![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 4 to 28 of 95. Go back in thread:
Posted by Christ_empowered on January 1, 2015, at 11:08:24
In reply to Re: psychiatry is an ougrowth of society, posted by linkadge on January 1, 2015, at 10:10:19
I think I have a bit of a chip on my shoulder. My treatment providers right now are compassionate and professional. I get easy breezy low key counseling...nothing too intense. 3 daily meds, only see the doc every 3 months or so. Disability....makes my life and my parents' lives easier.Its just...it wasn't always this way. When I was poor and my people were "rinky dink middle class" (other peoples' words, not mine), I was punished mightily for my very existence. Labels upon lables upon labels. Confidentiality violations. Publicly ridiculed by an ex-shrink. At one point, I filed a medical board complaint...
...so, yeah. I guess I should say the psychiatry that many *poor* people get is punitive and harsh, and always has been. What's frighening in that the all bio, all the time model that was en vogue for a while there (in the US) is exactly what poor people have always received. Now I've read that the tide is turning and there's more skepticism about drugs, especially complicated cocktails, and there's more openness to talk and reflection and looking at psychosocial issues.OK. At the same time...
...docs have used pills to punish me. Pills to shut me up. This was when I was younger. Wasn't the best person ever back then, mind you, but...
...punitive. sadistic. harsh. That's been my experience of psychiatry until fairly recently.
Posted by alexandra_k on January 1, 2015, at 17:47:12
In reply to Re: psychiatry is an ougrowth of society, posted by Christ_empowered on January 1, 2015, at 11:08:24
I have a lot of bad memories with psychiatry services, too. Most of those are 10+ years ago. 15 years ago. Sometimes I think that times have moved on and things have improved. I mean... Things are (mostly) better than the average Janet Frame novel... They closed a lot of the country institutions...
On the other hand my recent... Uh... Excursion with community mental health... My first ever court appearance... Leads me to believe that things haven't overly improved all that much.
Perhaps it is more that the more time you spend with something... The more you get to see it's... Uh... Perverted side. Those memories stick a lot more... Get really stuck in there... Resonate for a while...
I was talking to my community health nurse... Who really is terrific for me... And she was saying about how the hardest thing is how you don't have control over your case load. You might be required to have 40 clients on your case load. Where you know you could do a good job with 30 but you simply don't have the option of having only 40...
And I said that I appreciated that the worst of the 'care' I got was due to clinician's being overwhelmed / not having time for me / resource constraints. Why I was not admittted when I needed to be. Why I was discharged early. Why I didn't get the help I needed. Why the 'help' that was offered was never enough. Why people didn't want to work with me. Why people needed to stop working with me.
She said it's a long road... I guess the idea being... It's a long road to consultant. Maybe at the other end of it... Eventually, eventually, you get to decide things more on a case by case basis. Have control over your workload.
The reason my care is so good now... A huge whopping great big part of the reason my care is so good now... Is that she works 3 days a week. My GP works 3 days a week. They have the size case loads they feel comfortable with and when I am with them... I feel cared for. I feel heard. Even when I do the big ranting thing I do... They don't feel the need to interject their judgement. And there are moments where... I can soften. And be real. Which is, uh, kinda hard for me. Takes a bit of a process (who am I kidding, a lot of a process) to get to that.
The more money you have the more money you can spend. The more money clinicians make the more power / control they have over the size of their workload / over only accepting cases where they feel they can help.
I think that is a significant part of the situation...
Posted by baseball55 on January 1, 2015, at 20:36:57
In reply to Re: psychiatry is an ougrowth of society, posted by Christ_empowered on January 1, 2015, at 11:08:24
> ...so, yeah. I guess I should say the psychiatry that many *poor* people get is punitive and harsh, and always has been. What's frighening in that the all bio, all the time model that was en vogue for a while there (in the US) is exactly what poor people have always received. Now I've read that the tide is turning and there's more skepticism about drugs, especially complicated cocktails, and there's more openness to talk and reflection and looking at psychosocial issues.
>
If poor people get different mental health care than more affluent people, I suspect the reasons are:
(1) they lack health insurance and can only get the most minimal treatment
(2) very few therapists take medicaid
(3) they are less educated and articulate and therefore less able to connect with highly educated mental health clinicians
(4) they are more likely to be black or hispanic and less able to connect with mostly white clinicians
(5) they are from cultures where people just don't get mental health treatment, especially therapy
(6) Most poor people I know (mostly my husband's extended family and friends, very poor rural area) with mental illnesses can't afford or can't find psychiatrists or therapists and go to primary care doctors who just put them on meds.This explains why poor people don't get therapy as much (possibly). As far as "punitive and harsh"....what does this mean? What evidence do you have of this? Can you give an example, besides your own unfortunate experience?
The bottom line seems to be, CE, that you personally had a bad experience with the mental health system. On that basis, you make these broad generalizations about mental health care in general.
Posted by alexandra_k on January 1, 2015, at 21:50:23
In reply to Re: psychiatry is an ougrowth of society » Christ_empowered, posted by baseball55 on January 1, 2015, at 20:36:57
i found community mental health people much more likely to be judgemental and victim blaming... because they were burned out. their case-loads were too high. etc.
Posted by herpills on January 2, 2015, at 10:06:28
In reply to Re: psychiatry is an ougrowth of society, posted by alexandra_k on January 1, 2015, at 17:47:12
Good post, I'd like to comment on a couple things-
>
> And I said that I appreciated that the worst of the 'care' I got was due to clinician's being overwhelmed / not having time for me / resource constraints. Why I was not admittted when I needed to be. Why I was discharged early. Why I didn't get the help I needed. Why the 'help' that was offered was never enough. Why people didn't want to work with me. Why people needed to stop working with me.
>
>I think a big part of the problem, at least from my experience and perspective, especially in community mental health, is that clinicians spend so much time "assessing" instead of simply listening to the patient and what their particular needs are, and then providing that service to the patient.
>
> The more money you have the more money you can spend. The more money clinicians make the more power / control they have over the size of their workload / over only accepting cases where they feel they can help.
>This is one reason why I'm tired of hearing people complain about "Obamacare" or "socialized medicine". The fact is, no matter what healthcare system we have in place...the more money you have, the more options you will have, which means the better chance of receiving quality care.
Posted by herpills on January 2, 2015, at 10:10:42
In reply to Re: psychiatry is an ougrowth of society » Christ_empowered, posted by baseball55 on January 1, 2015, at 20:36:57
>
> The bottom line seems to be, CE, that you personally had a bad experience with the mental health system. On that basis, you make these broad generalizations about mental health care in general.You do the same thing! Why do you always get so defensive of the mental healthcare system when somebody else has a bad experience? We get it, you've had amazing doctors your whole life, and the rest of us are just doing something wrong.
Posted by Christ_empowered on January 2, 2015, at 13:10:48
In reply to Re: psychiatry is an ougrowth of society » baseball55, posted by herpills on January 2, 2015, at 10:10:42
I'm not the only one who's had terrible experiences w/ mental health. The anti-psychiatry movement of the 70s didn't die, it just kind of went into a deep slumber...
...books such as "Mad in America" and "Anatomy of an Epidemic" and "The Myth of The Chemical Cure" are bringing back a new, more nuanced sort of anti-psychiatry/critical psychiatry movement. Docs in Vermont have come up with the crazy idea that maybe people w/ schizophrenia need to talk about their problems nad take less neuroleptic. Imagine that...
Anyway, some people love their docs. These people are usually at least respectable and white. I'm treated better now in part because I"m white, male, and my people are relatively affluent, at least for this area.I can't cite studies, but there is data that would indicate that social class, race, gender, etc. influence diagnosis and treatment. Diagnosis, in particular, is a political decision. Non-white "crazy" people = schizophrenia. White, affluent "crazy" people=bipolar I. See what I'm saying here?
Public health is a lot like private practice, just...officially based on the recovery model. Lots of people on disability of some sort, probably more SSI than SSDI. Lots of high dose AP/AAP drugs. Are the patients more severely ill? I don't know. They do deal with people in jails and group homes, but...what of the outpatients?
Social class is a huge issue wherever you go, probably more in the US than in many European countries where, you know, poor people have rights and such.
In my case, I was poor, ugly, and stupid. I'm none of those things now, except poor, but I don't live in poverty because of my newly affluent parents. That makes people--including mental health people--angry.
Szasz wrote this book I have yet to read..."Psychiatric Slavery" . I like the concept, and I think he's right. Havnig been left dead eyed for a couple years by psychiatric torture (at a private, for profit mental hospital), I DO NOT think that shrinks are all helpful, happy people.
Lots of mental health people sexually exploit their patients. There are cases of straight up rape, usually male psychiatrists and female patients. In my case, my docs "made an example" out of me. My neighbors now know a little too much about my psych history. Wonder why...
...could it be because I filed a medical board complaint? See what I'm saying? "Trouble makers" ALWAYS get the worst "treatment," and there doesn't seem to be any escape.
Posted by alexandra_k on January 2, 2015, at 13:58:37
In reply to Re: psychiatry is an ougrowth of society, posted by Christ_empowered on January 2, 2015, at 13:10:48
> I'm not the only one who's had terrible experiences w/ mental health. The anti-psychiatry movement of the 70s didn't die, it just kind of went into a deep slumber...
It is still here. People like Tom Cruise started giving it a bad name... But it is very much alive and kicking in the form of the 'consumer movement'.
As the definition of mental disorder / the subject matter of psychiatry has broadened so as to include 1 in 4... Stigma has lessened, too. It hasn't gone away. Some diagnoses are more culturally acceptable than others. But it means that there are some professionals who identify with being mentally ill (openly or otherwise) and that has an effect on the literature, too. The tonality of the writing. The things that are said publicly and at after drinks during conferences. Parents write books about their children. Children grow up and write books about their experiences.
> Anyway, some people love their docs. These people are usually at least respectable and white. I'm treated better now in part because I"m white, male, and my people are relatively affluent, at least for this area.What sort of docs do the medical schools intentionally select for (do you suppose)?
Posted by alexandra_k on January 2, 2015, at 14:18:27
In reply to Re: psychiatry is an ougrowth of society » alexandra_k, posted by herpills on January 2, 2015, at 10:06:28
> I think a big part of the problem, at least from my experience and perspective, especially in community mental health, is that clinicians spend so much time "assessing" instead of simply listening to the patient and what their particular needs are, and then providing that service to the patient.
I think that part of the focus on assessing is giving junior docs practice assessing / something to do.
I think that the other part of the focus on assessing is that it is necessary for access to the $$$. Insurance companies and community mental health have strict rules on what treatments they will and will not fund and all of this is determined by the diagnosis that the patient has. Hence... Attempts to (fairly creatively, sometimes) recast the patients troubles in... More lucrative directions. If you are lucky enough to get a clinician who feels like going in to bat for you, anyway. They do have to be careful of being too creative or their managers / the insurance companies will start giving them grief.
If the insurance companies / the government management people aren't running the show then... If you are paying your doctor then... Your doctor has freedom to WORK FOR YOU. If the insurance companies or the government is funding the treatment then, well, lets not kid ourselves as to who is running the show. Remember Madmen how the guy phones the psychiatrist to talk about how treatment is progressing with his wife? The psychiatrist tell him... Makes recommendations to him... Lets not forget who is paying for what. Who people are working for.
> This is one reason why I'm tired of hearing people complain about "Obamacare" or "socialized medicine". The fact is, no matter what healthcare system we have in place...the more money you have, the more options you will have, which means the better chance of receiving quality care.
Yes. I think the idea of socialised medicine... Is an idea best applied to things like... If you get hit by a bus and you need emergency trauma surgery. The idea that you get that emergency care without being left with crippling debt. Or if you have a heart attack and you need a bypass. You get that without crippling debt, too. Not the idea that everyone who wants intensive psychotherapy for anxiety gets to have that intensive psychotherapy. Mostly because... We simply can't afford it. But then people get all upset about how 'mental illness is real - too!' and so on... But there isn't enough money...
Only... I really don't see how there isn't a bunch more money then we think there is. I mean... How much money did it cost for this or that government department to change their name and change the letterhead on all their stationary? How much money did it cost for them to research, come up with, implement a policy that moving people from the main waiting room to smaller rooms out back (thereby reducing waiting room times by half)? How much money does it cost them to have government workers sitting on $80,000? Flying business class on short notice in tiny (practically charter planes) between towns that are only, like, 4 hour drive... How much money do managers make (what bonus do they get) when they cook up some hare brained scheme to enable politicians to intentionally mislead the public about 'improvements' to 'intermediate performance measures' (meaningless ones like 'access to healthcare when a bunch of people don't trust it for obvious reasons, don't want a bar of it, and CHOOSE not to use it because of that)...
The problem is:
It is so easy to criticise. So very much harder to come up with helpful, practical changes.
So very much harder to get those practical changes to happen. People... There is some kind of attitude... Some kind of... Victim blaming of those who suffer the most. For sure. Like this idea of 'equal opportunity' which works out great so long as the impoverished classes were offered a bunch of things that weren't helpful... So then when they fail (as they were set up to) everyone alike gets to uniformly believe (but not say aloud) that they must be stupid... It certainly gets people stopping with proclaiming that a certain class is being intentionally kept down / that opportunities are being barred from them... We say we want impoverished classes to be healthy... But secretly... I think a bunch of people get a kick out of feeling 'better than' that you got people (who clearly aren't malnourished) suffering obesity and diabetes and so on... Helps people feel that the status quo (heredity, wealth inner circle) is in fact justified after all.
Posted by alexandra_k on January 2, 2015, at 14:45:14
In reply to Re: psychiatry is an ougrowth of society, posted by alexandra_k on January 2, 2015, at 14:18:27
I have to do an economics of healthcare paper first semester. I have trouble with economics. Not because of the math. Or, maybe because of the math. I haven't done enough economics to know...
Mostly I have trouble with economics on conceptual grounds. That very first thing they do of taking something meaningful and important like 'happiness' or 'quality of life' and they recast it into something they can measure. thereby... changing the subject.
It reminds me of Moore... Who was a philosopher. He was looking at the notion of 'good'. At how you can't identify (reduce) what is 'good' to anything else. If you identify the 'good' with 'what makes people happy' then you can always ask of whatever it is that makes people happy - 'I know that makes people happy - but is it GOOD?'
It reminds me of psychology... How they take a notion like 'consciousness' (where at least part of what is crucial is the subjective aspect of it) and then they do a bait and switch. They say they have solved the problem of consciousness (or that they are making significant progress on it) and proceed to talk about brain states or something else equally objective.
We start with something like the 'quality of our healthcare system' and somehow or other we end up with something like the idea that if we change the diagnostic criterion on this dx then we can reduce the number of people who are entitled to y treatment by half thereby cutting down the number of people who are waiting for treatment. Or if we change up the regional boundaries on the coverage area of a particular health board we can say we have reduced the number of people with y condition by a third, perhaps eliminating an epidemic... Or whatever.
Dishonest. That is what it is. Nobody in their right mind can possibly think that such moves improve the quality of our healthcare system. Along the way... The point was lost. People got hyper-focused on 'interim measures'...
Like how some people get hyper-focused on 'interim measures' like studying for 'pick the middle' and 'identify the next object in sequence' thinking that this will actually improve their intelligence...
The person has fallen out... and along the way... the point was lost.
But the idea seems to be... That what one person needs / wants... Is unsustainable at the population level. It simply isn't possible for all the people in the world to have the health care that they actually deserve / need.
That might be true... But I think it is also true that we could do a hell of a lot better than we are doing presently with what we have got. I simply don't understand why there needs to be... How many more managers than actual healthcare workers? I simply don't understand why managers need to be on how much money compared to actual healthcare workers?
It makes me angry how much people get paid to push paper around... Doing... I honestly don't think they care much what they are doing much of the time... So long as the status quo is preserved and they can afford the best health care (in virtue of how much money they earn). All is well in the world (fundamentally) - right?
i think that part of the problem is that the privaledge of some is crucially tied to the impoverishment of others. our old prime minister Helen Clarke said something about how our (fairly socialist) aim isn't that everybody have exactly the same... It is more that there are realistic prospects for moving up. The problem with that (since wealth / poverty is relative) is that the only way one has realistic prospects for moving up is if others have realistic prospects for moving down... Why would the haves (those with power) want that? They are more focused on preserving their power than they are focused on the good of society...
If you want a healthy population then you need to start with the children. Providing free healthy food at school. Lots of it. So it isn't appealing for them to fill up on junk food even if they have opportunity. And physical education. Not just rugby for all... But different options... Not just caring about the ones who seem talented... But everyone...
But of course we don't want a healthy population. We need for most people to believe that the reason they don't have more is because... They don't deserve it. They make bad choices in life etc etc etc.
It is nearly impossible to eat healthy food (enough of it) on the current domestic purposes rates.
This is why the government workers don't provide people who are on welfare with food plans / suggested grocery lists that work within their budgets.
The budget advice is about their stopping with smoking and drinking and making 'unhealthy food choices' like chips and doughnuts. But I think people are driven to those things... In part...
Anyway... I think I might have been the only person to have stood there and said 'well, you do me a budget that works then'. To have said 'here's my grocery list receipt what would you have done different'.
It isn't good enough.
Posted by alexandra_k on January 2, 2015, at 15:33:19
In reply to Re: psychiatry is an ougrowth of society, posted by alexandra_k on January 2, 2015, at 14:45:14
and of course bad philosophy is just awful, too. i'm sure there is some good work out there in economics...
the health system here...
You can pay a bunch of money to make an appointment with whichever GP has an appointment slot available.
Or... You can enroll with a particular clinic as your Primary Health Organization and then if you make an appointment there it is significantly cheaper.
Because the government contributes a certain amount of funding to clinics on the basis of the demographics of the people they have enrolled there.
The clinics get bonuses for things like having high need demographic people enrolled there. Bonuses for the number of Maaori and Pacific Island people enrolled there. Elderly people. Low income. Etc.
The clinics get bonuses for other things. Targets that the government sets. The government might have an objective like 'we want to increase the number of Maaori and Pacific Island kids who are immunised against the following diseases...' Then the clinic gets a bonus for the number of immunisations they give to the target kids. Lots of stuff like that. Cervical smears. Prostate exams. Etc.
When I went to the student clinic here they started out by making me fill out a form that involved them asking me about all kinds of things like that. So they knew which of their current targets they should target me for. Because it meant more money for them.
I then had to meet with a nurse. Since the government contributes a certain amount toward all PHO enrolled GP visits the government will save a significant amount of money if it can persuade me to prefer to see a nurse rather than a doctor wherever possible. So... That first meeting... The clinic made me meet with a nurse so as to build rapport etc etc etc to coax me nurse-wards in future. The clinic got a bonus for that. A bunch of research is starting to come out now on how people prefer to see nurses, they relate to them better etc etc etc. To help justify shunting people to nurses wherever possible. It isn't because the government said so / because it is cheaper for the government. It is because that is what patients prefer!
Just like what happened for me at community mental health where the nurse simply would not let me see a doctor...
_____
Lets suppose that I want the health care that is best for me. I don't want a GP pressuring me to get this or that mammogram or injection or whatever because it is in the PUBLIC's interests (according to some way of doing the math).
Lets suppose that I want my health care to be about ME instead of THE MAJORITY. The best thing I can do is to NOT enroll with a PHO. That way... The doctor is working for ME and not for the government.
Of course this doesn't have to be all or none. GP's are allowed to ask patients to contribute whatever they like over and above the amount the government contributes (unless the want a special bonus for agreeing not to go over and above a cap to help promote low income patients who they will also get a bonus for). So... You can contribute more towards your visit for less government interference. You can contribute more towards your visit for less homeless people in the waiting room, prettier secretaries, a little bit of art... more plants.
But but really what it is about is: A doctor who listens to YOU. Rather than the government.
That is what those assessment forms are about... The government / the health insurance company. It isn't about YOU it is about the healthcare industry. Which is about health about as much as the personal training industry is about training...
But the surest way to have the doctor work for me, rather than the government, is to ensure that the doctor doesn't get any bonuses for anything that does or doesn't happen with me. That way they are looking out for ME rather than the government / populations.
Then all I have to worry about is...
Pharma.
ahaha.
Posted by alexandra_k on January 2, 2015, at 16:02:51
In reply to Re: psychiatry is an ougrowth of society, posted by alexandra_k on January 2, 2015, at 15:33:19
It is a bit hard, though. The conflict between persons and populations.
Seems to me that my being immunised is something bad that happens to me and I'd really rather not have it happen. I mean, the site is a bit owie and it might get infected and so on... It isn't in my interests for me to be immunised... But seems to me that y'll being immunised is something good that happens for me insofar as it makes it significantly less likely that I'll catch a nasty disease from y'all.
So... Uh...
Poor people should be immunised in the interests of public health...
Whereas rich people should be allowed to free-ride / take advantage of the benefits of public health policies while bearing none of the costs of immunisation by being allowed to opt out?
That doesn't seem fair...
I guess... The socialist idea was... This idea of there being some minimum standard of living / quality of healthcare that all people are entitled to solely in virtue of being people. Or citizens... And / or visitors from Australia. Or something...
It didn't say anything about rich people not being allowed to have better care (for them, anyway).
____
I keep coming back to Plato... The tripartite theory of the human soul... The tripartite theory of government.
The way we did it in law... There was the government, the judiciary, the puplic / populace (who democratically elects the government).
This idea of balance of power...
Of each part pursuing it's own (narrowly conceived) self(defining)-interest... Of the checks and balances coming from one part critiquing other parts...
Doctors are supposed to work for patients interests.
Public health people / managers are supposed to work for populations.
Without the public health / manager balance the cost of health care would be exhorbatent, the health system inefficient, the public interest would be worse off...
Politicians... Are about placating the masses?For someone who says so much... I don't know what to say...
Posted by baseball55 on January 2, 2015, at 20:29:37
In reply to Re: psychiatry is an ougrowth of society » baseball55, posted by herpills on January 2, 2015, at 10:10:42
> You do the same thing! Why do you always get so defensive of the mental healthcare system when somebody else has a bad experience? We get it, you've had amazing doctors your whole life, and the rest of us are just doing something wrong.
>Yes. I have had good experiences. So have most of the people I know. I don't go around writing posts all the time talking about how psychiatry is perfect and never makes mistakes and treats all wonderfully. I only say that I was treated wonderfully. I deeply resent the generalizations from one negative experience into -
all poor people
all people whose parents are not powerful
all psychiatrists victimize people
all mental health practicioners are harsh and punitiveI resent it because I happen to know a number of practicioners for whom none of this is true.
If you or CE want to present some studies or data or evidence besides personal anecdotes for these broad denunciations of the mental health field, I am happy to read them.
Posted by baseball55 on January 2, 2015, at 20:38:57
In reply to Re: psychiatry is an ougrowth of society, posted by alexandra_k on January 2, 2015, at 14:45:14
There are all those aspects of economics. It depends a lot on who your teacher is.
Generally health care economics would (I expect - this is how I teach it) focus a lot on institutional issues, like who pays, where the spending goes, stuff like that.
But it would surely differ a lot from country to country, since all have different institutional set-ups.
You talk a lot about your experience with public mental health services, which barely exist in the US. There are community mental health clinics in some, but not most, cities and towns. There used to be state-run psychiatric hospitals and they still exist, but have mostly been closed (for example, my state, which used to have dozens, now has only two, one for the "criminally insane").
Health systems and mental health systems vary so much from country to country.I would expect that a class in health care economics would look in detail at these differences. When I teach it, I do a lot of cross-country comparison.
Posted by SLS on January 3, 2015, at 6:17:28
In reply to Re: psychiatry is an ougrowth of society, posted by Christ_empowered on January 2, 2015, at 13:10:48
My opinion:
The books you mention are little more than the seizing of opportunity by charlatans to make money. Although there is accuracy in some of the facts they present, they are artfully crafted into horror stories and are a source of disinformation. Mistakes have been made historically in psychiatry - just like in many other fields of medicine. I think it is a matter of intent. What is the intent of psychiatry in today's world? Individual healthcare professionals each have their goals which are often in conflict with both the field of psychiatry and the welfare of the patient. I have come across incompetency. I have come across ignorance and arrogance. However, this is far from being a systemic problem. I cannot comment on the older state hospitals, though. I have never been to one, but I understand they are horrible. One of the real problems I see is the dearth of psychiatrists in rural areas.
By the way, treating people with schizophrenia with psychotherapy and titrating their medication to the lowest effective dosage during ongoing psychotherapy is not a novel idea.
Sexual crimes perpetrated by predators upon the vulnerable is not limited to the field of psychiatry, nor even medicine in general. Do you have an opinion as to what is the rate at which this occurs in psychiatry, and how it compares to clergy?
* Out of curiosity, what are the changes that you are about to make in your life based upon what you have read in these books?
- Scott
-----------------------------------------------
> I'm not the only one who's had terrible experiences w/ mental health. The anti-psychiatry movement of the 70s didn't die, it just kind of went into a deep slumber...
>
> ...books such as "Mad in America" and "Anatomy of an Epidemic" and "The Myth of The Chemical Cure" are bringing back a new, more nuanced sort of anti-psychiatry/critical psychiatry movement. Docs in Vermont have come up with the crazy idea that maybe people w/ schizophrenia need to talk about their problems nad take less neuroleptic. Imagine that...
>
>
> Anyway, some people love their docs. These people are usually at least respectable and white. I'm treated better now in part because I"m white, male, and my people are relatively affluent, at least for this area.
>
> I can't cite studies, but there is data that would indicate that social class, race, gender, etc. influence diagnosis and treatment. Diagnosis, in particular, is a political decision. Non-white "crazy" people = schizophrenia. White, affluent "crazy" people=bipolar I. See what I'm saying here?
>
> Public health is a lot like private practice, just...officially based on the recovery model. Lots of people on disability of some sort, probably more SSI than SSDI. Lots of high dose AP/AAP drugs. Are the patients more severely ill? I don't know. They do deal with people in jails and group homes, but...what of the outpatients?
>
> Social class is a huge issue wherever you go, probably more in the US than in many European countries where, you know, poor people have rights and such.
>
> In my case, I was poor, ugly, and stupid. I'm none of those things now, except poor, but I don't live in poverty because of my newly affluent parents. That makes people--including mental health people--angry.
>
> Szasz wrote this book I have yet to read..."Psychiatric Slavery" . I like the concept, and I think he's right. Havnig been left dead eyed for a couple years by psychiatric torture (at a private, for profit mental hospital), I DO NOT think that shrinks are all helpful, happy people.
>
> Lots of mental health people sexually exploit their patients. There are cases of straight up rape, usually male psychiatrists and female patients. In my case, my docs "made an example" out of me. My neighbors now know a little too much about my psych history. Wonder why...
>
> ...could it be because I filed a medical board complaint? See what I'm saying? "Trouble makers" ALWAYS get the worst "treatment," and there doesn't seem to be any escape.
Posted by herpills on January 3, 2015, at 18:55:30
In reply to Re: psychiatry is an ougrowth of society » herpills, posted by baseball55 on January 2, 2015, at 20:29:37
> >
>
> Yes. I have had good experiences. So have most of the people I know. I don't go around writing posts all the time talking about how psychiatry is perfect and never makes mistakes and treats all wonderfully. I only say that I was treated wonderfully. I deeply resent the generalizations from one negative experience into -
> all poor people
> all people whose parents are not powerful
> all psychiatrists victimize people
> all mental health practicioners are harsh and punitive
>
> I resent it because I happen to know a number of practicioners for whom none of this is true.
>
> If you or CE want to present some studies or data or evidence besides personal anecdotes for these broad denunciations of the mental health field, I am happy to read them.
>He listed 3 books in his last post, you could start there. I think it would be good for you to read something that offers a different perspective than what you have experienced in mental healthcare.
Posted by herpills on January 3, 2015, at 19:04:55
In reply to Re: psychiatry is an ougrowth of society » Christ_empowered, posted by SLS on January 3, 2015, at 6:17:28
> My opinion:
>
> The books you mention are little more than the seizing of opportunity by charlatans to make money. Although there is accuracy in some of the facts they present, they are artfully crafted into horror stories and are a source of disinformation. Mistakes have been made historically in psychiatry - just like in many other fields of medicine. I think it is a matter of intent. What is the intent of psychiatry in today's world? Individual healthcare professionals each have their goals which are often in conflict with both the field of psychiatry and the welfare of the patient. I have come across incompetency. I have come across ignorance and arrogance. However, this is far from being a systemic problem. I cannot comment on the older state hospitals, though. I have never been to one, but I understand they are horrible. One of the real problems I see is the dearth of psychiatrists in rural areas.
>
Scott, how do you know that the authors of those books don't have the same good intentions that you think psychiatry has?I agree with most of what you are saying here...but I really, really doubt that those books were written just so the authors could make some money. I'm sure they also feel like they are doing something good for the welfare of people...that their intention is for good, just like psychiatry.
Posted by baseball55 on January 3, 2015, at 19:16:22
In reply to Re: psychiatry is an ougrowth of society » baseball55, posted by herpills on January 3, 2015, at 18:55:30
I am familiar with these books. They are not serious studies. They are polemics. Show me an actual empirical study, not just anecdote.
My own experiences and those of others I know are just anecdote. I don't claim that everyone has had my experience.
That's the issue. Generalizing from anecdote.
> He listed 3 books in his last post, you could start there. I think it would be good for you to read something that offers a different perspective than what you have experienced in mental healthcare.
>
>
Posted by SLS on January 3, 2015, at 23:40:18
In reply to Re: psychiatry is an ougrowth of society » SLS, posted by herpills on January 3, 2015, at 19:04:55
> > My opinion:
> >
> > The books you mention are little more than the seizing of opportunity by charlatans to make money. Although there is accuracy in some of the facts they present, they are artfully crafted into horror stories and are a source of disinformation. Mistakes have been made historically in psychiatry - just like in many other fields of medicine. I think it is a matter of intent. What is the intent of psychiatry in today's world? Individual healthcare professionals each have their goals which are often in conflict with both the field of psychiatry and the welfare of the patient. I have come across incompetency. I have come across ignorance and arrogance. However, this is far from being a systemic problem. I cannot comment on the older state hospitals, though. I have never been to one, but I understand they are horrible. One of the real problems I see is the dearth of psychiatrists in rural areas.> Scott, how do you know that the authors of those books don't have the same good intentions that you think psychiatry has?
I don't know for sure. It is just an opinion based upon my readings of the things they write. I find the works of some of the more vocal authors to contain too much drama, rhetoric, and hyperbole, and not enough objective scientific thought. I wonder if any of these folks have had the good fortune to be severely mentally ill and achieve remission by refusing to be treated with psychotropic medication. I don't know. It is late, and there is too much crap here to be addressed. So, I will concede that these authors are sincere in their desire to help people.
Here are a few people whose works offer criticisms of psychiatry:
Peter Breggin
Robert Whitaker
David Healy
John McManamy
Irving KirschIt is good that there are people who are brave enough to challenge the current consensus. There are some people who have challenged the challenges. It is informative to read these criticisms of criticisms:
- Scott
Posted by Angela2 on January 4, 2015, at 0:19:23
In reply to Re: psychiatry is an ougrowth of society, posted by baseball55 on January 3, 2015, at 19:16:22
CE, I'm with you. I've seen the bad in psychiatry and mental health, I've also seen the good, so it's a mixed bag with me. I don't need to see any study or report from you, even if I didn't agree with you. Your feelings and opinions are yours and they matter.
Baseball, you come off as like you're attacking here and knit picking. So CE made a generalization. So what?
Posted by Christ_empowered on January 4, 2015, at 0:43:27
In reply to Re: psychiatry is an ougrowth of society )) Agreed, posted by Angela2 on January 4, 2015, at 0:19:23
I get the sense that the more stigmatized you are going into a mental health place, the more dreadful your experience will be. They're like the rest of society, just more conservative and sometimes straight up oppressive.
Posted by Angela2 on January 4, 2015, at 1:03:43
In reply to Re: psychiatry is an ougrowth of society )) Agreed, posted by Christ_empowered on January 4, 2015, at 0:43:27
When you say "the more stigmatized you are" do you mean, like, the condition that's stigmatized the worst vs the least stigmatized? Or something different?
For a long time, I thought something was wrong with me, and I felt the stigma of my own mental illness. I still do....but its lessened because of a few things: 1.) I had a therapist who helped me feel normal again. She treated me like a normal person and not some kind of rat in a mental health zoo behind a cage to be studied. 2.) There's this book called "There Is Nothing Wrong With you" by Cheri Huber. It's a really good book. To be honest, I haven't read the whole thing, but in a way, just knowing there's a book with that title...makes me feel better. So, I guess what I'm trying to say is, yes, I know there's stigma, but sometimes I think it's a state of mind. Like, if you like yourself, regardless of what your diagnosis is....I think, THAT person's gotta be doing ok. :) I am kind of inspired to post my own thread about my own journey with mental health system and illness, perhaps I will later.
Posted by alexandra_k on January 4, 2015, at 15:00:39
In reply to Re: psychiatry is an ougrowth of society » alexandra_k, posted by baseball55 on January 2, 2015, at 20:38:57
The thing that surprised me the most about my visit to the US was... Just how similar to home my psychiatric care was...
While health insurance was a condition of entry on my visa (for Emergency / the cost of shipping me back home mostly) they said that they considered me a resident of the state since I was currently residing in it (not on a holiday). So I got... Psychotherapy (to talk to) a student doc and the state paid for that. Just like home ahahaha.
The main difference seems to be that we have GP's (that we pay co-payment for) and that they gatekeep access to specialists. (And increasingly, nurses gatekeep access to GPs - mental health nurses gatekeep emergency access to psychiatry). So... We need GP to refer us for specialist services. If you don't have health insurance you have to take what you are given but the service is free. Health insurance can help with your GP co-payment and give you (limited) options on specialists including which one you go to and whether you get treatment in private hospitals. But services are very limited there so usually you basically just in effect get yourself bumped up the public hospital waiting lists because your specialist probably works there some of the time anyway).
One thing that surprises me... Is the diversity of services within a country. I know that people move to the US state that I was in precisely because of access to education / health care. That things seem very different for people in different states. I think the teaching hospital thing makes a big difference (health care becomes much more accessible because students have to practice and they are just learning so not charging so very much of a fee). Then being a graduate student... I would expect that I would have got the better-end of free healthcare on offer there because the doctors would have more readily identified with me rather than many of the other cases walking through the door...
:(
In NZ we have different 'District Health Boards' that seem to result in there being significant differences in the care received in different parts of the country...
I've only more recently learned that my experience of healthcare is fairly different from most people living in NZ. The region I grew up... Has the distinction of having the largest hospital in Australasia with the largest service coverage area... Most other places have lots of smaller hospitals... Most of the smaller hospitals / clinics don't have student docs. This one had... 2 general community psychiatric wards (around 24 people per ward) 1 higher care ward... 1 seclusion cell ward... a couple lower care / more transitional to community / longer term wards... a forensic ward or two... Was a bit of an outcry when they shut down the haunted institution out in the country and brought the psychiatric units (including forensic) into the hospital in the city... But there it is. So very much easier to discharge people by simply booting them out the door... to transition people by extending their day-leave... or night leave since we don't have enough beds...
Anyway... Big hospitals. That's what I think / that's what I'm used to. But apparently this isn't 'normal' for most people in the country around here... So...
Seems that we do some cross-country comparison. Mostly... As a bit of a platform to teach us why we have gone the way we have. I've looked at the readings a bit and... Well... It is a first year paper (rather than being a graduate level paper) and it is supposed to be a load-lightener for the pre-med's... The moral of the course seems to be something-something about trade-offs. These much abused notions of 'accessibility' and so on... Second semester we do a course on equity of healthcare... Have to write about an inequality but not allowed to be SES. AW. has to be to do with age or gender. Yawn. maybe i'll write about the abuses of trans-gender individuals in the name of 'healthcare'... Or about infant circumscision and the gender hypocracies there are around that... THink the state pays for boys and prosecutes for girls ahaha.
Specialist care is free. That's a big deal. If you get hit by a bus you will wake-up pre-theatre, post-theatre and your operations will get done. And you won't rack up any kind of surgical / hospital bill at all.
But then... I guess... I suppose... What really happens... Is that the triaging / managing / prioritising / deciding goes on behind the scenes. With respect to what they do do / what they don't do etc. They saved my foot... Some other doc may well have decided not to... I don't know... I think mostly he was trying to teach his students a thing or two since when they did their ward rounds some gasped in horror and one actually proclaimed 'it's f*ck*d!'
And 'non-urgent' things like hip replacements... Waiting lists are long. In large part because they only want to be doing one of them and the expected life expectancy of a hip replacement is xxx years so they want to wait until you are of the age such that you won't be requiring another one. Ugh, ugh, UGH.
Posted by alexandra_k on January 4, 2015, at 15:06:10
In reply to Re: psychiatry is an ougrowth of society, posted by alexandra_k on January 4, 2015, at 15:00:39
> The thing that surprised me the most about my visit to the US was... Just how similar to home my psychiatric care was...
Hmm... I guess that's the thing. For all the differences 'in theory' and perhaps differences in billing structures or whatever whatever whatever...
When it comes to where the rubber hits the road...
For all the talk about whether one system is better or worse or much the same...
For all my travels... My care has been... Much the same.
It has come down to particular individuals whom I clicked with. Who decided to go into bat for me. To... Treat me. To... Prioritise me, I guess. Hardest thing... Is coming to the attention of these people. Getting to meet the good ones (the ones I click with). Them being at the right place in their career, or whatever, to be able to give me more than they are able to give to others. I guess.
I've been a 'graduate student' or an 'honours student' for so long. OF COURSE it has significantly impacted on my healthcare. I was at tech for a while... Was simply unemployed for a while... The way people treated me (even though I had not changed at all). Shocking. And that... Is what a whole bunch of people experience nearly or even all of their lives...
I guess this has been something that doctors have wondered... For all the money we spend on health reforms. On research looking into such things... Etc etc etc... All the paperwork aside... What changes? What has changed? Business... As usual.
Posted by alexandra_k on February 13, 2015, at 16:04:41
In reply to Re: psychiatry is an ougrowth of society, posted by alexandra_k on January 4, 2015, at 15:06:10
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