What do you guys hate about psychiatry?

[psyche108]

Residents and attendings, what do you guys hate about psychiatry? I have read other threads about what people like and don't like about psychiatry, but I was wondering if any opinions have changed the longer you guys practice.

For other fields of medicine, I hear random things about how there's so much paperwork and bureaucracy or that patients don't listen to nutritional or exercise recommendations and are just looking for a pill to solve their problems (I guess for psychiatry, it would be patients saying they want psychotherapy, but they're not being committed). Other things I've read would be that patients are ungrateful and awful or that you don't feel like you're actually helping people or it's draining and stressful or that the other doctors are terrible.

What about for psychiatry? For the most part, this has been a pretty positive forum, but I'm wondering what you guys don't like about it. Could you also mention what setting you work in? Inpatient, outpatient, prison/forensic psych, emergency psych, VA, hospital, private practice, how much time spent doing med management or therapy, and so on.

A few things I've read about disliking psychiatry on this forum are the patient population is stressful, giving diagnoses when a diagnosis isn't necessary, 1/2 to 2/3 of psychiatrists are terrible and good psychiatrists that care about their patients are in the minority and usually don't serve the poor/lower middle class because of the way their practice is set up, psychiatry is being used to solve problems that are more societal in nature (ex. giving someone a medication to help them deal with stress/anxiety when the cause of their stress is their 80 hour a week investment banking job or an abusive spouse or whatever), etc.

Please note, these are just random things that I remember finding on the forums. I have also read so many things about why people like psychiatry, but not much about why people dislike it. This is just so I know what to expect.

Thanks!

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[splik]

things i don't like about psychiatry:

1. this ridiculous quest people have to make psychiatry sound more 'scientific' and technical than it is or ever should be
2. academic posturing from idiots who are an embarrassment to the field
3. the generally poor standard of alot of mental health care in the community
4. the fact that so many psychiatrists have abandoned the mentally ill
5. dismissing genuine criticisms of the field as "anti-psychiatry"
6. psychiatrists who claim that those that aren't psychiatrists can't criticize the field
7. the excessive use of coercion in the field
8. people using the term "med management" - makes them sound like pharmacists
9. the artificial divide between psychiatry and medicine
10. the challenges of providing basic medical care to patients as a psychiatrist
11. lack of intellectual curiosity in clinical practice
12. the reification of psychiatric diagnoses that have no validity and little reliability
13. disparaging of evidence-based practice
14. the overselling of evidence-based practice
15. the obsession in some quarters for measurement-based practice with silly things like the PHQ-9
16. psychiatrists referring to themselves as "eclectic"
17. dogmatism in psychiatry from those who think they have the only claim to "truth"
18. pervasiveness of pseudoscience in the field
19. the promotion of the myth that mental illnesses are "brain disorders" - which has been shown to increase the stigma of mental illness
20. institutional racism and the marginalization of african american psychiatrists
21. the obsession with "objectivity" and finding biomarkers
22. the almost complete irrelevance of the NIMH to clinical practice
23. the relative neglect of psychiatry to address the question of how to expand access to mental health care for those most in need
24. the proneness of the field to fadishness - both diagnoses and treatments
25. the almost total neglect of social aspects of mental health and illness in the US
26. psychiatrists capitalizing on mass shootings and other tragedies to campaign for increased funding for mental health care despite our inability to predict or prevent these occurrences
27. outpatient commitment/"assisted outpatient treatment"
28. rampant polypharmacy and off-label use of too many drugs, and too high doses, for too long
29. how the pharmaceutical company has undermined the credibility of the profession despite things being much better than a few years ago
30. lack of honesty about what psychiatry can and cannot do (cannot cure social ills, prevent suicide in majority of cases, predict violence, reform non-mentally ill criminals and sex pests)

 

[Wilf]

things i don't like about psychiatry:

18. pervasiveness of pseudoscience in the field
19. the promotion of the myth that mental illnesses are "brain disorders" - which has been shown to increase the stigma of mental illness

Definitely agree with 18.
Am curious though, you don't believe mental illness is due to problems in the brain?

 

[Armadillos]

Definitely agree with 18.
Am curious though, you don't believe mental illness is due to problems in the brain?

Splik is an awesome poster, but this point is something that has left the forum scratching their collective heads at times.

Throughout the brain we see pathology impair motor function, sensation, memory, balance, speech, etc.
It would be very strange if other functions of the brain such as emotion and thought were not also uniquely effected by yet to be understood pathological processes. The brain brings the mind/thoughts into existence, so any disorder of the mind must in someway involve the brain even if the ultimate source is an external social factor.

Obviously Splik is a proponent of social approaches to psychiatry, but a social intervention could still be the best approach even if mental illness was hypothetically thought to be 100% "biological" or brain disorders.

Our environment and experience influences the brain, psychotherapy or stable housing is no less biological than Prozac when it comes to influencing the brain.

 

[l0st1]

hey splik, that's a rather long list. Why are you in psychiatry?

 

[F0nzie]

hey splik, that's a rather long list. Why are you in psychiatry?

Don't make splik say the 90 things she loves about Psychiatry. We're trying to keep this club exclusive.

 

[wolfvgang22]

What does #4 mean?

 

[TexasPhysician]

My dislikes are really about all of medicine.

1. Documentation is useless as the purpose is reimbursement and prevent/protect from lawsuits.

2. Stupid lawsuits.

3. People that believe I can read their minds when I say I'm a psychiatrist.

4. Sweater vests are awful. Stop it.

 

[smalltownpsych]

Definitely agree with 18.
Am curious though, you don't believe mental illness is due to problems in the brain?

Some mental illness appears to be due to dysfunctional processes in the brain although we don't really know enough to say that very definitively. Many mental illnesses are not due to neurological dysfunction. About 20% of inpatient and 10% outpatient are BPD. Not much evidence that is a brain disorder. PTSD can be thought of as a typical response to trauma with people having differing amounts of resiliency. How often is MDD purely biological in nature and isn't depressed mood a normal response to many life events. Same for anxiety or obsessive thoughts or compulsive behaviors. For most mental illnesses it is more of a matter of degree and where we draw the line than it is with a typical physical illness.

What does #4 mean?

I'm sure that Splik is referring to too many psychiatrists working with the worried well as opposed to the truly sick.

 

[F0nzie]

I'm sure that Splik is referring to too many psychiatrists working with the worried well as opposed to the truly sick.

CEO's with private jets aren't immune to getting depressed, manic, suicidal, or psychotic. They get it just the same! Despite having their own tennis courts and every possible family member giving them support. Seriously! I could not believe it either.

And their children.... Riding their beautiful horses all day in their 300 acre ranch. I was almost 100% sure they would be immune.

 

[smalltownpsych]

CEO's with private jets aren't immune to getting depressed, manic, suicidal, or psychotic. They get it just the same! Despite having their own tennis courts and every possible family member giving them support. Seriously! I could not believe it either.

And their children.... Riding their beautiful horses all day in their 300 acre ranch. I was almost 100% sure they would be immune.

I spent three years as a clinical director of a private pay treatment program for adolescents. What I found was that the biggest difference between the rich and the poor when it comes to mental illness is ability to pay for the best treatment while living on a fully staffed 300 acre ranch. We had close to a one to one staff to patient ratio with cows, horses, music program, art program, theatre, college prep academics. man, I should have gone to school there. I don't think my folks could have afforded the 8k per month price tag though.

 

[splik]

Splik is an awesome poster, but this point is something that has left the forum scratching their collective heads at times.

Perhaps because I am prone to hyperbole and exaggeration my point has been missed.

But let me first mention that I'll be specializing in (forensic) neuropsychiatry, and I head the neuropsychiatry consultation service, lead the neuropsychiatry case conference, teach neuropsychiatry didactics, and am responsible for coordinating the neuroanatomy and neuropsychology exposure in the residency program. I also work largely with patients with real brain diseases: FTD, HIV dementia, neurosarcoid, autoimmune limbic encephalitis, Alzheimer's, Vascular dementia traumatic brain injury, Lewy Body dementia, stroke, Tourette's and so on. I probably perform more neurological examinations, order and look at more head imaging and EEGs, and workups for organic causes of psychiatric disturbance than 99% of psychiatrists. So I absolutely believe that psychiatrists should know more about functional neuroanatomy of emotion and cognition, and the neurological causes of psychiatric disturbance. Even subtle neurological insult can cause emotional and cognitive disturbances.

But, mental illnesses are not best conceived of a "brain disorders". The public don't buy it, and they don't like it. Medical students don't like it either as evinced by the decline in interest in psychiatry residency in the 80s and 90s during the biologization of psychiatry and the "decade of the brain". Of course everything influences the brain, but this kind of neuroessentialism has very negative implications for our field, how we view our patients, how they view themselves, and encourages a sense of fatalism and provides moral exculpation and abdication from personal responsibility. I completely agree with you that "biological" problems can be treated with "social" interventions. But your rationale is again predicated on the reductionistic neuroessentialist view that as everything can be reduced to its neural underpinnings, that "social" intervention is actually as somatic in influence as any drug. The problem with this is in many instances our understanding of the social, cultural, and psychological are rich enough and in no way are enhanced by neuroscience. A narrow focus on the brain on the other hand without reference to context is often unhelpful. I find it troubling that in our new way of looking at the world, privileging a neuroscientific discourse means that the social and psychological sciences increasingly need to rely on "neuroscience" to justify what is meaningful in itself.

I am sure if I was in the 60s I would be railing against the analysts and the lack of consideration for the brain. But in the current era, we have almost become mindless with this monomanical fixation on the brain. As others have noted, the "biopsychosocial" model is really the "bio-bio-bio" model as psychosocial factors have been relegated in significance and only seen as importance when transmuted into the neurobiological. The NIMH is increasingly closing funding for those who do not have a focus on genetics or imaging or incorporate this in their work. This is especially true for those early in their careers. The reason I am such a proponent of the social is because it is so neglected in American psychiatry and because I believe than in the social we often find, what Michael Marmot calls "the causes of the causes".

It is not that I don't appreciate that there is a biological basis for our emotions, thoughts, and behaviors. Far from it. Biology can influence these things in profound ways. My contention is that by framing mental illnesses as brain disorders we narrow the field (as has been happening for many years). As Nikolas Rose noted, we have come to recode our moods in terms of serotonin levels, we have become, in his words, "neurochemical selves". In doing so, we have actually undermined our own sense of agency and personhood. This is not good for patients. Part of the misguided rationale for saying mental illnesses are "brain disorders" (which I think we all know is oversimplistic) is to try and reduce the stigma. It turns out that actually, while patients and families like it because it absolves them of blame, it actually increases public stigma, social distancing, increases public perceptions of dangerousness and unpredictability, and psychiatrists who see their patients as brain diseased are less likely to include them in their care.

See:

Rebalancing academic psychiatry - why it needs to happen and soon
Mindlessness and brainlessness in psychiatry
Attitudes towards psychiatric treatment and people with mental illness: changes over two decades
Prejudice and schizophrenia: a review of the "mental illness is and illness like any other" approach
Decline of U.S. medical student career choice of psychiatry and what to do about it

Also see:
Interview with Professor Alwyn Lishman (who wrote the definitive single author neuropsychiatry textbook) he said:
"Before that neuropsychiatry got a bad reputation. That was Wilhelm Griesinger at the Charité Hospital. He said mental disorders are brain disorders, full stop. And he tried to make the whole of psychiatry nothing but brain science. Of course that made it very unpopular in the world in general because people were saying: this is a ridiculously narrow view" and "You have got to have a finger in every pie in psychiatry and be ready to turn your hand to whatever is the most important avenue: an EEG one day, a bit of talking about a dream another day. You just follow your nose. All psychiatrists should be all types of psychiatrist. You shouldn’t turn your back on talking therapies as many patients need this. I’ve always said the fundamental skill of a psychiatrist is being able to talk meaningfully and helpfully with patients."

 

[Nasrudin]

things i don't like about psychiatry:

1. this ridiculous quest people have to make psychiatry sound more 'scientific' and technical than it is or ever should be
2. academic posturing from idiots like jeffrey lieberman who are an embarrassment to the field
3. the generally poor standard of alot of mental health care in the community
4. the fact that so many psychiatrists have abandoned the mentally ill
5. dismissing genuine criticisms of the field as "anti-psychiatry"
6. psychiatrists who claim that those that aren't psychiatrists can't criticize the field
7. the excessive use of coercion in the field
8. people using the term "med management" - makes them sound like pharmacists
9. the artificial divide between psychiatry and medicine
10. the challenges of providing basic medical care to patients as a psychiatrist
11. lack of intellectual curiosity in clinical practice
12. the reification of psychiatric diagnoses that have no validity and little reliability
13. disparaging of evidence-based practice
14. the overselling of evidence-based practice
15. the obsession in some quarters for measurement-based practice with silly things like the PHQ-9
16. psychiatrists referring to themselves as "eclectic"
17. dogmatism in psychiatry from those who think they have the only claim to "truth"
18. pervasiveness of pseudoscience in the field
19. the promotion of the myth that mental illnesses are "brain disorders" - which has been shown to increase the stigma of mental illness
20. institutional racism and the marginalization of african american psychiatrists
21. the obsession with "objectivity" and finding biomarkers
22. the almost complete irrelevance of the NIMH to clinical practice
23. the relative neglect of psychiatry to address the question of how to expand access to mental health care for those most in need
24. the proneness of the field to fadishness - both diagnoses and treatments
25. the almost total neglect of social aspects of mental health and illness in the US
26. psychiatrists capitalizing on mass shootings and other tragedies to campaign for increased funding for mental health care despite our inability to predict or prevent these occurrences
27. outpatient commitment/"assisted outpatient treatment"
28. rampant polypharmacy and off-label use of too many drugs, and too high doses, for too long
29. how the pharmaceutical company has undermined the credibility of the profession despite things being much better than a few years ago
30. lack of honesty about what psychiatry can and cannot do (cannot cure social ills, prevent suicide in majority of cases, predict violence, reform non-mentally ill criminals and sex pests)

This list is incoherent. You circumscribe a position in which psychiatrists: cannot respond to critics--and when they do it's entirely unfair to expect passing familiarity with the clinical predicament of modern mental health delivery; must endure having their practice conditions dictated by bureaucrats--and if they leave they are abandoning the weak and the helpless, but if they serve in a beat down public mental health clinic they can't do just med management--the miscreants; psychiatrists neglect the social but at the same time need to be aware that psychiatry cannot cure social ills.

Here's my list:

1. Psych academics are the worst. Like out of touch nerds with no shame about it. Bow ties, glasses, sweaters, the kind of people who flex as many literature references during cocktail conversations as they can. Just miserably annoying pricks who are in love with their own opinions and who have a paucity of physical culture. Talking about other people emotions but with no sense of their own physicality or that of their patients.
2. The socialist moral superiority complex again...of academics.
3. Insurance companies' power over how we practice
4. The influence of pharmaceutical companies
5. How the billing is set up to favor med management style of practice.

 

[Achillees]

things i don't like about psychiatry:


20. institutional racism and the marginalization of african american psychiatrists

First time I'm hearing about this. Do you mind expounding on that?

Can other Psychiatrists here corroborate this?

 

[Achillees]

Residents and attendings, what do you guys hate about psychiatry? I have read other threads about what people like and don't like about psychiatry, but I was wondering if any opinions have changed the longer you guys practice.

For other fields of medicine, I hear random things about how there's so much paperwork and bureaucracy or that patients don't listen to nutritional or exercise recommendations and are just looking for a pill to solve their problems (I guess for psychiatry, it would be patients saying they want psychotherapy, but they're not being committed). Other things I've read would be that patients are ungrateful and awful or that you don't feel like you're actually helping people or it's draining and stressful or that the other doctors are terrible.

What about for psychiatry? For the most part, this has been a pretty positive forum, but I'm wondering what you guys don't like about it. Could you also mention what setting you work in? Inpatient, outpatient, prison/forensic psych, emergency psych, VA, hospital, private practice, how much time spent doing med management or therapy, and so on.

A few things I've read about disliking psychiatry on this forum are the patient population is stressful, giving diagnoses when a diagnosis isn't necessary, 1/2 to 2/3 of psychiatrists are terrible and good psychiatrists that care about their patients are in the minority and usually don't serve the poor/lower middle class because of the way their practice is set up, psychiatry is being used to solve problems that are more societal in nature (ex. giving someone a medication to help them deal with stress/anxiety when the cause of their stress is their 80 hour a week investment banking job or an abusive spouse or whatever), etc.

Please note, these are just random things that I remember finding on the forums. I have also read so many things about why people like psychiatry, but not much about why people dislike it. This is just so I know what to expect.

Thanks!

This is a great post and question. Thank you for this.

 

[Achillees]

Perhaps because I am prone to hyperbole and exaggeration my point has been missed.

But let me first mention that I'll be specializing in (forensic) neuropsychiatry, and I head the neuropsychiatry consultation service, lead the neuropsychiatry case conference, teach neuropsychiatry didactics, and am responsible for coordinating the neuroanatomy and neuropsychology exposure in the residency program. I also work largely with patients with real brain diseases: FTD, HIV dementia, neurosarcoid, autoimmune limbic encephalitis, Alzheimer's, Vascular dementia traumatic brain injury, Lewy Body dementia, stroke, Tourette's and so on. I probably perform more neurological examinations, order and look at more head imaging and EEGs, and workups for organic causes of psychiatric disturbance than 99% of psychiatrists. So I absolutely believe that psychiatrists should know more about functional neuroanatomy of emotion and cognition, and the neurological causes of psychiatric disturbance. Even subtle neurological insult can cause emotional and cognitive disturbances.

But, mental illnesses are not best conceived of a "brain disorders". The public don't buy it, and they don't like it. Medical students don't like it either as evinced by the decline in interest in psychiatry residency in the 80s and 90s during the biologization of psychiatry and the "decade of the brain". Of course everything influences the brain, but this kind of neuroessentialism has very negative implications for our field, how we view our patients, how they view themselves, and encourages a sense of fatalism and provides moral exculpation and abdication from personal responsibility. I completely agree with you that "biological" problems can be treated with "social" interventions. But your rationale is again predicated on the reductionistic neuroessentialist view that as everything can be reduced to its neural underpinnings, that "social" intervention is actually as somatic in influence as any drug. The problem with this is in many instances our understanding of the social, cultural, and psychological are rich enough and in no way are enhanced by neuroscience. A narrow focus on the brain on the other hand without reference to context is often unhelpful. I find it troubling that in our new way of looking at the world, privileging a neuroscientific discourse means that the social and psychological sciences increasingly need to rely on "neuroscience" to justify what is meaningful in itself.

I am sure if I was in the 60s I would be railing against the analysts and the lack of consideration for the brain. But in the current era, we have almost become mindless with this monomanical fixation on the brain. As others have noted, the "biopsychosocial" model is really the "bio-bio-bio" model as psychosocial factors have been relegated in significance and only seen as importance when transmuted into the neurobiological. The NIMH is increasingly closing funding for those who do not have a focus on genetics or imaging or incorporate this in their work. This is especially true for those early in their careers. The reason I am such a proponent of the social is because it is so neglected in American psychiatry and because I believe than in the social we often find, what Michael Marmot calls "the causes of the causes".

It is not that I don't appreciate that there is a biological basis for our emotions, thoughts, and behaviors. Far from it. Biology can influence these things in profound ways. My contention is that by framing mental illnesses as brain disorders we narrow the field (as has been happening for many years). As Nikolas Rose noted, we have come to recode our moods in terms of serotonin levels, we have become, in his words, "neurochemical selves". In doing so, we have actually undermined our own sense of agency and personhood. This is not good for patients. Part of the misguided rationale for saying mental illnesses are "brain disorders" (which I think we all know is oversimplistic) is to try and reduce the stigma. It turns out that actually, while patients and families like it because it absolves them of blame, it actually increases public stigma, social distancing, increases public perceptions of dangerousness and unpredictability, and psychiatrists who see their patients as brain diseased are less likely to include them in their care.

See:

Rebalancing academic psychiatry - why it needs to happen and soon
Mindlessness and brainlessness in psychiatry
Attitudes towards psychiatric treatment and people with mental illness: changes over two decades
Prejudice and schizophrenia: a review of the "mental illness is and illness like any other" approach
Decline of U.S. medical student career choice of psychiatry and what to do about it

Also see:
Interview with Professor Alwyn Lishman (who wrote the definitive single author neuropsychiatry textbook) he said:
"Before that neuropsychiatry got a bad reputation. That was Wilhelm Griesinger at the Charité Hospital. He said mental disorders are brain disorders, full stop. And he tried to make the whole of psychiatry nothing but brain science. Of course that made it very unpopular in the world in general because people were saying: this is a ridiculously narrow view" and "You have got to have a finger in every pie in psychiatry and be ready to turn your hand to whatever is the most important avenue: an EEG one day, a bit of talking about a dream another day. You just follow your nose. All psychiatrists should be all types of psychiatrist. You shouldn’t turn your back on talking therapies as many patients need this. I’ve always said the fundamental skill of a psychiatrist is being able to talk meaningfully and helpfully with patients."

You're my new favorite Psychiatrist. It seems our interests align. I've been battling between Psych and Neuro, considered a combined program then decided against it. Seems Neuropsychiatry fellowship might be in the stars for me.

 

[kobebeefmd]

Definitely agree with 18.
Am curious though, you don't believe mental illness is due to problems in the brain?

I would say most mental illness is not from pathology, but a cognitive flaw that the patient developed at a critical point in their life and continued to follow that cognitive process. Repeated mental abuse, none to little social social support, loneliness, poverty, lack of education, perpetuates the problem. I'm not a psychiatrist, but I could imagine how difficult it is to find the root cause, and change the cognitive pathway -- as certain patients have lived more of their life thinking a certain way than the way "correct" way. Take some serious time and effort on both parties. On my psych rotations, I've realized how society has pretty much abandoned these patients, and hospitals and physicians use them to generate some profit, even if it's not high reimbursement.

Technology has not caught up to psychiatry yet, and that's why people tend to dismiss psychiatry because they can't understand the process without an absolute value.

 

[Armadillos]

Perhaps because I am prone to hyperbole and exaggeration my point has been missed.

But let me first mention that I'll be specializing in (forensic) neuropsychiatry, and I head the neuropsychiatry consultation service, lead the neuropsychiatry case conference, teach neuropsychiatry didactics, and am responsible for coordinating the neuroanatomy and neuropsychology exposure in the residency program. I also work largely with patients with real brain diseases: FTD, HIV dementia, neurosarcoid, autoimmune limbic encephalitis, Alzheimer's, Vascular dementia traumatic brain injury, Lewy Body dementia, stroke, Tourette's and so on. I probably perform more neurological examinations, order and look at more head imaging and EEGs, and workups for organic causes of psychiatric disturbance than 99% of psychiatrists. So I absolutely believe that psychiatrists should know more about functional neuroanatomy of emotion and cognition, and the neurological causes of psychiatric disturbance. Even subtle neurological insult can cause emotional and cognitive disturbances.

But, mental illnesses are not best conceived of a "brain disorders". The public don't buy it, and they don't like it. Medical students don't like it either as evinced by the decline in interest in psychiatry residency in the 80s and 90s during the biologization of psychiatry and the "decade of the brain". Of course everything influences the brain, but this kind of neuroessentialism has very negative implications for our field, how we view our patients, how they view themselves, and encourages a sense of fatalism and provides moral exculpation and abdication from personal responsibility. I completely agree with you that "biological" problems can be treated with "social" interventions. But your rationale is again predicated on the reductionistic neuroessentialist view that as everything can be reduced to its neural underpinnings, that "social" intervention is actually as somatic in influence as any drug. The problem with this is in many instances our understanding of the social, cultural, and psychological are rich enough and in no way are enhanced by neuroscience. A narrow focus on the brain on the other hand without reference to context is often unhelpful. I find it troubling that in our new way of looking at the world, privileging a neuroscientific discourse means that the social and psychological sciences increasingly need to rely on "neuroscience" to justify what is meaningful in itself.

I am sure if I was in the 60s I would be railing against the analysts and the lack of consideration for the brain. But in the current era, we have almost become mindless with this monomanical fixation on the brain. As others have noted, the "biopsychosocial" model is really the "bio-bio-bio" model as psychosocial factors have been relegated in significance and only seen as importance when transmuted into the neurobiological. The NIMH is increasingly closing funding for those who do not have a focus on genetics or imaging or incorporate this in their work. This is especially true for those early in their careers. The reason I am such a proponent of the social is because it is so neglected in American psychiatry and because I believe than in the social we often find, what Michael Marmot calls "the causes of the causes".

It is not that I don't appreciate that there is a biological basis for our emotions, thoughts, and behaviors. Far from it. Biology can influence these things in profound ways. My contention is that by framing mental illnesses as brain disorders we narrow the field (as has been happening for many years). As Nikolas Rose noted, we have come to recode our moods in terms of serotonin levels, we have become, in his words, "neurochemical selves". In doing so, we have actually undermined our own sense of agency and personhood. This is not good for patients. Part of the misguided rationale for saying mental illnesses are "brain disorders" (which I think we all know is oversimplistic) is to try and reduce the stigma. It turns out that actually, while patients and families like it because it absolves them of blame, it actually increases public stigma, social distancing, increases public perceptions of dangerousness and unpredictability, and psychiatrists who see their patients as brain diseased are less likely to include them in their care.

See:

Rebalancing academic psychiatry - why it needs to happen and soon
Mindlessness and brainlessness in psychiatry
Attitudes towards psychiatric treatment and people with mental illness: changes over two decades
Prejudice and schizophrenia: a review of the "mental illness is and illness like any other" approach
Decline of U.S. medical student career choice of psychiatry and what to do about it

Also see:
Interview with Professor Alwyn Lishman (who wrote the definitive single author neuropsychiatry textbook) he said:
"Before that neuropsychiatry got a bad reputation. That was Wilhelm Griesinger at the Charité Hospital. He said mental disorders are brain disorders, full stop. And he tried to make the whole of psychiatry nothing but brain science. Of course that made it very unpopular in the world in general because people were saying: this is a ridiculously narrow view" and "You have got to have a finger in every pie in psychiatry and be ready to turn your hand to whatever is the most important avenue: an EEG one day, a bit of talking about a dream another day. You just follow your nose. All psychiatrists should be all types of psychiatrist. You shouldn’t turn your back on talking therapies as many patients need this. I’ve always said the fundamental skill of a psychiatrist is being able to talk meaningfully and helpfully with patients."

I don't think most would disagree with much in there, but what you wrote in this post is a lot different than saying the brain doesn't matter!

 

[wesleysmith]

First time I'm hearing about this. Do you mind expounding on that?

Can other Psychiatrists here corroborate this?

Institutional racism is just like your run-of-the-mill racism; overt and covert prejudices inherent in U.S. institutions (e.g., healthcare) that keep minorities (in regard to Splik's post, African American psychiatrists) from experiencing (achieving/obtaining/being recognize/promoted/given a raise/etc.) the same personal and professional privilege as the majority (i.e., European Americans). So, regardless of if the person in charge is racist or not, the current system simply isn't set up to benefit anyone who is not European American, or male for that matter.

 

[Achillees]

Institutional racism is just like your run-of-the-mill racism; overt and covert prejudices inherent in U.S. institutions (e.g., healthcare) that keep minorities (in regard to Splik's post, African American psychiatrists) from experiencing (achieving/obtaining/being recognize/promoted/given a raise/etc.) the same personal and professional privilege as the majority (i.e., European Americans). So, regardless of if the person in charge is racist or not, the current system simply isn't set up to benefit anyone who is not European American, or male for that matter.

I see. I was under the impression Splik referred to something specific to Psychiatry.

 

[WingedOx]

The blank stares I get when I walk into work and try to talk about last night's football game. Sometimes it makes me pine for Ortho...

...also about 70% of what @splik said.

 

[l0st1]

But, mental illnesses are not best conceived of a "brain disorders". The public don't buy it, and they don't like it. Medical students don't like it either as evinced by the decline in interest in psychiatry residency in the 80s and 90s during the biologization of psychiatry and the "decade of the brain". Of course everything influences the brain, but this kind of neuroessentialism has very negative implications for our field, how we view our patients, how they view themselves, and encourages a sense of fatalism and provides moral exculpation and abdication from personal responsibility. I completely agree with you that "biological" problems can be treated with "social" interventions. But your rationale is again predicated on the reductionistic neuroessentialist view that as everything can be reduced to its neural underpinnings, that "social" intervention is actually as somatic in influence as any drug. The problem with this is in many instances our understanding of the social, cultural, and psychological are rich enough and in no way are enhanced by neuroscience. A narrow focus on the brain on the other hand without reference to context is often unhelpful. I find it troubling that in our new way of looking at the world, privileging a neuroscientific discourse means that the social and psychological sciences increasingly need to rely on "neuroscience" to justify what is meaningful in itself.

I am sure if I was in the 60s I would be railing against the analysts and the lack of consideration for the brain. But in the current era, we have almost become mindless with this monomanical fixation on the brain. As others have noted, the "biopsychosocial" model is really the "bio-bio-bio" model as psychosocial factors have been relegated in significance and only seen as importance when transmuted into the neurobiological. The NIMH is increasingly closing funding for those who do not have a focus on genetics or imaging or incorporate this in their work. This is especially true for those early in their careers. The reason I am such a proponent of the social is because it is so neglected in American psychiatry and because I believe than in the social we often find, what Michael Marmot calls "the causes of the causes".

It is not that I don't appreciate that there is a biological basis for our emotions, thoughts, and behaviors. Far from it. Biology can influence these things in profound ways. My contention is that by framing mental illnesses as brain disorders we narrow the field (as has been happening for many years). As Nikolas Rose noted, we have come to recode our moods in terms of serotonin levels, we have become, in his words, "neurochemical selves". In doing so, we have actually undermined our own sense of agency and personhood. This is not good for patients. Part of the misguided rationale for saying mental illnesses are "brain disorders" (which I think we all know is oversimplistic) is to try and reduce the stigma. It turns out that actually, while patients and families like it because it absolves them of blame, it actually increases public stigma, social distancing, increases public perceptions of dangerousness and unpredictability, and psychiatrists who see their patients as brain diseased are less likely to include them in their care.

I really don't want to derail this thread by talking about a specific point, because I think this thread is valuable and this forum is in need of some realistic perspectives from practicing psychiatrists to balance out the overwhelmingly positive views generally expressed here.

But in reply to splik, I just wanted to say that I have been under the impression that the reason NIMH has chosen to focus on the biological model and the recent trends in that direction are due to the previous slow pace of progress in finding treatments using the alternative models. To practice hour long psychotherapy over multiple sessions, or attempt to fix social/environmental factors to treat schizophrenia for example, is so daunting and impractical that without advances in biological treatments, new genetic treatments, and I hesitate to say, more advanced forms of pharmacotherapy, how can we ever hope to find treatments or even cures to some of the severe mental illnesses that we currently have no answer for?

The bio-psycho-social model seems to equate psychiatrist-psycholologist-social worker for me, and while I wholeheartedly agree that the model is necessary for appropriate treatment, why should the psychiatrist practice what psychologists and social workers are specifically and better trained for? It would seem that focusing on biological approaches should be the next frontier for medicine to achieve.

In regards to stigma, I would argue that medicalizing mental illness does actually reduce stigma in most cases. If a given patient no longer feels the shame that comes for feeling responsible for their thoughts and actions, and absolved from the ensuing guilt, they may be more willing to seek and accept treatment. If a person feels ashamed about how they feel every day or their thoughts, they tend to rationalized blame onto themselves. Whereas one doesn't usually feel responsible or ashamed of having an arrhythmia, or even a lifestyle disease or high blood pressure for example. and immediately seeks treatment to fix it.

 

[WingedOx]

what psychologists and social workers are specifically and better trained for?

this is highly debatable.

plus, too many psychiatrists believe that they aren't responsible for having a working knowledge of the patients' psychosocial issues. Having that attitude is a good way to be a sh-tty psychiatrist with sh-tty outcomes.

 

[Jorje286]

In regards to stigma, I would argue that medicalizing mental illness does actually reduce stigma in most cases. If a given patient no longer feels the shame that comes for feeling responsible for their thoughts and actions, and absolved from the ensuing guilt, they may be more willing to seek and accept treatment. If a person feels ashamed about how they feel every day or their thoughts, they tend to rationalized blame onto themselves. Whereas one doesn't usually feel responsible or ashamed of having an arrhythmia, or even a lifestyle disease or high blood pressure for example. and immediately seeks treatment to fix it.

I just want to add that the biological model does and should not remove the sense of agency. Do we even have the slightest scientific explanation for free will (for or against)? In fact, even monoist philosophers tend to be compatibilists (arguing for the presence of some form of free will in line with the brain model of behavior).

I think it's fair to take a middle road between what splik is saying and the "biological model" the way it is formulated in pop culture. There are so many missing links in our scientific formulation of brain processes that we should be very skeptical of things like "neurochemical imbalance" or what is very hip nowadays, "network dysfunction" (in regard to the DMN or executive networks..etc) as root causes of psychiatric disease. But that does not mean that psychiatric disorders are not rooted in the brain. They are, because that's the organ responsible for behavior.

 

[HarryMTieboutMD]

Residents and attendings, what do you guys hate about psychiatry? I have read other threads about what people like and don't like about psychiatry, but I was wondering if any opinions have changed the longer you guys practice.

For other fields of medicine, I hear random things about how there's so much paperwork and bureaucracy or that patients don't listen to nutritional or exercise recommendations and are just looking for a pill to solve their problems (I guess for psychiatry, it would be patients saying they want psychotherapy, but they're not being committed). Other things I've read would be that patients are ungrateful and awful or that you don't feel like you're actually helping people or it's draining and stressful or that the other doctors are terrible.

What about for psychiatry? For the most part, this has been a pretty positive forum, but I'm wondering what you guys don't like about it. Could you also mention what setting you work in? Inpatient, outpatient, prison/forensic psych, emergency psych, VA, hospital, private practice, how much time spent doing med management or therapy, and so on.

A few things I've read about disliking psychiatry on this forum are the patient population is stressful, giving diagnoses when a diagnosis isn't necessary, 1/2 to 2/3 of psychiatrists are terrible and good psychiatrists that care about their patients are in the minority and usually don't serve the poor/lower middle class because of the way their practice is set up, psychiatry is being used to solve problems that are more societal in nature (ex. giving someone a medication to help them deal with stress/anxiety when the cause of their stress is their 80 hour a week investment banking job or an abusive spouse or whatever), etc.

Please note, these are just random things that I remember finding on the forums. I have also read so many things about why people like psychiatry, but not much about why people dislike it. This is just so I know what to expect.

Thanks!

From the perspective of a resident:
1) Everyone on the inpatient unit thinks he or she is the doctor (social workers, nurses, techs, unit secretaries, etc etc). This is true to some extent in other areas of medicine, but I think its the worst in psychiatry
2) All of the social work involved that the physician has to do. We have excellent social workers, but even as doctors we have to do a lot of SW/non MD things, which is very irritating. This is of course true in all of medicine, but it is bad in psychiatry
3) Lack of respect from other services. I am doing my residency at one of the country's top academic medical centers, and our psych department is very well respected both within the University and nationally. However, because we are psychiatry, every other service views us as "less than" and incompetent. This is probably true everywhere, and some of it has to do with what Splik touched upon, but it sucks. I can hold my own in internal medicine and neurology, but among nearly other service, psychiatry residents are perceived as incompetent (sometimes we do bring it upon ourselves).
4) Having to go to court for involuntary commitments. We have to do this as interns, and it's annoying. I dislike lawyers and the court system in general. Forensics is interesting in theory, but dealing with lawyers is just the worst!
5) Revolving door nature of the inpatient unit. I hate working up a patient, sedating them with enough antipsychotic, and then discharging them. I really wish we had a better opportunity to follow the clinical course of the disease.
6) The obsession over NMDA and ordering the serum test on every new break that comes in

 

[nitemagi]

I would paraphrase splik (probably inaccurately) by just saying avoid extremes. One does that by fully exploring the counterpoints to every presumption of the field.

 

[splik]

First time I'm hearing about this. Do you mind expounding on that?

Can other Psychiatrists here corroborate this?

it is true that institutional racism pervades all institutions but there is alot more racial tension in psychiatry. African Americans who are mentally ill are more likely to be incarcerated, less likely to seek care, more likely to have a pathway of care involving emergency services, the police, and the criminal justice system, have psychopathology influenced by racial injustices and social inequalities, and more likely to experience coercive practices including so-called "assisted outpatient treatment" (outpatient commitment). African Americans with psychosis/schizophrenia are more likely to be perceived as violent and dangerous as their white counterparts despite, if anything, the white schizophrenics being more violence-prone (that is a big if though). The APA has never had an African American President (the AMA and the other APA on the hand both had their first black President 20 years ago or so). There is alot of racial tension within the APA and the Black Psychiatrists Caucus has taken the administration to task for failing to speak out on wider issues affecting African Americans they feel are relevant to mental health.

This btw, makes it even more important, imho that more African American medical students go into psychiatry. Unfortunately, medical students from minority backgrounds seem to be less likely to go into psychiatry for various reasons.

 

[wolfvgang22]

From the perspective of a resident:
1) Everyone on the inpatient unit thinks he or she is the doctor (social workers, nurses, techs, unit secretaries, etc etc). This is true to some extent in other areas of medicine, but I think its the worst in psychiatry
2) All of the social work involved that the physician has to do. We have excellent social workers, but even as doctors we have to do a lot of SW/non MD things, which is very irritating. This is of course true in all of medicine, but it is bad in psychiatry
3) Lack of respect from other services. I am doing my residency at one of the country's top academic medical centers, and our psych department is very well respected both within the University and nationally. However, because we are psychiatry, every other service views us as "less than" and incompetent. This is probably true everywhere, and some of it has to do with what Splik touched upon, but it sucks. I can hold my own in internal medicine and neurology, but among nearly other service, psychiatry residents are perceived as incompetent (sometimes we do bring it upon ourselves).
4) Having to go to court for involuntary commitments. We have to do this as interns, and it's annoying. I dislike lawyers and the court system in general. Forensics is interesting in theory, but dealing with lawyers is just the worst!
5) Revolving door nature of the inpatient unit. I hate working up a patient, sedating them with enough antipsychotic, and then discharging them. I really wish we had a better opportunity to follow the clinical course of the disease.
6) The obsession over NMDA and ordering the serum test on every new break that comes in

Regarding #3: Not everywhere is like this. I've been fortunate in that everywhere I've worked the psychiatrists are valued and appreciated. I get way more appreciation from other non-psychiatrist MDs and staff than I ever expected, and more than I get from patients, which is a little. And I got no real complaints if my ass is not getting constantly kissed as I'm getting paid more than primary care, but less than the procedural/ROAD specialties.

 

[heyjack70]

...why should the psychiatrist practice what psychologists and social workers are specifically and better trained for?

In my experience we hardly ever get patients scheduled with psychologists for therapy because there aren't enough of them. If we do the therapy is typically very good from a CBT standpoint. The social workers doing therapy are unfortunately a huge mixed bag. I think social workers as case managers, as in getting patients bus passes, housing, disability applications, etc, are definitely better trained than psychiatrists, but social workers doing therapy can be great or absolutely horrible (as in "Let me tell you about my family and pets and all of my life problems even though you're the patient and I clearly have no sense of boundaries in therapy.") I think many psychiatrists have training on par or better than psychologists for therapy, they just choose not to do it or are employed in places that do not want them doing it for payment reasons.

 

[OldPsychDoc]

Let's see if we can get splik's list up to #95 and nail it to a church door somewhere.

(http://en.wikipedia.org/wiki/The_Ninety-Five_Theses for those of you who don't live in a world where Lutheran theological references are common conversational currency.)

 

[Therapist4Chnge]

Very interesting read.

My biggest gripe is the frequency of non-emperically validated prescribing. I know cases are messy and there needs to be room for clinical judgement, but I've seen a real prevalence of the same combination of meds used across disorders. To be fair, this isn't just a psychiatry issue, it happens all over medicine.

My next biggest gripe is the use of analytic theory despite little to no support for the vast majority of diagnosis being treated. Round Peg, Square Hole…same freaking hammer for a hundred years.

 

[wesleysmith]

In my experience we hardly ever get patients scheduled with psychologists for therapy because there aren't enough of them. If we do the therapy is typically very good from a CBT standpoint. The social workers doing therapy are unfortunately a huge mixed bag. I think social workers as case managers, as in getting patients bus passes, housing, disability applications, etc, are definitely better trained than psychiatrists, but social workers doing therapy can be great or absolutely horrible (as in "Let me tell you about my family and pets and all of my life problems even though you're the patient and I clearly have no sense of boundaries in therapy.") I think many psychiatrists have training on par or better than psychologists for therapy, they just choose not to do it or are employed in places that do not want them doing it for payment reasons.

I personally take issue with the lumping together of case-management, medical social work, and any other direct practice sw with psychotherapy under the umbrella term "clinical." We have separate licenses for clinical and generalist practice, but with clinical being so broad this means someone not formerly trained in psychotherapy can get their foot in the door at some desperate community clinic, build up a background there conducting "therapy", all the while they continue to hurt their clients and the profession in general by doing exactly what you say (e.g., break boundaries, give "advice", etc.). They need to be more specific with what kind of education leads to what kind of qualifications under social work licensure IMHO.

 

[heyjack70]

I personally take issue with the lumping together of case-management, medical social work, and any other direct practice sw with psychotherapy under the umbrella term "clinical." We have separate licenses for clinical and generalist practice, but with clinical being so broad this means someone not formerly trained in psychotherapy can get their foot in the door at some desperate community clinic, build up a background there conducting "therapy", all the while they continue to hurt their clients and the profession in general by doing exactly what you say (e.g., break boundaries, give "advice", etc.). They need to be more specific with what kind of education leads to what kind of qualifications under social work licensure IMHO.

This issue with bad therapists getting their start at desperate community mental health clinics seems to be the norm around here. The ones who know they're doing piss poor work seem to stay put, but the confident ones start their own practices and offer weird services like "two therapist" appointments, where the husband and wife therapist will both be in your session with you. I see a lot of medication deniers in this group too.

 

[splik]

But in reply to splik, I just wanted to say that I have been under the impression that the reason NIMH has chosen to focus on the biological model and the recent trends in that direction are due to the previous slow pace of progress in finding treatments using the alternative models.

No this is entirely dogma led by people like Tom Insel who have been on the misguided quest to transform psychiatry into a "clinical neuroscience" discipline. I think neuroscience is great but a singular focus on this impoverishes the field. I think it is important for there to be genetics and neuroimaging research. The problem is the imaging research in general is so poor quality it has done nothing to advance the field is is tantamount to phrenology. Academic psychiatry has become so obsessed with neuroimaging, genetics, proteomics and the like it is has become irrelevant to clinical practice. The NIMH was set up to expand mental health care in the US after the 2nd world war. It is unrecognizable now.

I would like to see the NIMH put more into education and training of psychiatrists and primary care providers, looking at residential alternatives to psychiatric hospitalization, developing interventions to upscale mental health services in the US (such as use of community support workers, collaborative care models, telepsychiatry), more comparative effectiveness research with larger scale studies comparing combinations of drugs, or psychotherapies, or psychotherapies + drugs, looking at complementary/integrative modalities for mental illness, nutrition and mental health, funding research on stigma, focusing more on getting the mentally ill back to work, funding evaluation of club houses and vocational rehabilitation programs, large scale epidemiological studies on the social determinants of mental health, more mental health policy based research, funding evaluations of peer support programs, hearing voices groups, and promoting training for psychiatrists in the care of basic medical problems in the SMI population and evaluations of this. They should also be looking at alternatives to outpatient commitment, and means prevention for suicide. Also more on the long-term outcomes from psychotropic drugs including adverse effects like supersensitivity psychosis, and tardive dysphoria syndrome. They should also expand their clinical programs.

In short, I can think of a ton of things that money could be used for that would actually be much more beneficial for patients that have absolutely nothing to do with imaging and genetics. I do think that neurobiological research is important, but the real advances are not going to come from this, certainly not any time soon.

 

[Jorje286]

To follow up on splik's point, I had a mentor (a bigwig in neuropsych and stuff) who once told me "we know more about the brain than the kidney". Personally I found the comment stupefying (unless I'm missing something), but what it showed is that a lot in the neuropsych community are overselling the current knowledge/approaches we have to understand the brain and psychiatric disorders. I don't agree that neuroscience isn't central, but imo we have a way to go in basic science before we start tackling psych disease more appropriately.

 

[kobebeefmd]

How is the clinical practice of psychiatry going to change in the next 10-15 years?

I understand there is a demand for psychiatrist for the next 10 years, how about afterwards?

My friends sister is a psychiatrist, runs a suboxone clinic. 9-5 M-F, 225/year, minimal insurance hassle. That sounds peachy.

 

[splik]

I just want to add that the biological model does and should not remove the sense of agency. Do we even have the slightest scientific explanation for free will (for or against)? In fact, even monoist philosophers tend to be compatibilists (arguing for the presence of some form of free will in line with the brain model of behavior).

one of our forensic psychiatrists likes to say "you can't be a psychiatrist if you believe in free will". clearly there are psychiatrists (the religious ones typically) who believe in free will but all the major models of psychopathology are deterministic. compatibilism is essentially deterministic and let's face it, it's a bit of a cop out.

apologies for derailing this thread!

 

[manly_man246]

Great thread.

The blank stares I get when I walk into work and try to talk about last night's football game. Sometimes it makes me pine for Ortho...

I don't know how serious you were but as somebody applying for Psychiatry this year honestly this sort of thing and some of the other comments in here (the intellectualism that Nasrudin describes, the need for many academic psychiatrists I've met to be quirky or different, and their incompetence with basic medicine) really give me second thoughts. I realize that if I do PP I won't have to interact with many people like this but it does worry me that many of my future colleagues will be this sort of person. Fingers crossed the next generation isn't so damn weird. You can be a psychiatrist and have normal person interests and do normal person things.

 

[Leo Aquarius]

There's nothing I hate about psychiatry - sure, dislikes, but the benefits far outweigh the dislikes.

I'm darn glad I'm in this field and not stuck in surgery, internal medicine, radiology, path, OB, rad onc, EM, urology, NSGY.

 

[Leo Aquarius]

Great thread.



I don't know how serious you were but as somebody applying for Psychiatry this year honestly this sort of thing and some of the other comments in here (the intellectualism that Nasrudin describes, the need for many academic psychiatrists I've met to be quirky or different, and their incompetence with basic medicine) really give me second thoughts. I realize that if I do PP I won't have to interact with many people like this but it does worry me that many of my future colleagues will be this sort of person. Fingers crossed the next generation isn't so damn weird. You can be a psychiatrist and have normal person interests and do normal person things.

The residents at my program are super cool. The psych residents at my medical school were the coolest guys too. So I know there are weirdos, but there's also well-balanced socially fun residents out there too.

 

[Nasrudin]

Great thread.

I don't know how serious you were but as somebody applying for Psychiatry this year honestly this sort of thing and some of the other comments in here (the intellectualism that Nasrudin describes, the need for many academic psychiatrists I've met to be quirky or different, and their incompetence with basic medicine) really give me second thoughts. I realize that if I do PP I won't have to interact with many people like this but it does worry me that many of my future colleagues will be this sort of person. Fingers crossed the next generation isn't so damn weird. You can be a psychiatrist and have normal person interests and do normal person things.

Look I love my colleagues. They're funny and cool, my favorite types. What I was responding to is the self selection of academic types on sdn and also yes at the more academic places where cerebral forms of masturbation flourish, such as the notion that you're not anybody in psychiatry until you have academic enemies at the top and can express, vociferously, your contempt for this or that brand of psychiatry. And the rest of us are supposed to be awed by your mojo.

What I'm saying is you take a line up of these sorts and try to interrogate them for common sense you might be there all night. Also, I'm saying they suffer from not having proper physical training as part of their daily lives and having spent most of their lives circle jerking with other academics lack this dimension of being.

For example, on the subject of masculinity which is considered a grotesque animalistic thing to be abhorred by these types, training a martial art would not be intuitive, but passive aggressive feuding with other academics all day long is considered civilized.

My solution, to not being soiled with the vileness of these environments is to have gone to a more community oriented program. And to take as many notes from Fonzie as I do splik. Although perhaps lacking Fonzies cool with rolling with haughty opinions of splik, which while I learn from I am not awed or overly impressed with. Owing largely to a prior life as a man. Before ever donning shrinks clothing. I consider myself, gratefully, not as influenced by academic wizardry or socialism spells.

 

[Ceke2002]

Ooh, how about a list from a patient's point of view, just to mix things up a bit ('cause I'm handy that way)

In no particular order:

Psychiatrist's who forget the PsychoSocio part of BioPsychoSocio. I mean it's not that I don't appreciate that you (general 'you') can offer me all manner of pills and potions to assist in what ails me, and chances are at some stage I may even take you up on the offer of an antidepressant, or even a nice atypical antipsychotic when it's needed, it's just that I'm really into that whole talking thing Psychiatrists do - you know with one person that you form a therapeutic relationship with, and not umpteen different people who each grab a BioPsychoSocio segment and then kinda fragment all over the place.

Psychiatrists who don't respect their patient's (non pathologically related) religious or spiritual beliefs ~ Why yes that is a pentagram with a Celtic shield knot tattooed on my chest. Yes that does indicate I follow a Wiccan belief system. If you have any legitimate questions about my practice of Wicca then feel free to ask, but if you're going to attempt to tie my spiritual practices into my mental health issues in a manner that attempts to pathologise my beliefs then off is the general direction in which I'd like you to you know what.

Psychiatrist's who seem to be attempting some sort of Guinness world record for 'fastest diagnosis of a mental illness'. Mood instability? Bingo, it's Bipolar Disorder! - Hearing Voices? Schizophrenia, come on down! Er, no.

 

[oldanddone]

So a guy so invested in normal that the user name flies a flag of reproducing idealized gender is upset that psychiatry tolerates too much difference. May your ilk never be in ascendancy in psych! Also...have you embraced that feminine shadow ever? Could be a blast.

My gripe is the mainstreaming of psych. Where there are less characters and more conformist khaki pants business casual.

 

[WingedOx]

Great thread.



I don't know how serious you were but as somebody applying for Psychiatry this year honestly this sort of thing and some of the other comments in here (the intellectualism that Nasrudin describes, the need for many academic psychiatrists I've met to be quirky or different, and their incompetence with basic medicine) really give me second thoughts. I realize that if I do PP I won't have to interact with many people like this but it does worry me that many of my future colleagues will be this sort of person. Fingers crossed the next generation isn't so damn weird. You can be a psychiatrist and have normal person interests and do normal person things.

Oh make no mistake I loved my co-residents (and it's sad to type that in past tense since we're all trickling out of the program now). There isn't a single one that I didn't love sitting down and having a beer with, and they all have diverse, cool interests. Problem is with the exception of maybe a few here and there, sports aren't one of those interests.

Of course there are a few oddballs, but it's not like we're all walking around with Aspergers. We're not Neuro, after all.

 

[Nasrudin]

So a guy so invested in normal that the user name flies a flag of reproducing idealized gender is upset that psychiatry tolerates too much difference. May your ilk never be in ascendancy in psych! Also...have you embraced that feminine shadow ever? Could be a blast.

My gripe is the mainstreaming of psych. Where there are less characters and more conformist khaki pants business casual.

OK I googled the feminine shadow....and...I'm still not sure what you mean. I'm curious. But at the same time, wondering if your trying to convince me to have man-man sexual relations on the sly. Heterosexual masculinity has to be rigorously defended tooth and nail, after all, less we slide into all male orgiastic hedonism.

On the other hand, I do share your passionate disgust for khaki, but also those pinkish red slacks that dandyish young lads are sporting like degenerate corporate ad sucking ******.

 

[nitemagi]

Look I love my colleagues. They're funny and cool, my favorite types. What I was responding to is the self selection of academic types on sdn and also yes at the more academic places where cerebral forms of masturbation flourish, such as the notion that you're not anybody in psychiatry until you have academic enemies at the top and can express, vociferously, your contempt for this or that brand of psychiatry. And the rest of us are supposed to be awed by your mojo.

What I'm saying is you take a line up of these sorts and try to interrogate them for common sense you might be there all night. Also, I'm saying they suffer from not having proper physical training as part of their daily lives and having spent most of their lives circle jerking with other academics lack this dimension of being.

For example, on the subject of masculinity which is considered a grotesque animalistic thing to be abhorred by these types, training a martial art would not be intuitive, but passive aggressive feuding with other academics all day long is considered civilized.

My solution, to not being soiled with the vileness of these environments is to have gone to a more community oriented program. And to take as many notes from Fonzie as I do splik. Although perhaps lacking Fonzies cool with rolling with haughty opinions of splik, which while I learn from I am not awed or overly impressed with. Owing largely to a prior life as a man. Before ever donning shrinks clothing. I consider myself, gratefully, not as influenced by academic wizardry or socialism spells.

Everyone generalizes from their experience.

And like every treatment choice, there are pros and cons to each training locale. Dismissing a group outright for aspects of them that are upsetting is, IMO, as extreme as the opposite.

There are benefits to academia and community training. And downsides. Learn from both. Swallow the chicken. Spit out the bones. Thus an independent identity is formed.

 

[Nasrudin]

Everyone generalizes from their experience.

And like every treatment choice, there are pros and cons to each training locale. Dismissing a group outright for aspects of them that are upsetting is, IMO, as extreme as the opposite.

There are benefits to academia and community training. And downsides. Learn from both. Swallow the chicken. Spit out the bones. Thus an independent identity is formed.

I hear you thanks. I realize I was letting some subconscious irrational spill out all messy. And I do enjoy quixotic enemies of my own creation. Still...I respect what you're doing and how you're doing it...so I appreciate the notes on how to achieve independence of mind.

 

[PistolPete]

I hate this so much!

 

[PistolPete]

Psychiatrist's who seem to be attempting some sort of Guinness world record for 'fastest diagnosis of a mental illness'. Mood instability? Bingo, it's Bipolar Disorder! - Hearing Voices? Schizophrenia, come on down! Er, no.

I hate this so much!

 

[oldanddone]

OK I googled the feminine shadow....and...I'm still not sure what you mean. I'm curious. But at the same time, wondering if your trying to convince me to have man-man sexual relations on the sly. Heterosexual masculinity has to be rigorously defended tooth and nail, after all, less we slide into all male orgiastic hedonism.

On the other hand, I do share your passionate disgust for khaki, but also those pinkish red slacks that dandyish young lads are sporting like degenerate corporate ad sucking ******.

Yes it would be the weakening of the fence around male orgiastic hedonism...but hoping to convince "machoman" to paraphrase the username...you on the other hand I can imagine have embraced what Society would rigidly bar against at least conceptually

The shadow I was using I suppose in a jungianish kind of way. Or in terms of polarities. If masculinity is embraced so definitively that is an erasing of femininity or a putting it in the shadow. To embrace what has been relegated to the shadow could blow a mind. Then the pieces might come back in a reconfiguration that is a little less bound up in khaki pants. Or corporately defined dandy. Just something a little authentic and less bound and gagged to normal.