The Tone

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Have you even educated yourself about the bills brought to congress in a multitude of states around the country regarding this issue?
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Several months ago, on this forum, I debated a bill that would allow psychologists to prescribe in Oregon with Daniel Carlat, M.D. I spent the time to read the bill that Carlat advocated for, and concluded the training required in the bill, the lack of final authority on to who bore medical responsibility for psychotropic medication prescriptions (the medical doctor or the psychologist?), and lack of a standardized examination method all led me to conclude the Oregon bill should not be passed. I came to that conclusion after literally spending hours reading the fine print and specifics of the proposed law.

The APsychologicalA pursues psychologist prescription powers, but they do not represent the will of the majority of psychologists but rather the special-interests of the field. Also bear in mind a lot of this has to do with money. Pharmaceutical companies have supported this measure because this only increases the number of people giving out their meds. You bet the billions of dollars to be reaped has created an unholy alliance, not just between the pharm industry and physicians but with however (edit: meant to write "whoever," not however) they can find to "sell" their product. That drug rep that gives you free meals is much more an enemy in this "war" than most psychologists if you want to look at it that way.

William N. Robiner, Ph.D. (A psychologist by the way) wrote a very good paper on the problems with psychologist prescribers. In fact he actually advises against this and instead did write in favor of psychologists collaborating with other physicians without doing the prescribing themselves.

http://www.med.umn.edu/gim/prod/groups/med/@pub/@med/documents/asset/med_87453.pdf

We believe that psychologists' deficits in education and knowledge constitute major hurdles to competent prescribing. They are not likely to be surmounted through abbreviated training programs, such as that recommended by the APA
2

Unless the deficiencies .in psychologists' training for the pharmacologic management of mental health problems are appropriately remedied (i.e., they are trained up to the level of other prescribers), the quality of psychopharmacologic care rendered to patients would likely be compromised and should not be presumed to be equivalent to that provided by psychiatrists. The conundrum inherent in psychologists prescribing is that by not knowing what they don't know, they may unwittingly expose their patients to needless risks. No matter how wellintentioned psychologists may be in seeking prescriptive authority, and regardless of their competence in other clinical endeavors, the inadequacies in their preparation pose unacceptable risks that they will do harm if they prescribe.
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On a side note, I'm doing some psychanalysis on myself because I can't help but notice the two bulges in the picture below. No, I'm not gay, I swear, not that there's anything wrong with it.

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Just for you who might not have gotten the joke..

Those guys with the bulges are from an old Trek episode.
http://en.wikipedia.org/wiki/Let_That_Be_Your_Last_Battlefield

It's about two aliens, locked in hatred of each other because one has a right sided black face and a left sided white face, the other is the opposite.
But despite the silliness of the reason for the hatred, every single political, BS, out-of-context, misleading thing you can think of is being spewed by one with the intent to get others to hate the other. The crew of the Enterprise are forced to endure hearing these two guys argue all the time, while they try to insert the crew into their histrionic and dysfunctional war.
 
And thus confirms the real lack of anonymity on the internet...

http://psychiatry.osu.edu/education/...gram/index.cfm
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OSU huh? Food for thought.

Well Wallstreet, I guess I have been of the opinion that you are a psychiatrist on a psychiatry forum and entitled to your views although you perhaps step over the line sometimes. I know I can be seen as being harsh regarding psychology prescribing or psychiatry training and privileges/expertise but I will consistently post that way because its based on my conclusions after evaluating everything through evidence and personal experience. So I am curious RE: Wallstreet's anger at certain people and just wondering what makes him tick.

I am also intrigued by Dr. Kugel's proposal that there may actually be a method to this posting. A desire to create chaos in a structured manner in a way. WS clearly knows pharmacology but shows little understanding of psychotherapy. If he/she were truly from OSU, this should not be the case as they have a pretty strong psychotherapy program (like most Ohio programs as Whopper could probably attest). So it makes me think something else is going on.
http://psychiatry.osu.edu/education/residency_program/index.cfm
 
Did WS actually say he was at OSU? I saw him posting somewhere about being in Ohio, but I didn't see the specific OSU mention. There are lots of other programs in Ohio ...
 
I am going on purely the previous post as nitemagi is pretty reliable. There may have been a misunderstanding.
 
In general I like the majority of WS' posts. RE: tone, well this is the internet and sometimes I wonder if tone gets misconstrued. I know my tone has gotten misconstrued a couple of times.
 
Agree.

In general, when I see two people get at it on the internet, I think if these guys actually met in person, things would be different. I really wasn't bugged by his comments. My own post about the aliens with the bulges was meant with humor but the more I think about it, it could be interpreted as a "laugh at you" thing instead of a "laugh with me" thing.

In any case, I do think if someone starts using a particular tone where they start pointing fingers and such, while that may not be meant with bad intent, the person needs to be aware that because of the limitations of the internet, things could get out of hand, and if you give it, you also need to be able to take it spade-for-spade.

I don't believe psychiatrists should be at "war" with psychologists, and the actions of both of our respective APAs sometimes does not speak to the better elements of our profession, nor should we define ourself by the lobbying efforts of special interests. I felt I had to address that given the posts from WS.

As for OSU, I don't know much about that program. I can tell you that Ohio has some of the country's best forensic fellowship programs and forensic psychiatrists. Resnick, Mossman, and Noffsinger are all in this state (all rated top doctors in the country, not just psychiatrists, all considered in the upper echelons in the field), which is something out of the ordinary considering this is not NY or CA. But even if OSU was a great program, even the best programs can have bad residents. That's not to say WS is bad, just that someone's program doesn't necessarily speak about them. People I know that when to Columbia, Harvard, and other programs were some of the worst residents I ever seen.
 
nitemagi said:
I'm also aware of this:
http://www.npr.org/blogs/alltechcon...-crawls-the-web-bringing-fame-and-a-book-deal

Some people join forums with multiple personas, one of which is a troll and the other more reasonable, trying to create factions for the purpose of their own entertainment.
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Re: Trolling, a quotation from the first, biggest and probably never to be repeated troll.

"We shall proceed to expel you from the Internet and systematically dismantle the Church of Scientology in its present form ... We are anonymous. We are legion. We do not forgive. We do not forget. Expect us."[

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

http://www.wired.com/culture/culturereviews/magazine/17-10/mf_chanology?currentPage=2

Then again

http://en.wikipedia.org/wiki/Operation_Payback#Operation_Avenge_Assange

EDIT: Sorry missed the shhhh anyway I reckon it's not Amber .....that's all I have to say about it.....
 
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nitemagi said:
Some people join forums with multiple personas, one of which is a troll and the other more reasonable, trying to create factions for the purpose of their own entertainment.
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Really?? 😱 One must really have a crappy social life and a lot of time on their hands to do something like that.

A little off topic, but I did have a patient who had social anxiety that ended up causing a high amount of anxiety IN A CHAT ROOM. She was so anxious about what others thought of her posts that that is all she wanted to talk about during her appointments. The rapidly changing media and technology environment is causing some very interesting landscapes for psychiatric illness and social issues to fester.

With all the headaches that I see kids getting into from social media (sexten, cyber bulling, etc.), I'd like to see kids banned from that until their 18....
 
Chimed said:
With all the headaches that I see kids getting into from social media (sexten, cyber bulling, etc.), I'd like to see kids banned from that until their 18....
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Good luck!
More likely they get the ability to text hardwired into them at birth. I wonder if AT&T would sponsor something like that...
 
Young kids do use a lot more emoticons so are probably better at getting "tone" across than we are (at least me).

Also, I wonder how much their interaction on the internet leads to their interactions in the real world. Having little or no consequences on the internet while developing must have some real world implications.
 
Wow, the board has been interesting lately! I'm so sorry I've been gone! To think the other night I got my laughs by watching two grown attendings (psych vs EM) duke it out at the hospital over a misunderstanding involving a transfer, and I could have been entertaining myself here instead!
 
billypilgrim37 said:
Here.
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I haven't caught up on this whole debate, but someone posted a link that easily links to a picture of the OSU PGYIV class. There's 2 males in the class. WS could be lying here on SDN about where he's from, and by vilifying the real life people complete with pictures--that's pretty unfair, I would think, especially if it harms those people. Though I also notice that no one has posted claiming to be from OSU and deny his existence there.
 
nancysinatra said:
I haven't caught up on this whole debate, but someone posted a link that easily links to a picture of the OSU PGYIV class. There's 2 males in the class. WS could be lying here on SDN about where he's from, and by vilifying the real life people complete with pictures--that's pretty unfair, I would think, especially if it harms those people. Though I also notice that no one has posted claiming to be from OSU and deny his existence there.
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👍

Although WS' reaction to being 'outed' was quite dramatic, indicating that it could have been him, we probably shouldn't be outing people. Harm could be done in many ways. By outing someone this way, there is a definite sticks and stones nature to the harm as well as it can have real world consequences.
 
Manicsleep said:
👍

Although WS' reaction to being 'outed' was quite dramatic, indicating that it could have been him, we probably shouldn't be outing people. Harm could be done in many ways. By outing someone this way, there is a definite sticks and stones nature to the harm as well as it can have real world consequences.
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Agree with this ^^^.

Aside from all else, anonymity is a right on SDN and violating that is a violation of SDN terms of service. Whether folks like the dude or not is really irrelevant.
 
Intention was never to "out" someone. The discussion was that there is little real anonymity on the internet, and that one should remember that when posting. Someone pointed out that WS mentioned his program, and I googled and put a link to that program (not to the individual because I don't know who he is). People then draw conclusions as they may.

To play devil's advocate, though, maybe a little accountability is a good thing. My identity can easily be discovered through minimal detective work here (comes from being on SDN since before I was in med school).

To quote the terms of service:
1. Protect anonymity. Remember, the SDN Forums are followed by students, doctors, schools and professional organizations. Please keep your identity protected – don't post or use your real name on the forums. Additionally, members are not permitted to solicit personally identifiable information from other members or disclose another member's identity without their written permission.
...
13. Once you've posted on the site, it's there forever. We do not delete posts except in extreme cases. Even if we can remove a post that you regret posting, they are often permanently cataloged in sites like Google or the Internet Archive.
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No one here has solicited personal info, nor disclosed another person's identity.
 
While his/her tact could (and should) at times use refining, I have learned many interesting things from Wallstreet's posts and personally think it would be unfortunate to lose his/her participation here.
 
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nitemagi said:
Someone pointed out that WS mentioned his program, and I googled and put a link to that program (not to the individual because I don't know who he is). People then draw conclusions as they may.
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It would take some serious ethical yoga to position that as in the spirit of "protect anonymity," no?

To each their own. Anyone who has done any significant amount of posting on this site and has been clear and honest when doing so has undoubtedly let enough slip that folks could figure out what program he or she is affiliated with or even their name.

We don't do post autopsy and try to give out personally identifying information about someone because we're a civil community. I'd hate to see that trend change.
 
He was putting the evidence out there. Someone just did the math and showed 2+2 is 4. However, wally supplied all that info himself. There was a post (now suspiciously gone :meanie:) that showed that only one of these guys had a new status in a certain state. That was not by Nite but actually by someone who is a moderator. Either way, I don't think evil is at hand.

Nancy and Manic bring up a good point though. What if someone is faking and we are buying in?
 
notdeadyet said:
We don't do post autopsy and try to give out personally identifying information about someone because we're a civil community. I'd hate to see that trend change.
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I'm not sure that linking to a 3 week old post that I remembered off the top of my head is "post autopsy" or somehow demonstrates a lack of civility. And the only reason I linked back to the post was because people started questioning my recollection from 3 weeks prior. If you're accusing me of somehow violating something or other, I just don't see it.
 
Mis-representing oneself is a valid concern, especially when more nefarious intentions are involved. I think this thread brings up the idea of a collective agreement about our forum. Everyone wants active discussion and participation. Hostility, threats, insults don't add much, from anyone, and it should be recognized that the internet isn't totally anonymous, no matter how much we wish it was. I've never tried to censor anyone, nor told anyone to get off the site. I do recognize the difference between posts that forward a discussion and those that are attempting to stir up conflict (which may be a subjective distinction). WS had posts from both camps.
 
I am not accusing anyone of anything. From what I can see nobody was engaged in malicious activity (including WS).

However, the point of notdeadyet stands on its own merit. Blurry information was made crystal clear although luckily, no names were mentioned. I mean nobody ill will, certainly not BP or nite, but we would be better served by learning from this for the future.

In retrospect I find this was an excellent thread and I am glad it was opened.
 
nitemagi said:
Mis-representing oneself is a valid concern, especially when more nefarious intentions are involved. I think this thread brings up the idea of a collective agreement about our forum. Everyone wants active discussion and participation. Hostility, threats, insults don't add much, from anyone, and it should be recognized that the internet isn't totally anonymous, no matter how much we wish it was. I've never tried to censor anyone, nor told anyone to get off the site. I do recognize the difference between posts that forward a discussion and those that are attempting to stir up conflict (which may be a subjective distinction). WS had posts from both camps.
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You are right but do you believe it was malicious (or nefarious if you choose 😉) in nature?
 
billypilgrim37 said:
I'm not sure that linking to a 3 week old post that I remembered off the top of my head is "post autopsy" or somehow demonstrates a lack of civility. And the only reason I linked back to the post was because people started questioning my recollection from 3 weeks prior. If you're accusing me of somehow violating something or other, I just don't see it.
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Nope, I'm not accusing anyone of anything. Apologies if it sounded like that.

Given the direction the thread is going, I just wanted to point out that posting personally identifying information about a user, even if they posted that information themselves, goes against the spirit of the anonymity of SDN. That's all.
 
Manicsleep said:
You are right but do you believe it was malicious (or nefarious if you choose 😉) in nature?
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I think there's overt intention and intention via neglect. That gets into how conscious anything is, and whether someone was aware of an intent to harm or strike at others. Most often people on SDN are just getting defensive or territorial because they're feeling threatened, but it's the way they respond that's at issue. When someone jumps into pure insults and/or generalizations because they feel threatened, that's reactionary and doesn't really help a debate much. I don't think WS was malicious in his(presuming it's a he) intent, but had a hostile tone in many posts and was dismissive and even insulting with generalizations quickly. I doubt it was for the purpose of stirring up conflict, of instead more neglectful of the consequences of his posts.
 
WS frequently responded to differing points of view with belittlement. I seem to remember something about no psychology student being able to tell him something that he didn't know 10 times better. Any challenge was met with accusations of "spewing misinformation", having "an agenda", or being overly "politically correct." Any useful content to his posts (and to be honest, I found very little) was lost in the conflict he created. The brouhaha also detracted from discussion of the fun and interesting stuff we usually deal with here.
 
Concur with Doc Samson. Honestly, if I met WS in person, I wouldn't care. Like I said, too many times I've seen guys who just came off as rude by the way they type a message on a forum, and it turned out they really weren't a bad guy after all.

Nonetheless, some black-and-white thinking was exhibited with fingers pointed against people that IMHO should be our colleagues in the field. People did try to suggest to WS to calm down, and he just upped the ante.

I haven't seen WS post since. On the flip-side, I've also seen people on forums being given multiple chances, and each time they just start a flame war over and over again. It's easy when you're a bystander with little responsibility over a forum to make comments on how it should be run. I'm not a moderator on this forum, but I have been in others. If he came back I'd be fine with it so long as the tone is civil, but if it continued I would encourage a ban, and if banned, I wouldn't look back. Chronic trollers often demoralize a forum to the degree where people who could contribute something meaningful would go elsewhere.
 
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