Friday, August 17, 2007

I Don't Care If You Hate Shrinks

First, check out our latest Podcast, just up: Click Here!

So I want to talk about some of the stuff going on in the comments section of Shrink Rap: if you haven't been reading along as we rant, it's gotten pretty heated. I'm not sure I can get this line straight as it's gone through a number of posts, but let me try.

Jayme commented on my thoughts about The Sopranos in my post Shrinks aren't Perfect.

I responded to her comment in a post called Continuing With That Thought.

Jayme returned and told us that she is a psychiatry "survivor" and an anti-psychiatrist activist.

Roy put up a post where he linked to one of Jayme's posts and to her drawings as well, in his post Grand Rounds, Campgrounds, & Breakdowns (what a great post title).

Lily commented on Roy's post that she's angry that he's supporting an anti-psychiatry activist by linking to her. I have to admit, I sort of wondered about that one, too, but I assumed Roy liked an isolated part of the blog, and who says we have to agree with all the views of everyone we link to?

So here at Shrink Rap, we get a fairly diverse group of commenters: some love psychiatrists, some hate psychiatrists, and oh, some have a love-hate relationship with psychiatrists, psychiatry, and the whole concept of mental illness.

My feelings? Not that anyone asked, but here's what I think. Please remember that I don't work in any setting where I see anyone against their will--I'm an outpatient doc and my patients walk in the door willingly and walk out the door willingly. I'm here if you want and need me, very few exceptions.

I believe that if someone is suffering and wants the help of mainstream psychiatry, they should get it. Maybe they don't, or maybe psychiatry has failed them-- either because they saw the wrong doc, were given the wrong meds, had the wrong kind of therapy, or had a resistant problem that just didn't get better with the right therapy and numerous trials of the right meds with the right therapy. Psychiatric treatments help a lot of people, clearly they don't help everyone.

If someone wants to go it on their own or try alternative treatments: great. I'm not the person to see to obtain those remedies, although I am usually happy to treat my patients with conventional treatment while they also do yoga or have acupuncture, or even go to a faith healer, have their bowels cleansed, speak with their clergyman, or do anything else they think might help. I believe in what works-- if it helps someone, I'm all for it, with the exception of illegal drugs, but hey, I treat plenty of folks who use those, too, I just don't condone it.

Still, I don't like Anti-Psychiatry Activism and this is why. If psychiatric treatment didn't help a given patient, if the given patient even felt harmed by it, then perhaps that particular patient feels better served by another form of treatment or self-help. The problem with the activist part is that it becomes judgmental, it makes the case that others shouldn't seek psychiatric care-- that they are somehow wrong, weak, or flawed if they want to try conventional treatments or even if they feel helped by them. Anti-psychiatry activism enhances the stigma associated with psychiatric illness and treatment and serves as a deterrent to those who are seeking relief from their suffering.

If it helps, do it. And as someone who's back had back pain for the past 10 days, rest assured that it's part of the human condition to say to someone else: This Helped Me, Maybe It Will Help You. But don't condemn those who find help in a different place than you did.

Note to Jayme: I have not read your blog, this isn't a personal attack, just the springboard for a post inspired by Lily's distress.


Rach said...

Dinah, great, great, GREAT post.

I know that at times, I get so wrapped up in my own saga of continuous care --> treatment --> side effects --> suffering --> treatment that I doubt whether I'm being helped or hurt. But never have I been "anti-psychiatry". I agree with the sentiment, if it helps, go with it, which is why I suggest therapy to most, if not all of my friends. I don't necessarily agree that meds are always the right course of action, but I do think that they can be part of a larger treatment plan that may include other things (many of which you mentioned - diet change, exercise regime, meditation, spirituality, naturopathic treatment, other support networks, etc).

Perhaps the best years I had in terms of my own mental illness were the ones where I finally hit on the right equation of treatments - not just meds and therapy, but a larger understanding and implementation of lifestyle changes that enabled me to better participate in my therapy.

... But I digress.

Yes, I still hate the shrink at times, but who doesn't? So then... I'm left to wonder... do I hate the shrink, the treatment or the entire "mental health industry"?

I think I might take this over to my own blog this evening...

Anonymous said...

Dinah, Dinah, Dinah, don't take it all so personally. You started a blog and there is some, ooooh here it comes, transference stuff going on. Of course some people lurve you even though they don't know you and others might be pissy with you in equal measure even though they don't know you. and others go back and forth. You are the stand -in for the shrink they wish they could say some of this stuff to. And, that shrink is the stand in for all those other people they really wish they could say these things to.

Dr. Rob said...

I would like to be an anti-(anti-psychiatrist activist) activist. Is that possible, or does that betray inner emotional turmoil?

Seriously, you guys delve a little more into the gray zones than most areas of medicine (you don't have many anti internal medicine activists). I guess it just goes with the territory, but as an internist myself, I am a VERY big fan of the profession. I have seen how bad people can get and how much you guys can do for them. The problem with these activists is that they generalize from very little data. Do you always help your patients? No, but 100% of my patients will eventually die, so I guess I am more of a failure than you guys are.

Keep up the good work.


Anonymous said...

Furthermore, Roy, being Roy, linked to an anti-psych site because he loves playing devil's advocate (no religious connotations intended)and while he may tell you not to, he loves to stir things up. (From behind the safety of the blog). Now he will come and say hey anon, who are you to talk about hiding behind a bloggy persona when you are always ANON?? To which I will say that i could call myself King Kong or The Friendly Giant or Mud Puddles or Nebbishatadesk or Elmer or Elmo or Tariq or Kathleen and who would know anything more about me? Maybe you can put spyware on my laptop or something and find out all about me but that would be a boring waste of time.
But, back to Roy, it seems as though if someone says left, he says no it's right and then stays with that a bit until he has had enough fun. I am sure his Mama or whoever loved him is way proud of the guy but also really glad he moved out of the house.

Anonymous said...

...and, I am not an anti psychiatry activist, (most of the time.) Even shrinks I have hated (and would hate no matter what state I was in becasue they were just yucky people) have saved my life. They put me away. They could have been more sensitive in general but hey, they did their job in that respect. Some shrinks I have liked, sort of, if you can like someone you don't know, maybe the way you can like some made up character from an HBO show....Don't know how good they were but they were okay.
The shrinks that I both like and respect are the ones who acknowledge the big flaws in the system, that the shrink bible is a mess, that they hold the greater share of power, that drugs can help at the same time as they are causing harm and stuff like that. I don't think that makes them anti psychiatry psychiatrists. I think it makes them the ones who try to force the system to improve, often failing but always trying. They do their best.But even though I like em, i can still hate them sometimes too and they can handle it because they are not my friends.And to complete the circle, that is why i like them.

Roy said...

Two thoughts triggered by Anon or Al or Paul or Dick...

1-the reason why a name, even if "not real" is preferred to Anonymous, is that when there is an ongoing communication thread, it is easier to figure out who is speaking. Otherwise, when 10 people post Anonymous comments, it is hard to tell which one is a continuation from the same person and which is a different person. I suppose we could disable Anonymous commenting, but I think it may discourage some who may not otherwise comment. So I'm hoping to be more inclusive by leaving this option. At least sign your Anonymous post with some identifier, like "Al" or "Paul S," like "EEK!...abf" does. Most folks will not deliberately impersonate you, even though it would be easy.

2-Do I like to "stir the pot"? Well, to some extent, yes, because I enjoy a good discussion. If everything in the pot settles to the bottom, then it needs a stir. I do not like to stir a pot that is already well-stirred.

My intent on linking to Jayme's post was not to raise controversy or troll for flames but was to recognize that there are alternative viewpoints, which are worth discussing, but only if it can be discussed without using provocative techniques like commenting on their parents or their physical appearance or other ad hominem attacks. Jayme appears to be someone who can be thoughtful, respectful, yet maintain a position mostly contrary to many found here. I am hopeful that the Anonymous poster with the attitude can be more mindful of this, rather than uncontrollably playing out the "transference stuff" with us here. That is when this feels like "work". You've got some really interesting things to say, but they are not heard when the layer of animosity obliterates the message.

To quote Jayme: "Gotta keep that mind open and free so I won't drown in bitterness."

(Sorry, folks. I usually don't respond to trolling comments, but I guess I had too much time on my hands today. Or I am just being oppositional, like Anon has so astutely observed I can be ;-)

jcat said...

Can I join you, Rob?

Seems to me that anti-psychiatry activism reinforces exactly the same view that they all claim to reject, namely that mental illness is different from physical illness.

I don't CHOOSE to be Bipolar and MDD, and I sure as shit am not going to EMBRACE it. Yes, there are many other things one can do - as well, not instead of - that will help. Both my docs recommend various non-medical/traditional things as well. This one is a long and deep downer, but I know that sooner or later we'll hit the right combination, and I will literally go to bed feeling like whale shit and wake up feeling like me again. I will not embrace BP because that is not who I am. Anymore than cancer is who I am, or any of the other physical things that have happened to me.

And BTW I love my shrink. Because he is there for me, because he gives up his time to try to help me, because I get the benefit of huge amounts of knowledge. I love my gynaecologist too. For the same reasons, often. Hey, I even have a lovable dentist....

Somehow though, it seems to be only psychiatry and psychiatrists that it's acceptable to rant against. And to me that does more damage to society as a whole than any p-meds have ever done.

Anonymous said...

Anon (Al, Paul S., but definately not eek abf):

You wrote:
"Of course some people lurve you even though they don't know you and others might be pissy with you in equal measure even though they don't know you. and others go back and forth. You are the stand -in for the shrink they wish they could say some of this stuff to."

I concur with Roy on this point: when we get angry displaced comments from people who don't even know us, it feels like work (without the pay). Somehow, and as unfair as it might be, I don't think we so much mind the nice comments--that feels more like fan mail than transference-- nor do we mind an intellectual debate over a hot topic --that's why we started the blog.

But sometimes, the comments feel both hostile and personal, and those I can do without.

This is for Fun.

Rach said...

I'm going to open up a can of worms here... but I've been wondering this for a while...

Why allow anonymous comments on your blog?

Aqua said...

Thank you, Thank you, Thank you!! My husband is anti-med, verging on anti-psychiatry. It has been super difficult to get well with all the anti-med rants he spews everytime a medication, treatment or therapy hasn't helped me.

...but I'm the patient and I know that what I feel is constant anxiety and despair. And I know this is not how most people feel about life.

I also know I would not be here without the support of an incredible psychiatrist.

...anti-psychiatry ranters stigmatize the patients seeking the help. They make us feel like if we only tried harder we would get well.

I cannot tell you the number of days/hours I have spent trying to convince my family that my pdoc is helping me. They just about disowned me when I went in for ECT...but it was the only thing that has helped me at all.

I just don't need all that negativity about my treatment plan...I need support....period. That will help me live through this...and that is what I get from my pdoc...unconditional caring and support. He helps me, even when others cannot see that.

Anonymous said...

Good post.

I am somewhat baffled by the anti-psychiatry brigade. Which, again, like many of the other issues discussed on Shrink Rap does not seem to be as prevalent in Australia as it is in the US (however it's probably only a matter of time - the Zyprexa class actions have started!).

Would I be right in thinking that it probably somehow stems from psychiatrists having the authority to admit patients non-voluntarily?

I concur with your point regarding the obvious truth that psychiatry does benefit many people. And Rob's point that other branches of medicine also tend to kill off patients or not help them in the way they would like.

I think that one reason behind it would be the perception that all psychiatric drugs change who you are and severely limit your ability to make informed decisions about your life. ie. the chemical lobotomy conspiracy. And, come to think of it, probably the lobotomy movement in the twentieth century didn't help matters (although Walter Freeman, who popularised lobotomy, was not a psychiatrist!).

I think what concerns me (in many areas of thought!) is when someone says that they have found THE answer to a problem and that it is applicable to ALL people with that problem. People are complicated and mental illness is complicated. Nothing is going to work for everyone. And for some people, nothing is going to work full stop.

Oh I have a lot more to say! But I have to read about kidneys for a while :(

Unknown said...

I still believe, strongly, that psychiatry and psychology FAR too often fall to Martha Michell error: That is, hear something which is truth, but a bit uncommon and label the TRUTH, not-truth. That error hurts innocents and hurts innocents WAY too often.

Plus, it does seem that there is some problem in medication that needs soem heavy duty work.

I am not anti-psychiatry or psychology for that matter. I am skeptical.

For the life of me, I can't see why there's so much fighting on the issues. Problems have been pointed out --by both sides-- and they should be addressed.

Anonymous said...

Hi Ho, Hi Ho, it's off to work we go. This is work for Dinah and Roy. It is also fun for me. I see anyone who uses the easy button "anon" as being lazy and lacking any kind of creativity. Get a name, Anon.
Since I grew up with a brother who was a shrink, I love shrinks. That's it in a nutshell. Shrinks Rock!

Jayme said...

Dinah wrote: Anti-psychiatry activism enhances the stigma associated with psychiatric illness and treatment and serves as a deterrent to those who are seeking relief from their suffering.

I hate to agree with a shrink on an anti-psychiatry topic, but I have to agree (somewhat) with this point. I can't stand the thought of someone feeling judged for seeking help through mainstream psychiatry. Some of my friends are satisfied with their psychiatric treatment, and they swear by their medications. I would never dissuade an individual from something that works well for them, even if I disagree with those methods for myself. I'm just happy that I have that choice now, where at one time I did not. But it was through anti-psychatry that I learned of my choices.

Here's my biggest problem with psychiatry:

If a new patient has pronounced symptoms that could be diagnosed as bipolar or schizophrenia or any other "severe and persistent" mental illness, the typical prognosis is poor. It breaks my heart to know that recovery is not recognized in mainstream psychiatry at the onset of a serious diagnosis.

Recovery is possible for everyoone, though, including those sitting on the back wards, drooling from overmedication. I was once one of those patients, and so were many of my friends. Now we work and play and have lives outside of the mental health system. Some take medication, others don't, and many are beginning an agonizing withdrawal process. It's all about choice, and I personally support all choices, as long as they are informed choices.

Shrinks are in a unique position to offer hope of recovery from the start and inform patients about their choices. If this were happening in mainstream psychiatry, the nature of serious mental illnesses would look entirely different than it does today.

If the anti-psychiatry movement is deterring someone from receiving a serious diagnosis with life-long implications, I can live with that for now, at least until psychiatry offers better outcomes and hope for recovery from the start. I think we could easily come to a happy medium with this.

Monica Cassani said...

I'm with Jayme here.

I was diagnosed bipolar 20 years ago and told I was doomed to a lifetime of meds. I went to several doctors all of whom agreed with the diagnosis and settled on one who treated me for 10 years. He was well reputed. He was not a "bad" psychiatrist, but he did continue what others started and that was poisoning me.

At the end of my treatment with him I was on 7 medications which included 11 mg of Risperdal. As a social worker in mental health I never met another soul on such a high dose.

I became completely disabled 5 years ago. Upon reflection I realized it was the meds that disabled me not the psychiatric diagnosis. Indeed, I've come off virtually all my meds now (at a snails pace--most doctors would have you do it in a matter of months only to see you fail and put you back on the meds) I've been at withdrawal for 3 years and have a couple more to go.

It's become glaringly apparant that I never had bipolar disorder. I have PMS. I took a hallucinogenic when I was 19 that made me psychotic with the mix of hormones during a premenstrual phase (I repeated this twice). I am not bipolar. I continue to have PMS but I have not had a single sign of relapse. (I don't take hallucinogens anymore!!)

The drugs got added one by one because of side effects. My doctor had me convinced I needed them. I went along for the ride. That's what we all do when we're in the system and that's what the doctors do when they buy into the system.

How many people out there are like me? How many people can get greatly improved by eating well and using therapy and coping skills that are virtually never taught by psychiatrists? How many of us are getting progressively worse because of the meds! There are more of us then most people realize.

I do not call myself anti-psychiatry. I have a psychiatrist now that believes me and is overseeing my withdrawals. He is, however allowing me to educate him on how to do it properly. (taking years instead of months)

I am part of a huge community of people withdrawing from meds. All sorts of people who were diagnosed for all sorts of reasons. I also know of hundreds who have already withdrawn.

The problem is mainstream psychiatry refuses to see us. To recognize us--to admit we exist. We are a sore on the system. We were mistreated and we are coming alive once again.

We have to listen to each other if we want to improve mental health care for all.

Monica Cassani said...

by the way I had to use my blogger account on this form.

my blog has moved to

Alison Cummins said...

I'm a big fan of the anti-psychiatry movement. Not because I'm anti-psychiatry - I'm not - but because it gives a voice to some of the complexities inherent in living with mental illness - and in treating it as an illness in the first place.

It's easy to say 'whatever works,' but who gets to define what 'works' means?

If two people disagree on whether one of them is ill or not, whose voice carries?

Anti-psychiatry engages these questions strongly and provides a community and a place to speak and be heard for those who do not feel that the DSM speaks for them, and for those whose voices are hard to hear in a clinically-defined context.

Insight is one of yer basic bones of contention. A psychotic, schizophrenic person who refuses treatment on the grounds that she is not ill and does not wish to be drugged is considered clinically to be 'lacking in insight' because she doesn't see herself from the outside; she perceives her broken brain with her broken brain and does not see the problem. The job of the clinician is to try to get her to accept medication she doesn't want, to fix a problem she can't see, to improve her functioning for her own good.

From her perspective, she doesn't have a problem. She's just fine the way she is. She doesn't want to accept treatment. She wants society to accept her as she is. If she can accept herself, as difficult and marginal an example of the human condition as there is, why can't other people do the same?

When I lived in Nigeria, there were a couple of schizophrenics in the local community. They walked solitary, naked, up and down the road. Sometimes they talked to themselves. One of them lived in a broken-down car visible from the highway; his family brought him meals. Physically, they seemed in good shape. As community members their status signalled to me an acceptance of diversity, though it's equally probable that they served as bogeymen, warnings of what could happen to people who don't conform. Either way, they had a place in their communities.

Clinically, they were clearly ill. Medication could probably have improved their functioning. If it had been more available to them, and if they had refused, how wrong would that have been?

I'm not trying to romanticise mental illness. Even people who deny their illness may be obviously suffering. Some may be dangerous to others, especially if they are paranoid.

A guy I had a crush on in junior high (the strong, silent type I could project anything I wanted on) assaulted two neighbours when he was in his twenties, killing one of them. Last I heard he was doing time, having refused a sentence that took into account his mental illness on the grounds that he was not mentally ill.

I definitely want my brother taking his meds instead of living in a homeless shelter and frightening people. He was convinced to accept psychiatric hospitalisation and medication on the grounds that the alternative was inprisonment for stealing a bicycle and assaulting a police officer. Now he (mostly) stays on his meds because accepting his status as mentally ill is what gets him his disability cheque and subsidised apartment.

But still, when a friend talked to me about wanting to start medication for depression, I warned her that there were consequences. That depending on how severe her depression was she might have choices and should think carefully about them. I take medication for depression (and hypo-hypomania) and the consequences are something I have made peace with. That doesn't mean they aren't there. Identifying your own suffering as a symptom of illness is a double-edged sword. It can be empowering but also alienating.

There are also concrete, here-and-now consequences of treating the marginal. If you treat a homeless person, or someone on welfare who lives in a rooming house and eats in shelters, with depot injections of antipsychotics - what happens in a heat wave? Some antipsychotics put people at risk of fulminating hyperthermia, which can be fatal. If you are living under a bridge, or simply don't have air conditioning, and you are isolated, who is going to make sure that you drink extra liquid and stay cool? Anti-psychiatry makes the point that people need to be enabled to look after themselves on their own terms. And that legislation that would put marginalised people at increased risk of dying so that those of us who are clinically considered 'well' will not have to face panhandlers yelling at invisible voices, quiet panhandlers being bad enough, would be fundamentally disrepectful of the psychotic.

Psychiatry speaks to the empowerment of being able to identify suffering as something outside oneself and to treat it as an illness to improve one's function. Being able to do this has saved my life. (In another society, however, one less demanding of the individual to be self-sufficient in multiple areas simultaneously, it might not have been necessary. I can never know.)

Anti-psychiatry speaks to the alienation inherent in this approach, and advocates for the interests of people treated medically against their own perceived self-interest.

I can't see that as a bad thing.

Gerbil said...

I, too, agree that there are people who have been harmed in some way by mental health treatment. Sometimes this harm can be attributed to the individual provider; sometimes to the treatment itself (whether therapy or medications); and sometimes to the nascence of the field. Psychiatry, as we now know it, is still pretty new. Psychology isn't much older.

But I don't agree that the entire field should be blamed for an individual's suffering. Okay, so lobotomies were a really bad idea; de-institutionalization turned out to have some serious downsides; and Eli Lilly ought to have been more open about the Zyprexa-diabetes connection a lot sooner. At the same time, though, I think that the overall field of mental health treatment has always done its best given its resources at the time. And I believe the same is true of any other field of medicine.

(And what good would it do society if psychiatry really did exist for mind control? I've yet to see a non-paranoid answer to this question.)

So maybe anti-psychiatry could be better framed as increased awareness of informed consent, instead of a perpetuation of the "just pull yourself up by the bootstraps already" philsophy. I say this as someone who lost a good chunk of memory to a few years of Zyprexa--but who also credits same (and a psychiatrist who did as well as he could, with what he had) with the fact that she's still alive today.

Anonymous said...

What I see missing from this is any mention of critical psychiatry. I don't think that it's the antipsychiatry movement that helps people most with seeing the alternatives to conventional treatment, it's the critical psychiatry movement, which I see as a valuable balancing force.

I don't like the antipsychiatry movement because of the message that some of its proponents put out that mental illness simply doesn't exist. I experience it. It exists.

Dr. Val said...

Fan mail alert: I appreciate all that psychiatrists do - and (like most physicians) I know that your deepest desire is to help people. I think your blog feels like work sometimes because it is work - you are providing a guided forum for discussion, and there is therapeutic value in that. So keep it up! And anonymous folks please don't be mean to the shrinks - you wouldn't want them to be mean to you. Let's all help one another on our quest for healthier minds and bodies.

Ladyk73 said...

I really like my psychiatrist, the doctor I have chosen as my out-patient doctor. I embrace drugs (did I tell you I studied to be a pharmacist?) for myself and others. I think vegans (as opposed to vegetarians that eat at least milk products-humans do not have the ability to digest enough nutrients without some animal protein), herbal supplement freaks (who seem to ignore the fact that vitamins and herbs are not regulated), and those who think that balancing their charakaras are going to cure a Severe mental illness. I like doctors. Most of them are really cool too!

However….I really hate the POWER that psychiatrists have at their disposal. They can imprison someone in a sub-standard “medical” ward for days…months…YEARS! My psychologist does NOT have this power. Other doctors do not have this power. If I was hospitalized with a non-mental illness, I am free to leave against medical advice.

I was just released from a nine day stay at a horrible inpatient psy ward. I was threatened with the “quiet” room because I told an aide that I thought it was mean of him to yell at me because I lower the volume on a TV (Although not a heated discussion, one is which I was obviously mad). My assigned psychiatrist decided that I needed to have some inner healing with Jesus (and this was NOT a religiously sponsored hospital). I felt truly dehumanized. I believed I needed a 72 hour stay (as I was actively trying to hurt myself)…not nine days. I believe this experience traumatized me.

This is the kind of experiences that make anti-psychiatrist websites flourish. That being said…… I cannot imagine anyone of the fine doctors who write this blog…ever treating a patient this way.

Gratefully, I was released from the ward (against the nursing staff’s advice) by the Jesus loving psychiatrist who understood and saw how the situation was negatively impacting me. I also left with a RX for an atypical antipsychotic (Seroquel), which with my borderline/bipolar madness….makes a lot of sense. At one point they tried Abilify on me (that made me very ill) and I giggled thinking I must have a hairy tongue!!!!!

Off topic, but related:
During the mental health parity discussion there was some reference to “therapists” without medical training, and the concern that paraprofessionals were diagnosing patients. I understand that the word “therapist” can be applied to anyone from a psychologist to a palm reader. And many “counselors” are created, without proper training, through institutional empowerment (the human services BA graduate working as a service coordinator!). Case workers are not counselors by the fact they are caseworkers. However, some caseworkers are trained therapists…so confusing!
But…back to my off topic parity comment. Insurance companies generally only pay for services that are provided by a licensed provider. Different states recognize different professions (psychologist, social worker, etc…) that are selected to meet the criteria to do “therapy.” To have a license, one must have completed an accredited program, and may need to pass an exam.
An insured individual should not have to pay $50 to see a mental health counselor, and only have a $15 copay to see a physical therapist. This is a good example…perhaps the readers (and writers) of this blog can use this analogy.
Anyways, I found it difficult to ingest that the Psychiatrists always know best vibe that I got from this podcast. And in my opinion, in general, medically trained psychiatrists are not generally trained to be good therapists.
With all due respect….in general, Psychiatrists spend 15 minutes with a patient. Those that spend hours with the patient (and have spent years learning about screening, evaluation, diagnosing, intervening, and hopefully treating mental illness) may actually be the experts in the field.
But….it makes me mad when biological “kindling” is allowed to occur, when only talk therapy is “prescribed” for serious to moderate illnesses.

I really like my psychiatrist, the doctor I have chosen as my out-patient doctor. And I really like you cool blogger people: Clink, Roy and Dinah.

Alison Hymes said...

I wish I could say I don't care if some psychiatrists hate their patients, but I do care. I care because the psychiatrists who dislike the patients they work with are often the most vocal and show up in the media and on Court TV ready to assasinate the character of anyone who might have had a psychiatric label and done something wrong or even been a victim of a crime.

I'm critical of psychiatry because psychiatrists misdiagnosed me and put me on medication that killed my kidneys and never gave me the information I needed to recognize the warning signs of problems with the drug I should not have been on in the first place. I'm critical of psychiatry because so mamy psychiatrists are pushing to have more power over their patients liberty interest. I am critical of psychiatry because when something terrible such as Virginia Tech. happens, the APA offers expert opinions to the media rather than reassurance that most people with mental illness are not violent and waits a month or more to remind psychiatrists of the Goldwater Rule.

I'm critical of psychiatry because psychiatrists stigmatize their patients in public in ways that other medical specialists never do. I don't expect to ever hear my nephrologist say publically nor privately the horrible things I have heard some psychiatrists say about their patients in public settings.

I'm critical of psychiatry because even when psychiatric patients and advocates are on the same side as them on an issue, the APA won't work with us--the issue of psychologist prescribing comes to mind. Psychiatric survivors are against it, NAMI is not, but the APA chose to continue to ally itself with NAMI and not with survivors.

I am going to die from psychiatry. My nephrologist, trained in internal medicine first as they all are, is keeping me alive. Internal medicine is doing something right.

Rach said...

Dinah, Roy & Clink... I'm tagging you for my 3 blog wishes meme... MOre details on my blog:

3 wishes meme

PS - I see you've changed to no more anonymous comments.... Verrrrry interesting!

Midwife with a Knife said...

I like shrinks. I hate that it's so hard to talk my patients into seeing them, though.

Sure, psychiatry isn't perfect. Our understanding of the brain is barely better than rudimentary. There are problems, there are mistakes, but my experience is that far more people are helped than are hurt.

I agree that the public distrust of shrinks is probably due to the fact that they are the only docs who can legally hospitalize you against your will. However, my impression is that this power is infrequently used and even less frequently abused. Not that there aren't EvilShrinks out there (heck, there are bad obstetricians and bad surgeons and bad internists and bad interior designers, so there must be bad shrinks), but I think that they are rare.

Then again, some of the coolest people I knew in med school grew up to be shrinks, so maybe I'm a bit biased.

flawedplan said...

Who calls themselves anti-psychiatry? That's a straw man used to discredit us as 1960s throwback hippies.
A current overview can be found in

A Fragile Revolution, Consumers and Psychiatric Survivors Confront the Power of the Mental Health System, by Barbara Everett, available at Amazon, et al.

Book plug excerpt:

"While it is clear that consumers and survivors have affected the rhetoric of reform, they know that words do not equal action. As they struggle to develop their own separate advocacy agenda, they acknowledge that theirs is a fragile revolution, but one that is here to stay."

Steve & Barb said...

flawedplan: Umm, the antipsychiatry people call themselves "antipsychiatry". Example: The Antipsychiatry Coalition. And, Crystal, what is "critical psychiatry?" That's a new one to me.

Alison: something's not right with your comment suggesting that the APA supports of NAMI's non-opposition to psychologist prescribing (unless I misinterpreted it). That is very far from the truth... the APA is strongly opposed to non-medically trained psychologists being given the legislative right to make prescribing decisions without a medical school education.

ladyk73: Actually, in most states, psychologists *do* have the power to involuntarily commit someone into a hospital if they are a danger to self or others. And, it is not just psychiatrists who can do this but *any* physician (in most, if not all, states). In fact, at most of the hospitals I have worked at, non-psychiatrists (usually ER docs) make the majority of the commitment decisions, not psychiatrists. For most of us, I'm sure, it is not a power we would choose, but one thrust upon us (physicians) by multiple interests. I believe that most use it judiciously.

and, Rach: I think your question about why we still allow anonymous commenters caused us to think that thru a bit more. Also, we have been getting increasing amounts of anon comment spam, so hopefully we won't need to squash as much of these as we've been doing.

AlisonHymes said...

I guess I did not write this clearly enough. No the APA does not support psychologist prescribing. Psychiatric survivors don't support it either. NAMI has not opposed it and has supported it in some states. My comment was to do with the fact that when approached on this issue a few years ago, the APA president had no interest in working with psychiatric survivors in opposing psychologist prescribing. They do however continue in coalition with NAMI despite NAMI's lack of official opposition to psychologist prescribing and despite the fact that many of their patients find NAMI to be against their interests.

Hope that makes more sense.

Roy said...

I see. I see your point, though an organization like APA is not going to nix their support of someone like NAMI just on one issue.

However, I don't understand APA's unwillingness to partner with a bonafide organization that also opposed RxP. Which organization(s) approached them about it? I would understand if it were some radical org, which felt like a "loose cannon". Most orgs will only "get in bed with" another org that they can understand and reasonably predict their positions and actions on issues. Not just psych or medical but any large group.

Otherwhys said...

Critical psychiatry is a movement that amounts to what anon was alluding to in the post about psychiatrists he/she respects. It is easy enough to look up. It is not the same as anti-psychiatry.

DrivingMissMolly said...

Funny how you never hear of
anti-cardiology movements, isn't it.


Jayme said...

Lily - there are no anti-cardiology movements because cardiologists do not force treatment on their unwilling patients. Cardiology is also based on science, not theory or behavior or assumptions. Cardiology is a proven physical illness, while mental illness is not.

Otherwhys said...

And yet, my shrink is a way nicer person than my cardiologist.I don't think my cardiologist has a heart but my shrink does.

catalyst said...

"And, Crystal, what is "critical psychiatry?" That's a new one to me."

Sorry, maybe we use different terminology in the UK. Here we have a critical psychiatry movement which exists within psychiatry. It's not anti-psychiatry because the people involved in the movement are working in psychiatry, not abandoning it or opposing it.

They challenge many aspects of modern psychiatry and their dialogues can be found on websites.

Sometimes they tip over the edge into anti-psychiatry. I don't know where the boundary lies. One key critical psychiatrist, Double, was made to undergo retraining because it was felt that he went too far in not prescribing, but I think that's the exception rather than the rule.

Jennifer said...

I have only seen a psych once, when I had PPD after the birth of my 2nd child. Black, black days. The meds helped and when I went off I was fine. The psych, however, was a cold woman. I always felt like she was looking down on me. She was Indian and had a very strong accent. I could not always uynderstand her and she said to me one time, "I'm speaking English as clearly as you! Don't you know your own language?" Jeesh. On the other hand, it's 15 years later and 2 of my dearest friends are shrinks at hospitals. They are warm and smart and really care about the people they see. They have a lot more compassion than I do! I'm more a dog person... I think being anti-psych because you've had a bad experience is like becoming a lesbian because your last boyfriend was a big mistake. Let's not throw out the baby with the bath water.