Ibid

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Everything he has in bold in the article I agree with. Nearly everything else not bolded is wrong imo. It all looks very retrograde and more of the same if you ask me. He just has his own idea of what psychiatry should look like and wants to dump the rest.

If you like him you like him but I'm not sure what he is saying is new. He is just presenting his own agenda.

Maybe the factions within psychiatry will split into different professions. That would be one way forward. As he wants to change the name perhaps he wants a new profession to be a part of. I imagine what is left will keep the name and what then?

Are you happy to change the name of your profession to something else? What would you call yourself if not a psychiatrist?

Interesting.
 
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Telamir

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I kind of like the idea of neurology + psychiatry. To be honest to me it seems like one without the other feels a bit "incomplete" at times. One of the reasons I'm considering one of the double boarding programs...if only they weren't so ridiculously long.
 

whopper

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I find the op-ed indicative of someone very insightful, and I find a lot of merit with it though I can see several people disagreeing with it and have valid reasons for doing so. At the very least, I think his op-ed is a good framework to start a debate.

Personally, I'm very much for the destruction of "false mythologies" within the field.
 

Ibid

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Personally, I'm very much for the destruction of "false mythologies" within the field.

I respect you and I know you respect this chap but the above could not be more ironic given how he has presented his arguement. It is as if he has tried to create a new myth ref what happened in Japan.



I wouldn't feel bad if the name changed to reflect modern practices.

I would say that there is more than one idea of what constitutes modern practice and what approach is best. I feel he has a rather narrow view of what psychiatry is and if I was being uncharitable I would say the part he likes is the bit that can be industrialised and leveraged for a profit.

How about this modern practice? How does this fit with his idea for "brain institutes".

[YOUTUBE]http://www.youtube.com/watch?v=aBjIvnRFja4[/YOUTUBE]

Can you be more specific?

One thing bothers me the most. I do think people should be able to choose the sort of interventions and style he is positing but so to should people have the chance to experience something informed by a different perspective. Both or all of these are currently called psychiatry.

Below c&p from the article.
In addition, the labels currently attached to psychiatric disorders also could also be changed, including stigmatizing diagnoses such as schizophrenia, mania, or borderline personality disorder. New names for such disorders can be linked to brain lesions, pathways, or circuits underlying them. Several years ago Japan replaced the term "schizophrenia" with "integration disorder," which was met with a positive response from patients and practitioners.2

What really bothers me about this article is how imo (people will just have to make up their own minds) he is misrepresenting what happened in Japan regarding the name change for schizophrenia.

From the abstract which he quotes but misrepresents imo. You can see it doesn't really support his argument at all.

http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1819.2010.02174.x/full


IN AUGUST 2002, with the aim of eradicating the misunderstanding and prejudice associated with the names of mental illnesses, the Japanese Society of Psychiatry and Neurology proposed a revision in the Japanese translation for ‘schizophrenia' from ‘seishin-bunretsu-byo', which literally means ‘split-mind disease', to ‘togo-****cho-sho' (integration disorder).1–3 In addition to the purpose of modifying an incorrect translation, the change was made with the intention of reducing the negative connotation associated with the term ‘seishin-bunretsu-byo' (split-mind disease)4–6 as well as the resulting prejudice and discrimination. This was in turn hoped to promote comprehensive health care, including drug therapy and psychosocial intervention.

Tut tut 50th best Doctor in America?? You just can't trust anyone these days.

Destroy myths? Create a new image? Yes. I agree. All this quoting articles that don't really support the argument in the body of the text has to stop. Has this ever happened before????
 

kugel

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Eh. Hypo-impressed.
Nearly everyone will agree with the headings, nearly everyone will disagree on the details.

Create a new name:
seems better to decide what the thing will be before you decide what to call it, but that's probably why I'm not in marketing.

Destroy false mythology:
everyone agrees, but lots disagree on which are false

Revolutionize diagnostic models:
to what?

Design novel treatment approaches:
With the $ involved, does anyone think this isn't going on?

Transform the delivery system setting:
same could (and should) be said for all of medicine, but at the very least we could reduce the duplication of effort by collapsing public health with public mental health.

New specialization and training model:
I can't imagine the majority of people who want to be neurologists also being psychotherapists, and vice versa. Perhaps we should divorce from psychotherapy (I hear the gnashing of teeth now) in the same way that PM&R is separate from physical therapy.

New image:
but I like bowties

A new destiny:
let me guess: one where we are revered and rich and follow you?
 

whopper

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I respect you and I know you respect this chap but the above could not be more ironic given how he has presented his arguement. It is as if he has tried to create a new myth ref what happened in Japan.

well thanks for the compliment. I was not thinking of your reference to Japan at all until I read your reference.

The part where I see people having valid disagreements with Nasrallah is that he presents his view of psychiatry. While he certainly is someone to be respected in the field, it's his own vision, and one where the's plenty of debate as to possibilities that could happen in the future.

As for false mythologies, I see psychiatrists very often in court or in psychotherapy try to make themselves out to be Jedi Masters, talking as if they know what's going on when in reality they only have hypothetical theories as to what is going on.

When I suspect something is going on, I tell the patient something to the effect of, (and I had a case where this happened), "Given what you told me, I'm getting theory that could be wrong that perhaps your frustration is possibly from you not being able to release your sexual frustrations. You're a virgin at age 45 and it's not by choice. I'm thinking that perhaps your loneliness is the root cause of your problems. I'm still getting to know you and I don't want you to believe that I believe I'm right. Tell me what your thoughts are on my theory and please feel free to tell me if you think I'm wrong."

Now I proposed this theory after quite a few interviews with the patient where I listened to him and only asked open-ended questions for quite some time. I would never push my theory as absolute fact or me being somehow all-knowing because I'm a psychiatrist, and let's assume I was wrong (the patient told me he thought I was right--thank God), I could've been causing major damage pushing such an idea that could be very embarrassing for the patient and the doctor.

Another example, if a Suboxone patient claims to have lost their script or their meds, I will not refill it, but I never accuse the patient of lying. I merely tell them that I cannot tell if they are lying or not and that from the beginning we established that they had the responsibility of handling the meds safely, and that this is not a test of their honesty. Not refilling their meds is my half of being part of a responsible treatment relationship.

Unfortunately, I've known psychiatrists to push their theory on a patient as if they are right and if the patient disagrees, the psychiatrist only uses that as further evidence to point out they are right and the patient is wrong. I've also known some psychiatrists to believe that they are almost always right because of their M.D. There is no logical connection in learning pathology, physiology or several other classes somehow makes someone an authority on the mind, and there are plenty of studies showing that psychiatrists truly do not know more than laymen in several aspects where they are asked for their expertise. (e.g. the Court asking a psychiatrist if the person is lying). I've also known dependent patients to then be further bullied by their mental health provider who pushes their ideas onto them.

We psychiatrists should practice within our expertise and that's it.
 
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F0nzie

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How about this modern practice? How does this fit with his idea for “brain institutes”.

[YOUTUBE]http://www.youtube.com/watch?v=aBjIvnRFja4[/YOUTUBE]

If we are to be respected and supported in the medical community, it might help to understand the neuroscience behind why going to a getaway in Finland with therapists, lakes, and ducks helps with Schizophrenia. Maybe there is a link. We have enough preliminary research in brain imaging to suggest medications and psychotherapy result in neuroplastic changes. Solidifying our understanding of the neurosciences in Psychiaty and increase funding for research may then help us fine tune and enhance our therapies. If we don't embrace it, we can't find out if the experiment is true. Our other option is to embrace ignorance of the research data and change the scenery from lakes to beaches and ducks to flamingos and see what happens. The latter option does not help our credibility.
 

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If we are to be respected and supported in the medical community,

Hold on. Stuff the medical community. What counts is results. This group in Finland claim outstanding results. That should comand interest at least in the first instance. The other really salient point is that there is NO ANTIPSYCHIATRY MOVEMENT in that part of the world. Outstanding results and happy customers, there is something worth looking into here.

it might help to understand the neuroscience behind why going to a getaway in Finland with therapists, lakes, and ducks helps with Schizophrenia.

Sure. Two of the people in that clip are psychiatrists. I'm sure they would not disagree. But it is not about the lakes and ducks (I know you are joking) it is about the open dialogue approach, keeping in mind that they claim that after an initial first episode with the right intervention that Schizophrenia is not appearing.


Maybe there is a link. We have enough preliminary research in brain imaging to suggest medications and psychotherapy result in neuroplastic changes. Solidifying our understanding of the neurosciences in Psychiaty and increase funding for research may then help us fine tune and enhance our therapies.

I fully agree with this but we need to invest an equal amount of time and effort investigating what it is about this approach that is working. (if it really is).

If we don't embrace it, we can't find out if the experiment is true. Our other option is to embrace ignorance of the research data and change the scenery from lakes to beaches and ducks to flamingos and see what happens. The latter option does not help our credibility.

I guess I have already made the point that this is not about scenery but an approach and the stock of mental health services and psychiatrists in that part of the world seems very high indeed, if what I read is correct.

They do have a group of historical patients for whom the approach is not changing anything and they dont deny that but their brand of early intervention is what they claim is working.

There is not much research out but I will look for some and edit it into this post when I find it.

Open Dialogue Approach: Treatment Principles and Preliminary Results of a Two- year Follow-up on First Episode Schizophrenia" Ethical and Human Sciences and Services, 2003, 5(3), 163-182. http://bit.ly/xV7eX4

Five-year experience of first-episode nonaffective psychosis in open-dialogue approach: Treatment principles, follow-up outcomes, and two case studies" Psychotherapy Research, March 2006; 16(2): 214_/228 http://bit.ly/Am67HE
 
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PETRAN

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The article is ok, but in order to establish such a rigorous and objective brain-based medical practice for mental disorders, you have to establish first some basic scientific principles in general. Pychiatry is not neurology in which you can explain "numbing" by a pinched nerve or by lesions in the cortico-spinal tract. What is belief? Where is it in the brain? What is a mental representation-knowledge? (an "idea" as they used to call it) and how is represented by neuronal codes/spikes? What is meaning and metaphor construction and how are they neurally realized? What are the brain differences between concrete and abstract thinking? Where is an emotion in a brain-circuit? How are different emotions organised and constructed? How are motivation and volition produced and regulated? What is phenomenal consciousness? (the so-called "hard-problem").



These are valid and crucial questions that modern experimental psychology and cognitive neuropsychology and neuroscience try to understand. If everything, i think a medical science-based mental-health specialty should be based on such behavioral/cognitive neuroscience/neuropsychology as well as psychopharmacology/neurochemistry, genetics/epigenetics (so i agree with this) and even reach as far as computational neuroscience, philosophy of mind, sociology and anthropology.


Maybe "psychiatry" through medical school is not as good as a model. Maybe a seperate doctorate (like dentistry) providing training in all those fields at once would be better. it sounds "herretic" and could cause some hot reactions but hey, we are just discussing. :p
 

billypilgrim37

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Doesn't Nasrallah basically write that same article about every 3 issues of Current? I think he only has 3 different essays, and he just rewrites them every 3 months. It's a pep rally article, nothing more. It's not a serious proposal, at least not as presented in Current Psychiatry, which is unfortunately both the most practical and the most pharma-tainted publication in existence.
 

F0nzie

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We aren't anywhere near incorporating neuroimaging tools into clinical practice. And we do not yet have biomarkers. I suspect a complete shift in this direction would kill the art of our profession that has drawn so many of us to it. I find neurology intellectually stimulating, but practicing it not so much.
 
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