Wednesday, March 10, 2010

Things We Argue About

Sometimes, especially on the podcasts, we get heated and go at it. Oh, sometimes on the blog, too. Among ourselves, we refer to these discussions as "The Benzo Wars" --the posts where we've argued about what role benzodiazepines and addictive medications have in psychiatry, and "Who Deserves Care" cause Clink thinks her patients need help more than mine (..if you see me walking around with bruises, you'll know it's me......)

So what else do Shrinks argue about? We've got a colorful history here. Took us decades to decided if homosexuality was a disorder (yes, maybe, no). Is psychosurgery with knitting needles good? Should our patients get special accommodations? What if I'm allergic to your support dog?

Ah, we're writing a chapter and I like the input you all give!

And please listen to our podcast. We're back...probably monthly for now, but weekly once we finish the book and they teach me how to edit them.


The Shrink said...

Things to argue about in our corner seem to include :

1) What's normal? In 1971 Rees showed half of bereaved patients hallucinate, Marius Romme took that further, so what's pathological and what's normal?

2) Okay, sometimes people feel their mental wellbeing's not good. When is it having a rubbish time and simply suboptimal psychological wellbeing, vs when is it psychiatric mental illness? What's the thresh hold?

3) If you're not normal, and it's a psychiatric disorder, should we frame is as psychosocial or biomedical?

4) Crisis Resolution and Home Treatment teams - do they work? Does assertive support in the community simply keep people at home longer when they should be in hospital (as Tyrer's paper this year showed) or is it a viable option to hospital admission/affording patients choice?

5) Since JAMA added yet mroe evidence that drugs don't work any better than placebo in mild, moderate and severe depression, drugs often don't work in dementia (the FDA have banned antipsychotics in dementia care, haven't they?), many swathes of psychiatry increasingly have poor evidence of drugs affording major benefit. We argue about the NNT vs NNH of drugs, fearing that most of the time people get better in spite of, rather than because of, medication; as Voltaire is said to have mused, "The art of medicine consists in amusing the patient while nature cures the disease."

The Girl said...

I don't have anything to add, but just wanted to say that I'm looking forward to the podcasts. :)

Sarebear said...

Is it acceptable practice for a psychiatrist to farm out most of the new patient interview to a colleague at their practice? I'd never heard of this before.

I just posted about my new patient experience w/my new psychiatrist . . . er, the bait-and-switch that happened when I showed up for my appointment, let alone some of the other stuff that happened.

Not sure you'll believe what kind of "specialty" conducted most of the interview, either.

I was so thrown for a loop, I totally didn't realize I was sitting in a steeply angled chair (ever since my knee surgery, my knee escalates from discomfort up into pain from signals sent from the thigh when I sit in chairs where the front edge is angled higher than the back) the whole long time. I was stunned at every turn of events, from what happened at the front desk to the bait-and switch thing and couldn't get my mental feet back under me.

Anyway. Was wondering what you three would think of the whole thing.

Dinah said...

Sarebear: post a link!

Sarebear said...

Psychiatry Bait & Switch post by me

Here you go, should've thought of that myself!

Unknown said...


Podcasts are back!

How about a show on "sham" or quack mental health practitioners, ie "energy healers", EFT, reiki, etc.

Maybe have guests from one of the skeptic podcasts (SkepChik, Skeptoid, Point of Inquiry, etc)