What's (What was) your motivation??

[surftheiop]

I'd tell them to take the criminal matter over to the police to handle. They can figure out why he wants to kill his neighbor

Ok fair enough you let the police handle this, so they talk to him, see he is psychotic and then drop him off at your psych hospital, now what?

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[pre med 2014]

Ok fair enough you let the police handle this, so they talk to him, see he is psychotic and then drop him off at your psych hospital, now what?

I'd tell them if they think he's going to kill his neighbor they should be filling a criminal complaint, filling restraining orders and going through the routine police procedure for these matters.

 

[surftheiop]

I'd tell them if they think he's going to kill his neighbor they should be filling a criminal complaint, filling restraining orders and going through the routine police procedure for these matters.

Ok, so they see he is psychotic and drop him off at your psych hospital, now what?

 

[hamstergang]

I'd tell them if they think he's going to kill his neighbor they should be filling a criminal complaint, filling restraining orders and going through the routine police procedure for these matters.

But if you want to actually protect the neighbors and turn the patient from a threatening psychotic man into someone that can better function in society, then the patient should be in the psych hospital, not watched by the police.

to have schizophrenia you have to hear voices or have visual hallucinations, threatening to kill your neighbor doesn't meet any of the criteria for schizophrenia.

Actually, you don't have to have auditory or visual hallucinations for the diagnosis of schizophrenia. Also, if you investigate the threat to kill his neighbors, you will possibly find underlying that a criteria for the diagnosis of schizophrenia.

Do you see anything wrong with you passing such judgement on the field when you don't even know how to make the diagnosis of schizophrenia?

 

[pre med 2014]

But if you want to actually protect the neighbors and turn the patient from a threatening psychotic man into someone that can better function in society, then the patient should be in the psych hospital, not watched by the police.



Actually, you don't have to have auditory or visual hallucinations for the diagnosis of schizophrenia. Also, if you investigate the threat to kill his neighbors, you will possibly find underlying that a criteria for the diagnosis of schizophrenia.

Do you see anything wrong with you passing such judgement on the field when you don't even know how to make the diagnosis of schizophrenia?

You're right, arguing hypotheticals is pointless. For all we know further investigation could reveal the neighbor is a real big jerk.

 

[OldPsychDoc]

You're right, arguing hypotheticals is pointless. For all we know further investigation could reveal the neighbor is a real big jerk.

Thank you for playing. Please come back in 6 years or so when you actually know something about medicine and psychiatry and try again...

 

[michaelrack]

I'd tell them to take the criminal matter over to the police to handle. They can figure out why he wants to kill his neighbor

The point of this 2nd hypothetical was to try and generate some interesting discussion. Sometimes psychiatry is abused, and there is nothing wrong with bringing a libertarian perspective to psychiatry- it is the extremes that are dangerous.

In this hypothetical, which is drawn from years of experience, the patient consciously does not want to kill his neighbor and is trying his best to resist his command hallucinations.

I don't think it is a criminal matter yet- in this hypothetical he hasn't been making threats.

A good psychiatrist may be able to engage the patient and get him to accept treatment voluntarily, but this isn't always possible.

I myself have strong libertarian tendencies, but feel that there are times when a psychiatrist needs to initiate forcible treatment (through the committment process).

There are a lot of gray areas when it comes to psychiatry and forcible treatment (especially when it comes to evaluating suicide risk).
However, this hypothetical is not in the gray area.

premed 2014, I encourage you to thoughtfully consider and research these issues (liberty/coercion in psychiatric treatment) in the upcoming years before you make a decision on medical specialty.

 

[notdeadyet]

premed 2014, I encourage you to thoughtfully consider and research these issues (liberty/coercion in psychiatric treatment) in the upcoming years before you make a decision on medical specialty.

I'd go one further and suggest he resolve this before going into medicine at all. Psychiatry is not the only specialty that at times has to override the decisions of the patient, and we are not the only specialty that at times holds people against their will.

Premed 2014- I have a hunch your worldview will change. To be honest, it smacks of the poorly thought out dorm-room bull$hit many of us are embarrassed to have spouted out in our younger naive years. But if it doesn't, you should avoid medicine, as it conflicts with your philosophy. You should also consider avoiding law. And the military. Actually, give careful thought to pretty much any occupation where you would have people working for you.

 

[surftheiop]

I'd go one further and suggest he resolve this before going into medicine at all. Psychiatry is not the only specialty that at times has to override the decisions of the patient, and we are not the only specialty that at times holds people against their will.

Premed 2014- I have a hunch your worldview will change. To be honest, it smacks of the poorly thought out dorm-room bull$hit many of us are embarrassed to have spouted out in our younger naive years. But if it doesn't, you should avoid medicine, as it conflicts with your philosophy. You should also consider avoiding law. And the military. Actually, give careful thought to pretty much any occupation where you would have people working for you.

Guilty as charged

I think Erikson missed a stage there- should span from 17-22ish.

 

[SmallBird]

Guilty as charged

I think Erikson missed a stage there- should span from 17-22ish.

Agreed, and guilty also. Still, I think its probably a good sign - I'd rather be remembered for having somewhat naive ideas than having no ideas at all.

 

[notdeadyet]

Yep. I'm particularly glad that most of my passion>>>intelligence/ experience/ common sense phase was pre-Internet. I posted something on an early BBS back in 1994 that still shows up if you search my name (though well buried at this point) and causes bad cringe factor.

 

[pre med 2014]

I'd go one further and suggest he resolve this before going into medicine at all. Psychiatry is not the only specialty that at times has to override the decisions of the patient, and we are not the only specialty that at times holds people against their will.

Premed 2014- I have a hunch your worldview will change. To be honest, it smacks of the poorly thought out dorm-room bull$hit many of us are embarrassed to have spouted out in our younger naive years. But if it doesn't, you should avoid medicine, as it conflicts with your philosophy. You should also consider avoiding law. And the military. Actually, give careful thought to pretty much any occupation where you would have people working for you.

False. Medicine does not conflict with my philosophy at all.

 

[diagonal]

I'd tell them to take the criminal matter over to the police to handle. They can figure out why he wants to kill his neighbor

Nice work, doc.

 

[sunlioness]

What about capacity consults in the hospital? Involuntary treatment doesn't only come up when it comes to psych admissions and most of capacity isn't actually determined by psychiatrists. What if a person is refusing to eat, cachectic, refusing a g-tube, but is clearly delirious and can't reason?

Interestingly, the bar for involuntary treatment is actually set higher in psychiatry than it is in the rest of medicine. In medicine, you just have to show that the person doesn't have the capacity to make the decision. In psychiatry, you need to show that they are dangerous. It can lead to some interesting situations where a psychotic person who isn't threatening himself or anyone else can be treated against his will for a medical condition, but not for his psychosis.

 

[pre med 2014]

What about capacity consults in the hospital? Involuntary treatment doesn't only come up when it comes to psych admissions and most of capacity isn't actually determined by psychiatrists. What if a person is refusing to eat, cachectic, refusing a g-tube, but is clearly delirious and can't reason?

Interestingly, the bar for involuntary treatment is actually set higher in psychiatry than it is in the rest of medicine. In medicine, you just have to show that the person doesn't have the capacity to make the decision. In psychiatry, you need to show that they are dangerous. It can lead to some interesting situations where a psychotic person who isn't threatening himself or anyone else can be treated against his will for a medical condition, but not for his psychosis.

This is generally not the kind of involuntary treatment that I am talking about.

 

[toothless rufus]

that attitude would make psych consults easy:
"Mr. X is a 25 y.o. male; the chart indicates a past history of schizophrenia. He appeares agitated and has reportedly been making homocidal threats toward his neighbor. He declines to engage with me. Thank you for requesting the consult, I have no recommendations to make."

I would LOVE this kind of consult! (I hate consult service)

 

[hamstergang]

This is generally not the kind of involuntary treatment that I am talking about.

So what kind of involuntary treatment is ok, and what kind isn't, in your view? What is the reason for the distinction you are making?

 

[diagonal]

So what kind of involuntary treatment is ok, and what kind isn't, in your view? What is the reason for the distinction you are making?

Slow down, his community college humanities class hasn't covered that yet.

 

[pre med 2014]

So what kind of involuntary treatment is ok, and what kind isn't, in your view? What is the reason for the distinction you are making?

Well, I do not think an involuntary psychiatrist should interfere with a voluntary psychiatrist's patient. If a person is successfully being treated for depression, it's great. If they decide to join the military I'd bet a lot of money that things will get bad for that patient really quickly when the involuntary psychiatrists take over the treatment.

 

[splik]

wtf is an involuntary psychiatrist? Is that like someone forced into a career in psychiatry against their will?!

 

[pre med 2014]

wtf is an involuntary psychiatrist? Is that like someone forced into a career in psychiatry against their will?!

lol. A psychiatrist who treats people against their will.

 

[hamstergang]

Well, I do not think an involuntary psychiatrist should interfere with a voluntary psychiatrist's patient. If a person is successfully being treated for depression, it's great. If they decide to join the military I'd bet a lot of money that things will get bad for that patient really quickly when the involuntary psychiatrists take over the treatment.

It's as if you have no understanding of the topic we're discussing. You completely avoided answering the question I asked, and what you typed doesn't even really make sense (there aren't voluntary and involuntary psychiatrists, none of this has anything to do with the military, and discussing successfully treated depression seems out of place given the other examples that have been used).

 

[pre med 2014]

It's as if you have no understanding of the topic we're discussing. You completely avoided answering the question I asked, and what you typed doesn't even really make sense (there aren't voluntary and involuntary psychiatrists, none of this has anything to do with the military, and discussing successfully treated depression seems out of place given the other examples that have been used).

yea I was in a hurry there. It's a term I made up, it doesn't exist. I refer to psychiatrists as voluntary or involuntary.

If we cut off completely all ties between the government and psychiatry, it would bring a complete and total end to my criticism of the field.

Edit: 'successfully treated depression' is not out of place at all. It describes the subtle nature of coerced psychiatry. Fixing depression is just like fixing the economy. Democrats and Republicans don't agree on the best way to fix the economy just like 'voluntary' and 'involuntary' psychiatrists don't agree on how to fix depression, or most any other mental problems.

 

[surftheiop]

 

[sunlioness]

That's funny. I don't recall the voluntary and involuntary tracks in residency....

Some days I think I'm an involuntary psychiatrist. Like today I'd rather be at home getting ready for thanksgiving than being here seeing outpatients and covering the consult service. But what are you going to do?

 

[pre med 2014]

Not sure what the eek is for. Are you implying that a psychiatrists political orientation and personal social values don't effect his opinion as to wether a condition was successfully treated or not?

 

[surftheiop]

Not sure what the eek is for. Are you implying that a psychiatrists political orientation and personal social values don't effect his opinion as to wether a condition was successfully treated or not?

What are you even talking about? Im still convinced you have some very specific situation that happened to someone you know and your trying to use it to draw all sort of absurd conclusions about psychiatry in general.

 

[OldPsychDoc]

Not sure what the eek is for. Are you implying that a psychiatrist's political orientation and personal social values don't affect his opinion as to whether a condition was successfully treated or not?

I think that 99% of the actual psychiatrists (including trainees) on this board would agree on what criteria constitute a successful treatment of depression, regardless of their political orientations and personal social values.

I'll let surftheiop explain the --though I have my own theories...

 

[vistaril]

I love psychiatry for the deep relationships with patients. Never in any other service have I felt such strong patient-physician dynamics as I do in psychiatry. Based on my experience, I believe psychiatry shines above all other medical specialties in this regard.

It accounts for a large rewarding aspect of daily work, worth more than a higher paying tier, but that's just my preference. I'd rather be practicing as a therapist psychiatrist making $270,000 than an anesthesiologist making $370,000. There's more to life than money.

the equivalent of the 'therapist psychiatrist' making 270k would be an anesthesiolgist making 700k.

 

[vistaril]

I've got to agree here. I have a hard time even remembering much about anatomy lab and not because it was too traumatic to remember -- it's just a relatively small part of my whole training experience that in the long run didn't make much of an impression. There are a lot of things in life that are harder than medical school. Heck, getting a psychology Ph.D. might be one of them -- I haven't done it, so I don't know.

As for being a physician first, I personally disagree somewhat here, too, in that I feel like such a different type of physician than all the other types of physicians and right now feel like my work is closer to a psychologist's work than to another type of physician's work (and I like it that way)..

Anyone who sees it any other way is either delusional or practicing a type of psychiatry that 99% of the rest of the US isn't....

I'm a psychiatrist. That means my job has MUCH more in common with a psychologist(or even a clinical LCSW) than a neurosurgeon or a gastroenterologist or an electrical engineer(just threw that in for fun). That's not a positive or negative statement either. It's just a rather common sense one.

 

[pre med 2014]

I think that 99% of the actual psychiatrists (including trainees) on this board would agree on what criteria constitute a successful treatment of depression, regardless of their political orientations and personal social values.

I'll let surftheiop explain the --though I have my own theories...

Then there should be no need for aviation psychiatrists for airline pilots with depression, or for people who want to join the military. Since 99% of psychiatrists would agree with each other.

 

[surftheiop]

Then there should be no need for aviation psychiatrists for airline pilots with depression, or for people who want to join the military. Since 99% of psychiatrists would agree with each other.

This is coming up over and over, can you just tell us the story that concerns you?

Also I dont know what you mean by these psychiatrists being "involuntary",

From a libertarian worldview like you have claim, a person is entering a voluntary contract to provide services to an organization (military) who has the right to confirm that the individual meets whatever arbitrary health/safety requirements that they agree to in voluntarily signing a contract. Where does the "involuntary" come in?

 

[diagonal]

Then there should be no need for aviation psychiatrists for airline pilots with depression, or for people who want to join the military. Since 99% of psychiatrists would agree with each other.

That may be the dumbest conclusion ever posted in the psych forum.

 

[Leo Aquarius]

The two dumbest people on these psychiatry forums are here in this thread, and I rarely rarely ever use that label. So caveat emptor.

 

[michaelrack]

From a libertarian worldview like you have claim, a person is entering a voluntary contract to provide services to an organization (military) who has the right to confirm that the individual meets whatever arbitrary health/safety requirements that they agree to in voluntarily signing a contract. Where does the "involuntary" come in?

While I don't really know what an "involuntary" psychiatrist is, I think that there are involuntary elements to the miltary... starting with need to register for the selective service and the theoretical possiblity of the draft being reinstated.
Also, once a person joins the military, many civilian rights are lost and a person can not easily leave (I am not an expert on the military and may not be using the correct terminology). I don't think joining the military should be viewed as a simple contract situation.

 

[michaelrack]

Anyone who sees it any other way is either delusional or practicing a type of psychiatry that 99% of the rest of the US isn't....

I'm a psychiatrist. That means my job has MUCH more in common with a psychologist(or even a clinical LCSW) than a neurosurgeon or a gastroenterologist or an electrical engineer(just threw that in for fun). That's not a positive or negative statement either. It's just a rather common sense one.

I agree. But what we all really want to know is, do you think it is better to be a voluntary psychiatrist or an involuntary psychiatrist??

 

[pre med 2014]

I agree. But what we all really want to know is, do you think it is better to be a voluntary psychiatrist or an involuntary psychiatrist??

A voluntary one

 

[pre med 2014]

The two dumbest people on these psychiatry forums are here in this thread, and I rarely rarely ever use that label. So caveat emptor.

This does not bother me at all. The patient is always first to me. If protecting human integrity means being called stupid, so be it.

And I sympathize with the needs of the military, however, since 'mental illness is just like physical illness' it makes no sense how someone can be healthy in civilian life, yet magically be sick if they want to join the military. This defies logic. If you are sick, then you must have the disease regardless of your occupation.

I don't understand why people are against me on this. 99% of you guys agree on successful treatments so why would you want the small minority of 1% of psychiatrists to make inaccurate diagnosis' for successfully treated patients who want to join the military, simply because that 1% of psychiatrists don't trust free and voluntary treatment?

 

[michaelrack]

And I sympathize with the needs of the military, however, since 'mental illness is just like physical illness' it makes no sense how someone can be healthy in civilian life, yet magically be sick if they want to join the military. This defies logic. If you are sick, then you must have the disease regardless of your occupation.

I don't understand why people are against me on this. 99% of you guys agree on successful treatments so why would you want the small minority of 1% of psychiatrists to make inaccurate diagnosis' for successfully treated patients who want to join the military, simply because that 1% of psychiatrists don't trust free and voluntary treatment?

We (at least myself) am not necessarily against you when it comes to military psychiatry, we just have no idea what you are talking about.

 

[surftheiop]

This does not bother me at all. The patient is always first to me. If protecting human integrity means being called stupid, so be it.

And I sympathize with the needs of the military, however, since 'mental illness is just like physical illness' it makes no sense how someone can be healthy in civilian life, yet magically be sick if they want to join the military. This defies logic. If you are sick, then you must have the disease regardless of your occupation.

I don't understand why people are against me on this. 99% of you guys agree on successful treatments so why would you want the small minority of 1% of psychiatrists to make inaccurate diagnosis' for successfully treated patients who want to join the military, simply because that 1% of psychiatrists don't trust free and voluntary treatment?

People dont come to these thoughts in a vacuum, you obviously know someone who may have been mistreated by the military or a physician, but we can't read your mind to understand the situation at hand.

 

[diagonal]

People dont come to these thoughts in a vacuum, you obviously know someone who may have been mistreated by the military or a physician, but we can't read your mind to understand the situation at hand.

I'd bet a bag of biscuits he has a psychiatric history on his record and couldn't get into the military because of it.

 

[surftheiop]

While I don't really know what an "involuntary" psychiatrist is, I think that there are involuntary elements to the miltary... starting with need to register for the selective service and the theoretical possiblity of the draft being reinstated.
Also, once a person joins the military, many civilian rights are lost and a person can not easily leave (I am not an expert on the military and may not be using the correct terminology). I don't think joining the military should be viewed as a simple contract situation.

I agree completely
But from a "orthodox" libertarian philosophy like it seems this poster is trying to adopt, you can contractually obligate yourself to literally anything so long as the contract is initially entered voluntarily.

 

[pre med 2014]

...

 

[diagonal]

.

 

[pre med 2014]

...

 

[diagonal]