Psychiatrists Cheerful but Not the Happiest of Specialists

[JMC_MarineCorps]

http://www.medscape.com/viewarticle/760747?src=stfb

March 22, 2012 — Psychiatrists are a pretty cheerful bunch, although, perhaps ironically, they are not the happiest of all specialists.

According to the Medscape Psychiatrist Lifestyle Report 2012 , among 28,108 physicians from 25 different specialties surveyed, when it comes to enjoying life outside work, psychiatrists ranked eighth.

Medscape asked US physicians to rate their level of happiness outside of work on a scale of 1 to 5, with 1 being the least happy and 5 being the happiest. The average happiness score for all physicians who responded was 3.96, which is on the cheerful side. Psychiatrists were happier still, with a score of 3.99.

With an average score of 4.09, the happiest of all specialists were rheumatologists, and the least happy were neurologists, who had an average score of 3.88.

Bookworms

Although psychiatrists enjoy many of the same pastimes as physicians in general, including exercise and physical activity, travel, cultural events, food, and wine, the survey results revealed that they tend to be a bit more bookish than their colleagues, ranking reading rather than exercise as their most popular pastime.

Among psychiatrists, more interesting pastimes were robotics and herpetology, the study of amphibians and reptiles.

Medscape Psychiatrist Lifestyle Report also revealed that psychiatrists take significantly less time off than other specialists. Almost 17% take more than 4 weeks, which is below the physician average, and 30% take fewer than 2 weeks per year.

The top 2 vacations for psychiatrists are foreign travel (54.1%) and beaches (47%). About 20% of psychiatrists preferred cultural trips, followed closely by road trips and stays at vacation homes. Others preferred to relax at home, and 1 psychiatrist reported needing the sanctuary of a monastery to relax.

Psychiatrists are slightly less likely to be married (71%) compared with their physician colleagues (81%). They also reported a higher divorce and separation rate — 8% vs 5.7% for all physicians.

The survey asked specialists to rank their physical health. The healthiest specialists included dermatologists, plastic surgeons, endocrinologists, orthopedists, and cardiologists. The 5 least healthy were general surgeons, psychiatrists, ob/gyns, pediatricians, and critical care physicians.

Psychiatrist survey respondents rated their health as slightly worse than the average physician in every age group, except for the youngest: those 31 to 40 years of age. That group reported an average health score of 4.04 out of 5, compared with the overall average of 4.00. Psychiatrists in all of the older groups rated their health worse compared with other physicians.

Most Liberal

The Medscape survey also revealed that psychiatrists are no less and no more likely to be overweight (32%) or obese (5.6%) than other physicians. It also showed that psychiatrists exercise about as frequently as other physicians and that their exercise frequency tends to increase with age.

For example, for psychiatrists in their 50s, 33% exercise 4 or more times a week. This proportion climbs to 35% for psychiatrists in their 60s and to 38% for those in their 70s or older.

Aerobic exercise is the most popular and is practiced by 72% of psychiatrists. Approximately 28% of psychiatrists report engaging in weight training. About 19% of psychiatrists engage in Eastern practices such as yoga and tai chi vs 14.6% of all physicians.

About 3% of psychiatrists smoke, which is well below the national average of 18%, and approximately 12% are ex-smokers.

According to a 2010 Gallup poll, 67% of Americans drink alcohol. Psychiatrists are slightly ahead of this rate, with 69% reporting that they drink and 31% reporting that they do not drink at all. However, those who do drink tend not to overindulge, with over 50% reporting that they have less than 1 drink per day, 14% reporting that they drink 1 or 2 drinks per day, and only 2.1% admitting to more than 2 drinks daily.

When asked about their political leanings, over 36% of psychiatrists defined themselves as being both socially and fiscally liberal — a percentage that is higher than in the general US population and also higher than in the general population of physicians.

About 18% of psychiatrists described their views as being conservative in both areas. When the data are broken down further, 60% of psychiatrists say that they are fiscally conservative, and almost 78% describe themselves as social liberals, making them among the most left-leaning of physician specialties surveyed.

The full Medscape Physician Lifestyle Report 2012 is available online.

http://www.medscape.com/features/slideshow/lifestyle/2012/psychiatry

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[st2205]

Herpetology, huh?

 

[peppy]

Interesting.
Hopefully the "less healthy" thing is more a reflection of people who already have health issues being more likely to join this field than a more physically demanding one, though I am concerned it's a sign that we're too sedentary.
I would agree that it is true that most psychiatrists are politically liberal, but I don't think that conservatives should be reluctant to be part of this field. It's possible to have compassion for mental illness without feeling that government intervention is the best way to address the social problems it causes. Sometimes I've been surprised by the politcal views of people once I've gotten to know them.

 

[whopper]

I don't know about other psychiatrists, I but I personally love the field, love what I do, and am very passionate about it, and I consider myself happy.

I am fiscally conservative (though I consider that a loaded term because conservatives or liberals are only fiscally "conservative" when their opponent is President), socially liberal, but highly vary on other issues (e.g. I'm for gun rights and ownership, for the environment, for national defense, didn't like the last President or the current one...)

 

[digitlnoize]

I don't know about other psychiatrists, I but I personally love the field, love what I do, and am very passionate about it, and I consider myself happy.

I am fiscally conservative (though I consider that a loaded term because conservatives or liberals are only fiscally "conservative" when their opponent is President), socially liberal, but highly vary on other issues (e.g. I'm for gun rights and ownership, for the environment, for national defense, didn't like the last President or the current one...)

I saw this a few days ago. Interesting.

I bet the numbers would be better if you could somehow correct for people who wound up in psych as a backup or "last resort" and aren't truly interested in the field.

I actually got in a bit of an argument with a classmate of mine who told me that I couldn't do psych because I was "too conservative" and conservative people can't do psych.

I don't agree at all, although I guess I could see how psychiatrists could wind up more socially liberal, since our patients would probably benefit from some socially liberal policies.

I am exactly like Whopper FWIW...socially liberal, fiscally conservative, and variable on numerous issues...and not a huge fan of either party, although Obama has a pretty good voice.

 

[JMC_MarineCorps]

people who wound up in psych as a backup or "last resort"

This is hard for me to imagine, not that it couldn't happen (I get the "lifestyle" argument, but that's just somebody's idealization as opposed to hard facts), but the idea that somebody could complete 4 years of this training (ie, looking at your own stuff, possibly getting in therapy yourself if indicated, managing countertransference and using it in the therapy, etc) and not really be interested seems (to me at least) unlikely.

 

[Ibid]

It's possible to have compassion for mental illness without feeling that government intervention is the best way to address the social problems it causes.

I think social problems cause a lot of illness and certainly exacerbates things as much as the other way around.

Sometimes I've been surprised by the politcal views of people once I've gotten to know them.

In my experience people are surprised to find out exactly where they are themselves on the political compass. It's not alway where they think they are.

http://www.politicalcompass.org/test

although Obama has a pretty good voice.

Probably the best speech giver the US has had since Lincoln. 10/10 imo with some real standout performances.

I don't know about other psychiatrists, I but I personally love the field, love what I do, and am very passionate about it, and I consider myself happy.

Allways look on the bright side eh?
[YOUTUBE]http://www.youtube.com/watch?v=WlBiLNN1NhQ[/YOUTUBE]

 

[digitlnoize]

Probably the best speech giver the US has had since Lincoln. 10/10 imo with some real standout performances.

Ha. No, I meant that he has a good VOICE

[YOUTUBE]http://www.youtube.com/watch?v=y6uHR90Sq6k[/YOUTUBE]

[YOUTUBE]http://www.youtube.com/watch?v=Z7x4ZS7ZZWc[/YOUTUBE]

 

[Ibid]

Ha. No, I meant that he has a good VOICE

Yes, pure staged managed political theatre. Very slick.

Not everyone can pull it off.
[YOUTUBE]http://www.youtube.com/watch?v=EvxKZRf8k2k[/YOUTUBE]

In the UK we had to put up with phoney Tony as guitar player. It does rather make the point that their are advantages to living in a constitutional monarchy. You can put all the politics and attendent silliness into one box and invest all the dignity of the state in someone else.

 

[notdeadyet]

This is hard for me to imagine, not that it couldn't happen (I get the "lifestyle" argument, but that's just somebody's idealization as opposed to hard facts), but the idea that somebody could complete 4 years of this training (ie, looking at your own stuff, possibly getting in therapy yourself if indicated, managing countertransference and using it in the therapy, etc) and not really be interested seems (to me at least) unlikely.

Psych is only hard if you want to do it well. If you just want to coast and dial it in, it's an excellent choice. There are a lot of folks in psychiatry that illustrate this point.

 

[Ibid]

Psych is only hard if you want to do it well. If you just want to coast and dial it in, it's an excellent choice. There are a lot of folks in psychiatry that illustrate this point.

I see this point being made a lot here or frequently enough to make one think that something significant is at hand. No one ever suggests a breakdown in terms of percentages or quantifies it in any way at all though. Obv its all subjective but I do wonder given that it is a problem what sort of scale it has. What is a lot in this context?

I understand that just pointing out the problem is a brave thing for some people to do though as it may be seen as seditious.

 

[splik]

I would agree that it is true that most psychiatrists are politically liberal, but I don't think that conservatives should be reluctant to be part of this field. It's possible to have compassion for mental illness without feeling that government intervention is the best way to address the social problems it causes.

I completely agree compassion for one's patients has nothing to do with your political leanings. But it certainly will influence how you view and practice psychiatry. In general psychiatrists who are more left wing are more likely to have a social model of madness, and outside of the US anyway, practice psychotherapy (in France this has been Lacanian psychoanalysis which was very much wedded to radical anti-psychiatry and marxism). Those to the right of the political spectrum tend to have a more biological model. Incidentally, during conservative/republican governments there tends to be more funding into biological aspects of psychiatry compared with psychosocial aspects (I read an interesting chapter that charted biological vs psychosocial articles in the green journal and yellow journals since the 1960s).

If you're a libertarian, how do you feel about coercion in psychiatric practice? What about asking patients about gun ownership? How do you feel about suicide prevention or means restriction? Might you believe that mental illness encourages individuals to abdicate personal responsibility?

If you are neoliberal do you believe that healthcare is a privilege and not a right? Do you believe health is a commodity like other commodities in a free market? That charities and not the state can deal the severely mentally ill? That it is a noble aim to have a cash only private practice for the rich, even if the most disadvantaged are the most in need of help?

If you have socially conservative values - how might you respond to an adolescent whose parents think it is 'wrong' to be gay? What about a woman who has had recurrent abortions and is now depressed? Was your sexually active woman who you are seeing for PTSD after being raped 'asking for it'?

If (like me) you have marxist leanings - are you denying patients treatments on the grounds their problems are social and not medical and rejecting your role as agent of social control and could this be to the detriment of your patients? Are your wealthy patients mentally ill or indulging in bourgeois ennui? Does it matter? Is it practical to reject positivism and reification and embrace individual experience? Have you romanticized madness rather than responded to its devastation in a practical way? If american psychiatry gained a powerful role in managing subjectivity during the ascendance of late capitalism what are you doing being an agent of repression?

 

[whopper]

There are a lot of folks in psychiatry that illustrate this point.

I know plenty of doctors that practice this way. It's quite sad. I said this before, but in the community I've seen this at 50-50 with 50% doing something way under the standard of care. I had a patient today with pretty bad OCD and whenever he tried an SSRI he got sick. His doctor got mad at him because he got sick from the SSRIs. I'm listening to this patient, and it seemed pretty clear that the doctor didn't seem to give a damn about the patient's opinion, only his own, and remember it's the patient suffering and experiencing a phenomenon where the conventional treatment isn't working so how does he feel? Like I said, if I hear one patient complain about a guy doing this level of shoddy work, that's one thing but when I hear literally dozens who haven't met each other and their stories are so similar, I figure there's got to be something to it.

Plenty of my patients in private practice told me they cannot believe how good I am, and when I ask why they tell me that they say I'm the only psychiatrist who ever listened to them. I in no way shape or form would ever consider that quality treatment because listening is so basic a requirement in an interview, it's like complimenting a restaurant for not having mouse droppings in the food. Personally, I think what's going on is they just had really really bad doctors, so anyone doing any semblence of quality work would be the greatest doctor in the world to them.

As I've said before, 1) 1/3 of people go into psychiatry because they're lazy (easier calls, looser standards), 2) 1/3 go because they're crazy (and yes, I know that's disrespectful and not PC but this is a mnemonic): they have a mental illness and want to understand their own illness better and 3) 1/3 go into it because they're highly passionate about psychiatry and due to that passion will do well in the field.

2 and 3 are compatible. You could have a mental illness and still be a great psychiatrist, in fact the illness may have laid down the inspiration to become such a good one. 1 and 3 are not compatible.

 

[spartak]

Dear friends,

please, help me and I promise, I'll be cheerful. I'm a psychiatrist with 11 years of experience and I got an offer for $500K. It is a position of a director of a geriartric unit. According to the description, it is 30-hour a week job. It involves seeing about 20 patients a day ( both inpatients and outpatients).

FIVE HUNDRED THOUSAND DOLLARS A YEAR.

It should be a catch but I can't see it. Can you? If so, please, help me, I would really appreciate it.

Yours

Spartak.

 

[whopper]

Assuming your post is actually serious...
You might want to just delete your post and make a new thread. It's not out of the ordinary for discussions on a thread to go off on a tangent but the associations aren't completely unconnected.

 

[peppy]

If you have socially conservative values - how might you respond to an adolescent whose parents think it is 'wrong' to be gay? What about a woman who has had recurrent abortions and is now depressed? Was your sexually active woman who you are seeing for PTSD after being raped 'asking for it'?

The flip side: how will a liberal psychiatrist respond if their patient expresses strongly anti-gay views? Or what about a patient who is a pro-life activist?
I think most reasonable people of all political views have sympathy for sexual assault victims - but several times I have had to treat people with admitted histories of sexual assault against women and children. That's tough for a lot of people to swallow.

I think it's true that psychiatrists' personal outlooks will probably influence how they practice, but we all need to try to be vigilant about if our personal feelings are getting in the way of doing the best we can for the patient in front of us.

 

[toothless rufus]

Dear friends,

please, help me and I promise, I'll be cheerful. I'm a psychiatrist with 11 years of experience and I got an offer for $500K. It is a position of a director of a geriartric unit. According to the description, it is 30-hour a week job. It involves seeing about 20 patients a day ( both inpatients and outpatients).

FIVE HUNDRED THOUSAND DOLLARS A YEAR.

It should be a catch but I can't see it. Can you? If so, please, help me, I would really appreciate it.

Yours

Spartak.

The catch is that you have to give half of it to me.

I know you probably don't want to discuss location, but for that salary and no other obvious catch, it's got to be in an awful location. Or seven days a week. Or something.

 

[splik]

The flip side: how will a liberal psychiatrist respond if their patient expresses strongly anti-gay views? Or what about a patient who is a pro-life activist?
I think most reasonable people of all political views have sympathy for sexual assault victims - but several times I have had to treat people with admitted histories of sexual assault against women and children. That's tough for a lot of people to swallow.

I think it's true that psychiatrists' personal outlooks will probably influence how they practice, but we all need to try to be vigilant about if our personal feelings are getting in the way of doing the best we can for the patient in front of us.

well assuming our conservative psychiatrists aren't a fan of rush limbaugh anyway

i think it is disingenous comparing a gay patient whose parents think it is 'wrong' to a liberal dealing with a patient who is anti-gay. in the former, one's view of homosexuality is central to the treatment of the patient, in the latter it is irrelevant (unless of course it is uncharacteristic and the patient is manic or psychotic which is sometimes associated with racism/homophobia/xenophobia that the person who not normally express or believe). I have had patients who have vocalized anti-gay or racist comments which I may find distasteful it has not affected their care and certainly did not take it personally. I only had one patient I ever felt I hated when I was a lowly surgical intern and she was a little old lady (with burnt out borderline pd) who made me feel incompetent and helpless (i was on the bad side of the split) and of course I was incompetent and helpless and didn't appreciate being reminded.

The good thing about psychiatry, is we're actually encouraged to look at the feelings we might have about certain patients. I think it is important to remember that sociopolitical factors can affect our relations as much as can countertransference and other dynamic processes.

 

[F0nzie]

As I've said before, 1) 1/3 of people go into psychiatry because they're lazy (easier calls, looser standards), 2) 1/3 go because they're crazy (and yes, I know that's disrespectful and not PC but this is a mnemonic): they have a mental illness and want to understand their own illness better and 3) 1/3 go into it because they're highly passionate about psychiatry and due to that passion will do well in the field.

This rule of 1/3rds is pretty darn good IMO.

#2 is an interesting phenomenon. Even if you consider yourself #1 or #3, nobody is immune to mental illness later in life. Sometimes I ask myself the question: What if I get late onset Bipolar or Schizophrenia? If I get manic would I be able to control risky or indecent behaviors? If I start hearing voices or start becoming delusional would I be able to tell they aren't real? Does all this psych training protect me from knowing what's real and what's not if for what ever reason I became psychotic? It is a very unsettling thought.

 

[Studious]

The flip side: how will a liberal psychiatrist respond if their patient expresses strongly anti-gay views? Or what about a patient who is a pro-life activist?
I think most reasonable people of all political views have sympathy for sexual assault victims - but several times I have had to treat people with admitted histories of sexual assault against women and children. That's tough for a lot of people to swallow.

I think it's true that psychiatrists' personal outlooks will probably influence how they practice, but we all need to try to be vigilant about if our personal feelings are getting in the way of doing the best we can for the patient in front of us.

I think various other types of counselors would raise the question, "Is there such a thing as neutral psychotherapy" or "neutral treatment?" Of course we want to do what's best for the patient - what will make them better. But we must first understand the patient's goals and preferences and be willing, ourselves, to help them within that context or else refer them.

I fall on the side of believing there is no neutrality, not even in psychiatrists/therapists. We're all leading the patient toward a goal - whether it be increased functionality, decreased episodes of XYZ, etc. and perhaps those things don't match up with what the patient wants. I'm reminded of a story I read about a young adult who was a homosexual Christian who believed it was wrong to act on his homosexual impulses. He wanted to seek therapy on how to remain chaste, etc. but he also had major depressive disorder, so he wanted a kind of "all in one" psychiatrist instead of getting meds from a psychiatrist and then counseling from, say, a pastor. He didn't say where he lived, but that he had a great deal of trouble finding someone who didn't have the philosophy that he must embrace his homosexuality in order to be "truly happy."

That's just an N=1 anecdote but shows that there are agendas in psychotherapy. With continued interactions with the faculty in my behavioral medicine department (psychiatrists and non-physicians), my belief that there is actually no neutrality in psychotherapy is further reinforced, despite a faux-neutrality that we like to believe we have.

 

[Apollyon]

Dear friends,

please, help me and I promise, I'll be cheerful. I'm a psychiatrist with 11 years of experience and I got an offer for $500K. It is a position of a director of a geriartric unit. According to the description, it is 30-hour a week job. It involves seeing about 20 patients a day ( both inpatients and outpatients).

FIVE HUNDRED THOUSAND DOLLARS A YEAR.

It should be a catch but I can't see it. Can you? If so, please, help me, I would really appreciate it.

Yours

Spartak.

If you ever come back, do like whopper said and start a new thread.

Now, in any case:
1. Location
2. Lifestyle
3. Pay

Pick 2 of 3.

If it's $500K, and 30hrs/week, then it has to be in an absolutely horrid place. Prison? A secure facility for sexual offenders and paraphiliacs - they're geri because they've been institutionalized/imprisoned for years and years and years? In the guts of rural Mississippi, with rank, grinding poverty? In Wyoming, with nothing around (like, not even radio reception), and a possibility for 10 feet of snow every winter?

 

[whopper]

I'm speculating it's a misprint at 150K and that actually is still darned good for 30 hours a week. 20 patients, is that a day? It's darned hard to see 20 patient a day in a facility. Maybe the facility doesn't require daily notes.

This may be one of those things where the job does have a major problem/catch but you won't be aware of it until you actually do the job.

I've thought of ways to make the most amount of money possible in my area and none of the jobs come close to 500K a year at 30 hours a week other than doing things that I find unethical, other than building a private practice, charge extremely high rates, and don't accept insurance. It can be done where I'm at but it'd take years to build up a patient base to fill up 30 hours a week at those rates.

The current way I could make a lot of money a year is doing work for the court, having a job with the state where I do the minimum to still get full-time benefits (20 hours a week), and private practice with a lot of Suboxone patients. I was doing that, making good money, nowhere near 500K/year (though more than half of that), the problem is that when I took my job with the university, they make you drop private practice, if you make them tons of money you still make the same salary though they give you some bonuses, and they made me drop my court job, but at the same time I don't have to pay for malpractice insurance and my wife, working on her doctorate, gets free tuition.

The benefit of being with the University is I literally get to work with some of the best doctors in the world as a colleague and they are teaching me quite a lot that I wouldn't have been able to learn elsewhere, and my university salary is darned good for that type of job (though it'd be making more outside the university).

 

[digitlnoize]

Those to the right of the political spectrum tend to have a more biological model. Incidentally, during conservative/republican governments there tends to be more funding into biological aspects of psychiatry compared with psychosocial aspects.

Interesting. I'd say that I agree. I'm probably more bio leaning, although it's very slight.

If you're a libertarian, how do you feel about coercion in psychiatric practice? What about asking patients about gun ownership? How do you feel about suicide prevention or means restriction? Might you believe that mental illness encourages individuals to abdicate personal responsibility?

I feel fine with all of these things, despite my libertarian leanings. Of these, I'm probably least comfortable with coercion, but it depends on the reason for the patient's refusal of treatment. If they're a paranoid schizophrenic who, once better, is likely to be thankful for their treatment, then coercion is awesome. If they're a mildly depressed outpatient, then not so much.

I'm fine with asking about gun ownership. It's a well documented risk factor. I'm even fine with temporary revocation of liberties in the interest of safety. Taking guns away from a suicidal patient, or even from a psychotic patient who might shoot up a school, is fine.

Abdication of personal responsibility is a trickier question, but I think it depends on the person. Some people will use their dx for this, others won't. Do I think it gives them a pass? Sometimes, yes, sometimes, no. "Go not to the elves for counsel, for they will say both yes and no."

If you have socially conservative values - how might you respond to an adolescent whose parents think it is 'wrong' to be gay? What about a woman who has had recurrent abortions and is now depressed? Was your sexually active woman who you are seeing for PTSD after being raped 'asking for it'?

I think if you're a reasonable social conservative (which I'm not, but I have some socially conservative friends, so I'll stick up for them here), these things don't get in the way. I am perfectly capable of accepting that there are people in this world whose beliefs differ from my own, and they have the right to those beliefs.

In the words of the renowned philosopher Miranda Lambert: "To make the world go 'round, it takes all kinds of kinds."

 

[Studious]

I think if you're a reasonable social conservative (which I'm not, but I have some socially conservative friends, so I'll stick up for them here), these things don't get in the way. I am perfectly capable of accepting that there are people in this world whose beliefs differ from my own, and they have the right to those beliefs.

I am more socially conservative than most here, probably. As I hinted at in my previous post, I seriously question the claim to neutrality of any psychiatrist or psychotherapist (e.g., "I don't let my beliefs get in the way.") For example, the belief that suicide is wrong (take the term how you want to interpret it) is a belief and it's imposed on those who want to commit suicide. I suspect I've met many "mountain men" who, when the time comes, could take their own life not because they're depressed but because they want that control. The mental health professional will attempt to correct this deviant behavior as they view it as unhealthy; the mountain man views it as his right (or something along those lines). A similar argument is being used for euthanasia, physician-assisted suicide, etc (along with the belief that the evil of suffering is greater than the evil of taking life).

My point being is that your beliefs are always coming into play in psychotherapy, even if you set aside your personal beliefs and take up other beliefs sanctioned by professional organizations (which still may or may not coincide with the patient's beliefs). What is neutral anyway?

 

[Ibid]

I know plenty of doctors that practice this way. It's quite sad. I said this before, but in the community I've seen this at 50-50 with 50% doing something way under the standard of care. .

Shocking as much as sad imo.

What if I get late onset Bipolar or Schizophrenia? If I get manic would I be able to control risky or indecent behaviors? If I start hearing voices or start becoming delusional would I be able to tell they aren't real? Does all this psych training protect me from knowing what's real and what's not if for what ever reason I became psychotic? It is a very unsettling thought.

The answer is no. That is the nature of being psychotic. While being psychotic is almost always going to be very unpleasant your training could add an extra layer of unpleasantness though. On the upside I can imagine you might be treated to an extra helping of patience and sympathy from staff which is better than nothing but that is all.

The danger is that your training causes you to think that you can "handle it" or "think your way out of what your experience is" before you finally "lose touch". In the worst case it could cause you to be more secretive about your thoughts as psychosis begins to take hold and you could become floridly psychotic before anyone decided you needed help.

 

[freaker]

well assuming our conservative psychiatrists aren't a fan of rush limbaugh anyway

Not a fair or accurate assumption from my experience.

i think it is disingenous comparing a gay patient whose parents think it is 'wrong' to a liberal dealing with a patient who is anti-gay.

Which is very true unless you're treating the patient who holds the viewpoint that being gay is wrong or sinful.

The good thing about psychiatry, is we're actually encouraged to look at the feelings we might have about certain patients. I think it is important to remember that sociopolitical factors can affect our relations as much as can countertransference and other dynamic processes.

They're definitely there. I don't feel I'm alone saying I have a hard time with countertransference with borderline and narcissistic patients at times. Or those with world views diametrically opposed to mine. They scream for it, and sometimes you just want to dish it right back. I think I've been good at not doing such, but there have to be times where we don't give the same quality to treatment and care that we would to someone else. Trying to prevent that and being aware of it is, I agree, a very unique aspect of psychiatry that we, I'd like to think, do better than other medical fields.

 

[digitlnoize]

I am more socially conservative than most here, probably. As I hinted at in my previous post, I seriously question the claim to neutrality of any psychiatrist or psychotherapist (e.g., "I don't let my beliefs get in the way.") For example, the belief that suicide is wrong (take the term how you want to interpret it) is a belief and it's imposed on those who want to commit suicide. I suspect I've met many "mountain men" who, when the time comes, could take their own life not because they're depressed but because they want that control. The mental health professional will attempt to correct this deviant behavior as they view it as unhealthy; the mountain man views it as his right (or something along those lines). A similar argument is being used for euthanasia, physician-assisted suicide, etc (along with the belief that the evil of suffering is greater than the evil of taking life).

My point being is that your beliefs are always coming into play in psychotherapy, even if you set aside your personal beliefs and take up other beliefs sanctioned by professional organizations (which still may or may not coincide with the patient's beliefs). What is neutral anyway?

I think there are a few life or death cases where the patient's belief system stops mattering, such as the above "suicide" case, but overall, we should be capable of treating a patient regardless of how their belief system clashes with ours.

We should be able to treat a homosexual patient, even if we are opposed to homosexuality, without trying to "cure" their homosexuality, to use an example from our history books.

Maybe I just have a particularly malleable belief system. I've lived most of my life in a place where Extreme Left meets Extreme Right frequently, and it's taught me that everyone has an opinion. You quickly learn to accept other people's opinions or risk a never-ending string of long arguments. I've encountered the "christian homosexual" more often than I care to mention.

"Who belongs? Who decides who's crazy?" - Billy Corgan (Smashing Pumpkins), "Luna", Siamese Dream.

 

[whopper]

In terms of politics, I generally don't discuss them much with colleagues but the people I've noticed being the most liberal and vocal about it are social workers.

Personally I don't think it's a good idea for psychiatrists to be too much into the debate that often happens in politics with colleagues or patients. We are supposed to help people whatever their political stripe. If I do get into discussions on politics with anyone I try to stay somewhat aloof on it at the workplace because some people can just get very dirty, hateful, and militant in their political views. I am, however, passionate about politics, and sometimes can't help myself when there's a political discussion.

Whatever your political opinoin, our practice needs to be evidenced-based and aligned with the ethics of medicine in general. If someone is against homosexuality, for example, that really shouldn't have anything to do with practice because unless there's science journal article somehow showing it's scientifically valid to incorporate being against it into practice, doing so is not medicine. Not to put homosexuals on the same par as inmates or prisoners, we too are supposed to give people, whatever their background, good quality care where they are respected.

 

[Ibid]

I think there are a few life or death cases where the patient's belief system stops mattering, such as the above "suicide" case, but overall, we should be capable of treating a patient regardless of how their belief system clashes with ours.

We should be able to treat a homosexual patient, even if we are opposed to homosexuality, without trying to "cure" their homosexuality, to use an example from our history books.

.

But homosexuality is not a belief system. How can one be opposed to homosexuality? It's not a choice that people make.

I think if a psychiatrist is not overtly opposed to homophobic attitudes along with racist attitudes or any other sort of bigotry they are hopelessly compromised as a professional.

You still have to treat bigots but that is a different matter.

 

[digitlnoize]

But homosexuality is not a belief system. How can one be opposed to homosexuality? It's not a choice that people make.

I think if a psychiatrist is not overtly opposed to homophobic attitudes along with racist attitudes or any other sort of bigotry they are hopelessly compromised as a professional.

You still have to treat bigots but that is a different matter.

It's not a belief system for the homosexual, but it IS a belief system for those opposed to it.

I agree that all bigotry is distasteful (to say the least), but at the same time, I don't really see it as my place professionally to judge the patient. It's our job to treat their medical condition. The grey area occurs when the one is complicating the other...

I live in close proximity to several rural, southern areas, and encounter bigots of various types fairly frequently. I'm not going to rid the world of bigotry in a few hour-long therapy sessions. All I'll do is wind up alienating the patient and pissing them off.

I guess it's just a matter of what you're used to...'round these parts, homophobia, racial-phobia, and the various grades of "low-grade paranoia" (gov't conspiracy, medical conspiracy, etc) are fairly common.

 

[Ibid]

It's not a belief system for the homosexual, but it IS a belief system for those opposed to it.

I agree that all bigotry is distasteful (to say the least), but at the same time, I don't really see it as my place professionally to judge the patient. It's our job to treat their medical condition. The grey area occurs when the one is complicating the other...

I live in close proximity to several rural, southern areas, and encounter bigots of various types fairly frequently. I'm not going to rid the world of bigotry in a few hour-long therapy sessions. All I'll do is wind up alienating the patient and pissing them off.

I guess it's just a matter of what you're used to...'round these parts, homophobia, racial-phobia, and the various grades of "low-grade paranoia" (gov't conspiracy, medical conspiracy, etc) are fairly common.

Yes, I suppose I was hypothesizing a bigoted psychiatrist who would set aside his bigotry to treat a homosexual and saying that this was an untenable or impossible senario. As such, if this is true then psychiatrists are defacto by necessity, liberal or politically correct if you like.

Where I am when bigotry is detected we call in the thought police who adminster summary justice by putting the offenders name in a book, march them out to the flag pole in front of the hospital where an officiating officer will rip the patches off thier jacket elbows and if they have been particularily criminal, smack them in the face with some latex gloves. All this infront of an assembly of staff with porters and cleaners, brooms held aloft acting as an honour gaurd.

Keeps people in line I have to say.

EDIT: Obv this punishment is just for men. Women are compelled to wear the uniform of a social worker for a week. Repleat with short spiked up hair, combat boots, dangly ear rings, ethnic bead necklace and undergarmants made from hessain sacking material. Cruel but effective.

 

[splik]

I guess it's just a matter of what you're used to...'round these parts, homophobia, racial-phobia, and the various grades of "low-grade paranoia" (gov't conspiracy, medical conspiracy, etc) are fairly common.

Which raises the question - how important is it that as a psychiatrist we understand and can relate to (even if we don't necessarily agree with) our local patient population?

I decided not to rank any programs in the South (and was reluctant to rank anywhere in the midwest) because I felt I was not really able to relate to the patients there and thus would not be best suited to working with the patient population. I currently live in one of the bastions of liberalism in this country, and will be going to another über-liberal place for residency (80% voted democrat in the last election). you may be able to work out where but keep it to yourself

my friends joke that coming to the US is my global health experience as I get to learn about a different culture and practice medicine in a backward and poor resource setting

 

[digitlnoize]

Which raises the question - how important is it that as a psychiatrist we understand and can relate to (even if we don't necessarily agree with) our local patient population?

I decided not to rank any programs in the South (and was reluctant to rank anywhere in the midwest) because I felt I was not really able to relate to the patients there and thus would not be best suited to working with the patient population. I currently live in one of the bastions of liberalism in this country, and will be going to another über-liberal place for residency (80% voted democrat in the last election). you may be able to work out where but keep it to yourself

my friends joke that coming to the US is my global health experience as I get to learn about a different culture and practice medicine in a backward and poor resource setting

Ha! I decided not to rank the North for the same reason! I was ALL South and Midwest.

 

[Shufflin]

NY was off my list completely. Didn't want to touch it. Only New Yorkers can really understand NY.

 

[whopper]

NYC from what I've heard from several friends in it is there isn't a shortage of psychiatrists, the cost of living is high and due to no shortage, the pay is relatively low for psychiatrists in general. That said, you can still do very well in NYC as a psychiatrist but you'll have to be enterprising and distinguish yourself as a higher quality one to draw in people willing to pay more money.

Which raises the question - how important is it that as a psychiatrist we understand and can relate to (even if we don't necessarily agree with) our local patient population?

Very important. I wasn't familiar with guys having sex with their sisters until I moved to Cincinnati. No it doesn't happen here but it does happen right across the river in KY and lots of those people need to go to Cincy to get psychiatric help.

If someone told me he was having sex with his sister back in NJ, I'd be a hair-trigger away from alerting the police thinking there was some type of rape or sexual exploitation going on.

 

[gbv]

Whatever your political opinoin, our practice needs to be evidenced-based and aligned with the ethics of medicine in general. If someone is against homosexuality, for example, that really shouldn't have anything to do with practice because unless there's science journal article somehow showing it's scientifically valid to incorporate being against it into practice, doing so is not medicine. Not to put homosexuals on the same par as inmates or prisoners, we too are supposed to give people, whatever their background, good quality care where they are respected.

Quoted for emphasis. I think musings on whether political bents/ideologies influence practice or how one deals with a patient is a bit unfortunate as such should not have anything to do with how we interface with the people we treat. In some ways I think clinic appointments in our mind should be treated like the dinner table (we don't talk [or think] about politics or religion). Now, one might say that such political views might simply infuse the way some practice medicine--if that is the case--well, THAT'S unfortunate as well.

 

[ShrunkenHeads]

Herpetology, huh?

http://en.wikipedia.org/wiki/The_Dragons_of_Eden

Great book btw. I should give it another read.

 

[mgdsh]

...

As I've said before, 1) 1/3 of people go into psychiatry because they're lazy (easier calls, looser standards), 2) 1/3 go because they're crazy (and yes, I know that's disrespectful and not PC but this is a mnemonic): they have a mental illness and want to understand their own illness better and 3) 1/3 go into it because they're highly passionate about psychiatry and due to that passion will do well in the field.

2 and 3 are compatible. You could have a mental illness and still be a great psychiatrist, in fact the illness may have laid down the inspiration to become such a good one. 1 and 3 are not compatible.

There are plenty of psychiatrists that fall under #2 who are simply so far from center they can't effectively establish rapport with their patients. Then again you could say there are physicians across all specialties that have poor bedside manner.

 

[Trismegistus4]

Sometimes I've been surprised by the politcal views of people once I've gotten to know them.

My experience in medical school/residency has been, as in every other arena of life, that liberals are much more open about their views and assume that everyone around them agrees with them. They usually feel free to interject gratuitous comments about, say, Sarah Palin (not that I'm a Sarah Palin fan) into discussions about a patient, or make stupid, irrational side comments about George W. Bush being psychotic or mentally ******ed or some such nonsense, presumably thinking (as all liberals do) that since everyone around them is an "educated" person, and "educated" people are liberal, that there couldn't possibly be anyone there who strongly disagrees. Contrast that with conservatives, who don't dare speak up for fear of being brought before a thoughtcrime tribunal and fired for "hate speech."

But homosexuality is not a belief system. How can one be opposed to homosexuality? It's not a choice that people make.

You can oppose it as a social phenomenon. I regard my fellow social conservatives who view it as a choice, or who think God routinely changes homosexuals into straights who then live perfectly normal lives, as naive, but I still think for the good of society homosexuality should remain in the closet.

 

[notdeadyet]

I still think for the good of society homosexuality should remain in the closet.

This might have something to do with your fears of being accused of "hate speech."

 

[billypilgrim37]

This might have something to do with your fears of being accused of "hate speech."

 

[Abider]

My experience in medical school/residency has been, as in every other arena of life, that liberals are much more open about their views and assume that everyone around them agrees with them. They usually feel free to interject gratuitous comments about, say, Sarah Palin (not that I'm a Sarah Palin fan) into discussions about a patient, or make stupid, irrational side comments about George W. Bush being psychotic or mentally ******ed or some such nonsense, presumably thinking (as all liberals do) that since everyone around them is an "educated" person, and "educated" people are liberal, that there couldn't possibly be anyone there who strongly disagrees. Contrast that with conservatives, who don't dare speak up for fear of being brought before a thoughtcrime tribunal and fired for "hate speech."


You can oppose it as a social phenomenon. I regard my fellow social conservatives who view it as a choice, or who think God routinely changes homosexuals into straights who then live perfectly normal lives, as naive, but I still think for the good of society homosexuality should remain in the closet.

You could always just go ahead and try some man sex. A little easier than worrying so keenly about is effects "on society."

 

[Ibid]

You can oppose it as a social phenomenon. I regard my fellow social conservatives who view it as a choice, or who think God routinely changes homosexuals into straights who then live perfectly normal lives, as naive, but I still think for the good of society homosexuality should remain in the closet.

But homosexuals are part of society as well. How is being open about ones sexuality going to cause damage to society? Who are you to say what is a perfectly normal life?

I find it odd that the political landscape (rather the republican primaries really) in the US seems to be dominated by arguements about issues that have largely been settled in the rest of the developed world. Your kind of thinking has more in common with the Taliban than anything else but that is an aside although it does rather beg the question as to what sort of values you think are being defended in Afganistan. Maybe the Westboro Babtist church has more followers than I thought.

Anyway for some light relief.

Two of these are real and one is a comedy although I'm wondering if everyone is going to be able to spot which is which.

BOYS BEWARE!!!
[YOUTUBE]http://www.youtube.com/watch?v=v3S24ofEQj4&feature=related[/YOUTUBE]

HOW TO SPOT A COMMUNIST!!
[YOUTUBE]http://www.youtube.com/watch?v=SkYl_AH-qyk&feature=related[/YOUTUBE]

TAKE NOTICE!! WOMEN KNOW YOUR LIMITS!!
[YOUTUBE]http://www.youtube.com/watch?v=P3Pwl8jTLK8&feature=related[/YOUTUBE]

 

[Abider]

But homosexuals are part of society as well. How is being open about ones sexuality going to cause damage to society? Who are you to say what is a perfectly normal life?

I find it odd that the political landscape (rather the republican primaries really) in the US seems to be dominated by arguements about issues that have largely been settled in the rest of the developed world. Your kind of thinking has more in common with the Taliban than anything else but that is an aside although it does rather beg the question as to what sort of values you think are being defended in Afganistan. Maybe the Westboro Babtist church has more followers than I thought.

Anyway for some light relief.

Two of these are real and one is a comedy although I'm wondering if everyone is going to be able to spot which is which.

BOYS BEWARE!!!
[YOUTUBE]http://www.youtube.com/watch?v=v3S24ofEQj4&feature=related[/YOUTUBE]

HOW TO SPOT A COMMUNIST!!
[YOUTUBE]http://www.youtube.com/watch?v=SkYl_AH-qyk&feature=related[/YOUTUBE]

TAKE NOTICE!! WOMEN KNOW YOUR LIMITS!!
[YOUTUBE]http://www.youtube.com/watch?v=P3Pwl8jTLK8&feature=related[/YOUTUBE]

Great stuff. It's quite useful to get slices of culture from 50-60 years ago. Did anyone happen to notice the "STOP KKK Terror!" sign in the procession of communist protesters. Slick and shady innuendo that.

This is why there needs to be separation of church and medicine. For some reason, at my school at least, it's perfectly normal for deans and leaders to pass on religious ideals as instruction. Heedless of the religious doctrines which work counter to the rational application of science and medicine for all. What they do is mainstream and generally accepted as proper. The fact that moderate religious people have the good sense to ignore much of their Holy Books' dogma is not an excuse to allow it's presence to percolate insidiously throughout the curriculum.

There does seem to be stolidly immobile religiosity in our country. But I'm not sure Europe with all of it's immigrants is immune to backsliding. Look at Ayaan Hirsi Ali's account of the Netherlands. On the one hand a bastion of Enlightenment liberalism on the other held hostage to Muslim religiosity and it's perpetual, provincial offense with western culture. With things like you know....free speech and secular government. They want western prosperity with shariat law.

We like to think all is forward and upward. And maybe in our educated circles of science and medicine where wingnuts can be roundly laughed at as here, this is the case. But the collision with the type of ideas Tri is talking about is the question of our age. He feels utterly comfortable thinking of sexual preference in terms of sin and damnation.

And he may very well be in the American majority.

 

[Ibid]

There does seem to be stolidly immobile religiosity in our country. But I'm not sure Europe with all of it's immigrants is immune to backsliding. Look at Ayaan Hirsi Ali's account of the Netherlands. On the one hand a bastion of Enlightenment liberalism on the other held hostage to Muslim religiosity and it's perpetual, provincial offense with western culture. With things like you know....free speech and secular government. They want western prosperity with shariat law.

It is certainly complex. The US has a seperation of church and state but "In God We Trust" is on the money and its all the politicians want to talk about at times.

In the UK there is an established religion with the queen as head of state and church, reserved places for bishops in the house of Lords but the politicians generally don't discuss their personal faith.

Meanwhile the UK also has religious courts. Sharia and Jewish, both legally binding on participants.

http://news.bbc.co.uk/1/hi/uk/7233040.stm
http://www.telegraph.co.uk/news/uknews/2957428/Sharia-law-courts-operating-in-Britain.html
http://news.bbc.co.uk/1/hi/uk/7232661.stm
"Dr Williams (Archbishop of Cantabury) argues that adopting parts of Islamic Sharia law would help maintain social cohesion." I'd say you can't get much more weirdy beardy liberal lefty intellectual than that for the head of a christian religion.

 

[Abider]

It is certainly complex. The US has a seperation of church and state but "In God We Trust" is on the money and its all the politicians want to talk about at times.

In the UK there is an established religion with the queen as head of state and church, reserved places for bishops in the house of Lords but the politicians generally don't discuss their personal faith.

Meanwhile the UK also has religious courts. Sharia and Jewish, both legally binding on participants.

http://news.bbc.co.uk/1/hi/uk/7233040.stm
http://www.telegraph.co.uk/news/uknews/2957428/Sharia-law-courts-operating-in-Britain.html
http://news.bbc.co.uk/1/hi/uk/7232661.stm
"Dr Williams (Archbishop of Cantabury) argues that adopting parts of Islamic Sharia law would help maintain social cohesion." I'd say you can't get much more weirdy beardy liberal lefty intellectual than that for the head of a christian religion.

Thanks for the links. I'd heard of these courts. Dangerous stuff. I agree the western liberal accommodationist/apologist stance is the worst thing for the future of the western republics with their constitutional protections of minorities.

I'm squarely in the Hitchens/Sam Harris Camp. This stuff should be treated as the dangerous threat that it is. And attacked on all fronts. Laughing at homophobia and pointing out is ridiculousness being just one.

I mean, if in this day, you still view homosexuality as a cultural threat, there's only one reasonable explanation. Everyone worried that much about how someone else does their sex must be unsure and ashamed of how they feel about themselves. Wanting another man is not contagious. Unless you like them to begin with. And have been shamed into an elaborate front game. By the same force you claim as basis for your fear.

 

[billypilgrim37]

I mean, if in this day, you still view homosexuality as a cultural threat, there's only one reasonable explanation. Everyone worried that much about how someone else does their sex must be unsure and ashamed of how they feel about themselves. Wanting another man is not contagious. Unless you like them to begin with. And have been shamed into an elaborate front game. By the same force you claim as basis for your fear.

Racists don't secretly want to be black. Misogynists don't secretly want to be women. Kentucky fans don't secretly want to be Duke fans. While I otherwise agree with your sentiments, the homophobia=closeted is dangerous too.

 

[Abider]

Racists don't secretly want to be black. Misogynists don't secretly want to be women. Kentucky fans don't secretly want to be Duke fans. While I otherwise agree with your sentiments, the homophobia=closeted is dangerous too.

Yeah. Good point. But having been raised in the Bible Belt I've just seen a whole gang of these obviously-gay-to-anyone-but-themselves-and their flock evangelicals foaming at the mouth talking about the sin of gayness. Thinking about naked dudes with closed eyes. The congregation with hands raised in rapture.

So, i'm reaching, as well as making use of native shaming structures. Unethical admittedly. But San Francisco is my adopted home now and I've got friends who have suffered these pious fools their whole life and it's long been time to kick these thought bullies in the nuts. Instead of talking about rainbows or some ****.

 

[nitemagi]

It is certainly complex. The US has a seperation of church and state but "In God We Trust" is on the money and its all the politicians want to talk about at times.

True, but it was only added in 1956 at the height of the Mccarthy red scare, which IMHO is being echoed in a lot of the rhetoric thrown around today. Fear tactics rather than respect, data, or rights.

 

[st2205]

Racists don't secretly want to be black.

If they don't want to be black, what color are they currently?