38 years old, looking for advice (psychology vs. psychiatry, family practice as psychiatrist)

[RomaniGypsy]

I'll start this thread by stating a few facts so that no bad assumptions are made.

1) I did search the threads and I still need information that I didn't find therein.
2) I am autistic, so don't compare me to neurotypical people - there's a huge probability of you getting me all wrong if you do.
3) I believe that I do not have all of the answers and that I am ignorant in many ways - hence my presence here. (If I had all of the answers, I wouldn't waste my time and yours asking questions to which I already have the answers.)
4) I will try to balance brevity and detail, but this is likely to be a longer-than-average post.

I say this because the last time I posted a thread on here, it turned into a bullying frenzy the likes of which I haven't experienced in 23 years. I see no benefit in a repeat of that.

Here's the scoop. I've been considering two career tracks for a while - counselor / clinical psychologist, or medical doctor. My main passion in life is helping to improve the human condition, generally through getting people to think properly. I've done extensive studying on human nature, as well as topics in the nascent field of social psychiatry. I gravitate toward that stuff, and doing research is no problem for me. Oddly enough, I enjoy it.

As an armchair counselor / psychologist for the past 21 years (entirely informally), I have come to the conclusion that the system itself is to blame for the majority of what we call mental illness. Social psychiatry appears to address this exact problem, so it appears that there is room in both psychology and psychiatry for consideration of environmental and situational effects on mental illness.

I have known multiple people who have suffered from diagnosed mental illness, and one thing has been true of them all - they were good people whose situations messed them up (even if those situations came about as unanticipated consequences of decisions they made). I've seen instances where people were prescribed psychoactive medications that they didn't need, that essentially messed them up more. These people were all friends of mine, so I had a solid basis for making that claim in each case. One person ended up dead (essentially suicide by drug overdose) and many others have been suicidal. (I just visited one who, unbeknownst to me until last month, attempted suicide a few months back.) One thing always reverberates in my mind... "they're good people!"

That's a brief overview of how I have developed a passion for helping people who "aren't right in the head", for any of many possible reasons. I've had a knack for counseling, for at least 21 years. I first realized this when people I didn't know started coming to me for advice, just because they heard through the grapevine that I gave good advice.

My study of people has also led me to the conclusion that our living arrangements typically contribute to the worsening of our mental conditions. A simple study of the places where the longest-lived people live will yield characteristic lists such as the following:

• A cultural environment that reinforces healthy lifestyle habits like diet and exercise
• Healthy social relationships and psychological well-being
• People who have a cooperative spirit
• People who tend to gardens
• Public health that is easily accessible
• Seniors are valued as members of their family and the community

(I lifted this list from an online source. Private message me if you want the URL - I seem to recall that I can't post URLs on these forums.)

Boiling this down, we have that people live in cooperative communities where social relationships, wisdom, and healthy living are valued, and that they have to have access to health care.

It's quite easy to see that most Americans don't live this way, and social psychiatrists have started trying to address this problem by creating "therapeutic communities" of sorts where people diagnosed with mental illnesses live in conditions such as those listed above. In essence, they're forming communes, and what we call "communes" is actually the way human beings always lived for the vast majority of our history.

I've spent a lot of time asking people about living this way, and it seems that many people (though not all) would actually prefer to live like this. The main area of resistance I have encountered deals with medical care - they don't think that they could live as they want to live and still be able to afford medical care. This is not a problem that is confined to those who would prefer to live on communes or the like; I've read articles attesting to how people will remain stuck in jobs they don't like, refusing to take a stab at an occupation they'd actually enjoy, because they have medical benefits in their current profession and they doubt they would get them, or be able to afford them, if they were doing what they really wanted to do in life.

This seems like an area of underrepresentation in medicine. How can people live the way they want to live, if they are constrained by lack of access to medical care? From my current vantage point, it would seem to be extremely beneficial to a person's mental health if he/she were able to live a more preferable type of life. I recently read a study that said that the best predictor of happiness is feeling that you have control over your life, and someone who is forced to work in undesirable conditions just to be able to afford medical care doesn't have that control. I'm more than willing to work with the underserved in any of these domains - medicine, psychology, and counseling.

The way this all pertains to me is as follows:

1) I know that I could be a good professional counselor. Yet, counselors don't make much money, and they're not medical practitioners. I feel like I couldn't reach my maximum potential for being able to help people now (and well into the future) if I were only working as a counselor. I couldn't help them live the way they really want to live - all I could do is figure out solutions to their problems, and if they can't afford the solution (as suggested above), then my efficacy stops at that point. If I'm wrong, let me know how.

2) I could go further and become a clinical psychologist, going for a Ph.D. or PsyD. I'd probably go the PsyD route because that's the angle better suited for clinical practice as I understand. Yet, again it would seem that my earning potential would be limited, and I don't think that I want to be tied down to an office. Whatever I do, I'd like to be able to travel, or at least do it at a distance. Counseling has that advantage, but the extra duties of clinical psychologists (such as administering tests for mental disorders or intellectual capabilities) would seem to be fixed in space. After all, you can't administer the MMPI over Skype. If there is a way to practice clinical psychology while traveling, or at a distance, I am open to hearing about it.

3) Going the route of becoming a medical doctor would enable me to serve these people and help them live as they really want to live, by providing medical care to them even if they couldn't afford health insurance or much by way of cash. (Heck, though it seems a country bumpkin tale, I really wouldn't mind if someone wanted to pay me for a visit by giving me some chickens or homemade food or whatever. I do believe in living off the land as much as possible.) Were I to go this route, I think I would aim toward psychiatry as a specialty, because then I would be specially trained to address mental conditions and the physical issues that undergird certain mental conditions. However, I would also want to be able to do some "family practice" when the situations call for it - such as traveling around to intentional communities of people who are trying to live as humans are meant to live, and giving them health care for whatever compensation they could offer me... or doing what I could do for the full-time RV community (of which I have been a part in the past). They also have concerns about health care, at least insofar as it tends not to be stable for them if they're constantly on the move.

My wife and I also talk about wanting to do disaster relief. I'd imagine that family practice would be a better specialty than psychiatry, unless a psychiatrist could legitimately operate as a family practitioner when need be because the psychiatrist, like the family practitioner, has received the same medical school training and also went through clinical rotations in family practice and internal medicine. The family practitioner may not be as qualified to deal with mental illnesses as the psychiatrist, if for no other reason than because some family practice programs are three years instead of four, eliminating clinical rotations for people who are committed to family practice. (Given my relatively advanced age, I'd probably shoot for that if I were going to specialize in family practice.) Were I a doctor, I wouldn't want to be in the position to have to say "I can't give you a good diagnosis for that sore throat, nor can I give you a prescription for Augmentin, because I'm a psychiatrist".

I know that a lot of my thoughts may appear disjointed here, but that's why I'm looking for advice. I know that doctors make a lot more money than psychologists, and I really do want to make that extra money... not because I'm the type to live extravagantly (I never have been, even when I've made a lot of money in the past), but because I could do a lot more for the people I care about, and the new type of system that people need in order to live healthier and happier lives, if I could finance that stuff myself. I don't believe that I can bank on any type of financial windfall either through inheritance or through fundraising (I have no experience with fundraising and as such I can't figure that I'd be any good at it if I tried), so all I can bank on is my own earning ability.

I should also state for the record that I don't "need" the money. When I talk about a counselor's salary or a psychologist's salary not being enough, I'm referring to it being enough to finance the plans I have for humankind, to put it simply. I don't need to change careers at all in order to be able to live and support my family. I've calculated that I could very easily get a simple and relatively low-paying job, and with that one salary afford to live in the house we have, with my wife not having to work, and keep the stress down to a minimum. We really could, with little trouble and with the resources we presently have, disappear from society and live a nearly stress-free life on a small piece of land and a cabin somewhere, living off the land. Yet, if I did that, I would feel like I was neutralizing the benefit I could provide to everyone else. If I CAN help others, I SHOULD help others. To disappear from society like that would take a huge load off of my mind... but it would be selfish... and I can't abide being selfish.

No matter what I do, I want to leave this world a better place simply because I lived in it. I want to leave a better world for my son and who knows how many other children I'll have, as well as all of the other little children who are likely to suffer on account of the way people tend to live these days.

Some parting thoughts, to help y'all out if need be:

1) I know that many medical doctors are tied to offices. I would hope to do something else, like locum tenens work or telemedicine work. My wife and I really enjoy traveling, and one would think that were I ever to decide that I was ready to "settle down" and be tied to an office, there'd always be one waiting for someone like me.

2) I don't know if the reason why a psychiatrist makes more than twice what a psychologist makes is because the psychiatrist tends to work more than twice as many hours as the psychologist does. If that were the case, it would seem that becoming a doctor might not be the best way for me to go, given the plans that I have. I would like to know if there is a significant differential in the number of hours worked by clinical psychologists and psychiatrists.

3) I am more the type to approach mental issues from an emotional standpoint rather than a medicinal standpoint, but I do know that sometimes mental issues can be caused by physical problems. (For example, my ex-wife had a thyroid problem that caused her to gain weight, and that weight gain caused her to suffer depression. Fixing a thyroid problem and enabling easier weight loss would, and did, call for a medical solution, not a therapeutic solution.) I guess it could be said that if I could make the same money as a clinical psychologist and a medical doctor, I would lean toward clinical psychology, though that's not certain because I couldn't serve the medically underserved in that capacity (even though I could serve the "psychologically underserved", if there is such a definable population). I would have to pay for medical doctors to serve these people I want to see served, which I would be willing to do.

4) I do have to consider my age. If I were to go to medical school, I wouldn't be able to practice until I was in my late 40s. If I stop after getting a master's in counseling, I can practice starting from about age 41. If I go for clinical psychology, I'll be in my mid-40s by the time I can practice. Now, I'm a pretty young 38, and people in my family tend to live a long time... and I really don't see myself being able to retire and do essentially nothing productive. Again I would think I were neutralizing my potential benefit to humankind, and also I have never been able to "do nothing", even back to childhood. I'm essentially hyperactive, so the prospect of working into my 70s or 80s doesn't bother me. If I feel that I'm "getting too old", I'll just dial back on the number of hours that I work.

5) I don't mind hearing people's stories. I've sought out opportunities to listen to people's stories for a long time.

6) I can handle academic rigor. I took three classes (10 credits) last semester, which would be necessary prerequisites for medical school and couldn't hurt were I to go for a master's in counseling or a Ph.D. / PsyD. I took these classes (two online, one in-person) while working at least full time hours, doing my part to raise an infant, working on the house, etc. I still got high A grades in all three. (My highest grade was in biology, unexpectedly enough, but since all three professors were different, it's not really an apples-to-apples comparison.)

7) I have a bachelor's degree in physics. In addition to core humanities work for that degree, I have taken two psychology classes and earned high A grades in both. I enjoyed them, but I did find that sometimes psychology seems nebulously defined. (For example, I answered a test question based upon something entirely relevant that actually happened in my life, and got it wrong. "But this ACTUALLY HAPPENED..." - didn't matter. I have difficulty with things like that, but, admittedly, not so much difficulty that I couldn't do well in the classes.)

8) It probably sounds like I'm leaning more toward being a medical doctor. That seems the most logical path, given the information I have at the present moment, if I want to do what I hope to do for humankind. It may not be what I would choose to do if "how I can serve others" were not a consideration - in fact, I wouldn't consider any of these three careers if I didn't care about how I could serve others. I just wouldn't want to become a medical doctor (assume a psychiatrist) and be pressured into medicating problems that I believe can be ameliorated through non-medical means.

9) I think that being trained as a counselor would be beneficial to both psychology and psychiatry, or even any branch of medical practice. Do you agree?

10) I worry about our litigious society where lawyers constantly advertise their services for people who suspect medical malpractice. It seems that malpractice lawsuits are commonplace, or at least that the threat is commonplace. Is this a true assumption?

I'm open to all relevant information that you have, which might help me make a decision.

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[deleted343839]

A few thoughts:

• The profession that came to my mind while reading your post is social work.
• No matter what training path you pursue, you should be prepared to have your assumptions questioned and to be "trained out of" some of the things you do as a lay/peer counselor.
• It's not unheard of for people your age to go to grad school or medical school. Definitely look at the non-trad student board for other perspectives.
• Your assumption about the PsyD being a better degree for clinically-oriented careers is incorrect. If you do a board search you will find plenty of information on this.
• Practicing medicine almost always means being part of a team. This is especially true if your aim is to work with socially vulnerable populations. You can't wear all the hats, and attempting to do so risks doing more harm than good. So figure out which hat best fits your interests and career needs (compensation, flexibility, intellectual stimulation, etc.). Figure out how to play well with others including referring/collaborating clinicians. If you can't see yourself working as part of a team and sharing responsibilities for your patients with others on that team, then medicine is not a good career choice.
• It may be worthwhile for you to volunteer for a community health agency and learn about how public health systems work and the role that various professionals play within these systems. Some systems (or implementations of systems) work better than others. You will not be able to make credible arguments about the system being broken unless you understand the system you're talking about (and based on your post it seems you have much to learn).
• The professionals I know whose work has had the greatest impact tend to work in one institution or community for a number of years. They may travel for professional or humanitarian reasons, but they have made a home and have built relationships with critical partners (community organizations, institutional leaders, patient advocacy groups, etc.) who are essential to making things actually happen. This is not to discourage you from a career in which you are more mobile, but rather to remind you that "making the world a better place" takes a large number of people working together, and that's hard to do when you aren't rooted somewhere.

And finally...

I know that doctors make a lot more money than psychologists, and I really do want to make that extra money... not because I'm the type to live extravagantly (I never have been, even when I've made a lot of money in the past), but because I could do a lot more for the people I care about, and the new type of system that people need in order to live healthier and happier lives, if I could finance that stuff myself.

It isn't clear what you are talking about financing all on your own. It sounds like you are interested in being some sort of benefactor to some unnamed group of people. Statements such as, "I would have to pay for medical doctors to serve these people I want to see served, which I would be willing to do" lead me to believe that you need to learn more about how health care financing works, how much medical services cost, and how much disposable income physicians really have.

 

[bcliff]

I skimmed your previous post on the nontrad forum and generally agreed with much of the feedback that was provided. Much of what you're curious about has been addressed in other threads, including the three below:

WAMC: What Are My Chances

"Help me decide" mega thread

*DOCTORAL APPLICANTS READ FIRST* Helpful Threads

One theme from your post on the nontrad forum that I agreed with most was that your posts are too long. I would review some of the other threads on this forum (including the three I've included) and look for other resources online (check out resources from APA, specific APA divisions relevant to your interests, specific programs you're interested in), then come back with more specific and tailored questions -- Remember that brevity is the soul of wit. I would also stick to posting within the WAMC thread with questions related to admissions/competitiveness.

 

[Dahresto]

Stick to being an armchair counselor

 

[RomaniGypsy]

MamaPhD, thanks for your detailed response. I'll do my best to provide an adequate reply.

A few thoughts:
The profession that came to my mind while reading your post is social work.

It's a close match to counseling, from what I can tell, and so is the pay. Without sounding too pompous, if I wanted to make 47 grand per year, I could keep on doing what I'm doing right now, without paying extra for graduate education and upending our lives to move to where I could get graduate education. Or, I could teach school. In some places, entry level salary for teachers is that or more, plus benefits. I want to make enough to live relatively comfortably (meaning that emergencies don't make me worry) while being able to finance philanthropic endeavors (that we, and others, would do) and make sure that my wife doesn't have to have a job at least as long as we have children to raise. (She would prefer that arrangement as well. I have firsthand knowledge of its benefits, as my mom stayed home with me and my brother.) I believe that the fact that we've been able to give our son a lot of attention up to this point is part of the reason why everyone seems to agree that he is unusually well-behaved and happy.

However, I would sooner take a low-paying job I loved than a high-paying job I hated...

No matter what training path you pursue, you should be prepared to have your assumptions questioned and to be "trained out of" some of the things you do as a lay/peer counselor.

I figure that's likely to happen. It's happened before, it'll happen again, that's life. Yet, I have to wonder, given how many stories I've heard about entirely ineffective / clueless professional counselors (and, for that matter, psychologists and psychiatrists), exactly what got messed up in translation. Apparently the person received all required training and got a license... by that point, aren't you supposed to be reasonably effective and clued-in? Maybe that's one of the things I still have to learn...

It's not unheard of for people your age to go to grad school or medical school. Definitely look at the non-trad student board for other perspectives.

I've been reading it. Yet, each person is different. When I posted there, to get responses about my own perspectives, you'd think I were a piece of raw steak thrown to a pack of starving wolves. Occasionally someone stepped up to tell the attackers that they were being unnecessarily brutal and they were misreading me, but that was an experience I would sooner not repeat. So... I lurk... I read... and I'll have to be careful about any questions I post.

Your assumption about the PsyD being a better degree for clinically-oriented careers is incorrect. If you do a board search you will find plenty of information on this.

Okay, I'll give you a "maybe" on this, right off the bat, since you're in the field. But if what you're saying is true, why would I find, on websites showing the difference between a Ph.D. in psychology and a PsyD, words to the effect of "the Ph.D. is more geared toward the research end of things and the PsyD is more geared toward the clinical end of things"? What I said about the PsyD is not what I came up with on my own; I read it online. Admittedly, you can't trust everything you read, but why would apparently reputable sites post misinformation like this? And, in your own opinion as a psychologist, exactly what is the functional difference (if any) between the Ph.D. and PsyD?

Practicing medicine almost always means being part of a team. This is especially true if your aim is to work with socially vulnerable populations. You can't wear all the hats, and attempting to do so risks doing more harm than good. So figure out which hat best fits your interests and career needs (compensation, flexibility, intellectual stimulation, etc.). Figure out how to play well with others including referring/collaborating clinicians. If you can't see yourself working as part of a team and sharing responsibilities for your patients with others on that team, then medicine is not a good career choice.

Is that not also the case for being a counselor, social worker, and clinical psychologist?

I have no problem being part of a team as long as my teammates are competent and willing to do their part. Historically, I have struggled with this a lot, because I have found that most of the time when I have teammates, they're either incompetent or unwilling to do a fair share of the work. When that happens, if I want the job to get done properly, I'm left with two choices - 1) do all work myself, 2) delegate only the stuff that few people would be likely to mess up, and check it myself after they do it.

This hasn't happened all the time, though. My go-to story is always freshman year chemistry lab. My lab partner and I could do every experiment without saying more than a few words to each other. We had the procedure papers, and when one needed something, the other always had it ready. We kept a step ahead of everything and our efficiency was astonishing. We always finished first and finished accurately, as evinced by the straight 100% grades we got on our labs.

Now, I don't have to have THAT kind of efficiency with every team on which I work, but I do need to feel that, when I delegate something out to someone else, the job will get done right. If I can have that, working as part of a team is a relief for me because then I don't have to be saddled with doing, or checking, all of the work that is done.

It may be worthwhile for you to volunteer for a community health agency and learn about how public health systems work and the role that various professionals play within these systems. Some systems (or implementations of systems) work better than others. You will not be able to make credible arguments about the system being broken unless you understand the system you're talking about (and based on your post it seems you have much to learn).

I'm working on that as we speak. But when I say "the system", I don't mean specifically the medical system. I mean the entire system of human interaction. (Simply put, it involves the economy and society. Every interaction can be placed into one of those two categories.) I have yet to meet one adult, of any ideological leaning, who thinks that there are no significant changes that have to be made in the way humans interact with each other. (A lot of teenagers recognize it too. The sad thing is that these are the people most likely to be despondent. They see what's wrong, they know why it's wrong for all humans, they recognize how things should be, and they see an impassable chasm separating "what is" from "what should be". At that point they feel like they have no control over their lives, because they will always suffer from things not being the way they should be. This is, as far as my research has shown, what social psychiatry is attempting to change / treat / perhaps cure.)

The professionals I know whose work has had the greatest impact tend to work in one institution or community for a number of years. They may travel for professional or humanitarian reasons, but they have made a home and have built relationships with critical partners (community organizations, institutional leaders, patient advocacy groups, etc.) who are essential to making things actually happen. This is not to discourage you from a career in which you are more mobile, but rather to remind you that "making the world a better place" takes a large number of people working together, and that's hard to do when you aren't rooted somewhere.

I'd be fine with planting roots somewhere (as long as I could still travel to an extent) as long as I found a "somewhere" that I liked. I've always been hoping that I will, and it hasn't happened yet. But, there are a lot of "somewheres" out there... more than can ever be truly known in one lifetime or even ten lifetimes. Maybe I'll be fortunate enough to find one. (I just remember this one doctor who used to be a piano student of mine... she seemed to gallavant all over the globe at a moment's notice. She would be around for 2-4 weeks, working fairly intensive shifts during those times, then off she went to some distant location. I never asked if she was working on her vacations, but she sure did travel a lot.)

It isn't clear what you are talking about financing all on your own. It sounds like you are interested in being some sort of benefactor to some unnamed group of people. Statements such as, "I would have to pay for medical doctors to serve these people I want to see served, which I would be willing to do" lead me to believe that you need to learn more about how health care financing works, how much medical services cost, and how much disposable income physicians really have.

I imagine that someone who makes around $200,000 per year has more disposable income than the average American, even after factoring in student loan payments. (If I'm wrong, feel free to explain how.)

I was purposefully vague about this because the last time I brought it up, I was clear, and people attacked me for it.

Here's the deal. Anthropological evidence shows that human beings historically lived and traveled in bands of no more than about 150 people. Modern research has shown that that number is about the limit of the number of meaningful social relationships any one person can have with others. (It's called "Dunbar's number" after the researcher who came to this conclusion.) The evidence would thus seem to show that our modern arrangement of living in huge towns or cities with gazillions of people, most of whom we don't know, with our 150 or so close relationships being spread out over ever-increasing geographic distances, just isn't cutting it. Even online, it ends up being the same thing. We're a click or two away from someone else's Facebook profile, yet we've never felt so alone. I believe that this needs to be changed, and I have talked with a lot of people who believe the same thing.

Were people to set up a small, tightly-knit community of 150 people or so, where they operated on the principles of communal ownership of property (legally only; socially there'd be no private ownership of anything but maybe a few implements), doing what's best for everyone rather than what's best for the individual, and having everyone know everyone insofar as that would be possible, "outsiders" would derisively label that a "hippie commune" or something similar.

Yet, for the vast majority of our history, that is precisely how human beings lived... and nobody ever applied pejorative labels to that. People who have wanted to live in that kind of arrangement have told me that their biggest issue would be medical care, and how they wouldn't likely be able to afford it if they lived like that. (Back in the day, yes, medicine was not as advanced as it is now. Yet, I think there's a lot to be said for how many modern medical problems would be avoided if people lived naturally and simply like they did back then. To present one example, before the spread of tobacco smoking and the modern tobacco processing methods that make tobacco less distasteful and more addictive, how many cases of lung cancer and COPD would have been found in the general population? I imagine the answer would be "very few".)

There are people out there who seek a better way, and I don't see why they should be prevented from pursuing that simply because in so doing they wouldn't be able to afford simple modern medical care. (You also have to figure that some of the natural medicines they used back then are not legal for use now, such as cannabis. Oh no, you have to have a PERMIT for it, or you have to live in a "legal state", and even at that you are limited in how much you can have... and that's not the only example.) Those are people I want to serve, and I would hope to be able to offer my services to them for nothing or next to nothing, financed by money I was making practicing medicine in other capacities. (I see no functional difference between this, and a doctor who volunteers at a community "free clinic" occasionally. That doctor would be financing his volunteer work by making money elsewhere.)

In my estimation, the vast majority of diseases that would have killed people ~150 years ago are now treatable or curable by what we'd call a simple trip to the doctor and a simple prescription like amoxicillin. That's why I figure that most medical needs of a "back to the land" population could be met relatively simply by a doctor who is a family practitioner or is capable of practicing in that way no matter what his/her specialty. (Hence, why I wondered if a psychiatrist could do that. I have enough passion for these people to want to treat their simple issues so that they can continue seeking a better way to live, but my main passion when it comes to humanity in general is the mind.)

I would also like to serve people who, though they may not be living in that type of communal setting and may not desire to do so at least in that sense, are trying to enjoy their lives rather than focus on the "almighty dollar". I'm thinking about people like the stereotypical "struggling artists". Art is one of the things that lasts a long time - look at any anthropological study on ancient societies and it's their artwork that always tells their tales (architecture, paintings, sculptures, etc). Are we, as a human race, truly better off when someone whose passion is art must take some generic, soul-crushing job which leaves him/her nowhere near as much time to be an artist (and perhaps nowhere near as much energy after suffering through yet another workday) just because the money he/she makes as an artist isn't enough to cover down on the exorbitant cost of medical insurance? I'd be totally fine with seeing people like that, were I a doctor, for little compensation. Maybe they could give me a piece of their artwork.

I also think that a lot of people with mental conditions are underserved even though they may be seen by therapists and doctors regularly. I've been working on one such person recently - a 16 year old girl. Her mom has told me, among other things, that even at the mental hospital where she currently resides, she has been seen or treated by many counselors, therapists, psychologists, and psychiatrists who just weren't getting the job done. Some of them, her mom has called "clueless"... some others just didn't do any good. My guess is that the ability to "do good" in this way is more a function of "personal touch" than scholarly training, because all such professionals have had the requisite scholarly training and would be equally effective were that the only determining factor. I think that my personal touch would be effective for some people who aren't being served by other types of personal touch, if for no other reason than because my perspective as a person who has had autism for the entirety of his life is different from the perspective of most other ("neurotypical") people. And, I'm sure that I wouldn't do well with some people. There are people I've tried to counsel who just don't get anywhere with me, and though I could hypothesize about why this happened in each case, the fact remains that it did happen, and even if my guess at the reasoning was correct, I doubt anything could be done to improve the outcome by much.

I look at people all the time, and I see so much sadness. I'm not content to sit back and do nothing about that. Sadness breeds sadness, and it's a cycle that I feel I should do my best to stop. Multiple people have told me, up to this point, that the best thing I could do for my infant son is make sure he never grows up... and they aren't meaning that I should kill him before he reaches adulthood. They are saying that they recognize what "adult life", as we commonly know it, tends to do to a person... and they would hate to see it happen to even one more, even though they probably know that it will.

In the words of George Bernard Shaw, "You see things; and you ask, 'Why?' But I dream things that never were, and ask, 'Why not?'"

 

[RomaniGypsy]

I skimmed your previous post on the nontrad forum and generally agreed with much of the feedback that was provided. Much of what you're curious about has been addressed in other threads, including the three below:

WAMC: What Are My Chances

"Help me decide" mega thread

*DOCTORAL APPLICANTS READ FIRST* Helpful Threads

One theme from your post on the nontrad forum that I agreed with most was that your posts are too long. I would review some of the other threads on this forum (including the three I've included) and look for other resources online (check out resources from APA, specific APA divisions relevant to your interests, specific programs you're interested in), then come back with more specific and tailored questions -- Remember that brevity is the soul of wit. I would also stick to posting within the WAMC thread with questions related to admissions/competitiveness.

I was once delightfully brief, in my younger years... until I found out that that tended to get me misunderstood on a shocking basis. I'd rather be able to convey my thoughts in fewer words because it'd take less of my time, but I prefer "lots of words and minimal chance of being misunderstood" to "few words and a high chance of being misunderstood". (Even as it stands now, I still get misunderstood too much for my liking, but it's not as bad as it once was.)

I'm not worried about admissions or competitiveness yet, because the first step is to determine whether or not this is a good route for me to take. Since that thread that I posted in January, I did take three more prerequisite classes and scored A's in all of them. I'm fairly confident that I could do well in all remaining prerequisites, and on the MCAT because I'm a good test taker. And I do know that I have to boost my volunteering and shadowing hours... I'm in a spot now where I should be able to do so.

Stick to being an armchair counselor

Try saying something helpful, or saying nothing at all, next time. When you make a comment like this, even the most peaceful person in the world is going to ask why, so you ought to include reasoning if you have any.

 

[Sanman]

A few thoughts on your original post...

1. What exactly is your question? You mention three different jobs and then mention multiple other issues related to society that would be the purview or a sociologist and mention more of an interest in social work and mental health/healthcare policy.

2. You may be an armchair counselor, but you seem to lack insight into what professionals do. What is it that you think that counselors and psychologists do? What is it that you think family practice docs and psychiatrists do daily?

3. Your plans show a shocking lack of insight over the financial side of healthcare. You talk about treating people for free and communes yet want to be a doctor for the financial security. If you are not billing for services that higher salary does not exist. If you work for any hospital or agency, you follow their rules and they don't usually accept chickens as payment. You also have a poor understanding of overhead beyond student loans. My suggestion is that you educate yourself on these financial realities prior to embarking on any path as not doing so will likely lead to your being bitter. For example, a large reason that psychiatrists make more money is doing 15 min med checks vs 45 min psychotherapy sessions for counselors/psychologists. If you want to take extra time to "get it right", you will lose money working for yourself. If you work for a hospital or agency, it likely won't be aloud at all. 15 min med checks or leave. One of the stark realities of American healthcare is that there is no incentive to imcreae quality as you are paid by quantity of care.

 

[deleted343839]

Were people to set up a small, tightly-knit community of 150 people or so, where they operated on the principles of communal ownership of property (legally only; socially there'd be no private ownership of anything but maybe a few implements), doing what's best for everyone rather than what's best for the individual, and having everyone know everyone insofar as that would be possible, "outsiders" would derisively label that a "hippie commune" or something similar.

Who cares what other people say? What's stopping you? People of many different political and philosophical persuasions have been experimenting with alternative social models for a long time, and still are. There have been volumes written on this subject. Maybe you could read some! And lest you think I'm one of those derisive outsiders, I have visited a stable, working commune with some of the features you describe, and I found a lot to admire about the community. But I don't think this or any other way or life is at all a panacea for mental suffering.

Perhaps what you're really looking for is a steady income stream and a group of people who will follow your lead in deciding what's "best for the individual." Because it really sounds like you want to lead a commune while enjoying special status as a healer and benefactor.

In my estimation, the vast majority of diseases that would have killed people ~150 years ago are now treatable or curable by what we'd call a simple trip to the doctor and a simple prescription like amoxicillin. That's why I figure that most medical needs of a "back to the land" population could be met relatively simply by a doctor who is a family practitioner or is capable of practicing in that way no matter what his/her specialty.

People also died of cancer, stroke, traumatic injuries, complications of childbirth, and other complex medical problems that are beyond the scope of what can be managed at the old country doctor's office. It's easy to romanticize a simpler time until it affects you or someone you care about.

To present one example, before the spread of tobacco smoking and the modern tobacco processing methods that make tobacco less distasteful and more addictive, how many cases of lung cancer and COPD would have been found in the general population? I imagine the answer would be "very few"

You don't need to imagine the answer. It's well documented (and by the way, you're correct, but the point is that you could do with visiting a library to check out some of your assumptions).

 

[WisNeuro]

Okay, I'll give you a "maybe" on this, right off the bat, since you're in the field. But if what you're saying is true, why would I find, on websites showing the difference between a Ph.D. in psychology and a PsyD, words to the effect of "the Ph.D. is more geared toward the research end of things and the PsyD is more geared toward the clinical end of things"? What I said about the PsyD is not what I came up with on my own; I read it online. Admittedly, you can't trust everything you read, but why would apparently reputable sites post misinformation like this? And, in your own opinion as a psychologist, exactly what is the functional difference (if any) between the Ph.D. and PsyD?

You can give her a maybe if you want, but she is correct, it's a false assumption. The websites are just either outdated, or intentionally misleading.

 

[clausewitz2]

So from the psychiatry side of things, some things to bear in mind:

1) What people have been telling you about medicine being a team sport is absolutely the case. I am very concerned that you have a pattern of finding all of your co-workers incompetent and refusing to delegate tasks appropriately. While I don't doubt that you have worked with people who are not carrying their weight, this is going to be the case any time you work in groups in any kind of institutional setting.

Guess where you're going to complete residency? Hint: not in an intentional community.

If you can't work well with people, figure out how to lower your expectations, skillfully redirect people to doing things to how you want them done, or just avoid medicine.

2) Psychiatric training is going to involve you imprisoning people against their will from time to time. In an ideal world this is always obviously and clearly necessary for the safety of themselves or others and is clinically imperative, but you are going to have cases you do not feel good about but don't have the final say so. Are you okay with that? If not, avoid psychiatry.

3) Medicine's culture is changing in many ways but the hierarchy in training remains very real. You seem like an adult with a fair degree of confidence in their abilities and are not someone who likes to accept professional authority, viz. arguing with practicing psychologists about the professional qualifications necessary to practice in their field. In medicine you will be expected on a number of occasions to shut your mouth and do what you're told. There is room to argue with some people some times, but you have to be careful about how you do it, and at the end of the day, many people will not care what you think and just expect you to do the work. Can you handle that?

4) Psychiatrists are still arguing about whether we should be treating obvious and clear side effects of the medications we give people or should just monitor weight gain and refer to primary care. I think that is stupid on many levels and easily justifiable by our scope of practice, but if you are diagnosing someone's sore throat and prescribing antibiotics, you are opening yourself to a potential world of legal hurt if you done goofed and missed a serious illness. Even a good lawyer isn't going to be able to save you if you are way outside of what psychiatrists typically do. Unless you get FM/Psych or IM/Psych dual-boarded, put away dreams of basically operating like a primary care doc except also you're a psychiatrist. There's a reason why FM residencies are three years - it is not because the three piddly months of medical training you get in residency is adequate for doing what they do.

5) You mention you are raising an infant. Is your wife okay with being effectively a single parent for several years of her life? Because that is what is going to happen if you go the medical route. Maybe she is and it's worth it on the other side. But nothing you said suggests to me you have had that conversation yet.

 

[WisNeuro]

5) You mention you are raising an infant. Is your wife okay with being effectively a single parent for several years of her life? Because that is what is going to happen if you go the medical route. Maybe she is and it's worth it on the other side. But nothing you said suggests to me you have had that conversation yet.

Ditto for PhD/PsyD route. At least for the reputable programs, anyway. Grad school, internship, postdoc. Also, many of the hierarchical issues you raised are there to an extent throughout this route as well.

 

[cara susanna]

Your post makes me worried that you would get burnt out pretty quickly. Part of sustaining a clinical job in this field is having to constantly acknowledge and accept your limitations. You will see a lot of human suffering and, as you said, a lot of it will be related to systemic factors. You can advocate, educate, and work for political and societal change as a private citizen. But you usually can't fix these issues in your day-to-day work.

 

[RomaniGypsy]

A few thoughts on your original post...

1. What exactly is your question? You mention three different jobs and then mention multiple other issues related to society that would be the purview or a sociologist and mention more of an interest in social work and mental health/healthcare policy.

I'm mostly looking for opinions and insight from those who have been in, or have more experience than I have with, the profession(s) I'm referencing. I don't have one single question - any information should help.

2. You may be an armchair counselor, but you seem to lack insight into what professionals do. What is it that you think that counselors and psychologists do? What is it that you think family practice docs and psychiatrists do daily?

I attended several hours of marital counseling with she who is now my ex-wife several years back, and the counselor did many things - he talked with us together and singly, he gave us questionnaires and sheets to fill out and then evaluated differences and similarities between our answers, asked questions, etc. Though that isn't much experience, it's some. I can do that stuff and more, with the proper training. I figure that counselors also do similar things for people who are having difficulties in family relationships, and individuals who are having their own private difficulties. They probably reach the point, with some people, where they know they aren't getting anywhere, and at that point they refer those people to more intensive psychotherapy or psychiatric treatment. I would imagine that counselors, like anyone else, have to deal with paperwork and insurance companies... a hassle nobody seems to like, yet everyone seems to accept (why?! Y'all can change that if you collectively refuse to put up with it!).

Psychologists - I imagine that a practicing clinical psychologist does all of the above at times, as well as things such as evaluating people's mental conditions. I have been to a psychologist twice - once at age 5 and once at age 32, both times to get evaluated for conditions. When I was 5, the psychologist had me do a variety of tests, of intellectual capacity and motor skills, and he observed my actions outside of the confines of those tests. It all came together in his report, which I read when I was older. At age 32, I went in of my own volition to be tested for Asperger's syndrome. The psychologist talked with me for a while, then administered the Minnesota Multiphasic Personality Inventory (MMPI). His report contained my "scores", as it were, on the MMPI, as well as his observations from our interactions. I can do that stuff and more, with the proper training. I imagine that there are many other possible branches of work for a psychologist; they can work with the incarcerated or for law enforcement agencies, they can teach at the college level, they may work in schools, they may work in conjunction with psychiatrists to treat the diagnosed mentally ill, etc. And there is probably more that I haven't even imagined.

Family practice doctors, as I understand, are essentially general practitioners for people of all ages. They're the first go-to doctor, especially in smaller communities that can't necessarily support multiple more specialized doctors (such as a pediatrician and an internist), for just about everything. If you have a sore throat, if you injure a joint, if you have a skin rash, if you feel uncommonly depressed, if you're throwing up a lot, etc, etc, etc... off to the family practice doctor you can go, and if that doctor feels unqualified to help you, he/she will refer you to someone more specialized. I've been to the doctor a lot in my life, and usually it was a general practitioner of some kind (though my current GP is an internist).

Psychiatrists, as I understand, specialize in treating diseases of the mind, usually from a medical / biological standpoint, though they have training in therapy and even if they cannot provide the therapy, they recognize when the indicated treatment is therapeutic rather than pharmaceutical. They are qualified to diagnose conditions and then prescribe psychoactive medications and therapies such as electroconvulsive therapy (even though I believe that has gone largely out of vogue in recent times). They are qualified to diagnose physical conditions as well, since those conditions could cause mental dysfunction in certain cases. They work with the most mentally ill of the mentally ill, often in or in conjunction with mental hospitals, seeking to "restore them to their lost reason" (a quote I saw when I visited an old mental hospital recently) insofar as that is possible.

3. Your plans show a shocking lack of insight over the financial side of healthcare. You talk about treating people for free and communes yet want to be a doctor for the financial security. If you are not billing for services that higher salary does not exist. If you work for any hospital or agency, you follow their rules and they don't usually accept chickens as payment. You also have a poor understanding of overhead beyond student loans. My suggestion is that you educate yourself on these financial realities prior to embarking on any path as not doing so will likely lead to your being bitter. For example, a large reason that psychiatrists make more money is doing 15 min med checks vs 45 min psychotherapy sessions for counselors/psychologists. If you want to take extra time to "get it right", you will lose money working for yourself. If you work for a hospital or agency, it likely won't be aloud at all. 15 min med checks or leave. One of the stark realities of American healthcare is that there is no incentive to imcreae quality as you are paid by quantity of care.

I don't need your comments about "shocking lack of insight". Dispense with the unnecessary barbs and just give me the insight I need. If I had all of the necessary insight, I wouldn't be here, so I am already recognizing that I lack sufficient insight. For that matter, I don't need this type of comment from anyone else. If I'm wrong about something, which surely I will be when talking about it from my current standpoint of limited knowledge, just disseminate the correct information and leave it at that. In my own mind, I'll be able to construct the conclusion that my former beliefs were wrong.

When I say that I want to be a doctor for financial security (which I didn't really say, but it's reasonable to conclude that everyone wants to have financial security, so I'll accept it), I don't mean that I need to make $200K/year in order to live. I want to be comfortable enough that I can finance movements and people that are aiming to make the world a better place, and also to have enough free time (eventually if not immediately) to be able to do things like that myself. It's really hard making the world a better place when you're constantly tied to work because you have no money and therefore nowhere near enough free time. I know that counselors, psychologists, and doctors work really hard... but I'm hoping eventually to dial back to part time hours. If you make $200K for full time hours, one would think that you'd make somewhere in the neighborhood of $100K for half of that work. And I understand overhead; I've been a businessperson for a long time, and I've talked with doctors about their overhead. Malpractice insurance is a big one for doctors in private practice.

I know that if you're working for an institution, you follow their rules. When I suggested chickens as payment, I was referring to "private practice". When you're working privately, you can accept anything as payment. When I taught music lessons through a studio, it was "cash only and you pay by our payment rules". When I taught privately, often I traded lessons for other things I found to be of value. I know how it works.

When you say I "will lose money" spending more time on quality care in private practice, don't you mean that I "won't make as much money" doing so as I would if I kept everything to 15 minute med checks or whatever it would have to be? Frankly, if a doctor can make $200K+ per year, I would be fine with reducing that by a bit if in so doing I could give better care... again, assuming I'm doing so in a private setting where I don't have to play by the rules of an employing institution. The point of going into medicine, should that be the route I take, would be because my ultimate goal is to help people and make the world a better place. Back in the day when I made a lot of money, I used to give a bunch of it away, help people out for free, etc. I'd do the same thing again.

Who cares what other people say? What's stopping you? People of many different political and philosophical persuasions have been experimenting with alternative social models for a long time, and still are. There have been volumes written on this subject. Maybe you could read some! And lest you think I'm one of those derisive outsiders, I have visited a stable, working commune with some of the features you describe, and I found a lot to admire about the community. But I don't think this or any other way or life is at all a panacea for mental suffering.

Ooooo... I can see why you're a psychologist! Nice insight, you have. I really don't care what others say, but when "what others say" dictates my income and thus my ability to do what I want to do, it's something worth considering. What's stopping me from "changing the world", as it were? Lack of funds, lack of visibility (and funds to increase such), lack of support (and funds to purchase such), etc. With a wife and an infant son, I can't just live with no consideration for money as once I did.

"Maybe I could read some" - not only have I done so, but I can go one better - I have written one. What stops me from publishing it? Two things - 1) lack of funds, 2) the belief that this information ought to be available to everyone, not just those wealthy enough to afford it.

I'd be interested to hear more about why you think that "communal living" is not a panacea for mental suffering. (I agree, but that's because many communes still must be too closely tied to "the system" in order to exist, for reasons such as "without money, we couldn't afford medical care".)

Perhaps what you're really looking for is a steady income stream and a group of people who will follow your lead in deciding what's "best for the individual." Because it really sounds like you want to lead a commune while enjoying special status as a healer and benefactor.

That is quite close to the truth. I want people to follow my lead only if my lead is best, and right now I'm seeking opinions from people on the new system I have proposed. I'm not so arrogant as to believe that I nailed it perfectly on my first try. (And, as I won't always be alive, it can't be about "my lead"; it has to be about what's best for humankind.) I don't wish to enjoy special status; I don't like the notion of status. I just want to do what I can, when I can, to make the world a better place. If I can best empower myself and others to do exactly that by being a healer and benefactor, I see no good reason why I shouldn't.

People also died of cancer, stroke, traumatic injuries, complications of childbirth, and other complex medical problems that are beyond the scope of what can be managed at the old country doctor's office. It's easy to romanticize a simpler time until it affects you or someone you care about.

At times like this, I think, "we're all going to die of SOMETHING". But, admittedly, I would like to be able to provide for this type of care as much as I can, or perhaps encourage other doctors to do the same. Making the world a better place goes beyond healing the sick; it requires that we establish a system that works for as many people as possible, and ensures the perpetuation of the human race. The only alternative to that is that humanity goes extinct because we're essentially destroying ourselves... and if that happens, all of our advancements, including the medical advancements that most everyone seems to love, go to the grave with us. That's a huge waste of human effort, even if evolution does at some point bring humans / hominids into existence again. (For the record, I don't believe that a non-man-made event would cause humans to go extinct if we were living cooperatively. We're an intelligent and adaptable species. Such an event might wipe out most of the humans who are alive, but it wouldn't wipe out all of them, and we could rebuild.)

You can give her a maybe if you want, but she is correct, it's a false assumption. The websites are just either outdated, or intentionally misleading.

Well, that's why I'm here. What do you say is the functional difference between a Ph.D. and a PsyD? (Or is there one?)

So from the psychiatry side of things, some things to bear in mind:

1) What people have been telling you about medicine being a team sport is absolutely the case. I am very concerned that you have a pattern of finding all of your co-workers incompetent and refusing to delegate tasks appropriately. While I don't doubt that you have worked with people who are not carrying their weight, this is going to be the case any time you work in groups in any kind of institutional setting.

If someone is incompetent, delegating tasks to that person that require competency is suicidal, if the entire team has to deal with the outcome... and it is detrimental to others if only others have to deal with the outcome.

If you, as a psychiatrist, recognize that someone else on "your team" (such as a psychologist, counselor, social worker, nurse, other medical doctor, et al.) is incompetent, are you still expected to delegate work to that person, or would you be encouraged to seek other providers of that service so as to find someone competent?

If you can't work well with people, figure out how to lower your expectations, skillfully redirect people to doing things to how you want them done, or just avoid medicine.

I can work fine with people as long as they're doing their best. I don't blame people for ignorance, though I'm not immune to getting hot under the collar when someone's ignorance is so severe that it causes harm to befall someone else. I'm fine with redirecting people to doing things the way I want them done.

2) Psychiatric training is going to involve you imprisoning people against their will from time to time. In an ideal world this is always obviously and clearly necessary for the safety of themselves or others and is clinically imperative, but you are going to have cases you do not feel good about but don't have the final say so. Are you okay with that? If not, avoid psychiatry.

Not sure how to answer this one. "Cases I do not feel good about but don't have the final say so" - if I don't have the final say so, then how would it be that I would be the one imprisoning the person against his/her will (presumably in a mental institution)?

3) Medicine's culture is changing in many ways but the hierarchy in training remains very real. You seem like an adult with a fair degree of confidence in their abilities and are not someone who likes to accept professional authority, viz. arguing with practicing psychologists about the professional qualifications necessary to practice in their field.

I wasn't arguing with a practicing psychologist. I am well aware that the Ph.D. is sufficient for clinical practice and has been for much longer than the PsyD has been around. Asking questions and bringing up contrary information that I have discovered elsewhere does not constitute an argument. At no point did I say that MamaPhD was wrong about anything. That would have been an argument.

I'm okay with authority as long as I believe that the authority has my best interests in mind. In medicine I would add to that that I would be fine with it if I believed that the authority had my patients' best interests in mind. I expect to be treated respectfully even when being told what to do; someone who disrespects me is immediately going to prove himself/herself not to have my best interests in mind, and if it deals with a patient, it'll show that the person doesn't have the patient's best interests in mind either. One can be told that he's wrong or that he needs to do something immediately without question, without insults being thrown.

I've been in situations where my authority figures didn't care about me, and I hated those situations. I've been in situations where my authority figures respected me even when I was the lowest man on the totem pole, and I thrived in those situations. It all depends on people's attitudes. Treat me kindly and respectfully, and I'll perform for you. Your poop doesn't stink any less than mine.

In medicine you will be expected on a number of occasions to shut your mouth and do what you're told. There is room to argue with some people some times, but you have to be careful about how you do it, and at the end of the day, many people will not care what you think and just expect you to do the work. Can you handle that?

Again, if I am confident in the ability of the superior, and the superior is treating me with respect. I think that any medical practitioner has a duty to violate authority if he/she has strong reason to believe that the patient's well-being and/or life hangs in the balance. If the primary directive of the Hippocratic Oath is "first, do no harm", that also means that you must do what you can to ensure that nobody else does harm, or so I interpret it.

Unless you get FM/Psych or IM/Psych dual-boarded, put away dreams of basically operating like a primary care doc except also you're a psychiatrist. There's a reason why FM residencies are three years - it is not because the three piddly months of medical training you get in residency is adequate for doing what they do.

To get dual-boarded like that, do you have to go through two separate residencies?

5) You mention you are raising an infant. Is your wife okay with being effectively a single parent for several years of her life? Because that is what is going to happen if you go the medical route. Maybe she is and it's worth it on the other side. But nothing you said suggests to me you have had that conversation yet.

She knows, and she's okay with it, insofar as anyone can be before getting into the fray. Surely there would come times when she wants to pull her hair out... I'd do what I could to help her. But she knows.

 

[RomaniGypsy]

Your post makes me worried that you would get burnt out pretty quickly. Part of sustaining a clinical job in this field is having to constantly acknowledge and accept your limitations. You will see a lot of human suffering and, as you said, a lot of it will be related to systemic factors. You can advocate, educate, and work for political and societal change as a private citizen. But you usually can't fix these issues in your day-to-day work.

I've read that psychologists, counselors, and doctors alike tend to burn out at rates higher than average. But, I've been counseling for 21+ years, and at any point I could have stopped... but I never have.

I can deal with seeing human suffering due to systemic factors. I've been seeing that my whole life, and I've suffered it more than most people due to being autistic. Yet here I am, still kicking. I think that if it were due to systemic factors, I could show the person how that is, and at least make him/her realize that even if the suffering continues to an extent, which surely it will, it has nothing at all to do with that individual person. (I've done so, successfully, many times in the past.) I've found that attributing "bad stuff" to systemic factors makes me a more peaceful person. When someone cuts me off, the person is feeling rushed to get somewhere (systemic problem) and has been brainwashed and raised to be an inconsiderate person (systemic problem). I keep going back to "every one of these people was once an innocent and delightful infant, like my own son, and what happened to the person to get him/her to this point was not his/her fault".

I know that these issues can't all be fixed in day-to-day work. That's the main reason why I am enticed by the earning potential of a medical doctor. I know I can't fix all of this through work, but I COULD produce a more likely workable solution if I could finance it. Such a solution would be "outside of work", but would likely require my involvement in a work-like capacity, as in - I make my money working as a doctor in a traditional type of setting, and then volunteer my work as a doctor to the movement that's working to live differently and change the world. I'd work extra hours to do that. Enabling such a movement to continue, and grow, after my death would be something that would make me look back on my life from my deathbed and think, "I did all right".

And, having a kid does make you think. In my case, I have to do SOMETHING for him. He's going to be a target of his peers' ridicule for sure - he'll likely grow to 6'6" and 250+ pounds, he has about a 50-50 chance of being autistic, and neither of his parents cares a lick about popular culture. None of that stuff would matter in an ideal society, and for his sake as well as the sake of all other kids who'd suffer similarly (and they all do, in their own way, regardless of how they look and behave outwardly), we have to do better as a human race. I need to do more about this than just talk about it. I've learned what stops others from going this route, and if I can remove that objection through my work, then I have enabled people to change the world, and my vision gets multiplied and perpetuated, at least in certain ways, even if not everyone agrees with everything I wrote in my book about the ideal system. Dramatic improvement is possible even without immediately overhauling the system. (Such overhaul would probably take much longer than the life I have left, even if I live to be 100.)

 

[WisNeuro]

Well, that's why I'm here. What do you say is the functional difference between a Ph.D. and a PsyD? (Or is there one?)

There is no functional difference between reputable balanced PhDs and reputable PsyDs

 

[Sanman]

I've read that psychologists, counselors, and doctors alike tend to burn out at rates higher than average. But, I've been counseling for 21+ years, and at any point I could have stopped... but I never have.

What is your definition of counseling? How often do you do it and how many people do you counsel?

 

[Sanman]

I don't need your comments about "shocking lack of insight". Dispense with the unnecessary barbs and just give me the insight I need. If I had all of the necessary insight, I wouldn't be here, so I am already recognizing that I lack sufficient insight. For that matter, I don't need this type of comment from anyone else. If I'm wrong about something, which surely I will be when talking about it from my current standpoint of limited knowledge, just disseminate the correct information and leave it at that. In my own mind, I'll be able to construct the conclusion that my former beliefs were wrong.

Well, no. If you want to pay me to teach you a class on this sure, but there are multiple books on the subject already. I'm not here to provide internet strangers with all the answers they request or a free education. I have a job, a family, and Netflix to binge watch (all of which take priority over this at various times). Look at the accounts of those already in practice and read the various threads on here. Look into what it takes to run a business utilizing health insurance (billing staff, EHR requirements, paperwork requirements, etc) and realize that you will spend as much or more time focused on this than on helping people.

When I say that I want to be a doctor for financial security (which I didn't really say, but it's reasonable to conclude that everyone wants to have financial security, so I'll accept it), I don't mean that I need to make $200K/year in order to live. I want to be comfortable enough that I can finance movements and people that are aiming to make the world a better place, and also to have enough free time (eventually if not immediately) to be able to do things like that myself. It's really hard making the world a better place when you're constantly tied to work because you have no money and therefore nowhere near enough free time. I know that counselors, psychologists, and doctors work really hard... but I'm hoping eventually to dial back to part time hours. If you make $200K for full time hours, one would think that you'd make somewhere in the neighborhood of $100K for half of that work. And I understand overhead; I've been a businessperson for a long time, and I've talked with doctors about their overhead. Malpractice insurance is a big one for doctors in private practice.

I know that if you're working for an institution, you follow their rules. When I suggested chickens as payment, I was referring to "private practice". When you're working privately, you can accept anything as payment. When I taught music lessons through a studio, it was "cash only and you pay by our payment rules". When I taught privately, often I traded lessons for other things I found to be of value. I know how it works.

When you say I "will lose money" spending more time on quality care in private practice, don't you mean that I "won't make as much money" doing so as I would if I kept everything to 15 minute med checks or whatever it would have to be? Frankly, if a doctor can make $200K+ per year, I would be fine with reducing that by a bit if in so doing I could give better care... again, assuming I'm doing so in a private setting where I don't have to play by the rules of an employing institution. The point of going into medicine, should that be the route I take, would be because my ultimate goal is to help people and make the world a better place. Back in the day when I made a lot of money, I used to give a bunch of it away, help people out for free, etc. I'd do the same thing again.

You have two competing goals described in your writing that do not work together is my point. You can chose to make money and be a benefactor to others to promote your beliefs or you can be a healthcare professional that is less focused on the bottom line and helps others. You are less likely to accomplish both as they are often competing goals. Being a benefactor is significantly hindered by taking out massive student loans and spending years in school. Better to get a high paying tech job with less debt and time commitment, save your money, and start your commune. So clarify which goal you want to accomplish and focus on that. We can help with the professional ones. I for one have gleaned little information about what you want to do as a counselor or psychologist from this thread.

 

[clausewitz2]

I've read that psychologists, counselors, and doctors alike tend to burn out at rates higher than average. But, I've been counseling for 21+ years, and at any point I could have stopped... but I never have.

I can deal with seeing human suffering due to systemic factors. I've been seeing that my whole life, and I've suffered it more than most people due to being autistic. Yet here I am, still kicking. I think that if it were due to systemic factors, I could show the person how that is, and at least make him/her realize that even if the suffering continues to an extent, which surely it will, it has nothing at all to do with that individual person. (I've done so, successfully, many times in the past.) I've found that attributing "bad stuff" to systemic factors makes me a more peaceful person. When someone cuts me off, the person is feeling rushed to get somewhere (systemic problem) and has been brainwashed and raised to be an inconsiderate person (systemic problem). I keep going back to "every one of these people was once an innocent and delightful infant, like my own son, and what happened to the person to get him/her to this point was not his/her fault".

I know that these issues can't all be fixed in day-to-day work. That's the main reason why I am enticed by the earning potential of a medical doctor. I know I can't fix all of this through work, but I COULD produce a more likely workable solution if I could finance it. Such a solution would be "outside of work", but would likely require my involvement in a work-like capacity, as in - I make my money working as a doctor in a traditional type of setting, and then volunteer my work as a doctor to the movement that's working to live differently and change the world. I'd work extra hours to do that. Enabling such a movement to continue, and grow, after my death would be something that would make me look back on my life from my deathbed and think, "I did all right".

And, having a kid does make you think. In my case, I have to do SOMETHING for him. He's going to be a target of his peers' ridicule for sure - he'll likely grow to 6'6" and 250+ pounds, he has about a 50-50 chance of being autistic, and neither of his parents cares a lick about popular culture. None of that stuff would matter in an ideal society, and for his sake as well as the sake of all other kids who'd suffer similarly (and they all do, in their own way, regardless of how they look and behave outwardly), we have to do better as a human race. I need to do more about this than just talk about it. I've learned what stops others from going this route, and if I can remove that objection through my work, then I have enabled people to change the world, and my vision gets multiplied and perpetuated, at least in certain ways, even if not everyone agrees with everything I wrote in my book about the ideal system. Dramatic improvement is possible even without immediately overhauling the system. (Such overhaul would probably take much longer than the life I have left, even if I live to be 100.)

Way too long to do the multiquote thing.

1. Search some of the medical forums for "pimping" if you want to get a taste of medical culture. If you go the medicine route you will get yelled at, asked ridiculous questions until you get one wrong and then mocked for it, have preceptors literally walk away while you are staffing a case if they think you're rambling, and possibly have things thrown at you (much rarer than it used to be but still happens occasionally). You will be told to do things you disagree with and sometimes it will seem.much more related to someone's ego, institutional politics, or money than patient care. While you are in training, guess what? Shut up and do it is what.

2) yeah as a psychiatry resident it is typically your job to petition holds/involuntary committments but often this is at the behest of your seniors. If you flat out refused they probably couldn't force you to do it legally, but you can only get away with that a few times before you become the problem resident with an enormous bullseye on your back.

3) The realities of medical training pathway is that if you wash out at any point before completing residency, you get nothing but enormous debt and no prospect of a clinical career. Keep this in mind if you have a family. Also expect to move, probably twice, possibily long distances.

4) do some shadowing or read more about these professions. I get the sense you have a really poor idea of what psychologists or psychiatrists actually do.

5) to be dual boarded you need to find a combined FM/Psych or IM/Psych residency. All told there are about a dozen of these in the country. Both are typically five year programs.

 

[deleted343839]

What's stopping me from "changing the world", as it were? Lack of funds, lack of visibility (and funds to increase such), lack of support (and funds to purchase such), etc. With a wife and an infant son, I can't just live with no consideration for money as once I did.

It's a problem a lot of charitable people can relate to, I'm sure. But why does it need to be you and you alone who comes up with the money? Maybe you could join up with a like minded community that already exists somewhere?

I'd be interested to hear more about why you think that "communal living" is not a panacea for mental suffering.

I don't have the time or interest to open that conversation in this forum. However, I'll give you the bullet points:

• I do not believe that all suffering is preventable, or without a function, or even without value.
• Hierarchies and social reinforcement of valued behaviors seem to be the trade-off for erosion of instinct in mammals that live in groups. I haven't seen evidence that humans have found a workable, sustainable alternative.
• The explanations you've offered don't scan when I think about the concerns of patients I've treated who grew up in small, isolated communities (including, in a small number of cases, communes!).

 

[Therapist4Chnge]

If you, as a psychiatrist, recognize that someone else on "your team" (such as a psychologist, counselor, social worker, nurse, other medical doctor, et al.) is incompetent, are you still expected to delegate work to that person, or would you be encouraged to seek other providers of that service so as to find someone competent?

This comes up more than I thought it would once I started my career. While someone may not “harm” the patient, often times the style of the provider is problematic, but for many reasons you still need to navigate them. It’s something that frustrates me, but it happens in most setting if you look close enough.

I'm okay with authority as long as I believe that the authority has my best interests in mind. In medicine I would add to that that I would be fine with it if I believed that the authority had my patients' best interests in mind. I expect to be treated respectfully even when being told what to do; someone who disrespects me is immediately going to prove himself/herself not to have my best interests in mind, and if it deals with a patient, it'll show that the person doesn't have the patient's best interests in mind either. One can be told that he's wrong or that he needs to do something immediately without question, without insults being thrown.

In a perfect world this would be nice, but it isn’t as easily found in practice. I’m not saying everyone is a jerk, but if a supervisor tells you to do something, you do it. I can think of times I thought I was right...and I wasn’t, and other times I was right and they were wrong. However, the mentoring process isn’t always fair nor overly friendly. Most of the time it didn’t matter if I was right bc ultimately i’m working under their license and they are responsible for my actions.

For those times I was wrong...it was humbling. In the moment it might have felt like a terse response from the supervisor, but sometimes there isn’t time to hash it out in the moment. Training can and should be a humbling experience. Respect should be present, but the devil is in the details. I’m thankful for having supervisors that took the time to teach me bc it's often a thankless job bc everyone thinks they can do it better...the patient, family, trainee, other discipline, etc.

 

[foreverbull]

What you mention sounds exactly like my undergrad course in ecological anthropology (I majored in anthropology)...lots of discussion of the "myth of progress" in civilizations, forager societies, and how most human societies have actually moved into being parasitic rather than symbiotic with the earth. The books "Ishmael" and "Story of B" by Daniel Quinn get at the heart of this issue.

Spiritually/philosophically I can get on board with some of what you've said about culture/society, although I don't think you realize how difficult it would be to enact your plan. But by all means, if you want to try to buck the system or change it, go for it. Just know that "armchair counseling" will not be anything near our profession once you're trained, and mental illness is not always culturally-created, as much as you might like to think. Trepanation (drilling a hole in the skull) has been used for thousands of years to cure mental illness, even in "ideal" foraging societies.

Career-wise, you're talking about being a shaman/healer, really, but you want the Western degree and license to give you legitimacy and some money? What about getting a master's/doctorate in cultural anthropology and also becoming a nurse, nurse practitioner, etc? Anthropology captures the cultural side of how people organize ourselves in groups and our evolutionary history, and nurse practitioners can get at more of the physical health side. From what I gather, it sounds like you don't think folks need mental health services if they're in an ideal commune kind of social setup, and that physical health needs might take more precedence?

Getting a doctorate in cultural anthropology would require you to live amongst a subculture/another culture in the world for about a year for your dissertation....could be of interest to you. It'll be a tough path to carve, though, whatever you choose. What you mention also reminds me of Doctors Without Borders and that kind of work, as well.

Just throwing out some thoughts...

 

[tr]

Why would someone with autism spectrum disorder, of which a core element is persistent difficulties in social interaction and communication, wish to become a counselor or therapist? This seems akin to someone with a congenital absence of limbs desiring to become a professional dancer.

The OP states that he thinks he would be a good therapist because people come to him for advice. My humble opinion is that the giving of advice is exactly the sort of thing that good therapists should avoid at all costs. It's a very natural human instinct to wish to give advice when confronted with a problem, but it is an urge that must be overridden in the course of training to become an effective therapist. (This is because the typical human reaction to receiving almost any statement/thesis/advice is typically to push back with an opposing statement, hypothesis, or desire. In order for solutions to be effective, they have to come from the individual concerned, not from an outside source. Good therapists have the skill to help people define their own goals and arrive at their own solutions. Pushing a client/patient to implement a solution devised by the therapist is almost invariably counterproductive.) If the OP wishes to give advice professionally then he might consider areas such as consulting, or writing an advice column if that appeals.

Beyond that, the OP seems to have a goal of nurturing the growth and development of communal living organizations. While this seems an interesting and laudable goal, it is completely unrelated to the practice of mental health care, pretty much regardless of degree path. Furthermore, the level of financial, temporal, and intellectual commitment required to complete a doctoral level degree and/or physician training would seriously impede the OP's ability to devote much attention to these alternative interests for at least a decade.

 

[RomaniGypsy]

Way too long to do the multiquote thing.

1. Search some of the medical forums for "pimping" if you want to get a taste of medical culture. If you go the medicine route you will get yelled at, asked ridiculous questions until you get one wrong and then mocked for it, have preceptors literally walk away while you are staffing a case if they think you're rambling, and possibly have things thrown at you (much rarer than it used to be but still happens occasionally). You will be told to do things you disagree with and sometimes it will seem.much more related to someone's ego, institutional politics, or money than patient care. While you are in training, guess what? Shut up and do it is what.

I would never tolerate being "pimped". That is disrespectful. If someone wants to question me until I get something wrong because that person is legitimately concerned about making sure that I know as much as I can know, that's fine. As a teacher, I've been known to do that with my students. But once they get something wrong, I don't mock them for it. I say words to the effect of "this is something you need to know in order to be successful, so look it up".

Yet, I look at people like my own GP and think, "This guy is totally not the type of person to do what people have called 'pimping'". That leads me to believe that it is not a foregone conclusion that a young doctor or medical student will get "pimped". How realistic is it to get into a residency program where current and former students state specifically that the culture is one of mutual respect and things like "pimping" simply don't happen (if for no other reason than because the senior doctors running the program have personalities akin to that of my GP)?

3) The realities of medical training pathway is that if you wash out at any point before completing residency, you get nothing but enormous debt and no prospect of a clinical career. Keep this in mind if you have a family. Also expect to move, probably twice, possibily long distances.

I do recognize the harsh reality of this, for sure. Moving a long distance wouldn't bother me... I've moved all over the country and I'd do it again if need be.

4) do some shadowing or read more about these professions. I get the sense you have a really poor idea of what psychologists or psychiatrists actually do.

I'm on it...

5) to be dual boarded you need to find a combined FM/Psych or IM/Psych residency. All told there are about a dozen of these in the country. Both are typically five year programs.

Five years vs. four years... seems not so terrible to me, but I would imagine that the problem would be that these few dual residencies are likely to be competitive. True or not?

It's a problem a lot of charitable people can relate to, I'm sure. But why does it need to be you and you alone who comes up with the money? Maybe you could join up with a like minded community that already exists somewhere?

I would hope that it wouldn't be. But I can only count on myself. To think about others who might be able to provide funds is to venture into the unknown, and I've never been one to bank on the unknown. Yet, it would be a wonderful thing... even if it still didn't address the problem of lack of access to medical care...

• I do not believe that all suffering is preventable, or without a function, or even without value.

• Hierarchies and social reinforcement of valued behaviors seem to be the trade-off for erosion of instinct in mammals that live in groups. I haven't seen evidence that humans have found a workable, sustainable alternative.
• The explanations you've offered don't scan when I think about the concerns of patients I've treated who grew up in small, isolated communities (including, in a small number of cases, communes!).

I guess it depends upon what you're referring to, when you talk of suffering. Muscular pain due to exertion isn't so bad, because you become stronger later on. But unnatural suffering foisted upon people, such as by the hand of the fashion and cosmetics industries that have to make you feel ugly in order to coerce you to buy their products, seems to have no function but concentrating wealth in the hands of a few people and no real value. The end result is that a few people get rich and millions of people lose their self-esteem (with a commensurate increase in depression and other forms of mental illness, for sure).

I think that humans are intelligent enough to be able to find a workable, sustainable alternative.

What were the concerns of the patients you referenced, especially as they appear to be at odds with things I've said?

In a perfect world this would be nice, but it isn’t as easily found in practice. I’m not saying everyone is a jerk, but if a supervisor tells you to do something, you do it. I can think of times I thought I was right...and I wasn’t, and other times I was right and they were wrong. However, the mentoring process isn’t always fair nor overly friendly. Most of the time it didn’t matter if I was right bc ultimately i’m working under their license and they are responsible for my actions.

If they're responsible for my actions due to it being their license on the line, one would think that they have a vested interest in making sure that I do things the right way. That would qualify as concern for my well-being, because only by being and doing well would I not pose a threat to the supervisor's license. That may not be the ideal reason to have concern for someone else's well-being, but I never said that the reasoning underlying the concern had to pass muster. I just said that they have to evince concern.

For those times I was wrong...it was humbling. In the moment it might have felt like a terse response from the supervisor, but sometimes there isn’t time to hash it out in the moment. Training can and should be a humbling experience. Respect should be present, but the devil is in the details. I’m thankful for having supervisors that took the time to teach me bc it's often a thankless job bc everyone thinks they can do it better...the patient, family, trainee, other discipline, etc.

I wouldn't mind terse responses in the heat of the moment when there is no time to issue a comprehensive explanation, as long as when the time comes that a more comprehensive explanation can be issued, it is. (Without that, I would risk committing the same infraction again, perhaps under only slightly different circumstances.)

What you mention sounds exactly like my undergrad course in ecological anthropology (I majored in anthropology)...lots of discussion of the "myth of progress" in civilizations, forager societies, and how most human societies have actually moved into being parasitic rather than symbiotic with the earth. The books "Ishmael" and "Story of B" by Daniel Quinn get at the heart of this issue.

Spiritually/philosophically I can get on board with some of what you've said about culture/society, although I don't think you realize how difficult it would be to enact your plan. But by all means, if you want to try to buck the system or change it, go for it. Just know that "armchair counseling" will not be anything near our profession once you're trained, and mental illness is not always culturally-created, as much as you might like to think. Trepanation (drilling a hole in the skull) has been used for thousands of years to cure mental illness, even in "ideal" foraging societies.

I would hope that the training would move the person toward being truly effective as a healer of interpersonal rifts and a solver of personal problems... or at least that it would help the person get to the root cause of personal problems. I do know that not all mental illness is culturally created, but I think that most of it is, and that a lot of what isn't culturally created can still be used for beneficial purposes if harnessed correctly. But, there are those times when someone is just so far off the deep end that he/she has to be isolated and treated, so as not to be a threat to himself or anyone else. I would like to learn about those conditions and what causes them.

Career-wise, you're talking about being a shaman/healer, really, but you want the Western degree and license to give you legitimacy and some money? What about getting a master's/doctorate in cultural anthropology and also becoming a nurse, nurse practitioner, etc? Anthropology captures the cultural side of how people organize ourselves in groups and our evolutionary history, and nurse practitioners can get at more of the physical health side. From what I gather, it sounds like you don't think folks need mental health services if they're in an ideal commune kind of social setup, and that physical health needs might take more precedence?

I have considered the NP or PA track, but as far as I understand, NPs and PAs have to work under the auspices of physicians. It would therefore seem to me that you lose a certain amount of autonomy, if you always have to have your work and your records checked by doctors. Am I wrong about this? Is it possible for an NP to be autonomous at least as far as the NP's practice scope permits?

Anthropology probably would fascinate me, and at some point I may take a couple of anthro classes just to check it out. I don't think that people would need anywhere near as many mental health services if they were living in a situation that was better fit to basic human nature. It's the oft-used "if you evaluate a fish on its ability to climb a tree, it will spend its whole life thinking it's a failure" thing. The current system doesn't play well with basic human nature. I've seen enough to know. One of my go-to examples is this - we're musical performers and one of our places we play on a regular basis is a home for MR/DD adults. These are people who are too mentally feeble to be able to be brainwashed by the system. They're a delightful, awesome audience. They have no inhibitions, they don't care about anything superficial, they don't judge each other, it's really a beautiful display of raw humanity, and what mentally strong humans could be like if they weren't subjected to the dehumanizing pressures of the system. So, yes, I do believe that if humans were living in a much more "human" system, the balance of the health care they would need throughout their lives would be much further tilted toward "physical health care" and away from "mental health care", compared to the way it is for people in our current system.

Getting a doctorate in cultural anthropology would require you to live amongst a subculture/another culture in the world for about a year for your dissertation....could be of interest to you. It'll be a tough path to carve, though, whatever you choose. What you mention also reminds me of Doctors Without Borders and that kind of work, as well.

Just throwing out some thoughts...

That might interest me, but I'm not positive what I would do with that degree after getting it. I don't even know what a cultural anthropologist does. Right off the bat, it strikes me as one of those careers sort of like getting a degree in philosophy, where the only thing you could really do with it is teach it to the next generation. There are probably other career tracks within cultural anthropology, but I would be most interested to find one that would pass the test of "this work truly aims to make the world a better place". If I could find something like that, I'd bet I'd be more interested in the line of work and the program of study.

Why would someone with autism spectrum disorder, of which a core element is persistent difficulties in social interaction and communication, wish to become a counselor or therapist? This seems akin to someone with a congenital absence of limbs desiring to become a professional dancer.

The autism spectrum is called a spectrum because no two autistic people manifest the condition exactly alike. While you are correct that often, autistic people have major problems with both social interaction and communication, that is not true for all of them.

In my case, I do have major problems with social interaction, mostly because the "rules of engagement" are generally not followed, and it's a really nebulous concept. We're all taught the rules of socialization, things like "don't interrupt others", but many times have I seen people interrupt others without suffering any consequences. I've gone to business mixers where you're essentially supposed to "talk shop" with other businesspeople in the area and make useful professional contacts, and most of the time they talk about things like football and seem totally uninterested in meeting other people they don't know. I don't understand this stuff and I never will.

I have no problem with communication and I never have. The only two things anyone has ever complained about are that I'm too wordy and I tend to use big words. Well, truth be told, I am no more wordy than I need to be. Just because most people value brevity over being comprehensive doesn't mean that that's the best way to go. I have seen too many examples of misunderstandings arising therefrom to place my stamp of approval on that M.O. And if I'm using big words that people don't understand, all they have to do is ask me what I meant and I'll rehash it in simpler terms. (One would think they should take it as a compliment that I thought they were intelligent enough to be able to understand the big words I used.)

When I tell people I'm autistic, most of the time they are surprised. "But you seem so...... NORMAL!" Yeah, because when you get to my age, you have had enough time to practice being normal that it appears to come naturally. Yet, inside, my brain is running red-hot. You can get a VW Bus up to 65 miles per hour, but its engine will be spinning something like 4,000 RPM. Most "normal" cars these days wouldn't even have to hit 2,000 RPM to maintain 65 mph.

I fail to see why a person must be a master of social interaction in order to be a counselor or therapist. All you have to do is understand people and be able to get to the root cause of problems that are presented to you. I've been instrumental, if not solely so, in preventing at least three suicides... and bringing about who knows how much more not-so-easily quantifiable positivity in the lives of others. In no case did I ever need to be a social master in order to bring about positive adjustment in a person's thought processes.

The OP states that he thinks he would be a good therapist because people come to him for advice. My humble opinion is that the giving of advice is exactly the sort of thing that good therapists should avoid at all costs. It's a very natural human instinct to wish to give advice when confronted with a problem, but it is an urge that must be overridden in the course of training to become an effective therapist.

This is one example of where me being brief, as opposed to wordy, causes misunderstandings.

When I say "advice", that is a catch-all term encompassing all of the strategies I use. I am a trained and successful teacher, and one of the things I learned is that you really can't inject knowledge into a person's head. Rather, you must provide an environment and an avenue through which the student constructs the knowledge in his/her own head. (For example, if I tell a piano student "don't speed because you will make mistakes", that's nowhere near as effective as what I usually do, which is tell the student to play the song faster and faster and faster until it becomes a complete train wreck, then ask, "What have you learned about speed?")

What I tend to do is ask lots of questions, generally based upon what the person tells me, so that the person I'm counseling will be led to state the root cause of the problem and as many potential solutions as possible. (I think that we all have, within ourselves, the means to develop solutions. We all have the tools and the raw materials; sometimes we just need the step-by-step instruction sheet.) My advice is typically limited to telling them things about humanity or other external factors that they don't seem to know. Adding that into the mix gives them perspective, and with perspective they can develop a different take on their problems or the causes of their problems.

For example, my most recent counseling work has been done on a 16-year-old girl who tried to kill herself. I know it wouldn't be all that effective to say "you shouldn't kill yourself because [reason], [reason], [reason]". Rather, I took the reasons why she wanted to kill herself... abuse from her father, abuse and rejection from her now ex-boyfriend, and socially ostracizing effects of autism... and told my own stories. I, too, was abused by my parents, abused and rejected by love interests, and socially ostracized due to the effects of autism. My experiences have been objectively much worse than hers, sometimes due to degree of severity and sometimes just because I've suffered through them for 22 years longer than she has. (I know that much care must be exercised when making this comparison, but it holds. She was abused by one parent; I was abused by both. She was abused and rejected by one boy; I was abused and rejected by more than one girlfriend, and one wife. She has suffered the social effects of autism for 16 years; for me it's been 38 years.) Now, she thinks I'm totally cool. So, after telling each story, I asked things like "Should I have killed myself because of this?" "Are you glad I didn't kill myself in [year] because of this?", etc. She loves my wife too. I included some similar stories about her, same deal. "Should she have killed herself because of this?" The point was to get her thinking "wow, they've been through a lot, and I think they shouldn't have killed themselves because of it, therefore I shouldn't kill myself because of it". Thus far, according to her mom at least, it seems to be working.

When I say "advice", it encompasses all of this and more.

Beyond that, the OP seems to have a goal of nurturing the growth and development of communal living organizations. While this seems an interesting and laudable goal, it is completely unrelated to the practice of mental health care, pretty much regardless of degree path. Furthermore, the level of financial, temporal, and intellectual commitment required to complete a doctoral level degree and/or physician training would seriously impede the OP's ability to devote much attention to these alternative interests for at least a decade.

Well, hopefully I have a few decades left... it seems that nobody in my family has ever died young except from car accidents or complications of smoking. I have never smoked, I don't intend to start, and I hope not to die in a car accident... so if I can avoid that last one, I have no reason to worry about not living at least into my 80s.

Is the practice of mental health care totally unrelated to the adjustment of societal or environmental conditions? If some mental conditions are societally created, are they not best treated or annihilated through adjusting the societal situation so that it no longer causes that problem? I mean, I see it like this - if you have persistent headaches and coughing because you live in a place that is full of black mold, taking Advil and Robitussin will only alleviate symptoms temporarily; they won't actually solve the problem. Move into a place that isn't full of black mold, and you won't have to take Advil or Robitussin because the trigger for your headaches and coughing will be gone. In the first case, medicating the problem without removing the triggers doesn't solve the problem. In the second case, the problem is solved by removing the triggers, and medication isn't needed. Yet, the second solution - the non-medical solution - is the one that works.

 

[WisNeuro]

I would never tolerate being "pimped". That is disrespectful. If someone wants to question me until I get something wrong because that person is legitimately concerned about making sure that I know as much as I can know, that's fine. As a teacher, I've been known to do that with my students. But once they get something wrong, I don't mock them for it. I say words to the effect of "this is something you need to know in order to be successful, so look it up".

If you can't deal with this, I would strongly advise against med school.

 

[PsyDr]

I’d love a job where I told people what to do that allowed me to travel, study in an area where I already know the answers, education the term do which I dictated, and received professional advice on my own terms.

 

[RomaniGypsy]

If you can't deal with this, I would strongly advise against med school.

Explain to me why this "pimping" stuff is necessary... and why, if it is not necessary, people don't rise up en masse to quash it.

 

[WisNeuro]

Explain to me why this "pimping" stuff is necessary... and why, if it is not necessary, people don't rise up en masse to quash it.

Never said it was necessary. As to the "rising up en masse," probably because the "masse" does not care enough to rise up against it. It's a minor annoyance, along with countless other minor and moderate annoyances, along a long path to an end goal. I guess you could try and go it solo, but just don't be surprised when it starts to close doors. You gots to play the game to reach a point where you can change the game, however slim the chance.

 

[WisNeuro]

For example, my most recent counseling work has been done on a 16-year-old girl who tried to kill herself. I know it wouldn't be all that effective to say "you shouldn't kill yourself because [reason], [reason], [reason]". Rather, I took the reasons why she wanted to kill herself... abuse from her father, abuse and rejection from her now ex-boyfriend, and socially ostracizing effects of autism... and told my own stories. I, too, was abused by my parents, abused and rejected by love interests, and socially ostracized due to the effects of autism. My experiences have been objectively much worse than hers, sometimes due to degree of severity and sometimes just because I've suffered through them for 22 years longer than she has. (I know that much care must be exercised when making this comparison, but it holds. She was abused by one parent; I was abused by both. She was abused and rejected by one boy; I was abused and rejected by more than one girlfriend, and one wife. She has suffered the social effects of autism for 16 years; for me it's been 38 years.) Now, she thinks I'm totally cool. So, after telling each story, I asked things like "Should I have killed myself because of this?" "Are you glad I didn't kill myself in [year] because of this?", etc. She loves my wife too. I included some similar stories about her, same deal. "Should she have killed herself because of this?" The point was to get her thinking "wow, they've been through a lot, and I think they shouldn't have killed themselves because of it, therefore I shouldn't kill myself because of it". Thus far, according to her mom at least, it seems to be working.

When I say "advice", it encompasses all of this and more.

This approach generally does not work well. The whole, "I've had it worse than you, and I kind of have my **** together, why don't you" is incredibly invalidating to most patients. To anyone reading this, please never do this with a patient.

 

[foreverbull]

More thoughts:
If wanting more of the shaman/doctor route I'd look into classes in transpersonal psychology and/or psychiatrist Stanislav Grof at the California Institute of Integral Studies, perhaps. The transpersonal doctorate won't allow licensure in clinical/counseling psychology...BUT if you also had a medical degree/license, you could blend spiritual and medical models and use that more holistic view. It doesn't capture the anarcho-primitivism/community model that you're into though, which would come from anthropology classes.

The Primitivist Critique of Civilization--Richard Heinberg
- See if this fits for you. None of the primitivists have a background in psychology, as far as I know, yet they're quick to say mental illness is a product of how we live, so if you wanted to, you could trailblaze as a clinical/counseling psychologist scholar/researcher in this area with training and the tools to do research to back you up.

 

[AbnormalPsych]

 

[Dahresto]

This is like watching a train wreck slowly unfold, lol

 

[erg923]

Explain to me why this "pimping" stuff is necessary... and why, if it is not necessary, people don't rise up en masse to quash it.

Good Lord, are you serious with this? "Rising up in mass" bc someone is rude to you? What planet do you live on?

 

[Dahresto]

For example, my most recent counseling work has been done on a 16-year-old girl who tried to kill herself. I know it wouldn't be all that effective to say "you shouldn't kill yourself because [reason], [reason], [reason]". Rather, I took the reasons why she wanted to kill herself... abuse from her father, abuse and rejection from her now ex-boyfriend, and socially ostracizing effects of autism... and told my own stories. I, too, was abused by my parents, abused and rejected by love interests, and socially ostracized due to the effects of autism. My experiences have been objectively much worse than hers, sometimes due to degree of severity and sometimes just because I've suffered through them for 22 years longer than she has. (I know that much care must be exercised when making this comparison, but it holds. She was abused by one parent; I was abused by both. She was abused and rejected by one boy; I was abused and rejected by more than one girlfriend, and one wife. She has suffered the social effects of autism for 16 years; for me it's been 38 years.) Now, she thinks I'm totally cool. So, after telling each story, I asked things like "Should I have killed myself because of this?" "Are you glad I didn't kill myself in [year] because of this?", etc. She loves my wife too. I included some similar stories about her, same deal. "Should she have killed herself because of this?" The point was to get her thinking "wow, they've been through a lot, and I think they shouldn't have killed themselves because of it, therefore I shouldn't kill myself because of it". Thus far, according to her mom at least, it seems to be working.

Not the approach I would have taken...your armchair experience does show tho

 

[PsyDuck90]

Is no one else concerned this person is counseling suicidal adolescents without any formal clinical training or licensure?

 

[tr]

The autism spectrum is called a spectrum because no two autistic people manifest the condition exactly alike. While you are correct that often, autistic people have major problems with both social interaction and communication, that is not true for all of them.

Criterion A in the DSM5 definition of ASD is
persistent deficits in social communication and social interaction across multiple contexts.

DSM-5 Diagnostic Criteria

If you don't have that, you don't have autism. And if you do have it, it's going to be pretty difficult to be a good therapist. Maybe there could be an argument for there being an advantage in providing ABA to ASD children. It didn't sound like that was at all your area of interest though.

For example, my most recent counseling work has been done on a 16-year-old girl who tried to kill herself. I know it wouldn't be all that effective to say "you shouldn't kill yourself because [reason], [reason], [reason]". Rather, I took the reasons why she wanted to kill herself... abuse from her father, abuse and rejection from her now ex-boyfriend, and socially ostracizing effects of autism... and told my own stories. I, too, was abused by my parents, abused and rejected by love interests, and socially ostracized due to the effects of autism. My experiences have been objectively much worse than hers, sometimes due to degree of severity and sometimes just because I've suffered through them for 22 years longer than she has. (I know that much care must be exercised when making this comparison, but it holds. She was abused by one parent; I was abused by both. She was abused and rejected by one boy; I was abused and rejected by more than one girlfriend, and one wife. She has suffered the social effects of autism for 16 years; for me it's been 38 years.) Now, she thinks I'm totally cool. So, after telling each story, I asked things like "Should I have killed myself because of this?" "Are you glad I didn't kill myself in [year] because of this?", etc. She loves my wife too. I included some similar stories about her, same deal. "Should she have killed herself because of this?" The point was to get her thinking "wow, they've been through a lot, and I think they shouldn't have killed themselves because of it, therefore I shouldn't kill myself because of it". Thus far, according to her mom at least, it seems to be working.

As noted by others, this would be a terrible approach for most neurotypicals at least.

Is the practice of mental health care totally unrelated to the adjustment of societal or environmental conditions?

Not that it should be at all (I agree with much of what you say about the organization of modern society) but in practice it is. As a practitioner you are working with individuals who come to you for help with a specific set of problems. Discarding the existing structure of their lives and moving to a commune will likely not be a realistic or palatable therapeutic option for most. If you found a commune and only treat the members, you likely won't have anything like enough income to sustain yourself. If you want to make a reasonable income you'll have to work within existing billing structures and, more likely than not, mostly see patients who are not commune members.

You could work as an in-house therapist or psychiatrist for a board and care. At least in the good ones, that's a wraparound care situation where a lot of attention is paid to optimizing social and environmental factors. But those are mostly for people with severe, chronic mental illness of the type that is not going to be eliminated by fresh air, sunshine, and a supportive social environment.

 

[MAClinician]

Criterion A in the DSM5 definition of ASD is
persistent deficits in social communication and social interaction across multiple contexts.

DSM-5 Diagnostic Criteria

If you don't have that, you don't have autism. And if you do have it, it's going to be pretty difficult to be a good therapist.

His autism diagnosis did come from his scores on the MMPI 2, and not....ADOS, GARS, or any of the other standardized protocols typically used to diagnose autism.

 

[RomaniGypsy]

This approach generally does not work well. The whole, "I've had it worse than you, and I kind of have my **** together, why don't you" is incredibly invalidating to most patients. To anyone reading this, please never do this with a patient.

She's a friend, not a "patient". I know that this wouldn't work with a patient. I do understand context. (Besides, I never told her that I have my stuff together. That would be somewhat of a lie. I played to the angle that she actually cares for and about me. I know that that angle wouldn't work in a regular counselor-patient relationship.)

Good Lord, are you serious with this? "Rising up in mass" bc someone is rude to you? What planet do you live on?

Give me one good reason why people shouldn't rise up against unnecessary and unproductive rudeness.

And yes, I am serious. This type of rudeness is not necessary. It is of zero benefit and plenty of detriment; anything satisfying both of those conditions ought never be practiced or accepted... especially by those dedicating their lives to serving and healing humanity.

Criterion A in the DSM5 definition of ASD is
persistent deficits in social communication and social interaction across multiple contexts.

If you don't have that, you don't have autism. And if you do have it, it's going to be pretty difficult to be a good therapist. Maybe there could be an argument for there being an advantage in providing ABA to ASD children. It didn't sound like that was at all your area of interest though.

"Social communication" - yes, there I tend to have issues, as evinced by how so many people misunderstand me. (Ordinary communication is easy. I'm good at putting thoughts into words that others can understand.)

Yet, I have found that in nearly all (if not all) cases, the reason why there is ever any unusual misunderstanding (exceeding the degree that everyone experiences at some point) is because people take my exact words and mentally translate them into something they never were. Okay, they do that because most people speak in metaphors to an extent and those people tend to mean things other than what they say, but not me. I choose my words precisely and I mean each one exactly as it is spoken. If I make a mistake as I'm going, I will correct it as soon as I recognize that what I said did not match what I meant. This is why I use a lot of words. I prefer not making people guess at my real meanings.

As noted by others, this would be a terrible approach for most neurotypicals at least.

I'll take it a step further and say that it would be a terrible approach for everyone who doesn't fall into the "friend" category. I can recognize.

But let's put everything into perspective. My wife and I drove 3,000 miles round trip last month to see this girl, whom we haven't seen in five years due to having moved away, as soon as we found out that she had attempted suicide. The trip was a surprise. When she saw us, she cried for 15 minutes straight. She gave me the strongest hug I've gotten in the last ten years from anyone except my wife. I first met her when she signed up for piano lessons with me and we eventually became fairly tight with her family.

If ordinary counselors and their clients have that kind of relationship... generally speaking, something is definitely not as it should be, and that counselor's license is likely not long for this world.

However, when dealing with a friend, it'd seem silly to use a bland textbook approach. You use the tools you can use to accomplish the job that needs to be accomplished.

Not that it should be at all (I agree with much of what you say about the organization of modern society) but in practice it is. As a practitioner you are working with individuals who come to you for help with a specific set of problems. Discarding the existing structure of their lives and moving to a commune will likely not be a realistic or palatable therapeutic option for most.

Quite true. Most people wouldn't want to do that. Step one in the endeavor to change the system is to establish one small community that lives and operates by a better system. That one will stand to prove that the new system does work on a microcosmic level, and also it will entice others to join up with the new system... eventually necessitating starting more communities.

I know it sounds like a radical change, but if we look around, we can see loads of evidence that the current system has failed. Left unchecked for much longer, we're in for major trouble, if for no other reason than because the current system is fueled by a mathematical impossibility - the notion that there can be infinite growth on a finite planet.

If you found a commune and only treat the members, you likely won't have anything like enough income to sustain yourself. If you want to make a reasonable income you'll have to work within existing billing structures and, more likely than not, mostly see patients who are not commune members.

It'd have to be that last one, and I'd see commune members in the structure of "private practice".

His autism diagnosis did come from his scores on the MMPI 2, and not....ADOS, GARS, or any of the other standardized protocols typically used to diagnose autism.

Scores on the MMPI 2, as well as an interview / conversation with the psychologist. Furthermore, as this was in early 2012, they were still on the DSM-IV. My official diagnosis was termed "Asperger Disorder", though everyone outside of psychologists and their ilk calls it "Asperger's Syndrome". In the DSM-V, that title was absorbed into the category of high-functioning autism.

 

[super.ego]

Honestly, what impresses me most about RomaniGypsy and his psychotherapeutic potential is his ability to patiently sift through and respond to the disheartening comments on this thread. With that said, I agree with nearly all the objections raised by other posters.

 

[AbnormalPsych]

Honestly, what impresses me most about RomaniGypsy and his psychotherapeutic potential is his ability to patiently sift through and respond to the disheartening comments on this thread. With that said, I agree with nearly all the objections raised by other posters.

I concur.

 

[WisNeuro]

She's a friend, not a "patient". I know that this wouldn't work with a patient. I do understand context. (Besides, I never told her that I have my stuff together. That would be somewhat of a lie. I played to the angle that she actually cares for and about me. I know that that angle wouldn't work in a regular counselor-patient relationship.)

Then I definitely wouldn't trot that tidbit out as proof of your acumen in the context of your "counseling work."

 

[WisNeuro]

Agreed. My initial reaction was "you can't have it both ways," i.e., you can't use professional terminology to describe your work and then duck behind the guise of informality ("friend") when people criticize you.

I am more concerned about naïve future readers who may think that is a good therapeutic technique, when it has much more potential for iatrogenic damage. In my many years of doing trauma work, I've seen what happens when the "trauma comparisons" go bad in poorly run trauma groups.

 

[Mama Bear]

I am more concerned about naïve future readers who may think that is a good therapeutic technique, when it has much more potential for iatrogenic damage. In my many years of doing trauma work, I've seen what happens when the "trauma comparisons" go bad in poorly run trauma groups.

Agreed. Also, this type of self-disclosure risks supporting the assumption some people may hold that one must have gone through a specific experience similar to the client’s in order to provide effective intervention.

 

[deleted760483]

Why bother going to school if you already know what the problem is and how to fix it?

 

[cara susanna]

And you hold the risk that your patient will start to hold back from you ("jeez, they've been through so much, I shouldn't add to it").

 

[BuckeyeLove]

I don't want to come across as hyperbolic....but greatest thread ever?

 

[deleted760483]

I don't want to come across as hyperbolic....but greatest thread ever?

I'm holding out hope that the OP is actually a high school senior and not a 38 year old adult. The thought process here is so overtly adolescent that it is hard to imagine it coming from anyone else.

 

[AcronymAllergy]

Mod Note: Let's please try to remain on-topic and helpful/professional in our posts. Thanks.

 

[tr]

It'd have to be that last one, and I'd see commune members in the structure of "private practice"

OK so if you are going to be the commune psychiatrist for a group of 150 people, and we can estimate that about 10 percent of that group has some kind of mental health or counseling need, you're looking at a patient roster of 15. No way that is going to be enough to make a living, especially if they pay you in chickens. Typical patient population for a full-time psychiatrist is in the several hundreds at least.

 

[jblil]

if you are going to be the commune psychiatrist for a group of 150 people, and we can estimate that about 10 percent of that group has some kind of mental health or counseling need (...)

In such a commune, I'd guess 75% of the group has some kind of mental health or counseling need.

My brother-in-law lived in a commune. My wife and I went to visit him once... I got a whole new appreciation for the phrase "the inmates are running the asylum" after that trip.

 

[deleted343839]

What were the concerns of the patients you referenced, especially as they appear to be at odds with things I've said?

My recollection is that their concerns were overwhelmingly related to abuse (sexual, physical, and/or emotional) in the family of origin.