is the amount of psychiatrists that all of us encounter that continue to practice with very poor regard to accurate diagnosis. Everywhere I've worked I've seen them, in NJ, Ohio, KY, NYC, PA, Illinois, and St. Louis.

2-Patient cannot get services and is truly mentally ill, or cannot get enough resources to pay for the meds they need. This is especially true of psychotic patients in poor areas. Many of them are put on typicals despite the newer data showing such medication is neurotoxic.
Many areas do not have community psychiatric treatment for such patients.

As for Ferguson itself, I live in St. Louis and that case shows no signs that psychiatry was involved as far as I can tell, unless you want to consider nicotine abuse and stealing cigars as somehow psychiatrically related.

We need more people in the field talking about this. I think half the reason for problem two is because of problem one. Another related issue is with substance abusers. I just met with a relative who has been diagnosed with Major Depressive Disorder and needs to stay on his meds when his real problem is that he is a heroin addict. he can't figure out why the meds aren't making him feel better. He has a team of counselors and other mental health providers and probation officers who tell him that the reason he used heroin was because he was self-medicating his underlying mental illness and that if he wants to get better he needs to "take his meds". The main reason he listens to them is to stay out of jail and unfortunately he is starting to believe them. There are drug addicts with serious mental illness that needs to be treated, but the majority do not and telling a substance abuser that the key to them feeling better is another substance is counter-productive.

 

[notdeadyet]

There are drug addicts with serious mental illness that needs to be treated, but the majority do not

This has not been my experience. We must have very different patient panels. With the people I see, people with drug addiction problems serious enough to require treatment tend to have other underlying psychiatric pathology beyond just their substance abuse.

If anything, hard-core drug addicts without underlying pathology have been more the exception than the rule.


Sent from my iPhone using Tapatalk

 

[smalltownpsych]

This has not been my experience. We must have very different patient panels. With the people I see, people with drug addiction problems serious enough to require treatment tend to have other underlying psychiatric pathology beyond just their substance abuse.

If anything, hard-core drug addicts without underlying pathology have been more the exception than the rule.


Sent from my iPhone using Tapatalk

The people that I work with tend to be a bit higher functioning (primarily outpatient setting) and many of their psychiatric problems are a result of long-term substance abuse as opposed to the cause. Also, there are co-morbidities because of risky behaviors and family pathologies. Many of these are best treated without use of medications. I have also worked with truly dual-diagnosed patients, as well. It is very important to differentiate between these types to be most effective. The pendulum used to be too far in the direction of addicts needing to stay away from all medications. Now I think the pendulum is too far in the other direction and that treatment centers are overdiagnosing and over-medicating patients who will actually do better if they learn how to cope with life without the use of substances.

 

[OldPsychDoc]

...Now I think the pendulum is too far in the other direction and that treatment centers are overdiagnosing and over-medicating patients who will actually do better if they learn how to cope with life without the use of substances.

Then again, if they were any good at that, they probably wouldn't have gotten addicted in the first place!

 

[smalltownpsych]

Then again, if they were any good at that, they probably wouldn't have gotten addicted in the first place!

Exactly! Also, because of the hereditability of the biological predisposition for addiction combined with the family environment that supports it, they tend to be taught that using substances is a way to cope and have less access to healthy coping. Just for an example, in the addicted family system, expressing and validating emotional experience is not nearly as common as shut it down or someone gets hurt.

 

[Ceke2002]

We need more people in the field talking about this. I think half the reason for problem two is because of problem one. Another related issue is with substance abusers. I just met with a relative who has been diagnosed with Major Depressive Disorder and needs to stay on his meds when his real problem is that he is a heroin addict. he can't figure out why the meds aren't making him feel better. He has a team of counselors and other mental health providers and probation officers who tell him that the reason he used heroin was because he was self-medicating his underlying mental illness and that if he wants to get better he needs to "take his meds". The main reason he listens to them is to stay out of jail and unfortunately he is starting to believe them. There are drug addicts with serious mental illness that needs to be treated, but the majority do not and telling a substance abuser that the key to them feeling better is another substance is counter-productive.

I'm sorry to hear about your relative, and more to the point I'm sorry to hear about the shoddy treatment he's receiving for his addiction. Unfortunately, as I found out from my own experience, far too many in both the medical and legal fields find it easier to just shove a pill (or several) down a junkie's throat rather than actually bother to treat the addiction itself. I mean sure give him 6 months off heroin, reassess him for signs of clinical depression and then make a judgement call on what treatment he may or may not need, but to diagnose someone with depression whilst their smack bang in the midst of a heroin addiction is just poor clinical practice in my book.

 

[smalltownpsych]

I'm sorry to hear about your relative, and more to the point I'm sorry to hear about the shoddy treatment he's receiving for his addiction. Unfortunately, as I found out from my own experience, far too many in both the medical and legal fields find it easier to just shove a pill (or several) down a junkie's throat rather than actually bother to treat the addiction itself. I mean sure give him 6 months off heroin, reassess him for signs of clinical depression and then make a judgement call on what treatment he may or may not need, but to diagnose someone with depression whilst their smack bang in the midst of a heroin addiction is just poor clinical practice in my book.

Unfortunately that appears to becoming the standard of care.