Psychiatry Rant

[apoptosisosis]

DO NOT QUOTE

I'm not sure if I'm the only one who feels this way, but does anyone else feel like psychiatry is a pseudoscientific field?

I've seen how psychiatrists diagnose patients, based on a collection of symptoms and are very subjective not only to the patient themselves, but also to the physician, particularly in depression.
I rarely see psychiatrists factor in the patients' environment, how much of their illness, like depression, is because of just certain personality traits (that are fiercely resistant to change)?
There is absolutely no objective way to tell if anyone is depressed, have anxiety, OCD, depersonalization, and so on. There is no biomarker to confirm the illness, or if the patient was cured.

They throw all these terms at you like they know what they’re talking about, they prescribe meds that supposedly cover a very broad range of symptoms but work only like 40% of the time and often result in much more side effects, and from there psychiatrists play a guessing game and suggest trying a different med. This goes on and on, and the poor patients get their hopes up with every new attempt and soon get those hopes crushed again, leaving them feeling helpless and in distraught.

I feel for the patients, mental illnesses are stressful and can be very isolating. I do not undermine their suffering, I question the efficiency of psychiatry as a field.

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[ndafife]

I feel this is coming from an ignorant perspective on the diagnosis and treatment of mental health conditions.

 

[Oso]

DO NOT QUOTE

I'm not sure if I'm the only one who feels this way, but does anyone else feel like psychiatry is a pseudoscientific field?

I've seen how psychiatrists diagnose patients, based on a collection of symptoms and are very subjective not only to the patient themselves, but also to the physician, particularly in depression.
I rarely see psychiatrists factor in the patients' environment, how much of their illness, like depression, is because of just certain personality traits (that are fiercely resistant to change)?
There is absolutely no objective way to tell if anyone is depressed, have anxiety, OCD, depersonalization, and so on. There is no biomarker to confirm the illness, or if the patient was cured.

They throw all these terms at you like they know what they’re talking about, they prescribe meds that supposedly cover a very broad range of symptoms but work only like 40% of the time and often result in much more side effects, and from there psychiatrists play a guessing game and suggest trying a different med. This goes on and on, and the poor patients get their hopes up with every new attempt and soon get those hopes crushed again, leaving them feeling helpless and in distraught.

I feel for the patients, mental illnesses are stressful and can be very isolating. I do not undermine their suffering, I question the efficiency of psychiatry as a field.

I quote when I want

 

[libertyyne]

I would suggest you read this.
https://www.cambridge.org/core/serv...n_into_perspective_review_of_metaanalyses.pdf

 

[Crayola227]

I quote when I want

especially when someone has the equivalent of a throwaway acct, is talking about anything personally identifiable, and is just overall being obnoxious

 

[Crayola227]

dunno... being inpt and seeing almost word salad-y psychosis cooled down to with antipsychotics to where people are safe for discharge, or even to normal depending, that's pretty frakking cool

not saying that sort of dramatic and fairly rapid improvement is standard, but this idea that psychiatry is useless and doesn't have appreciable affects is frankly offensive

just because you need to use functional measuring tools doesn't mean improvement isn't happening, real, and measurable

lots of mental health illnesses can be successfully treated or managed

helping anyone get from miserable couch-potato status to living fairly normal, that's an improvement on level with septic in bed to up and about in terms of subjective

if you don't think medicine mostly about causing subjective improvements meant to increase functional status and QOL....sometimes only by degrees... I think you have no idea what anyone is actually trying to do here, and by here, I mean the whole stinking field from surgery to neurology to FM

 

[CherryRedDracul]

I have seen enough psych patients mismanaged that I can sort of empathize with OP.

 

[Goro]

Having seen family members have to deal with the short shrift of their HMO with mental health issues, all I can say is that this country doesn't have enough psychiatrists. More power to them and their profession.

Also, Medicine is a lot easier when you have biomarkers. There aren't any good biomarkers for psychiatric diseases.

Where's the wise @WingedOx when you need him?

 

[niblet]

The stigma that has historically surrounded mental illness is something that should be changed, and psychiatry is an important field that has the chance to, and often does in reality, make a hugely positive impact on people's lives.

But I do see the OP's point, to an extent, re: the subjectiveness of many psychiatric diagnoses, particularly depression, and the current reliance on pharmacologic management with drugs whose mechanisms aren't specifically targeted to what is largely unknown pathophysiology.

Like, the whole idea behind SSRIs bugs me. Take something that keeps more serotonin available in all your countless synapses--in countless different pathways, both relating to mood and not--after having checked the requisite number of boxes based on the way you felt that day and the way the psychiatrist asked their questions, to treat a disorder that is not the simple result of serotonin deficiency.

Antipsychotics even--they may improve the daily functioning of people with schizophrenia, but until there's a treatment that is more directed towards the underlying disease (perhaps not realistic), they will always seem to me like a much gentler version of the lobotomy.

 

[zero0]

Eh I'll throw you a bone.

I love the idea of psych, what it could be, but it's too much of an imperfect science as is, I feel, partly because it ignores the phenomenon of spirit. You can't practice good psych without bringing spirit into the scientific discourse, and that will never happen. Rather than frustrate over the fact, I'd rather just steer clear altogether.

As is, it doesn't work. What's worse, it's become a way for a broken society to shift blame on the individual, to say there's something wrong with you. No man is an island. We are a product of our environment and the environment is polluted. When 1 in 10 people in our society suffers from mental illness, it means there's a bigger problem that goes beyond the individual that we're not getting to the root of.

 

[Crayola227]

Antipsychotics even--they may improve the daily functioning of people with schizophrenia, but until there's a treatment that is more directed towards the underlying disease (perhaps not realistic), they will always seem to me like a much gentler version of the lobotomy.

 

[Crayola227]

Eh I'll throw you a bone.

I love the idea of psych, what it could be, but it's too much of an imperfect science as is, I feel, partly because it ignores the phenomenon of spirit. You can't practice good psych without bringing spirit into the scientific discourse, and that will never happen. Rather than frustrate over the fact, I'd rather just steer clear altogether.

As is, it doesn't work. What's worse, it's become a way for a broken society to shift blame on the individual, to say there's something wrong with you. No man is an island. We are a product of our environment and the environment is polluted. When 1 in 10 people in our society suffers from mental illness, it means there's a bigger problem that goes beyond the individual that we're not getting to the root of.

I agree mostly with this, but the idea that psych doesn't work....

see above gif

 

[apoptosisosis]

The stigma that has historically surrounded mental illness is something that should be changed, and psychiatry is an important field that has the chance to, and often does in reality, make a hugely positive impact on people's lives.

But I do see the OP's point, to an extent, re: the subjectiveness of many psychiatric diagnoses, particularly depression, and the current reliance on pharmacologic management with drugs whose mechanisms aren't specifically targeted to what is largely unknown pathophysiology.

Like, the whole idea behind SSRIs bugs me. Take something that keeps more serotonin available in all your countless synapses--in countless different pathways, both relating to mood and not--after having checked the requisite number of boxes based on the way you felt that day and the way the psychiatrist asked their questions, to treat a disorder that is not the simple result of serotonin deficiency.

Antipsychotics even--they may improve the daily functioning of people with schizophrenia, but until there's a treatment that is more directed towards the underlying disease (perhaps not realistic), they will always seem to me like a much gentler version of the lobotomy.

you couldn't have said it more perfectly!

 

[Crayola227]

The stigma that has historically surrounded mental illness is something that should be changed, and psychiatry is an important field that has the chance to, and often does in reality, make a hugely positive impact on people's lives.

But I do see the OP's point, to an extent, re: the subjectiveness of many psychiatric diagnoses, particularly depression, and the current reliance on pharmacologic management with drugs whose mechanisms aren't specifically targeted to what is largely unknown pathophysiology.

Like, the whole idea behind SSRIs bugs me. Take something that keeps more serotonin available in all your countless synapses--in countless different pathways, both relating to mood and not--after having checked the requisite number of boxes based on the way you felt that day and the way the psychiatrist asked their questions, to treat a disorder that is not the simple result of serotonin deficiency.

Antipsychotics even--they may improve the daily functioning of people with schizophrenia, but until there's a treatment that is more directed towards the underlying disease (perhaps not realistic), they will always seem to me like a much gentler version of the lobotomy.

I've seen some miraculous things as far as positive side effect of SSRIs on IBS sx... and that totally makes sense from a physiological standpoint

same with chronic pain

the improvements don't just seems to be a question of an overall improved sense of well-being from treating depression

the nervous systems involved in the gut and the transmission of pain, also rely on serotonin

I speak from some personal experience on this one, but I'm hardly the only one whose had benefit on that front

IBS can be much more limiting than one might think from a condition where you don't have any tissue damage to speak of, I tell patients when they scope clean that the good news is that they don't have lesions that are going to pop and bleed or such, they don't have increased risk of cancer, they're not going to get blood loss anemia, the bad news is that their symptoms are still just as real in the presence of a normal appearing gut

this is somewhat similar to mental health
life isn't just about lesions you can point to in the addressing of symptomotology

 

[apoptosisosis]

Not that I don't think psychiatry is not important, but as it is right not, its inefficient and even harmful in some cases.
We still do not understand the brain, we still don't know the mechanisms for almost all cognitive functions, nor the areas involved. And while psychiatrists and are attempting to help with the knowledge we have, their efforts seem like a hit or miss.
I mean something as simple as chronic sleep deprivation can result in serious cognitive impairments and mood instability, which would lead a psychiatrist to falsely diagnose them with depression/anxiety based of arbitrary metrics that are subjective and relative to each individual. Then the patient is prescribed a medication which is not likely to work and can even cause bad side effects, only to come back to the psychiatrist again and get prescription for a different medication and so on. See what I mean?

I just feel like its a broken field, and the patients are suffering because if it.

 

[apoptosisosis]

Eh I'll throw you a bone.

I love the idea of psych, what it could be, but it's too much of an imperfect science as is, I feel, partly because it ignores the phenomenon of spirit. You can't practice good psych without bringing spirit into the scientific discourse, and that will never happen. Rather than frustrate over the fact, I'd rather just steer clear altogether.

As is, it doesn't work. What's worse, it's become a way for a broken society to shift blame on the individual, to say there's something wrong with you. No man is an island. We are a product of our environment and the environment is polluted. When 1 in 10 people in our society suffers from mental illness, it means there's a bigger problem that goes beyond the individual that we're not getting to the root of.

I agree with everything you said!

 

[SunsFun]

I personally feel for psychiatrists. Having imperfect tools and only rudimentary lnowledge of human mind, psychiatrists are tasked with solving problems that may require much better understanding of neuroscience than what we have, but also much broader range of solutions. It’s not like a psychiatrist can prescribe someone a new life in Bhutan.

 

[Anti-PD1]

I know where you're coming from, I have had some of the same thoughts. I read The Myth of Mental Illness by Szasz (a psychiatrist) in a philosophy of medicine class in college. It's an interesting read, particularly with how mental illness interacts with our legal system:

Classics in the History of Psychology -- Szasz (1960)

Since then, I've become more of a realist. If psychiatry doesn't know what they're talking about, odds are no one else has a better idea. If I find myself questioning psychiatry, I ask myself, do I have a better plan? When you're in any specialty, you'll come to appreciate what they do. There's a conversation to be had about prescribing vs. therapy, but still, I'm glad they take care of these patients. The science is exploding, it's a better era for patients.

 

[deleted343839]

I'm not sure that you understand what pseudoscience is. The science might not be as far along as you'd like it to be, but that doesn't mean it doesn't exist.

Many of your concerns (lack of unambiguous markers of disease or cure, failure to consider the environment context of illness, etc.) could be extended to other areas of medicine. Even when you have lab, path, and imaging at your disposal you will encounter plenty of diagnostic uncertainty in medicine. It's well understood, perhaps no more so than in psychiatry, that some diagnoses are more ambiguous than others. Look up the methodology for the DSM field trials and consider how many other clinical diagnoses have been evaluated at that level of rigor.

 

[mehc012]

As someone who hates psych meds and is highly averse to actually using any of them...the way they're being characterized here is pretty inaccurate. They're better than that.

As someone who just suffered through the Psych/neuro block...annoying naysayers like y'all are why Psych feels the need to overcompensate with ridiculously, uselessly overspecific criteria (see: the entire DSM) so that people can't just pretend that a depression diagnosis → psych meds happens just "because of the way you felt that day and what kinds of questions you were asked by the psychiatrist". Seriously.

The field as a whole is not meaningless; it's actually incredibly important. Some of the unnecessary (don't affect treatment) nuances between disorders and weird technicalities in the diagnostic criteria, though...that's on people like OP and niblet.

 

[VA Hopeful Dr]

Obvious troll is obvious

 

[mehc012]

Obvious troll is obvious

And yet bringing out some interesting discussion nonetheless. Trolls are a normal part of the internet ecosystem, and they have a far less negative impact than those who hunt them.

 

[WingedOx]

DO NOT QUOTE

I'm not sure if I'm the only one who feels this way, but does anyone else feel like psychiatry is a pseudoscientific field?

I've seen how psychiatrists diagnose patients, based on a collection of symptoms and are very subjective not only to the patient themselves, but also to the physician, particularly in depression.
I rarely see psychiatrists factor in the patients' environment, how much of their illness, like depression, is because of just certain personality traits (that are fiercely resistant to change)?
There is absolutely no objective way to tell if anyone is depressed, have anxiety, OCD, depersonalization, and so on. There is no biomarker to confirm the illness, or if the patient was cured.

They throw all these terms at you like they know what they’re talking about, they prescribe meds that supposedly cover a very broad range of symptoms but work only like 40% of the time and often result in much more side effects, and from there psychiatrists play a guessing game and suggest trying a different med. This goes on and on, and the poor patients get their hopes up with every new attempt and soon get those hopes crushed again, leaving them feeling helpless and in distraught.

I feel for the patients, mental illnesses are stressful and can be very isolating. I do not undermine their suffering, I question the efficiency of psychiatry as a field.

quoted.

 

[deleted407021]

DO NOT QUOTE

I'm not sure if I'm the only one who feels this way, but does anyone else feel like psychiatry is a pseudoscientific field?

I've seen how psychiatrists diagnose patients, based on a collection of symptoms and are very subjective not only to the patient themselves, but also to the physician, particularly in depression.
I rarely see psychiatrists factor in the patients' environment, how much of their illness, like depression, is because of just certain personality traits (that are fiercely resistant to change)?
There is absolutely no objective way to tell if anyone is depressed, have anxiety, OCD, depersonalization, and so on. There is no biomarker to confirm the illness, or if the patient was cured.

They throw all these terms at you like they know what they’re talking about, they prescribe meds that supposedly cover a very broad range of symptoms but work only like 40% of the time and often result in much more side effects, and from there psychiatrists play a guessing game and suggest trying a different med. This goes on and on, and the poor patients get their hopes up with every new attempt and soon get those hopes crushed again, leaving them feeling helpless and in distraught.

I feel for the patients, mental illnesses are stressful and can be very isolating. I do not undermine their suffering, I question the efficiency of psychiatry as a field.

Just you and the Scientologists.

 

[NotYou20]

Not that I don't think psychiatry is not important, but as it is right not, its inefficient and even harmful in some cases.
We still do not understand the brain, we still don't know the mechanisms for almost all cognitive functions, nor the areas involved. And while psychiatrists and are attempting to help with the knowledge we have, their efforts seem like a hit or miss.
I mean something as simple as chronic sleep deprivation can result in serious cognitive impairments and mood instability, which would lead a psychiatrist to falsely diagnose them with depression/anxiety based of arbitrary metrics that are subjective and relative to each individual. Then the patient is prescribed a medication which is not likely to work and can even cause bad side effects, only to come back to the psychiatrist again and get prescription for a different medication and so on. See what I mean?

I just feel like its a broken field, and the patients are suffering because if it.

Yeah surely no psychiatrist has ever considered sleep habits before making a diagnosis. Why can't everyone be as smart as you

 

[deleted407021]

I’ve personally seen someone with intractable depression and GAD undergo a regimen of TMS and had a 93% reduction in depression indices after treatment. I saw a similar case presented at an APA conference last year.

 

[Candidate2017]

DO NOT QUOTE

I'm not sure if I'm the only one who feels this way, but does anyone else feel like psychiatry is a pseudoscientific field?

I've seen how psychiatrists diagnose patients, based on a collection of symptoms and are very subjective not only to the patient themselves, but also to the physician, particularly in depression.
I rarely see psychiatrists factor in the patients' environment, how much of their illness, like depression, is because of just certain personality traits (that are fiercely resistant to change)?
There is absolutely no objective way to tell if anyone is depressed, have anxiety, OCD, depersonalization, and so on. There is no biomarker to confirm the illness, or if the patient was cured.

They throw all these terms at you like they know what they’re talking about, they prescribe meds that supposedly cover a very broad range of symptoms but work only like 40% of the time and often result in much more side effects, and from there psychiatrists play a guessing game and suggest trying a different med. This goes on and on, and the poor patients get their hopes up with every new attempt and soon get those hopes crushed again, leaving them feeling helpless and in distraught.

I feel for the patients, mental illnesses are stressful and can be very isolating. I do not undermine their suffering, I question the efficiency of psychiatry as a field.

SSRIs work 30-40% of the time which is very good when considering other drugs' number needed to treat. Please read up on number needed to treat and the number needed to treat for commonly prescribed meds such as statins.

We can also titrate SSRIs, augment SSRIs with other classes of medications and therapy. We can also switch classes of medications. What we cannot do is force patients to be compliant, go to therapy or change their personality or environment. Like any specialty. All in all the rate of efficacy is higher than 30-40% given the adjustments we can do.

The psych patients students see on the wards will also generally be the worse of the worse. This is similar to the patients on the med floors who will go on to ESRD, HF, IDDM or get amputated no matter how well you medically manage them. Arguably, psych patients can have better long term outcomes than many on the medical floors regarding QOL and mortality.

 

[Candidate2017]

The stigma that has historically surrounded mental illness is something that should be changed, and psychiatry is an important field that has the chance to, and often does in reality, make a hugely positive impact on people's lives.

But I do see the OP's point, to an extent, re: the subjectiveness of many psychiatric diagnoses, particularly depression, and the current reliance on pharmacologic management with drugs whose mechanisms aren't specifically targeted to what is largely unknown pathophysiology.

Like, the whole idea behind SSRIs bugs me. Take something that keeps more serotonin available in all your countless synapses--in countless different pathways, both relating to mood and not--after having checked the requisite number of boxes based on the way you felt that day and the way the psychiatrist asked their questions, to treat a disorder that is not the simple result of serotonin deficiency.

Antipsychotics even--they may improve the daily functioning of people with schizophrenia, but until there's a treatment that is more directed towards the underlying disease (perhaps not realistic), they will always seem to me like a much gentler version of the lobotomy.

This is not really how SSRIs work for depression. The couple of slides you get in med school on SSRIs or schizophrenia is inadequate. I suggest reading a few chapters each on SSRIs and the underpinnings of schizophrenia.

 

[NontradCA]

As someone applying Psych I actually agree with much of what you said, besides the hyperbole of pseudoscience. Our treatments aren’t all that great, and as you say, can not address an exact ideology and do not take into account the environment. Resiliency is going to determine a lot of the outcome of our efforts, and there’s nothing we have that is going to target that.

The DSM doesn’t follow along with a biological construct of disease. But, I am looking forward to the future which include things like bio markers, pharmacogenetics, and a more biological construct of mental illness.

That being said, these efficiency problems are in all other areas on medicine.

 

[Entadus]

Eh I'll throw you a bone.

I love the idea of psych, what it could be, but it's too much of an imperfect science as is, I feel, partly because it ignores the phenomenon of spirit. You can't practice good psych without bringing spirit into the scientific discourse, and that will never happen. Rather than frustrate over the fact, I'd rather just steer clear altogether.

As is, it doesn't work. What's worse, it's become a way for a broken society to shift blame on the individual, to say there's something wrong with you. No man is an island. We are a product of our environment and the environment is polluted. When 1 in 10 people in our society suffers from mental illness, it means there's a bigger problem that goes beyond the individual that we're not getting to the root of.

The beauty of psychiatry is that it's the only field that even comes close to acknowledging the reality of spirit. The subjectivity that causes uneasiness for the OP is the same subjectivity that initially fascinated Carl Jung, leading to a new age of psychiatry that began in the early 20th century. I think there is an enormous potential for innovation and growth in psychiatry over the next few decades

EDIT: (7 years later) I ended up going into palliative care (via internal medicine).

 

[VA Hopeful Dr]

And yet bringing out some interesting discussion nonetheless. Trolls are a normal part of the internet ecosystem, and they have a far less negative impact than those who hunt them.

I disagree

 

[Wilf]

I have seen enough psych patients mismanaged that I can sort of empathize with OP.

Unfortunately psychiatry is not competitive so we get some of the worst doctors coming out of medical schools. We also have quite a few mid levels (some even able to practice independently in some states!) working in psychiatry. So yes, quite a few providers in the field are not very good and sometimes flat out bad. Sadly it will probably remain this way because of the relatively low pay of psychiatry.

 

[mehc012]

I disagree

Just because it's not interesting to you, doesn't mean it's not interesting to others. That's true of every thread in here, and it's why I don't participate in 95% of them and yet others who are interested carry them on anyway. Not sure why you feel the need to point out when you don't find OP worth responding to...seems rather counterproductive, but sure.

At any rate, I'm going to take my own advice now. I find your whining about troll posts to be a very uninteresting conversation, and so I'm going to just not engage it anymore.

 

[WingedOx]

As someone applying Psych I actually agree with much of what you said, besides the hyperbole of pseudoscience. Our treatments aren’t all that great, and as you say, can not address an exact ideology and do not take into account the environment. Resiliency is going to determine a lot of the outcome of our efforts, and there’s nothing we have that is going to target that.

The DSM doesn’t follow along with a biological construct of disease. But, I am looking forward to the future which include things like bio markers, pharmacogenetics, and a more biological construct of mental illness.

That being said, these efficiency problems are in all other areas on medicine.

So I commented on this earlier this week on the psych boards regarding the future of psychiatry and neuroscience.....

I think there's a lot to be cynical about too.

A lot of people have this opinion about psychiatry more than a lot of other fields that we're on the cusp of this grand neuroscience technology-driven revolution in how we practice. I just don't see it beyond the hype, and I see it less and less the more I look for it.

TMS looks to have an insanely high placebo response. Ketamine infusions are trending in that direction too (plus I had an experience with one of my own patients involved in one of the recent ketamine analog trials that made me really question the quality of what they've been doing in their studies). There's no evidence that genetics-based interventions like GeneSite guide a pathway to more precise treatment compared to just picking meds at random (or by cheapest). I've yet to see an fMRI study that I should actually care about at the level of my clinical practice. I see some of the interventions coming through the pipeline for my friends over in oncology and compare it to the pace of change in our field, and we're pretty much primitive unless you're going to get really excited about the makers of brexpiprazole trying to throw sh-t to the wall to see what sticks at the FDA.

I think it's that relatively primitive nature of psychiatry that makes people have wishful thinking about its future ("psychofuturism"?). I suppose that's all well and good, and mostly harmless, but my own personal Luddite philosophy of practice emphasizes the importance of seeing things as they are over seeing them as you want them to be. You'll do a lot of good for peoples' lives in this field, but even 20 years from now it'll be not from the precision of a genetically-tailored chemical infusion, but from a referral to the talented CBT therapist in the office next door.

I'm somewhat cynical about the future of biomarkers as well. Theoretically we should be able to come up with some related to a limited number of conditions, but that still relies heavily on theories of "imbalances" in neurochemical compounds, which I think if true, are less common than people want to believe for a lot of conditions. I'm also skeptical about how the specificity/sensitivity of such tests could be made to have them be clinically useful.
...

Though to the central theme of this thread, our field does throw some students off because there are no biomarkers, no objective tests to run in most cases. However, being able to properly evaluate changes in mental status are something you need to be proficient at in any medical specialty except perhaps path and rads. The IM residents at the hospital where I trained seemed to take a perverse pride in their inability to do so. There aren't any shortcuts to it. You just have to learn how, and for a lot of students don't know how to handle a new way of processing things, the way premed students get thrown off by having to use spacial reasoning for the first time ever when they take orgo. Yeah, there are a lot of psych programs out there graduating residents with poor diagnostic skills, and psychiatry needs to be more honest with itself about its limitations at times (see my sig), but I'm not sure it's someone like the OP who doesn't understand the concept of number needed to treat who should be the one doing the criticism.

 

[Mad Jack]

DO NOT QUOTE

I'm not sure if I'm the only one who feels this way, but does anyone else feel like psychiatry is a pseudoscientific field?

I've seen how psychiatrists diagnose patients, based on a collection of symptoms and are very subjective not only to the patient themselves, but also to the physician, particularly in depression.
I rarely see psychiatrists factor in the patients' environment, how much of their illness, like depression, is because of just certain personality traits (that are fiercely resistant to change)?
There is absolutely no objective way to tell if anyone is depressed, have anxiety, OCD, depersonalization, and so on. There is no biomarker to confirm the illness, or if the patient was cured.

They throw all these terms at you like they know what they’re talking about, they prescribe meds that supposedly cover a very broad range of symptoms but work only like 40% of the time and often result in much more side effects, and from there psychiatrists play a guessing game and suggest trying a different med. This goes on and on, and the poor patients get their hopes up with every new attempt and soon get those hopes crushed again, leaving them feeling helpless and in distraught.

I feel for the patients, mental illnesses are stressful and can be very isolating. I do not undermine their suffering, I question the efficiency of psychiatry as a field.

I mean, have you been in an inpatient psych unit long enough to see the difference psychiatry can make? People can go from unable to care for themselves to fully functional members of society again in the best of cases.

 

[mehc012]

I mean, have you been in an inpatient psych unit long enough to see the difference psychiatry can make? People can go from unable to care for themselves to fully functional members of society again in the best of cases.

I honestly think that inpatient psych represents the worst that psych has to offer. At least the ones that I've seen the inside of, there's no humanity left in how patients are dealt with. They're not treated as people.

 

[Mad Jack]

I honestly think that inpatient psych represents the worst that psych has to offer. At least the ones that I've seen the inside of, there's no humanity left in how patients are dealt with. They're not treated as people.

Depends on where you're at. I've seen both the best and the worst of psychiatry on various inpatient units

 

[operaman]

Sounds like OP hasn't had much psych experience or comes from a school with a particularly poor student rotation.

Regardless of the field, you rarely get as many confirmatory tests as you would like and all the testing in the world won't tell you whether your chosen intervention will work for your patient. There are a few certainties scattered throughout medicine, but overall all fields are at best a guessing game. Sometimes you get enough evidence that makes you confident of your diagnosis and plan, but sometimes you're working off incomplete information and have to make the best decision you can with what you know at the time.

I don't think this is unique to psychiatry in any way, just perhaps more frustrating in that you rarely have exam and imaging and lab findings that will support your diagnosis. The flip side in other fields is that we often get enough for a diagnosis based off the history and then waste a lot of time and money confirming what we already know is the case.

I was lucky and had a fantastic psychiatry experience as a student. While it's uncommon, I do still find myself using it at times when we get referred a patient who doesn't really have a surgical issue but rather an undiagnosed psych issue. Being able to conduct a rudimentary psych interview and make appropriate recommendations for formal psych eval and followup is a handy skill to have. It also spares the surgeon a potentially poor outcome in a patient who doesn't have a surgical disease to begin with.

 

[DrfluffyMD]

DO NOT QUOTE

I'm not sure if I'm the only one who feels this way, but does anyone else feel like psychiatry is a pseudoscientific field?

I've seen how psychiatrists diagnose patients, based on a collection of symptoms and are very subjective not only to the patient themselves, but also to the physician, particularly in depression.
I rarely see psychiatrists factor in the patients' environment, how much of their illness, like depression, is because of just certain personality traits (that are fiercely resistant to change)?
There is absolutely no objective way to tell if anyone is depressed, have anxiety, OCD, depersonalization, and so on. There is no biomarker to confirm the illness, or if the patient was cured.

They throw all these terms at you like they know what they’re talking about, they prescribe meds that supposedly cover a very broad range of symptoms but work only like 40% of the time and often result in much more side effects, and from there psychiatrists play a guessing game and suggest trying a different med. This goes on and on, and the poor patients get their hopes up with every new attempt and soon get those hopes crushed again, leaving them feeling helpless and in distraught.

I feel for the patients, mental illnesses are stressful and can be very isolating. I do not undermine their suffering, I question the efficiency of psychiatry as a field.

Quoted

 

[NYCdude]

Then do them a favor and never consult Psych. Let's see how long you can go without their pseudoscience.

 

[VA Hopeful Dr]

Just because it's not interesting to you, doesn't mean it's not interesting to others. That's true of every thread in here, and it's why I don't participate in 95% of them and yet others who are interested carry them on anyway. Not sure why you feel the need to point out when you don't find OP worth responding to...seems rather counterproductive, but sure.

At any rate, I'm going to take my own advice now. I find your whining about troll posts to be a very uninteresting conversation, and so I'm going to just not engage it anymore.

That's quite the <incorrect> box you've put me in, nicely played.

There is an argument to be made that a discussion on how psychiatry is different from the rest of medicine has merit. I think its fairly straightforward, but I can appreciate that not everyone feels that way and so such a discussion could be worthwhile.

This is not such a discussion. The OP didn't come in asking why that's the case or wanting to discuss how that affects outcomes for treatment of say manic episodes versus hypertension or anything like that.

No, instead this was very obviously an attempt to smear the entire field for no apparent reason.

That's why my attitude was so dismissive. This wasn't someone genuinely interested in answers or understanding.

 

[VA Hopeful Dr]

Depends on where you're at. I've seen both the best and the worst of psychiatry on various inpatient units

It also depends on the patients. When you have someone who has been institutionalized for 20+ years and very obviously is never getting better, its hard.

Conversely, as you point out, often inpatient psych can make an enormous difference. Going from a literal raving lunatic to functional in a few weeks with appropriate treatment is one of the more impressive things I've seen in medicine.

 

[sliceofbread136]

Eh I'll throw you a bone.

I love the idea of psych, what it could be, but it's too much of an imperfect science as is, I feel, partly because it ignores the phenomenon of spirit. You can't practice good psych without bringing spirit into the scientific discourse, and that will never happen. Rather than frustrate over the fact, I'd rather just steer clear altogether.

As is, it doesn't work. What's worse, it's become a way for a broken society to shift blame on the individual, to say there's something wrong with you. No man is an island. We are a product of our environment and the environment is polluted. When 1 in 10 people in our society suffers from mental illness, it means there's a bigger problem that goes beyond the individual that we're not getting to the root of.

Living with some who goes from uncontrolled psychosis to controlled psychosis will change that view real quick.

 

[Stagg737]

I rarely see psychiatrists factor in the patients' environment, how much of their illness, like depression, is because of just certain personality traits (that are fiercely resistant to change)?

If this is in fact true I'm guessing the number of psychiatrists you've seen is in the neighborhood of 1, as I've worked with dozens and all of them considered both the patient's environment and personality traits when treating.

they prescribe meds that supposedly cover a very broad range of symptoms but work only like 40% of the time and often result in much more side effects

If you think that's bad in psych, I can name a half a dozen other fields you should stay far, far away from as well...

I have seen enough psych patients mismanaged that I can sort of empathize with OP.

Yes, but a lot of those patients that I've encountered were either being treated by NPs or FM/IM docs and the psychiatrist is called in to clean up their mess. Plus, psych is heavily dependent on history, kind of hard to do when large portions of your patient population are demented, delirious, or psychotic and the people surrounding them are completely useless for collateral info.

its inefficient and even harmful in some cases.

Again, I can name a half dozen other fields where this is is the case...

we still don't know the mechanisms for almost all cognitive functions, nor the areas involved.

This is just straight up BS. This tells me you either haven't taken neuro and psych, the people who taught it to you suck at their job, or you just didn't pay attention. We may not know the precise details of every aspect of everything, but we certainly know the pathways and receptors involved in almost every mental process you could name.

The DSM doesn’t follow along with a biological construct of disease. But, I am looking forward to the future which include things like bio markers, pharmacogenetics, and a more biological construct of mental illness.

The research potential is part of what I love about psych. Even if we do find out that the biological models are overstated, there is still so much opportunity in almost every area of the field that it actually makes me want to consider jumping back into research.

I honestly think that inpatient psych represents the worst that psych has to offer. At least the ones that I've seen the inside of, there's no humanity left in how patients are dealt with. They're not treated as people.

Sounds like you worked at a crappy hospital. The inpatient units I worked on were nothing like that at all, and while many people were burnt out and had some edge of gallows humor, they cared about their patients a lot. The biggest frustrations I saw was ensuring patients had appropriate follow-up care after d/cing. Also, if you think inpatient psych is the worst I'd be willing to bet you've never worked in an addiction clinic.

 

[mehc012]

Sounds like you worked at a crappy hospital. The inpatient units I worked on were nothing like that at all, and while many people were burnt out and had some edge of gallows humor, they cared about their patients a lot. The biggest frustrations I saw was ensuring patients had appropriate follow-up care after d/cing. Also, if you think inpatient psych is the worst I'd be willing to bet you've never worked in an addiction clinic.

It was a horrible hospital, and a horrible unit, but even the nice fancy psych inpatients I've been to are depressing as hell. There's no getting around it, the very concept of putting someone on a psych hold is dehumanizing. And no matter how much people may care about their patients, the patients often feel that aspect as well. I've seen it from both ends - visiting people I cared about (both voluntary/pleased with the experience, and involuntary/not), and as a med student - and at a variety of hospitals, and I truly believe that while implementation matters, it's the core concept that's the most unsettling.

I agree that addiction is likely even worse. Fortunately I haven't experienced an addiction clinic, and I hope to avoid it. If I'd wanted to be a jail warden, I could have gone through a lot less schooling. It's necessary, and often helpful, but that doesn't mean I want to touch it with a 200ft pole. I would rather deal with terminally ill children than inpatient psych; it's less depressing to me.

 

[Stagg737]

It was a horrible hospital, and a horrible unit, but even the nice fancy psych inpatients I've been to are depressing as hell. There's no getting around it, the very concept of putting someone on a psych hold is dehumanizing. And no matter how much people may care about their patients, the patients often feel that aspect as well. I've seen it from both ends - visiting people I cared about (both voluntary/pleased with the experience, and involuntary/not), and as a med student - and at a variety of hospitals, and I truly believe that while implementation matters, it's the core concept that's the most unsettling.

I agree that addiction is likely even worse. Fortunately I haven't experienced an addiction clinic, and I hope to avoid it. If I'd wanted to be a jail warden, I could have gone through a lot less schooling. It's necessary, and often helpful, but that doesn't mean I want to touch it with a 200ft pole. I would rather deal with terminally ill children than inpatient psych; it's less depressing to me.

That's all well and good, but the vast majority of people held involuntarily are for a very good reason. While some will always see it as a dehumanizing and awful experience, I have seen patients later who were incredibly thankful that they were forced to go inpatient. I also happen to think that making "soup" in your toilet bowl out of your own piss and stool or being dead to be more dehumanizing than being committed involuntarily, but maybe that's just me.

Either way, it is a depressing field by nature, but I feel like the rewards of seeing patients go from having no control over their lives or literally hitting rock bottom to seeing them get back on their feet has been by far the most rewarding experience of my clinical years.

 

[mehc012]

That's all well and good, but the vast majority of people held involuntarily are for a very good reason. While some will always see it as a dehumanizing and awful experience, I have seen patients later who were incredibly thankful that they were forced to go inpatient. I also happen to think that making "soup" in your toilet bowl out of your own piss and stool or being dead to be more dehumanizing than being committed involuntarily, but maybe that's just me.

Either way, it is a depressing field by nature, but I feel like the rewards of seeing patients go from having no control over their lives or literally hitting rock bottom to seeing them get back on their feet has been by far the most rewarding experience of my clinical years.

I literally said that it was necessary and often helpful. I've never argued that it isn't. It's still dehumanizing and depressing. It can be both. You can be grateful for the outcome without losing sight of the fact that the process sucked.
I don't personally find either of your examples particularly dehumanizing from the perspective of the patient, not in the way that institutionalization is; they don't even involve interactions with other people, which I find pivotal to the entire concept of not being treated like a person or considered one.

I don't actually feel that we disagree on the utility or validity of psychiatry, even inpatient treatment, so there's not much debate to be had here.

I do find it interesting that you can choose not to have medical intervention, should it ever become necessary to preserve your life/function. You can choose to risk future death from something that would otherwise be treatable/manageable, simply because you find the treatment too distasteful to be worth the outcome...but you cannot choose the same thing about institutionalization, should it ever become necessary to preserve your own life/function. I don't necessarily disagree with it, but I do find it an interesting philosophical point.

 

[Crayola227]

lol you want to talk depressing and dehumanizing let's talk inpt IM

 

[Crayola227]

a LOT of medicine is just as depressing and dehumanizing, it might seem less so because of the underlying disease process, there's something about a 20 something who's suicidally depressed vs a 70 end stage COPD'er in terms of eventualities and treatability, than again, that's why I'd argue that a lot of psych actually offers greater order of magnitude of potential for improvement

of course there's something specially tragic about an otherwise healthy young person having disability and death from mental illness vs someone dying when a major organ goes out, a sense that it all could be avoided

but that's true of all the major killers from lifestyle factors

 

[mehc012]

a LOT of medicine is just as depressing and dehumanizing, it might seem less so because of the underlying disease process, there's something about a 20 something who's suicidally depressed vs a 70 end stage COPD'er in terms of eventualities and treatability, than again, that's why I'd argue that a lot of psych actually offers greater order of magnitude of potential for improvement

of course there's something specially tragic about an otherwise healthy young person having disability and death from mental illness vs someone dying when a major organ goes out, a sense that it all could be avoided

but that's true of all the major killers from lifestyle factors

Ehhh, a lot of times I find it more depressing when we force people's bodies to keep on living than when they pass, but that may also just be me.
Agreed that much of medicine is depressing and dehumanizing; this just happens to be the area that strikes me the hardest. Relative levels of 'utterly depressing outcome' are different for everyone.