Your opinion of Freud and Psychoanalysis

[IvanPavlov]

When the average person thinks of a psychiatrist, they think of Freud, a couch and psychoanalysis. Obviously with the advent of managed care the typical psychiatrist mostly writes scripts while talk therapy is provided by social workers, psychologists etc.

Thankfully, most people are not schizophrenic, bipolar et al., they are just perhaps neurotic members of the "worried well". What is your opinion of traditional Freudian psychoanalysis for the rest of society (assuming they can afford psychoanalysis). Is Freudian psychoanalysis beneficial or is it just a quaint idea which is no longer relevant. For instance, do you believe that is all behavior is bio chemically based and Freud's ideas while interesting are no longer valid?

By the way, I find Whopper to be a fascinating character. He is definitely ENTJ as he stated on another thread.

decisive, fearless, planner, thrill seeker, engaged, social, self centered, comfortable around others, image conscious, likes to be center of attention, adventurous, outgoing, manipulative, emotionally stable, leader, ambitious, hard working, dominant, prepared, hates to be bored, confident, opinionated, analytical, prepares for worst case scenarios, organized, orderly, clean, driven, resourceful, finishes most things they start, achieving, risk taker, desires fame/acclaim, image focused, narcissistic, arrogant, perfectionist, driven, academic, scientific, critical, avoids giving in to others, does not like to compromise, skeptical

Favored careers:

marketing specialist, government employee, lawyer, developer, political scientist, bounty hunter, international relations specialist, software designer, systems analyst, business manager, entertainment lawyer, foreign service officer, strategist, project manager, advertising executive, cia agent, marketing manager, geneticist, private investigator, administrator, business analyst, politician, management consultant, producer, financial advisor, entrepreneur, genetics researcher, cardiologist, professor, fbi agent

Disfavored careers:

singer, bookstore owner, job in the performing arts, poet, photographer, english professor, chef, health care worker, child psychologist, massage therapist, video editor

---

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[ClinPsycMasters]

This post is quite...something.

 

[michaelrack]

Some parts of Freudian theory- transference/countertransference, role of unconsiousness, etc are relevant to modern psychiatry. Some of Freud's ideas about sex are outdated. Traditional psychoanalysis is irrelevant. Basic psychodynamic ideas are relevant.

 

[IvanPavlov]

You may be right Michael however I suspect that there is considerable disagreement in the psychiatric community akin to disagreement between various religions.

For instance after a quick perusal of your blog, I assume that you are probably a fundamentalist Christian. I on the other hand am a nominal Christian who believes in God as an abstract force and I do not believe in religion. I am quite sure that you would disagree with me.

The problem I see with the psychiatric profession is that practitioners have tried to make a science out of what is really an art and the general public is utterly confused.

There is an old saying on Wall Street that "When the ducks quack you feed them". If I were a psychiatrist, I would live in a wealthy community, install a couch in my office, not accept insurance and practice Freudian psychoanalysis. You probably would not cure anyone but you would be giving the public what it expects and I doubt if it would be harmful, but that is just me.

 

[loveoforganic]

So you'd go through 8 years of postgraduate training (+whatever additional time a psychoanalytic institute runs) to deliver what's expected?

 

[erg923]

Then Im glad you're not practicing.... Giving people what they expect/want can be done for free, from friends/acquaintances. Id like to think I can offer a litltle bit more than that.

Your unforntunate attitude is largely why that form of therpay has died out.

 

[Mortal_Lessons]

It's slightly misleading when you say giving people what they want or expect. They want to be shocked and given new insights. So in giving them what they want or expect, you are giving them something new that helps them resolve a problem or make better sense of their lives. Old acquaintances and friends might not be trained to pick up on these patterns within a whole different framework of thinking and be able to interpret them for these patients. When you go see a surgeon, you expect him to do something. Hopefully, he gives you what you expect.

 

[IvanPavlov]

Then Im glad you're not practicing.... Giving people what they expect/want can be done for free, from friends/acquaintances. Id like to think I can offer a litltle bit more than that.

Your unforntunate attitude is largely why that form of therpay has died out.

I agree completely, I would be a horrible doctor. Back in the sixties, I thought that I wanted to become a doctor because all of the girls in high school were in love with Dr. Kildare on television. The only problem was I was only interested in economics, finance, math and law and had zero interest in science.

After my freshman year of college I decided it was time to bite the bullet so I asked my family doctor if he could arrange for me work in the local hospital during summer vacation. He arranged for me to be hired as as an orderly and I lasted a week. I then met with him and said that I didn't think I wanted to be a doctor. He just smiled and said, "that is good to know, isn't it".

I was weeded out early and ended up as an investment banker.

 

[snarfer]

The problem I see with the psychiatric profession is that practitioners have tried to make a science out of what is really an art and the general public is utterly confused.

If I were a psychiatrist, I would live in a wealthy community, install a couch in my office, not accept insurance and practice Freudian psychoanalysis. You probably would not cure anyone but you would be giving the public what it expects and I doubt if it would be harmful, but that is just me.

then what will happen to the millions of people all over the world suffering from autism, schizophrenia, severe depression, bipolar disorder, etc...? Should we just let them suffer and/or die? the burden on society will be unimaginable. We might as well let people with stroke or cancer get sham treatment.

FYI-There is quite a substantial amount of science behind psychiatry. I will say that it isn't as crystal clear as physics or infectious disease but it is there. It is one of the core rotations in medical schools.

 

[IvanPavlov]

then what will happen to the millions of people all over the world suffering from autism, schizophrenia, severe depression, bipolar disorder, etc...? Should we just let them suffer and/or die? the burden on society will be unimaginable. We might as well let people with stroke or cancer get sham treatment.

FYI-There is quite a substantial amount of science behind psychiatry. I will say that it isn't as crystal clear as physics or infectious disease but it is there. It is one of the core rotations in medical schools.

That is the problem. I understand the roughly 1% of the population is suffering from schizophrenia, what about the other 99% of the population, the worried well who are simply neurotic to some extent? If they can afford it should they not be able to avail themselves of traditional Freudian analysis? What is the harm?

 

[erg923]

What the heck are you talking about?! Psychoanalysis is not illegal!! The ATF doesnt storm your office should you practice it. It not plentiful anymore, but its around....

 

[IvanPavlov]

What the heck are you talking about?! Psychoanalysis is not illegal!! The ATF doesnt storm your office should you practice it. It not plentiful anymore, but its around....

I never said that psychoanalysis is illegal. It is just that psycharitry focuses on treating a small segment of the population schizophrenics, bipolar etc. Why leave out the majority of population who are merely neurotic? It makes zero economic sense to allow this market to remain unserved.

If you don't believe in psychoanalysis, fine but you are leaving money on the table by not responding to an obvious demand. I think the average person would be shocked if they knew that psychiatry had disolved into a chemical imbalance problem and that Freud had been thrown out with the trash.

Maybe Freud's theories are rubbish, I am not qualified to state an opinion, however I am sure that Freudian psychoanalysis could help a tremendous number of people even if it were only through a placebo effect.

Obviously schizophrenia is real and antipsychotics were responsible for emptying mental hospitals throughout the world starting in the late fifties and sixties however do you honestly believe that the tremendous increase in their usage as a result of marketing by big parma is justified? Are there suddenly 8 times the number of people for which an antipsychotics are appropriate in comparison to say, 1960. I don't think so. Should antipsychotics really be given to children because they are victims of a breakdown in the family and society in general? In my opinion a little bit of kindness and talk therapy would be preferable.

 

[erg923]

Im not sure I understand why you think that the "worried well" population is being underserved by mental health professionals? If someone has the financial means, therapists of all kinds are readilty available. In fact, market saturation of masters and doctoral level therapists is an issue is some cities, especially the San Fran and LA areas. I guess Im just not sure what your getting at with any of this...

If you are asking why psychiatrists arent taking advantage of a paradigm that allows one to bilk patients of their money for X number of years when empriical research demonstrates that they could get comparable symptom relief in 20 weeks of CBT....well then the answer should be pretty obvious..dont you think?

 

[IvanPavlov]

Im not sure I understand why you think that the "worried well" population is being underserved by mental health professionals? If someone has the financial means, therapists of all kinds are readilty available. In fact, market saturation of masters and doctoral level therapists is an issue is some cities, especially the San Fran and LA areas. I guess Im just not sure what your getting at with any of this...

If you are asking why psychiatrists arent taking advantage of a paradigm that allows one to bilk patients of their money for X number of years when empriical research demonstrates that they could get comparable symptom relief in 20 weeks of CBT....well then the answer should be pretty obvious..dont you think?

Fair enough. If CBT really is more beneficial than traditional Freudian psychoanalysis then I stand corrected. Perhaps I am old fashion but I think that someone who has put in the time and has been vetted by the medical profession is more qualified to serve as a psychoanalyst than a psychologist whose professional quality has great variance. Now big pharma is pushing to allow psychologists to write prescriptions. Once that camel gets its nose under the tent what is next, let chiropractors write prescriptions or sell Xanax in bubble packs at the supermarket checkout?

All I am saying is that in my opinion, psychiatrists, who are real doctors, could benefit society if more of them practiced traditional psychoanalysis.

 

[erg923]

I know of few people that could reasonably argue that a medical education is necessary in order to be effective analyst. What benefits to you think it might have?

 

[michaelrack]

You may be right Michael however I suspect that there is considerable disagreement in the psychiatric community akin to disagreement between various religions.

For instance after a quick perusal of your blog, I assume that you are probably a fundamentalist Christian. I on the other hand am a nominal Christian who believes in God as an abstract force and I do not believe in religion. I am quite sure that you would disagree with me.

The problem I see with the psychiatric profession is that practitioners have tried to make a science out of what is really an art and the general public is utterly confused.

There is an old saying on Wall Street that "When the ducks quack you feed them". If I were a psychiatrist, I would live in a wealthy community, install a couch in my office, not accept insurance and practice Freudian psychoanalysis. You probably would not cure anyone but you would be giving the public what it expects and I doubt if it would be harmful, but that is just me.

IvanPavlov, you are wrong in your assumptions about my religion, but I do disagree with your notions of God.

When I said that traditional psychoanalysis is irrelevant, I meant that only a few psychiatrists (and psychologists) go to psychoanalytic institutes for advanced training. Only a small minority of the general public is willing and able to pay for psychoanalysis.

I have nothing against someone becoming a psychoanlalyst or receiving psychoanalysis.

 

[erg923]

Now big pharma is pushing to allow psychologists to write prescriptions. Once that camel gets its nose under the tent what is next, let chiropractors write prescriptions or sell Xanax in bubble packs at the supermarket checkout?

All I am saying is that in my opinion, psychiatrists, who are real doctors, could benefit society if more of them practiced traditional psychoanalysis.

Full disclosure: I am psychologist and don't particularly support Rx rights for us (which requires us to obtain more education, duh)...However, these are both completely idiotic statements. If you can't see why, then you are actually are an idiot.

PS: What is a "real doctor?" What does the Latin word "doctoris" mean?

 

[IvanPavlov]

A real doctor is someone with a medical degree. My brother has a PhD in mathematics and is chair of his department at a major university but that does not make him a real doctor. I seem to have stirred up a hornets nest with my post which I assure you was not my intention.

I am going to bow out of the discussion and let others discuss the post.

 

[michaelrack]

That is the problem. I understand the roughly 1% of the population is suffering from schizophrenia, what about the other 99% of the population, the worried well who are simply neurotic to some extent? If they can afford it should they not be able to avail themselves of traditional Freudian analysis? What is the harm?

Of the 99% of the population that doesn't have schizophrenia, many have bipolar disorder, major depression, PTSD, ADHD, etc.
There is supposedly a shortage of psychiatrists and psychiatrists have their hands full treating these patients.
Psychiatrists treat mental illness, and have their hands full doing it.

As for the treatment of neurosis, that would depend on how you are defining the term. Certainly there are some forms of neurosis (as defined by Freud) that psychiatrists do typically treat- with psychotherapy and/or medication.

Please clarify what you mean by "neurotic"

 

[erg923]

All I am saying is that in my opinion, psychiatrists, who are real doctors, could benefit society if more of them practiced traditional psychoanalysis.

I'm sorry, I still dont get the perserveration on the psychoanalytic paradigm?

You could have the exact same statement, replace psychoanalysis with "CBT" and have alot more evidence to support the validity of the statement.

By your logic, America would have been a super psychologically healthy society from about 1930-1970 (since the vast majority of practitioners were analytic or at least psychodynamically oriented at that time). I'm not sure I see the evidence for the that.

 

[erg923]

A real doctor is someone with a medical degree. My brother has a PhD in mathematics and is chair of his department at a major university but that does not make him a real doctor. I seem to have stirred up a hornets nest with my post which I assure you was not my intention.

I am going to bow out of the discussion and let others discuss the post.

Alright pal...you are confusing the term "physician" with the latin word doctoris (aka "Doctor") which means to teach.

Th above discussion is moot however, because you did not respond to my question regarding how/why you believe a medical education adds to the abilities of an analyst, but thats ok. I think Freud would disagree with you as well by the way...I would suggest you actually read his original work if you're really that interested.

 

[michaelrack]

All I am saying is that in my opinion, psychiatrists, who are real doctors, could benefit society if more of them practiced traditional psychoanalysis.

I am going to stay out of the "real doctor" debate.

I disagree about the benefit to society if more psychiatrists practiced psychoanalysis; this would most likely lead to less treatment for those with axis one disorders.

 

[billypilgrim37]

Alright pal...you are confusing the term "physician" with the latin word doctoris (aka "Doctor") which means to teach.

Actually, docere means to teach. Doctoris is a corruption of the term, as a teacher would be a magister, not a doctoris. But that's classical latin, not the crap that Catholics ruined over the past 2K years.

Doceo, Docere, Docui, Doctum. I teach, to teach, I taught, having been taught.

But I support your general point

Sorry, I met my wife over a discussion of gerunds.

 

[OldPsychDoc]

Fair enough. If CBT really is more beneficial than traditional Freudian psychoanalysis then I stand corrected. Perhaps I am old fashion but I think that someone who has put in the time and has been vetted by the medical profession is more qualified to serve as a psychoanalyst than a psychologist whose professional quality has great variance. Now big pharma is pushing to allow psychologists to write prescriptions. Once that camel gets its nose under the tent what is next, let chiropractors write prescriptions or sell Xanax in bubble packs at the supermarket checkout?

All I am saying is that in my opinion, psychiatrists, who are real doctors, could benefit society if more of them practiced traditional psychoanalysis.

A TRULY MASTERFUL post--pitting psychoanalysis vs. CBT AND Psychologists vs. Psychiatrists in a single blow, at the same time folding in references to Pharma, non-physicians prescribing, and even our favorite drug, Xanax! If he would have kept his reference to God in this post, as opposed to elsewhere in the thread, I think the Internet itself would have collapsed into a black hole!

:troll:

 

[dl2dp2]

A TRULY MASTERFUL post--pitting psychoanalysis vs. CBT AND Psychologists vs. Psychiatrists in a single blow, at the same time folding in references to Pharma, non-physicians prescribing, and even our favorite drug, Xanax! If he would have kept his reference to God in this post, as opposed to elsewhere in the thread, I think the Internet itself would have collapsed into a black hole!

:troll:

it's pretty amazing isn't it? it seems like psychiatry forum attracts the most trolls...i think it resembles the phenomenon of some scraggly bearded man who invariably shows up at every grand rounds and wants to discuss the the "spiritual implication" of his talk at the Q&A session. this doesn't happen nearly as often at internal medicine grand rounds. i'm voting for *more* medicalization of psychiatry for that very reason.

 

[Manicsleep]

Full disclosure: I am psychologist and don't particularly support Rx rights for us (which requires us to obtain more education, duh)...However, these are both completely idiotic statements. If you can't see why, then you are actually are an idiot.

PS: What is a "real doctor?" What does the Latin word "doctoris" mean?

I was watching Blood and Sand on Netflix and the Doctore was the guy who teaches the gladiators.

Now I am really confused. I have been going about this all wrong. I have to call my lawyer and partners tomorrow to get our building prepped for conversion into a ludus.

Anyone know where to find a good CME course on it. It has to be taught by MDs/DOs and no mid levels. I would of course want a dash of spirituality and alternative medicine included. I want people to think it was a balanced Ludus and while at the same time not based on pseudoscience.

 

[snarfer]

it's pretty amazing isn't it? it seems like psychiatry forum attracts the most trolls...i think it resembles the phenomenon of some scraggly bearded man who invariably shows up at every grand rounds and wants to discuss the the "spiritual implication" of his talk at the Q&A session. this doesn't happen nearly as often at internal medicine grand rounds. i'm voting for *more* medicalization of psychiatry for that very reason.

great observation and I agree with you. What is potentially damaging is the tendency of certain individuals to pass off their anecdotal stories, misguided agendas and opinions as the truth. Two examples come to mind is the one I often hear from lay people that medicalization of mental illness will somehow be detrimental to society, which just has not proven to happen, as it will pathologize people and take away personal responsibility. In fact, it is the other way around. Interventions, including therapy and medications, have resulted in kids with autism and severe depression and adhd attending colleges and join the work place. Before, these kids would have dropped out of school, gotten involved with drugs and spend the rest of the lives in and out of federal assistance programs, jail/rehab and in treatment at hospitals and clinics for kinds of ailments (physical and mental). Lots of wasted society resources and high social and individual burden impact here. And i don't buy that they are all the products of 'bad environments'. there are lots of kids in chaotic home environment who do fine. I've seen parents of children with leukemia, dm, congenital heart diseases more dishelved or 'crazier' than most of my patients with depression or adhd. Many times, the child's illness precedes the parent.

Human beings do not want to be ill and require any types of treatment for any physical let alone mental illness. How many people have met treatment resistance 60 y/o men who refuse daily aspirin, antilipids and diabetic meds even after cabg, cath and neuropathy? The above logic just doesn't make sense. Celebrities and the malingeres are exceptions and not the rules.

the other example is that the majority of medications are prescribed inappropriately and that 'most people will do fine without them". What we know from PTSD research is that memory is incrediably unreliable. clinical symptoms change with time and that patients and families reporting can change drastically from one clinicians to the next. Patients and families often have negative and inaccurate opinions regarding their social workers, psychologists, other psychiatrists/neurologists/pediatricians/NP/FP/cardiologists/surgoens/etc.. and would portray a whole different clincial impressions to their current doctors or social worker/psychologists. This and the patients own wish to be off medications or therapy (i've met 60 y/o men who is s/p cabg x2 who refused antihypertensives/asa/antilipids) once their symptoms have diminished can often give this false impression. To avoid this type I error, I often contact the clinician or records when the medicines or diagnosis were originally made. More times than not, I find that the clinicians impressions were spot on and that various therapy modalities, medicines, tms/ect are solid treatment options. Of course, we can always do better, particularly with early interventions (similarly to what have been done in cardiology, pediatrics and internal medicine) and diagnosis, which is true in all of medicine.

 

[IvanPavlov]

A TRULY MASTERFUL post--pitting psychoanalysis vs. CBT AND Psychologists vs. Psychiatrists in a single blow, at the same time folding in references to Pharma, non-physicians prescribing, and even our favorite drug, Xanax! If he would have kept his reference to God in this post, as opposed to elsewhere in the thread, I think the Internet itself would have collapsed into a black hole!

:troll:

Thank you OldPsychDoc, you made my day! I am not really a troll in that I was quite serious when I started this thread. On the other hand, I have read the psychiatry thread on and off for years, therefore I understand of the zeitgeist of the profession and I do enjoy writing in an entertaining manner.

Just think of me as a harmless friendly church mouse who pops in from time to time so as to provide an outside perspective. I assure you that I am not a disheveled nut baying at the moon.

 

[IvanPavlov]

Forgive me for being cynical but as I stated previously I am a retired investment banker and being cynical is in my blood.

Long ago, when I was sixteen, I made a remark to a lawyer concerning his profession. He chastised me with the statement, "always remember that the practice of law is not a profession, it is a business".

I have dealt with money my entire life and I like to think that I am an astute observer of human nature. In short, I just don't buy the rationalizations expressed on this thread regarding the demise of traditional Freudian analysis by psychiatrists. Please see the enclosed article at the end of this post.

I believe that all physicians including psychiatrists lost their autonomy long ago and you are now at the mercy of politicians and big Pharma together with lawyers constantly circling you and nibbling at your heels.

When a speed bump is erected on a road, people generally change their path and that is in my opinion is exactly what happened as psychiatry transitioned from a brainless model to a mindless model.

When I was growing up I had a good friend whose father was a sales rep for Abbott, I believe that they were called detail men at the time. Recently, I was waiting for my doctor in his waiting room together with 2 drop dead gorgeous sales reps who were not your father's sales reps. Big pharma knows exactly what it is doing and I assure you that they only think of physicians as necessary distribution agents which they can utilize and hopefully manipulate so as to broaden their market and increase their bottom line. It is simply business. If you don't believe me then believe Dr. Carlat.

Ask yourself this question and be honest. Assume that a random sample of the population, say 100 people made an appointment with you so as to discuss their mental state. What percentage of those individuals would walk away with a prescription?

Truly, it is no different than a developer who will buy a piece of ground whose only purpose is to hold the earth together - if he can obtain financing, a dentist who moves into cosmetic dentistry as cavities begin to disappear due to fluoride or an investment banker who will do a deal as long as it is legal and he will make money.

Why? We are all hammers looking for a nail. It is what we do.



Psychiatric Practice: A March from the Brainless to the Mindless?
When fewer psychiatrists provide psychotherapy, what is the effect on the patient — and on the field of psychiatry?
Psychotherapy has long been considered an essential component of the psychiatrist's work and is one of the cornerstones of the biopsychosocial model from the 1980s. Many experts still adhere to this model, which emphasizes that psychiatry was the specialty that could best integrate all relevant dimensions of illness. This report of data from a national survey of representative outpatient medical practices from 1996 to 2005 suggests that the psychosocial and biological components of psychiatry are increasingly split.
The investigators surveyed 14,108 visits to psychiatrists involving a psychiatric diagnosis. The percentage of visits with at least 30 minutes of psychotherapy decreased significantly over 10 years from 44% to 29%. For patients with private insurance, the decline was significant (from 50% to 25%), but not for those in publicly funded programs, where the initial percentage was low (Medicare, from 32% to 21%; Medicaid, from 22% to 13%). The percentage was highest among self-paying patients and did not change significantly (from 55% to 59%). In HMOs, the percentage of visits with psychotherapy decreased significantly to a remarkable degree (from 23% to 5%). Overall, the reduction in psychotherapy provided by psychiatrists was attributable to changes in payment sources and increased prescription of medications.
Comment: Third-party reimbursement to psychiatrists is 41% less for one 45-minute psychotherapy session than for three 15-minute "med checks." This model is based on the completely unsupported belief and self-fulfilling prophecy that it is cheaper to split than to combine psychotherapy and medication prescription: Today, psychiatrists in insurance plans cannot afford to provide psychotherapy. Given the pressure to see large numbers of patients briefly and the minimal reimbursement for non–patient-contact activity, true coordination of pharmacologic and psychosocial therapies is rare. This situation, combined with the vigorous marketing of medications to patients and practitioners, is altering psychiatric practice and, perhaps, the psychiatrist's professional identity. Meanwhile, as psychotherapy becomes less relevant to the actual practice of most psychiatrists, it is evolving into a theoretical topic in residency education.
Scientific practitioners would not defend the older practice of using whatever unstructured and unvalidated approach felt right. However, it is unrealistic to expect that components of care provided by different clinicians will somehow be integrated by the patient, especially since many of the target symptoms for medications overlap those for psychotherapy. Practicing psychiatrists might want to resist this trend before psychiatric practice becomes so technologically driven that it becomes one of the least holistic of specialties.
— Steven Dubovsky, MD

 

[michaelrack]

.

Ask yourself this question and be honest. Assume that a random sample of the population, say 100 people made an appointment with you so as to discuss their mental state. What percentage of those individuals would walk away with a prescription?

Back when I was practicing psychiatry (rather than 98% sleep medicine) most of those 100 wouldn't have made it through my door. Generally, when you call a psychiatrist's office to make an initial appt, you won't be scheduled without a general reason such as "depressed" or "anxious"- although I guess if you offer to pay a large amount of $ "discuss my mental state" may get you a visit.

 

[IvanPavlov]

Back when I was practicing psychiatry (rather than 98% sleep medicine) most of those 100 wouldn't have made it through my door. Generally, when you call a psychiatrist's office to make an initial appt, you won't be scheduled without a general reason such as "depressed" or "anxious"- although I guess if you offer to pay a large amount of $ "discuss my mental state" may get you a visit.

It was a hypothetical question. Assume in this case that you are sitting in your office and you see 100 people selected at random by an independent selection agent. Everyone has a problem, it is part of the human condition. What percentage will leave with a prescription? I think in your heart of hearts that you probably know the answer.

 

[erg923]

Ok, I get it. This isn't about the modality at all is it? Its about therapy vs meds? Is that right?

If not, you have presented no compelling data of the efficacy of traditional, imploring the fundamental rule psychoanalysis over more recent advances in the science of behavior change. I think it is your responsibility to do so, since you are so vigorously advocating the analytic model, dont you?

 

[IvanPavlov]

Ok, I get it. This isn't about the modality at all is it? Its about therapy vs meds? Is that right?

If not, you have presented no compelling data of the efficacy of traditional, imploring the fundamental rule psychoanalysis over more recent advances in the science of behavior change. I think it is your responsibility to do so, since you are so vigorously advocating the analytic model, dont you?

No, I am not necessarily advocating psychoanalysis. Humans are complex creatures and are influenced by many things including the power of suggestion. I understand the need to search for certainty in an uncertain world, however it is far from certain given the current state of knowledge, that the mental maladies of mankind can be alleviated solely by drugs. Can antipsychotics help a true schizophrenic? Of course, but my concern is about the rest of society that has been indoctrinated by big Pharma that the answer to their problems can be provided by a pill. Physicians are trapped in the game, just look at drug resistant staph? It only exists because physicians prescribed antibiotics to patients that demanded a "cure" for what the physician knew was most probably a viral infection, but what the heck, give the patient what they want and go on to the next in line.

When I was growing up there was one particular physician that everyone loved because he "cured" everyone. What was his secret? it was the placebo. In his office he displayed vials of brightly colored syrups and boxes of sugar pills. Everyone was guaranteed to receive something, either a real RX or a placebo and it worked!

In my opinion, true psychiatry is more of an art than a science notwithstanding the desire of those who would wish to mold it into a science in their own minds so as to justify their decision to enter the field.

Unfortunately most, not all, but most of you have drunk the Kool-Aid and truly believe that you are practicing a scientific form of medicine when in point of fact you are practicing a subjective art. There is nothing wrong with accepting the fact that psychiatry is an art, it may even be liberating.

Obviously, I am not against your chosen profession, instead I have attempted to simply express what is intuitively obvious to many intelligent educated people outside of your profession. This is not the 1950's when doctors were placed on a pedestal by an uneducated populace, the world has changed as higher education has proliferated throughout society.

 

[IvanPavlov]

I just wanted to make one additional point. I am not anti-psychiatry. I have complete respect for anyone who completes 4 years of college, 4 years of medical school, a year as an intern, 5 years of residency plus perhaps a fellowship and in so doing incurs hundreds of thousands of dollars in student loans, before you begin to earn a return on your enormous investment of both time and money. You are very special people, I admire your dedication.

 

[erg923]

Um...so your vast insight with all this rambling is that psychiatry is to reliant on medications? Congrats on that unique observation.

I certainly disagree that psychotherapy can not be subjected to rigorous scientific investigation. Many clinical science oriented clinical psychologists including Mcfall, Wampold, Buetler, Strupp, just to name a few have made academic careers doing tightly controlled outcome studies. Are they perfect? No, of course not. But it would be unrealistic to expect it to me know wouldn't it?

 

[snarfer]

It was a hypothetical question. Assume in this case that you are sitting in your office and you see 100 people selected at random by an independent selection agent. Everyone has a problem, it is part of the human condition. What percentage will leave with a prescription? I think in your heart of hearts that you probably know the answer.

I can think of the last 10 new evaluations. I started one on a DNRI and another on an alpha agonist. One I sent back to her psychologist with rec for further family therapy after the clinician saw this patient only 3 times following initial eval 2 months ago and felt the patient needed a medication. one I started weekly CBT. the other two i sent back to their therapists. And the rest, I discharged them to their PCPs as they did not seem to have any mental illnesses. They were instructed to followup with me in 3 months if needed. Of course this pattern can vary from time to time but this is the general trend at my clinic.

This may not be obvious to the public (educated or not) but treatment, whether it be therapy or medications or tms/ect- require quite a bit of thought process involving pharmacokinetics, dynamics and human physiology.

Many of my colleagues carry a few therapy patients (as do I) and this is not something we advertise. Thereby, I can see why many have the perceptions that all psychiatrists only prescribe med.

regarding psychoanalysis, i do agree with others that this mode of treatment as proven to be irrelevant and even potentially harmful.

 

[IvanPavlov]

Ok, I get it. This isn't about the modality at all is it? Its about therapy vs meds? Is that right?

If not, you have presented no compelling data of the efficacy of traditional, imploring the fundamental rule psychoanalysis over more recent advances in the science of behavior change. I think it is your responsibility to do so, since you are so vigorously advocating the analytic model, dont you?

I suggest that you watch the following video. By the way there is nothing new about CBT, it dates back to B.F. Skinner.

http://forum-network.org/lecture/astonishing-rise-mental-illness-us

The Astonishing Rise of Mental Illness in the US
May 4, 2010
Robert Whitaker writer, journalist
Robert Whitaker shares the challenges he faced while writing his book Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, which looks at the merits of psychiatric medications through the prism of long-term results.
Since 1987, when Prozac was introduced, the number of adults in the United States on government disability due to mental illness has risen from 1.25 million people to more than four million today. In his book, Anatomy of an Epidemic, journalist Robert Whitaker explores this epidemic, and in so doing, raises this controversial question: Could our drug-based paradigm of care be fueling this modern-day plague?
To answer that question, Whitaker looks at how psychiatric medications affect the long-term course of mental disorders, and he does so by tracking outcome studies from the 1960s until today. Do psychiatric medications help people get better and stay well? Function better? Enjoy good physical health? Or do they, for some paradoxical reason, increase the likelihood that people will become chronically ill, less able to function well, more prone to physical illness? When researchers funded by the National Institute of Mental Health, the World Organization, and other government agencies studied these questions, what did they find?

 

[erg923]

I suggest that you watch the following video. By the way there is nothing new about CBT, it dates back to B.F. Skinner.

Well, no, it doesnt actually. Skinner had no interest cognition and even less interest in psychotherapy. CBT really comes from Beck, who actually emphasized the C more than the B, although both are utilized.

You are also incorrect that there is nothing new about CBT. Countless variants and specific techniques (for each disorder) are being developed in the field. A typical 16 week trial of CBT today is quite different from what one would have experienced in 1975 for example.

The video you posted appears to be another rehashing of the med vs therapy debate that you for some reason cloaked with psychoanalysis in your original post- the reason for which I don't understand, by the way. The video is really irrelevant to the debate between therapy modalities that you and I are having. If you are trying to push some agenda, fine, but at least cut the BS about the analytic and CBT stuff (which you obviously know little about in-depth) and be honest about it.

 

[IvanPavlov]

Well, no, it doesnt actually. Skinner had no interest cognition and even less interest in psychotherapy. CBT really comes from Beck, who actually emphasized the C more than the B, although both are utilized.

You are also incorrect that there is nothing new about CBT. Countless variants and specific techniques (for each disorder) are being developed in the field. A typical 16 week trial of CBT today is quite different from what one would have experienced in 1975 for example.

The video you posted appears to be another rehashing of the med vs therapy debate that you for some reason cloaked with psychoanalysis in your original post- the reason for which I don't understand, by the way. The video is really irrelevant to the debate between therapy modalities that you and I are having. If you are trying to push some agenda, fine, but at least cut the BS about the analytic and CBT stuff (which you obviously know little about in-depth) and be honest about it.

This is truly a silly response, you obviously have very little sense of history. CBT is as old as the hills. Almost any college student from the sixties on knows about CBT if only from an introductory psychology course. You may honestly believe that CBT is the holy grail and that is fine, believe as you wish.

My mother who was a student at The University of Chicago in the thirties was psychoanalyzed for 2 years by Franz Alexander and she found the experience quite beneficial. Be sure to Google "Franz Alexander" as I am quite sure that you are not familiar with the name.

My point is very simple, there are many people, myself included, who can easily afford psychoanalysis. Unfortunately, the system as currently structured is set to serve the lowest common denominator, thus the typical psychiatrist today is reduced to writing prescriptions and checking medications every few months.

In a way it is false advertising, in that what passes for psychiatry today has very little to do with real traditional Freudian psychoanalysis which most people consider to be the gold standard.

If a member of the "worried well" which includes myself, wishes to avail himself of real traditional Freudian psychoanalysis I suggest that they consult with

THE INTERNATIONAL PSYCHOANALYTICAL ASSOCIATION
http://www.ipa.org.uk/eng/international-psychoanalytical-association/

As I stated in a previous post, a PhD psychologist is not a real doctor. You can only be considered a real doctor if you hold a medical degree.

In addition, in my opinion and in the opinion of most of the population you cannot be considered a real psychiatrist unless you have extensive training in traditional Freudian psychoanalysis and practice same on a daily basis. Forget Jung (if he had not broken from his master, Freud then he could be considered) et al. as well as right winged religious quacks like Menninger (who established his reputation as an advice columnist for the Ladies Home Journal) or even primal scream therapy from the sixties. CBT which has its origins in the Skinner box may or may not be beneficial but it is not traditional Freudian psychiatry. CBT reminds me of something from the former Soviet Union or North Korea. You are too young to have ever seen "The Manchurian Candidate" again, Google is your friend.

 

[Manicsleep]

This is truly a silly response, you obviously have very little sense of history. CBT is as old as the hills. Almost any college student from the sixties on knows about CBT if only from an introductory psychology course. You may honestly believe that CBT is the holy grail and that is fine, believe as you wish.

My mother who was a student at The University of Chicago in the thirties was psychoanalyzed for 2 years by Franz Alexander and she found the experience quite beneficial. Be sure to Google "Franz Alexander" as I am quite sure that you are not familiar with the name.

My point is very simple, there are many people, myself included, who can easily afford psychoanalysis. Unfortunately, the system as currently structured is set to serve the lowest common denominator, thus the typical psychiatrist today is reduced to writing prescriptions and checking medications every few months.

In a way it is false advertising, in that what passes for psychiatry today has very little to do with real traditional Freudian psychoanalysis which most people consider to be the gold standard.

If a member of the "worried well" which includes myself, wishes to avail himself of real traditional Freudian psychoanalysis I suggest that they consult with

THE INTERNATIONAL PSYCHOANALYTICAL ASSOCIATION
http://www.ipa.org.uk/eng/international-psychoanalytical-association/

As I stated in a previous post, a PhD psychologist is not a real doctor. You can only be considered a real doctor if you hold a medical degree.

In addition, in my opinion and in the opinion of most of the population you cannot be considered a real psychiatrist unless you have extensive training in traditional Freudian psychoanalysis and practice same on a daily basis. Forget Jung (if he had not broken from his master, Freud then he could be considered) et al. as well as right winged religious quacks like Menninger (who established his reputation as an advice columnist for the Ladies Home Journal) or even primal scream therapy from the sixties. CBT which has its origins in the Skinner box may or may not be beneficial but it is not traditional Freudian psychiatry. CBT reminds me of something from the former Soviet Union or North Korea. You are too young to have ever seen "The Manchurian Candidate" again, Google is your friend.

I think its peanut butter jelly time.

 

[erg923]

Im not gonna argue history with you but, yes, of course strict behavior therapy (BT) utilized skinnerian principles almost exclusively. However, Cognitive-Behavioral Therapy (CBT), as it is currently practiced, owes alot more to Beck than to Skinner. But of course this doesn't discount the importance of Skinnerian learning theory in the practice psychotherapy, no mater what the orientation. However, this still does nothing to further your argument that there is "nothing new in CBT" recently. Im not sure why you feel qualified to makes such a silly statement since you are not a practicing mental health professional...

I also fail to understand your focus on this "real doctor" thing. True, Ph.D. psychologists are not medical physicians (this appears to be what you are referring to), this is quite obvious. However, you appear to be arguing that medical training is necessary for the conduction of psychoanalysis, or pehaps the conduction of psychotherapy? Is this correct? If so, can explain your reasoning here? Is this supported by anything other than your anecdotal belief? What was Freud's opinion regarding this?

Lastly, I (and most of us apparently) simply fail to see what your complaining about in this thread. You go back and forth between rambles about med and psychoanalysis, the superiority of psychoanalytic therapy (although you provude no peer reviewed empirical data for that assumption?).

From what I can gather, You are "worried well" and desire old-school style psychoanalysis. Good for you. Its still around (plentiful in the northeast actually), so go do it! What's the problem?

 

[erg923]

In a way it is false advertising, in that what passes for psychiatry today has very little to do with real traditional Freudian psychoanalysis which most people consider to be the gold standard.

Excuse me!? Outcome studies and empirical evidence dictate standards of practice and what tests/treatments doctors consider using, not the lay public! Jesus, think of the mess medicine would be if we just gave patients everything they wanted anytime they wanted it! Maybe check out the Disability video thread on here...

 

[HMSPSYCH]

You are "worried well" and desire old-school style psychoanalysis. Good for you. Its still around (plentiful in the northeast actually), so go do it! What's the problem?

This is true. There are quite a few in the Boston, Conn. and NYC area. Also in CA.

IvanPavlov-psychoanalysis is definitely not the gold standard. It is quite useless actually and has been for a long time.

 

[IvanPavlov]

Im not gonna argue history with you but, yes, of course strict behavior therapy (BT) utilized skinnerian principles almost exclusively. However, Cognitive-Behavioral Therapy (CBT), as it is currently practiced, owes alot more to Beck than to Skinner. But of course this doesn't discount the importance of Skinnerian learning theory in the practice psychotherapy, no mater what the orientation. However, this still does nothing to further your argument that there is "nothing new in CBT" recently. Im not sure why you feel qualified to makes such a silly statement since you are not a practicing mental health professional...

I also fail to understand your focus on this "real doctor" thing. True, Ph.D. psychologists are not medical physicians (this appears to be what you are referring to), this is quite obvious. However, you appear to be arguing that medical training is necessary for the conduction of psychoanalysis, or pehaps the conduction of psychotherapy? Is this correct? If so, can explain your reasoning here? Is this supported by anything other than your anecdotal belief? What was Freud's opinion regarding this?

Lastly, I (and most of us apparently) simply fail to see what your complaining about in this thread. You go back and forth between rambles about med and psychoanalysis, the superiority of psychoanalytic therapy (although you provude no peer reviewed empirical data for that assumption?).

From what I can gather, You are "worried well" and desire old-school style psychoanalysis. Good for you. Its still around (plentiful in the northeast actually), so go do it! What's the problem?

I have no idea what Freud thought. To me is a little like the difference between and optometrist and an opthamologist. I visit an opthamologist once a year for an eye exam because an opthamologist is a real doctor. I am a very conservative person, I drink in moderation and I have no interest in taking drugs although I must say I enjoyed the 10 mg of valium that I received before a recent cataract surgery, it was a very pleasant day.

On the other hand, I personally think that traditional Freudian psychoanalysis would be interesting just as I think this forum is interesting. Will I do it, probably not but I may. I have an excellent medical group and I only trust the doctors in my group although I probably trust 90% percent of doctors in general, it is the last 10% (the type that run pain clinic mills etc.).

I am just a typical member of the "worried well" maybe a little eccentric but there are many people like myself on Wall Street (although I am retired).

 

[erg923]

Congrats on addressing none of my points, not answering any of my questions regarding your above stated opinions/assertions, nor providing any scientific data for your opinions regarding psychoanalysis...you FAIL at debating.

PS:Freud was vocal in his opinion that medical training added little if anything to the abilities of an analyst.

 

[IvanPavlov]

This is true. There are quite a few in the Boston, Conn. and NYC area. Also in CA.

IvanPavlov-psychoanalysis is definitely not the gold standard. It is quite useless actually and has been for a long time.

How long has this been true? If it is true then I suppose that it could be dangerous (for the patient) if he visited a psychiatrist and innocently begin to free associate thinking this was proper behavior on his part.

I am curious what what most patients think when they visit your office, do they expect a couch and psychoanalysis?

 

[IvanPavlov]

This is true. There are quite a few in the Boston, Conn. and NYC area. Also in CA.

IvanPavlov-psychoanalysis is definitely not the gold standard. It is quite useless actually and has been for a long time.

How long has this been true? If it is true then I suppose that it could be dangerous (for the patient) if he visited a psychiatrist and innocently begin to free associate thinking that was proper behavior on his part.

I am curious what most patients think when they visit your office, do they expect a couch and psychoanalysis?

 

[erg923]

Why are you so focused on people expectations?

I don't have that experience much. Although that might be a vaguely common perception in the public to some degree, I think people simply want help when they come into the clinic. Period.

If someone expects that I conduct old school analysis then I simply explain to theme lack of evidence for this model's effectiveness. I further explain that I practice a style therapy that is based on a more empirical, scientifically sound theory of behavior/abnormal behavior. I tell them that early experiences, relationships, and especially relationships with ones parents are indeed important and we can certainly explore those issues. However, I also explain that we have come a long way in our understanding of human behavior in the past 100 years and that I am obligated (much like any medical physician) to use techniques (and theories) that are supported by recent empirical evidence as first line treatments. If they want psychoanalysis, they are free to walk...

 

[michaelrack]

How long has this been true? If it is true then I suppose that it could be dangerous (for the patient) if he visited a psychiatrist and innocently begin to free associate thinking that was proper behavior on his part.

Even if a patient was seeing a traditional psychoanalyst, treatment would not begin with free association. There would be several sessions in which history would be gathered and a treatment plan would be generated. Not every patient who visits a psychoanalyst is appropriate for psychoanalysis- in particular, the psychoanalyst would evaluate for psychosis (not approp usually for psychoanalysis) and suicidality (would need stablization prior to psychoanalysis).

 

[HMSPSYCH]

How long has this been true? If it is true then I suppose that it could be dangerous (for the patient) if he visited a psychiatrist and innocently begin to free associate thinking this was proper behavior on his part.

I am curious what what most patients think when they visit your office, do they expect a couch and psychoanalysis?

Maybe since the 70s?

I am not sure what my patients expect. If I had to guess, they expect labs, ekg,medications, a lot of talking. Many get brief physical exams, vital signs, history, consent to contact collaterals, lab slips and maybe a prescription. I have a few therapy patients and they leave with practice materials. Even the medication patients receive supportive therapy each visit.