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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 16 to 40 of 95. Go back in thread:
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
Dr-Bob?
Where are you?
Posted by alexandra_k on February 13, 2015, at 16:05:10
In reply to Helloooooooooooooooooooooooooooooooooooooooooooo, posted by alexandra_k on February 13, 2015, at 16:04:41
Dr-Bob?
Where are you?
Posted by alexandra_k on February 13, 2015, at 16:05:25
In reply to Re: Helloooooooooooooooooooooooooooooooooooooooooooo, posted by alexandra_k on February 13, 2015, at 16:05:10
Dr-Bob?
Where are you?
Posted by alexandra_k on February 13, 2015, at 16:05:40
In reply to Re: Helloooooooooooooooooooooooooooooooooooooooooooo, posted by alexandra_k on February 13, 2015, at 16:05:25
Dr-Bob?
Where are you?
Posted by alexandra_k on February 13, 2015, at 16:05:55
In reply to Re: Helloooooooooooooooooooooooooooooooooooooooooooo, posted by alexandra_k on February 13, 2015, at 16:05:40
Dr-Bob?
Where are you?
Posted by alexandra_k on February 13, 2015, at 16:06:10
In reply to Re: Helloooooooooooooooooooooooooooooooooooooooooooo, posted by alexandra_k on February 13, 2015, at 16:05:55
Dr-Bob?
Where are you?
Posted by alexandra_k on February 13, 2015, at 16:06:26
In reply to Re: Helloooooooooooooooooooooooooooooooooooooooooooo, posted by alexandra_k on February 13, 2015, at 16:06:10
Dr-Bob?
Where are you?
Posted by alexandra_k on February 13, 2015, at 16:06:39
In reply to Re: Helloooooooooooooooooooooooooooooooooooooooooooo, posted by alexandra_k on February 13, 2015, at 16:06:26
Dr-Bob?
Where are you?
Posted by alexandra_k on February 13, 2015, at 16:06:53
In reply to Re: Helloooooooooooooooooooooooooooooooooooooooooooo, posted by alexandra_k on February 13, 2015, at 16:06:39
Dr-Bob?
Where are you?
Posted by alexandra_k on February 13, 2015, at 16:07:07
In reply to Re: Helloooooooooooooooooooooooooooooooooooooooooooo, posted by alexandra_k on February 13, 2015, at 16:06:53
Dr-Bob?
Where are you?
Posted by alexandra_k on February 13, 2015, at 16:07:20
In reply to Re: Helloooooooooooooooooooooooooooooooooooooooooooo, posted by alexandra_k on February 13, 2015, at 16:07:07
Dr-Bob?
Where are you?
Posted by alexandra_k on February 13, 2015, at 16:07:34
In reply to Re: Helloooooooooooooooooooooooooooooooooooooooooooo, posted by alexandra_k on February 13, 2015, at 16:07:20
Dr-Bob?
Where are you?
Posted by alexandra_k on February 13, 2015, at 16:07:48
In reply to Re: Helloooooooooooooooooooooooooooooooooooooooooooo, posted by alexandra_k on February 13, 2015, at 16:07:34
Dr-Bob?
Where are you?
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