Psychiatry not working?

[henderman10]

Do a simple search in youtube or google video and type 'psychiatry'. Listen to the amount of negative feedback coming from REAL notable doctors. Knowing people who have been through the system and have nothing positive come out of it, it makes these doctors sound right.

 

 

There are no cures, just treatment with dangerous mind altering medications. That doesn't sound like science does it? Its 2011 and this is the best we have?

[Cap'n Refsmmat]

I don't think you can generalize the experiences of particular people to all of psychiatry; there are certainly parts of it that work, though perhaps not as well as we'd hope.

 

That said, there's a lot of evidence that some psychiatric treatments don't work nearly as well as we originally thought, and possibly that they're more harm than good. I'd recommend Robert Whitaker's book for those who want to read more about it.

 

There's also a lot of evidence for certain psychotherapy treatments. Don't throw everything out at once.

[Ringer]

Can you list some sources besides youtube? Of course there are people saying that things don't work, people still believe homeopathic medicine is as good or better than traditional medicine, and there are doctors who say as much. Show something of substance.

 

But more to the point, many of the ways that people use clinical psychology and psychiatry are not what one would consider a physical ailment. Many of the people who say psychiatry and clinical psych are fake and have been through treatment fall into two categories, those who went for some sort of arbitrary short term problem (i.e. marriage difficulties, someone died, etc) that would get better without treatment and people who did treatment only for a short term and didn't follow up on prescriptions or appointments. I will ignore the former because they had no need for therapy in the first place. The latter are as reliable as those who 'discredit' medical science because it didn't work for them.

 

Yes it is a young discipline so there will be growing pains like any other discipline, but it does help people with real problems.

[henderman10]

Not throwing everything out at once. Just stating theres a whole other argument here that isn't getting attention. Drug companies are in bed with doctors, thats a fact they cant really deny anymore. Doctors are pushing these drugs on young adults and even children, prescribing them without being approved by the fda and so on....

 

Look at the commercials on tv. They are trying to convince everyone theres is a huge serotonin problem going on and they have no idea why or how to cure it.... Give me a break

[Ringer]

Of course there are doctors in the pockets of companies, it's part of funding, but that is a problem for all areas of science, not just psychiatry. Drugs that are used to cure or treat illnesses must go through the FDA or they cannot claim to treat any ailment.

 

Yes there are problems with doctors prescribing medicines without knowing fully the consequences these medicines may have, that's not just drugs used for psychological reasons. Heroine was used in the early 1900 as a cure for cocaine addiction as well as a 'less addictive' form of morphine. We all know how well those statements held up.

 

Commercials are a way to get uneducated individuals to ask and push for certain prescriptions, if your doctor uses commercials to decide what product should be used in treatment he/she is an idiot. There are well documented connections between mental illness and serotonin, but serotonin is used so frequently and with so many other neurotransmitters it is hard to pinpoint the exact part it plays. Though the use of SSRIs have helped many people with clinical levels of depression

[Marat]

The OP said: "There are no cures, just treatments with dangerous ... drugs." That sounds to me like 80% of the rest of medicine, so psychiatry is not that far behind.

 

The basic problem in psychiatry is that most of its 'diseases' are in fact just functional conditions in which no specific lesion, microbe, or pathologically significant biochemical anomaly can be identified to establish that we are really dealing with a true disease and not just a collection of normal responses to difficult life experiences. Psychiatry keeps itself in business by pretending that 'healthy' people are those who would respond to the death of a close relative or friend, a diagnosis of fatal illness, bankruptcy, or unemployment by just fatuously exclaiming, like some sort of idiotic robot programmed only for success rather than a human designed to feel things, "Okay, now how do I make the most positive and creative use of this opportunity to succeed in my ultimate goals!!" Anyone who cannot instantly rebound from any tragedy in this stupid-for-success mode is defined as 'mentally ill' and 'in need of psychiatric care,' and the psychiatrists and the drug company owners go laughing all the way to the bank.

[Cap'n Refsmmat]

I don't think all cases of clinical depression can be summed up as "bad thing happens to person, they get sad, we give them drugs." In fact, the DSM-IV diagnostic criteria specifically excludes cases where the symptoms are a result of bereavement.

 

Also, one must remember that doctors don't go out aggressively finding people who are sad and giving them drugs. Patients present themselves because they can no longer handle the problem themselves. Of course, drug company advertising probably leads to patients expecting antidepressants in cases when they are not clinically warranted, but the aggressive psychiatrist model doesn't hold up.

[John Cuthber]

Hang on, have I missed something?

"bad thing happens to person, they get sad, we give them drugs."

bad thing happens to person, they get flu, we give them antibiotics (which don't affect the flu virus).

bad thing happens to person, they get arthritis, we give them anti inflamatories (etc which don't actually stop the disease).

bad thing happens to person, they get asthma, we give them drugs that reat the symptoms, but not the underlying cause.

What's the difference?

 

To be fair to the psychologists they are trying to deal with something that's a bit complicated.

[Cap'n Refsmmat]

I suppose the argument goes something like this: If I lose my high-paying job and get depressed over it and mope at home all day, the solution to the problem is to get me a new high-paying job, not medication.

 

Also, hugs are cheaper than drugs.

[Ringer]

The problem with finding the the underlying causes of certain mental diseases (insofar as that we can't tell if damage to the brain is caused by certain issues or if issues cause the damage) is we can't ethically put, say, brain lesions in people to find what that causes. Nor can we ethically increase or decrease levels of neurotransmitters to find if it would cause a clinical case of depression. What we can do is use studies in animals, which don't necessarily correlate to 'higher' brain function. We can also see what happens after the fact.

 

These problems do hold back progress in psychiatry and clinical psych quite a bit, but would anyone rather have the alternative? Purposefully causing structural damage or inflicting the abnormalities on test subjects just to find the exact underlying cause? It's not that psychological experiments can't be done to find these things, it's that they aren't allowed to. If you have a problem with the lack of knowledge of underlying causes and that we don't have perfect experimental controls complain to the ethics boards.

[Marat]

But then you would expect to find some good evidence of the objective reality of the DSM's diagnostic entities at autopsy, which you can't in most cases. Even with an extreme condition like schizophrenia establishing correlates of the diagnostic features at autopsy is controversial.

 

The DSM's diagnostic categories have often included some absolutely ridiculous items which were self-seriously treated as real clinical entities just as though they were as substantive as tuberculosis, Bell's palsy, or von Recklingshausen's Disease. For example, homosexuality was a 'disease' until it became politically incorrect to regard it as a disease, and somehow it just magically ceased to be a scientific disease entity for psychiatry at that same moment.

[lemur]

Psychiatry is terribly bound up with cultural normativism, imo. The problem is that it is in fact true that cultural conflicts can result in stress, alienation, conflicts, and other factors that can eventually affect one's mental health. The problem with psychiatry is that it ignores it's own cultural biases and often ends up attempting to address 'deviance' instead of mental health itself. Ironically, it does neither too badly - it works pretty well to stimulate/induce cultural conformity AND it makes people feel better in doing so. Still, it would be better if it would attempt to overcome cultural bias and treat these two functions separately. If you WANT to learn to conform culturally better, you should be able to use psychiatry for that. But if you want more cultural independence/freedom but you still want to feel mentally healthy, it should work for that too, imo.

[Marat]

Kurt Vonnegut, speaking of his son's mental illness, once said, "If my son had been born in Germany at the beginning of the 20th century, perhaps he would have been classified as mentally ill because of his inability to adjust normally to Nazi culture," or words to that effect.

[Ringer]

I don't see why so many people seem to think that deviance of cultural norms is the only criteria for psychological assessment. The assessment of deviance of behavior is not the end all be all, or even the start, of mental health diagnoses. Yes people that deviate from social norms may have a mental illness, but deviation does not mean that one must have a mental illness. Any intro psych class will tell you to tread carefully on the deviance portion, mainly because some level of deviance from norms is normal. The thought that psychologists say, "he doesn't fit in, he must be sick", is absolutely idiotic.

 

Kurt Vonnegut, speaking of his son's mental illness, once said, "If my son had been born in Germany at the beginning of the 20th century, perhaps he would have been classified as mentally ill because of his inability to adjust normally to Nazi culture," or words to that effect.

I wouldn't exactly consider a writer an expert on mental illness. His son had schizophrenia, it's not a fake disease. Ask anyone who has dealt with someone with such a disorder.

[PhDwannabe]

Hang on, have I missed something?

"bad thing happens to person, they get sad, we give them drugs."

bad thing happens to person, they get flu, we give them antibiotics (which don't affect the flu virus).

bad thing happens to person, they get arthritis, we give them anti inflamatories (etc which don't actually stop the disease).

bad thing happens to person, they get asthma, we give them drugs that reat the symptoms, but not the underlying cause.

What's the difference?

 

To be fair to the psychologists they are trying to deal with something that's a bit complicated.

 

Don't drag us into this. We're not (exception: New Mexico, Louisiana) the ones prescribing drugs. Reply: Huh? I don't get it, dude--what are you talking about?

 

OK, now that we've cleared that up, I'm going to hit a few things rapid-fire. I'm too lazy to throw in all of my damned references at the moment, which means I'm violating one of my more cardinal rules, but what the hell?

 

1. Henderman, for poop's sake, please, please, please, I'm begging you as much as one human being can beg another, please don't ground your opinions in what several people on YouTube seem to be saying.

 

2. The "drug companies are in bed with doctors" argument is as horribly tired as it is unnecessarily conspiratorial. There are more ways for systems and people to utterly suck and fail than to sit in a smoke-filled room full of all kinds of plotting and mustache-twisting. Look, a lot of psychotropic drugs suck. I tend to be pretty anti-calling-myself-pro-or-anti-things <giggle> but I'm very nearly "anti-drug." But I'm telling you, I also believe that this particular road to hell is paved with very good intentions.

 

3. Direct-to-consumer drug advertisements are indeed ridiculous. Their simplification of the etiology and treatment of mental illnesses is particularly egregious. Guess what? The serotonin hypothesis of depression rests on pretty thin empirical foundations. You wouldn't know it watching the ads. You can thank a Republican congress for all of it.

 

4. Biopsych studies tell you less about the etiology of mental illnesses than you think they do. So serotonin levels are low in depressed people. So what? Gasoline levels in the compression chambers are low when a car isn't moving very fast. That's cause the guy driving isn't pushing the pedal very hard. Biomarker does not suggest biological cause any more than behavioral marker suggests nonbiological cause. Nor do biomarkers suggest biological treatment. We're dealing with complex chains--no, webs, really--of causality, with factors moving in and out of fields that are amenable to an individual's conscious will, and fields that are amenable to biological/pharmacological manipulation. When I hear someone saying "[insert noun/verb here] causes [insert mental illness here]," I do all I can to stop myself from spitting out my drink. You may as well tell me that human beings have an average of one testicle.

 

5. Modern psych drugs don't perform terribly well. Part of this has to do with the fact that they have to compete against placebos, and placebos do really really well on their own. They're also less and less specific to disorder--if people knew the wide range of things docs try these meds for, both on-label and off--the drugs themselves would sound and seem a hell of a lot less impressive. Psychopharmacology is fairly significantly a game of trial and error. (Not that there's anything fundamentally wrong with that. A lot of physical medicine is too. That's, like, empiricism, right?) Of course, since people are wildly different, some of these drugs do work for some people. To dismiss every single one of them completely is an unwarranted injustice.

 

6. Mental illnesses are plenty real--a little more real than a unicorn, a little less real than a duck. They're generally not definable with single pathophysiological causes, but we're (I'm in psychology, not psychiatry, and I can't answer for Them) not a bunch of idiots out to pathologize anybody who looks different, either. I've known plenty of weird people; few of them are ill. Considerations of deviance, distress, and danger are all important in defining what a mental illness is. Some of these conditions are a little more taxonomic. Some, a little more continuous. People don't "have" depression like they "have" tuberculosis. We're talking about clusters of symptoms which hang together. In my experience, most psychologists tend to get this, and most psychiatrists tend not to. What do you expect? We're scientists. They're practitioners. Yeah. I said it.

 

7. Caveat on the last one: it's a shame, but there's a lot of stuff mixed up in the big book that does some amount of injustice to the differences between disorders. Remember how I said these diagnoses are realer than unicorns, less real than ducks? Well, take schizophrenia, for instance. That one's probably more or less a duck. (Not that there hasn't been a hell of a lot of historical difficulty in diagnosing it with high sensitivity and specificity. Not that it hasn't been cruelly used and manipulated by governments and other authorities for various nefarious ends.)

 

8. Psychiatrists and "mental health advocates" of the last two decades seem especially interested in screaming "IT'S A DISEASE!" It, of course, being depression, bipolar disorder, social anxiety, and so on. OK, fine, you've got a name for it. But what are you saying? Are you just trying to convince me that it's real? Well, my coffee table isn't a disease, and it's plenty real. Are you saying it's not my fault? Are you saying I can't do anything about it but battle it with pills? I could start eating cheesesteaks and doughnuts at every meal, and have diabetes fairly quickly. Diabetes is a disease. I could do behavioral things to make my influenza better or worse, or more or less likely to lead to poorer outcomes. Influenza is a disease. This shout of "DISEASE!" gets us nowhere.

 

9. Empirically supported psychological treatments for major mood disorders are pretty damn good. Most of the time, they show higher efficacy when compared to pharmacotherapy, lower long-term cost, longer maintenance of treatment gains, and lower drop-out rates (understandably, since psychotherapy doesn't typically pack weight on you, kill your erections, or make you sweat at night.) For the most common emotional nasties you and the loved ones are most likely to run into? Don't worry, babies. We got this.

 

10. As a (ahem, in a couple of years) psychologist, I don't really care about the Truth. I care about efficacy. I care about predictive validity. I want to classify people well enough to deliver to them the right sorts of treatments to improve their daily functioning and subjective well-being. Whether my classificatory scheme represents the real, beautiful, immanent Truth of the universe is borderline-pointless. Fun to argue about, of relatively minimal use to my patients. It'd be nice to improve upon it, but a few holes in it doesn't strangle what I'm able to do. Whether the theories behind my treatments are even correct is not even the issue of primal importance. Results are. And we have pretty good ones. Which has the greater effect size on its primary outcome variables: heart bypass surgery or exposure therapy for panic disorder? Since by now you already know my biases, I'll let you guess the answer.

[Gallstones]

Hi, new here, first post; I promise nothing erudite in it.

 

I have enough experience with mental health professionals to render an anecdotal opinion; that opinion is that they were, at best disappointing, and at worst marginally injurious. The conclusion I have come to as a result of my own experiences, is to have no confidence in them.

 

I'm not saying that most of them, as persons, weren't empathetic--they were--but what they had to offer amounted to nothing more than temporary and partial amelioration of symptoms and bullshit sessions that did not address any of my issues or give me any method or technique for dealing with those issues. The only useful thing I received from psychiatry was a diagnosis.