![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by Janet from Brazil on February 16, 2000, at 10:02:57
I don't think we have psychopharmocologists here. What is the difference? Are they both doctors but with different specialisations or are the former pharmocology majors? Do they have different approaches to treatment? Do psychopharmologists do therapy, Thanks Jan
Posted by Cass on February 16, 2000, at 15:27:18
In reply to Psychopharmocologists v Psychiatrists. , posted by Janet from Brazil on February 16, 2000, at 10:02:57
> I don't think we have psychopharmocologists here. What is the difference? Are they both doctors but with different specialisations or are the former pharmocology majors? Do they have different approaches to treatment? Do psychopharmologists do therapy, Thanks Jan
Janet, I'm glad you asked because I have been wondering the same thing.
Posted by Noa on February 16, 2000, at 17:48:36
In reply to Re: Psychopharmocologists v Psychiatrists. , posted by Cass on February 16, 2000, at 15:27:18
I may be wrong, but, here is my understanding:
Psychopharmocology is a subspecialty of psychiatry.
A psychiatrist might do both therapy and psychopharm, but it seems that more and more, those who specialize in psychopharm seem to be doing only that, as the demand is high, and there don't seem to be enough psychopharmocologists with available hours, and more and more people are being referred for psychopharm but not for therapy.
Posted by bob on February 16, 2000, at 22:36:49
In reply to Re: Psychopharmocologists v Psychiatrists. , posted by Noa on February 16, 2000, at 17:48:36
I think Noa hit the nail on the head -- it seems to me to be an emerging specialty within psychiatry. Consider all the new meds, the new *categories* of meds, the various cocktails that can be thrown together with these. Throw in the reams and reams of knowledge coming from the leaps and bounds of advances in our neuro/bio/chemical knowledge of brain function (the 90's were, apparently, the "Decade of the Brain" in medical research and advances). Then, for a little spice, toss in the web and all the patients who are becoming more informed and more active in the decisions being made about their care.
If my psychiatrist wants to leave most of the talk to my psychologist and me so he can keep up with the psychopharmaceutical literature, he's got my blessing and thanks.
bob
Posted by saint james on February 16, 2000, at 23:51:54
In reply to Re: Psychopharmocologists v Psychiatrists. , posted by Noa on February 16, 2000, at 17:48:36
> I may be wrong, but, here is my understanding:
>
> Psychopharmocology is a subspecialty of psychiatry.
>
> A psychiatrist might do both therapy and psychopharmJames here....
Psychiatrists receive little training in therapy and I would never pay 1 dollar to do therapy with one unless they could prove they were trained in this. To all my Pdoc's credit all have been upfront about this.... "feel free to talk or call me about any problem you are having, I am here to help, but I am a medical doc and will need to refer you to a talk person if you need on going help of a non medical nature" Nor are Pdoc well trained in neurology, which makes no sence as
this is the system they are treating. To me a psychopharmocoligist is someone well trained in neurology and the meds used to treat mental illness and a psyshatrist is a generalist. However there is no board certification for Psychopharmocologists, just as a psychiatrist, so any Psychiatrist can call themself a Psychopharmocologist.To me a Psychopharmocologist someone who has experience in treating hard to treat cases. AS there is no standard for who uses what term so it really means little in true qualifications.
james
Posted by Noa on February 17, 2000, at 0:46:58
In reply to Re: Psychopharmocologists v Psychiatrists. , posted by saint james on February 16, 2000, at 23:51:54
> Psychiatrists receive little training in therapy
I think there are some psychiatrists who have done extensive training, in their residencies, in therapy. I would imagine this is less common these days, tho.
Maybe Dr. Bob, who TRAINS psychiatrists, can fill us in.
Posted by saint james on February 17, 2000, at 9:40:45
In reply to Re: Psychopharmocologists v Psychiatrists. , posted by Noa on February 17, 2000, at 0:46:58
> > Psychiatrists receive little training in therapy
>
> I think there are some psychiatrists who have done extensive training, in their residencies, in therapy. I would imagine this is less common these days, tho.
>James here...
I agree that some are trained in this. I would prefer to see someone who is soley trained in therapy. I don't think we should be asking a MD to wear 2 hats. The pill guy needs to know his pills and neurology. The talk guy needs to know his talk.
Posted by bob on February 17, 2000, at 16:05:24
In reply to Re: Psychopharmocologists v Psychiatrists. , posted by saint james on February 17, 2000, at 9:40:45
Could have something to do with geographic variations as well ... by which I mean that in Manhattan I'd bet that 75% or better of the psychiatrists with private practices have had some level of psychoanalytic training.
(Outside of Manhattan? Who cares! It's outside of Manhattan! =^P ;^)
Posted by Noa on February 17, 2000, at 18:20:38
In reply to Re: Psychopharmocologists v Psychiatrists. , posted by bob on February 17, 2000, at 16:05:24
I can see why there might be advantages for some patients to see the same doc for therapy and meds: people who need their care consolidated, for whatever reason; people who have difficulty trusting people, and are able to bond with one doctor; people who find the logistics of going for care to be overwhelming--all the communication, transportation, remembering appointments, etc.; or people who find it comforting to keep it simple--deal with one doc that they have confidence in.
Posted by Chris A. on February 17, 2000, at 18:52:56
In reply to Re: Psychopharmocologists v Psychiatrists. , posted by saint james on February 17, 2000, at 9:40:45
I personally like having one person doing my meds, therapy and now my ect. As long as they're competent and willing to send me for a consult when we're in a treatment quandry. It also has to be a good "match," as aspect that clinicians and patients alike too often minimize. I get weary of trying to explain myself to different people. When dealing with a chronic neurobiological illness I think it is a great advantage to have one doc who knows you well enough to know when and how best to intervene. Some of the best "talk" therapy I have ever had has been done by my psychopharmacologist. He is still modest and calls himself a psychiatrist. Personally I like one stop shopping, provided the fit is good.
Chris A.
Posted by saint james on February 18, 2000, at 12:54:52
In reply to Re: Psychopharmocologists v Psychiatrists. , posted by Chris A. on February 17, 2000, at 18:52:56
> I personally like having one person doing my meds, therapy and now my ect.
James here.....
Of course you do but the reality of the situation is that Pdocs are MD's, which means at least 10 years of MD training most of which is not specific to mental illness and a talk person usually has a MA, 6 years of school with alot concentrated in psychology and behavior.
I will agree that for problems to do not mean long term therapy a pdoc is fine but no Pdoc that I have ever seen in 15 yrs ca or will do the kind of in depth disection of personality and behavior like a psycholigist.
james
Posted by Elizabeth on February 18, 2000, at 21:28:09
In reply to Re: Psychopharmocologists v Psychiatrists. , posted by saint james on February 18, 2000, at 12:54:52
> I will agree that for problems to do not mean long term therapy a pdoc is fine but no Pdoc that I have ever seen in 15 yrs ca or will do the kind of in depth disection of personality and behavior like a psycholigist.
James, before 1985 or so, all the psychoanalysts in this country were MDs. In any case, I don't think taking classes is primarily what makes a person a good talk therapist; rather, it's supervised experience, which psychiatrists and clinical psychologists certainly get plenty of.
I don't think clinical psychologists have a good enough understanding of medication that they would necessarily be a good fit for someone who takes meds. IME, they tend to attribute mood and behavior changes to environmental factors (rather than to the medication or to the illness itself), even when it doesn't make much sense to do so.
Posted by Cam W. on February 18, 2000, at 22:49:41
In reply to Re: Psychopharmocologists v Psychiatrists. , posted by Elizabeth on February 18, 2000, at 21:28:09
> > I will agree that for problems to do not mean long term therapy a pdoc is fine but no Pdoc that I have ever seen in 15 yrs ca or will do the kind of in depth disection of personality and behavior like a psycholigist.
>
> James, before 1985 or so, all the psychoanalysts in this country were MDs. In any case, I don't think taking classes is primarily what makes a person a good talk therapist; rather, it's supervised experience, which psychiatrists and clinical psychologists certainly get plenty of.
>
> I don't think clinical psychologists have a good enough understanding of medication that they would necessarily be a good fit for someone who takes meds. IME, they tend to attribute mood and behavior changes to environmental factors (rather than to the medication or to the illness itself), even when it doesn't make much sense to do so.All - I don't understand this debate, Would not a psychopharmacologist be a pharmacologist with a postgraduate specialty in neurophysiology. A pharmacology undergraduate would train in the Faculty of Pharmacy & the Pharmaceutical Sciences and then go on to study the mechanisms of the brain and its relation to the effects of medicinal chemical substances. This person would not need to know how to diagnose (psychiatrist) or do psychotherapy (psychologist), but would need just a basic understanding of the principles of these diciplines. He/she wouldn't need to know these arts in depth. I believe a good psychopharmacologist would need more than just the basics of drug pharmacokinetics, pharmacodynamics, biochemistry, microbiology, medicinal chemistry, etc. to be able to do his job. These fields are more likely to intensively covered under the umbrella of Pharmacy than Medicine or Psychology. This is how I see it. It may be right, it may be wrong, but I'd put my money on a good pharmacist over a good psychiatrist or a good psychologist on the topic of pharmacotherapy, any day. To build the solidest house, you have to begin with the strongest foundation.....Rebuttals would be appreciated, please. - Cam W.
Posted by Janet from Brazil on February 19, 2000, at 0:10:59
In reply to Re: Pharmacy v Psychiatry Psychology , posted by Cam W. on February 18, 2000, at 22:49:41
> > > I will agree that for problems to do not mean long term therapy a pdoc is fine but no Pdoc that I have ever seen in 15 yrs ca or will do the kind of in depth disection of personality and behavior like a psycholigist.
> >
> > James, before 1985 or so, all the psychoanalysts in this country were MDs. In any case, I don't think taking classes is primarily what makes a person a good talk therapist; rather, it's supervised experience, which psychiatrists and clinical psychologists certainly get plenty of.
> >
> > I don't think clinical psychologists have a good enough understanding of medication that they would necessarily be a good fit for someone who takes meds. IME, they tend to attribute mood and behavior changes to environmental factors (rather than to the medication or to the illness itself), even when it doesn't make much sense to do so.
>
> All - I don't understand this debate, Would not a psychopharmacologist be a pharmacologist with a postgraduate specialty in neurophysiology. A pharmacology undergraduate would train in the Faculty of Pharmacy & the Pharmaceutical Sciences and then go on to study the mechanisms of the brain and its relation to the effects of medicinal chemical substances. This person would not need to know how to diagnose (psychiatrist) or do psychotherapy (psychologist), but would need just a basic understanding of the principles of these diciplines. He/she wouldn't need to know these arts in depth. I believe a good psychopharmacologist would need more than just the basics of drug pharmacokinetics, pharmacodynamics, biochemistry, microbiology, medicinal chemistry, etc. to be able to do his job. These fields are more likely to intensively covered under the umbrella of Pharmacy than Medicine or Psychology. This is how I see it. It may be right, it may be wrong, but I'd put my money on a good pharmacist over a good psychiatrist or a good psychologist on the topic of pharmacotherapy, any day. To build the solidest house, you have to begin with the strongest foundation.....Rebuttals would be appreciated, please. - Cam W.Is there a professional association of psychopharmologists that require specific qualifications from its members and if so what are they ? Or are the labels psychopharmocologist and psychiatrist virtually interchangeable? Thanks Jan P.S CamW congratulations on the success of your presentation. I love reading your posts they are so informative. Besides being a pharmacist have you had any personal experience of depression ? You also seem to be very compassionate. Jan
Posted by medlib on February 19, 2000, at 1:55:56
In reply to Re: Pharmacy v Psychiatry Psychology , posted by Cam W. on February 18, 2000, at 22:49:41
> > > I will agree that for problems to do not mean long term therapy a pdoc is fine but no Pdoc that I have ever seen in 15 yrs ca or will do the kind of in depth disection of personality and behavior like a psycholigist.
> >
> > James, before 1985 or so, all the psychoanalysts in this country were MDs. In any case, I don't think taking classes is primarily what makes a person a good talk therapist; rather, it's supervised experience, which psychiatrists and clinical psychologists certainly get plenty of.
> >
> > I don't think clinical psychologists have a good enough understanding of medication that they would necessarily be a good fit for someone who takes meds. IME, they tend to attribute mood and behavior changes to environmental factors (rather than to the medication or to the illness itself), even when it doesn't make much sense to do so.
>
> All - I don't understand this debate, Would not a psychopharmacologist be a pharmacologist with a postgraduate specialty in neurophysiology. A pharmacology undergraduate would train in the Faculty of Pharmacy & the Pharmaceutical Sciences and then go on to study the mechanisms of the brain and its relation to the effects of medicinal chemical substances. This person would not need to know how to diagnose (psychiatrist) or do psychotherapy (psychologist), but would need just a basic understanding of the principles of these diciplines. He/she wouldn't need to know these arts in depth. I believe a good psychopharmacologist would need more than just the basics of drug pharmacokinetics, pharmacodynamics, biochemistry, microbiology, medicinal chemistry, etc. to be able to do his job. These fields are more likely to intensively covered under the umbrella of Pharmacy than Medicine or Psychology. This is how I see it. It may be right, it may be wrong, but I'd put my money on a good pharmacist over a good psychiatrist or a good psychologist on the topic of pharmacotherapy, any day. To build the solidest house, you have to begin with the strongest foundation.....Rebuttals would be appreciated, please. - Cam W.Cam-
Are you a psychopharmacologist? Do you see patients in a clinical setting? Clearly, you have accurately defined the noun and delineated optimal training for the task, but I think you make an even better case for a TEAM approach to the clinical treatment of "mentally ill" patients.
(Notice that I didn't say "treatment of mental illness.")
Much has been written about how, as the volume of medical information grows exponentially, the slice of it one can be an "expert" on grows smaller and smaller--and how the resulting fragmentation of medical care practically requires patients to become their own treatment managers. This bulletin board is good evidence of that phenomenon, and you can "see" the frustration it engenders in nearly every post.
Sure, patients who have a serious clinical illness need a good psychopharmacologist, and your contributions on this board are highly valued (by me and everyone else, I'm positive)--but, most of us who depend on Rxs also need Dx and Tx! When is the outpatient psych clinical community going to get its act(s) together?
It's probably quite different in Canada, but, in the US, the specialist run-around is often a health-endangering, and sometimes life-threatening, process. Managed care will eventually kill it off, and that won't necessarily be an improvement.
Oh well, guess I'll climb down off my soapbox and go drug myself to sleep.
Side note--Historically, the original use of the Internet was for peer consultation. Thanks to Dr. Bob (THANKS!) the original purpose is alive and well, only the "peers" are now the patients.
medlib
Posted by Noa on February 19, 2000, at 9:46:34
In reply to Re: Still Confused, posted by Janet from Brazil on February 19, 2000, at 0:10:59
Janet, I think that is a great question to pose to the American Psychiatric Association. I don't think psychopharmocology is an organized discipline yet, but there might be a kind of interest section within the psychiatric association. I don't know. Anyway, they have a website (the link is in Dr. Bob's virtual enpsychlopedia). You can ask them. Or maybe Dr. Bob will pop in to help us out.
Cam, If I were to encounter a pharmacist who had a lot of experience working in the field of mental health, maybe I would consult him or her. But in my experience most pharmacists are behind store counters filling prescriptions. I did know a pharmacist in the past whose job was being a member of a multidisciplinary team that went around to nursing homes to consult, evaluate how paitents were doing, etc. That kind of clinical experience would give him an expertise in treating people, but most pharmacists don't have that.
The medical school training of my pdoc is important, but more important is his years as a psyciatrist in a psychitric hospital. I know he has seen thousands of patients with all variations of disorders, and he has tried all mannre of combinations of meds. Plus, he goes to update his knowledge at conferences, at NIMH, etc. As some here know, I have also had issues with him having to do with how his practice operates (chaotically) and how difficult it is to reach him. But I have stayed with him because I believe he is very knowledgable. I would not see him for therapy (he doesn't do therapy now, although I think he did at one time) because he doesn't have the greatest social skills and he isn't reliable enough about contact. But I have learned how to manage dealing with this, more or less. I did look into getting another consult but discovered a lot of psychiatrists aren't taking any insurance, which really sucks. I know there are others that do, but for now, this guy knows my story, knows how I react to different meds, and I trust his knowledge.
Posted by Noa on February 19, 2000, at 9:53:00
In reply to Re: Pharmacy v Psychiatry Psychology , posted by medlib on February 19, 2000, at 1:55:56
> > > I don't think clinical psychologists have a good enough understanding of medication that they would necessarily be a good fit for someone who takes meds. IME, they tend to attribute mood and behavior changes to environmental factors (rather than to the medication or to the illness itself), even when it doesn't make much sense to do so.
I think this is an over generalization (though we are all overgeneralizing, aren't we). Some psychologist, social workers, or counselors would NOT be a good fit, because they haven't worked with people who are on medications, or because they have strong anti-med views or tend to think only in the realm of psychology/environment. But there are a lot of psychologists, social workers, counselors who DO work wellwith patients who are on medication, who have had lots of such experience, and who have been trained to look at the total picture--biopsychosocial, even if they arent specifically trained in the medical aspects. For this, they would consult, maintain contact with the patient's pdoc.
Posted by Cam W. on February 19, 2000, at 10:05:40
In reply to Re: Pharmacy v Psychiatry Psychology , posted by medlib on February 19, 2000, at 1:55:56
> > > > I will agree that for problems to do not mean long term therapy a pdoc is fine but no Pdoc that I have ever seen in 15 yrs ca or will do the kind of in depth disection of personality and behavior like a psycholigist.
> > >
> > > James, before 1985 or so, all the psychoanalysts in this country were MDs. In any case, I don't think taking classes is primarily what makes a person a good talk therapist; rather, it's supervised experience, which psychiatrists and clinical psychologists certainly get plenty of.
> > >
> > > I don't think clinical psychologists have a good enough understanding of medication that they would necessarily be a good fit for someone who takes meds. IME, they tend to attribute mood and behavior changes to environmental factors (rather than to the medication or to the illness itself), even when it doesn't make much sense to do so.
> >
> > All - I don't understand this debate, Would not a psychopharmacologist be a pharmacologist with a postgraduate specialty in neurophysiology. A pharmacology undergraduate would train in the Faculty of Pharmacy & the Pharmaceutical Sciences and then go on to study the mechanisms of the brain and its relation to the effects of medicinal chemical substances. This person would not need to know how to diagnose (psychiatrist) or do psychotherapy (psychologist), but would need just a basic understanding of the principles of these diciplines. He/she wouldn't need to know these arts in depth. I believe a good psychopharmacologist would need more than just the basics of drug pharmacokinetics, pharmacodynamics, biochemistry, microbiology, medicinal chemistry, etc. to be able to do his job. These fields are more likely to intensively covered under the umbrella of Pharmacy than Medicine or Psychology. This is how I see it. It may be right, it may be wrong, but I'd put my money on a good pharmacist over a good psychiatrist or a good psychologist on the topic of pharmacotherapy, any day. To build the solidest house, you have to begin with the strongest foundation.....Rebuttals would be appreciated, please. - Cam W.
>
> Cam-
> Are you a psychopharmacologist? Do you see patients in a clinical setting? Clearly, you have accurately defined the noun and delineated optimal training for the task, but I think you make an even better case for a TEAM approach to the clinical treatment of "mentally ill" patients.
> (Notice that I didn't say "treatment of mental illness.")
> Much has been written about how, as the volume of medical information grows exponentially, the slice of it one can be an "expert" on grows smaller and smaller--and how the resulting fragmentation of medical care practically requires patients to become their own treatment managers. This bulletin board is good evidence of that phenomenon, and you can "see" the frustration it engenders in nearly every post.
> Sure, patients who have a serious clinical illness need a good psychopharmacologist, and your contributions on this board are highly valued (by me and everyone else, I'm positive)--but, most of us who depend on Rxs also need Dx and Tx! When is the outpatient psych clinical community going to get its act(s) together?
> It's probably quite different in Canada, but, in the US, the specialist run-around is often a health-endangering, and sometimes life-threatening, process. Managed care will eventually kill it off, and that won't necessarily be an improvement.
> Oh well, guess I'll climb down off my soapbox and go drug myself to sleep.
> Side note--Historically, the original use of the Internet was for peer consultation. Thanks to Dr. Bob (THANKS!) the original purpose is alive and well, only the "peers" are now the patients.
> medlibJanet - I don't know about any associations, but yes, I have had a couple of major depressive episodes since my son died at birth in 1993. My philosophy towards life is: "Are you kind", from the Grateful Dead song 'Uncle John's Band'. I know there is a hidden double meaning with reference to drug use, but I feel I should try to help people who are in the pain, I have felt myself have felt. I believe that through compassion, empathy, understanding and my specialized knowledge, I can help ease some people's pain and show them how to live with their afflictions, while staying within the realm of my expertise. I cannot counsel; I cannot diagnose; but I can try (when it is necessary to be taking medication) to make the dosing schedule as easy as possible, to minimize side effects and to maximize compliance. In this way, one can recieve the most from their medicatons. I believe that compliance can be further enhanced by relating how, to the best of my knowledge, the medications work to someone who is taking them. This allows that person to make an informed choice on his medication. Never take my advice on faith. Always get a second opinion and discuss these with your doctor. I am but a link in the machine. Sincerely - Cam W.
medlib - I work halftime for a Mental Health Clinic and half time in a community pharmacy, in a larger Canadian city. My boss contracts me out to the government MH clinic. I am their pharmacy consultant. What do I do? Sometimes I'm not even sure. I give presentations to anyone who will listen, on a wide range of psychiatric medications; I review drug profiles and make recommendations; I give on-the-spot advice to clients, therapists, nurses, doctors, and administrators. I do work closely with most of the nurses and psychiatrists to formulate care plans for our clients and help to tweak these care plans as needed. All this was made possible when one wonderful and brilliant COO (chief operating officer) of the Alberta Mental Health Board (Eleanor Grant) decided that her group needed a pharmacist to compliment her extremely competent staff. I believe she is always looking better ways to improve the lot of those afflicted with mental disorders. She is one incredible lady.
So, basically I work for a community drug store and use my knowledge of dealing with people and their medication (and other drug) use in the community to help those with mental disorders (along with the support and education they receive from the rest of the team) to live in society, to the best of their ability. Idealistic? - yes; Frustrating? - sometimes; Satisfying? - enormously. Sorry for babbling, but you asked. Sincerely - Cam W.
P.S. If I need to be labeled, call me a Neuropsychiatric Community Pharmacist (we came up with that having beers after a psych lecture).
Posted by Cam W. on February 19, 2000, at 11:13:17
In reply to Re: Still Confused, posted by Noa on February 19, 2000, at 9:46:34
> Janet, I think that is a great question to pose to the American Psychiatric Association. I don't think psychopharmocology is an organized discipline yet, but there might be a kind of interest section within the psychiatric association. I don't know. Anyway, they have a website (the link is in Dr. Bob's virtual enpsychlopedia). You can ask them. Or maybe Dr. Bob will pop in to help us out.
>
> Cam, If I were to encounter a pharmacist who had a lot of experience working in the field of mental health, maybe I would consult him or her. But in my experience most pharmacists are behind store counters filling prescriptions. I did know a pharmacist in the past whose job was being a member of a multidisciplinary team that went around to nursing homes to consult, evaluate how paitents were doing, etc. That kind of clinical experience would give him an expertise in treating people, but most pharmacists don't have that.
>
> The medical school training of my pdoc is important, but more important is his years as a psyciatrist in a psychitric hospital. I know he has seen thousands of patients with all variations of disorders, and he has tried all mannre of combinations of meds. Plus, he goes to update his knowledge at conferences, at NIMH, etc. As some here know, I have also had issues with him having to do with how his practice operates (chaotically) and how difficult it is to reach him. But I have stayed with him because I believe he is very knowledgable. I would not see him for therapy (he doesn't do therapy now, although I think he did at one time) because he doesn't have the greatest social skills and he isn't reliable enough about contact. But I have learned how to manage dealing with this, more or less. I did look into getting another consult but discovered a lot of psychiatrists aren't taking any insurance, which really sucks. I know there are others that do, but for now, this guy knows my story, knows how I react to different meds, and I trust his knowledge.Noa - Sorry, maybe I read the above too fast, again. What I assumed was that a neuropharmacologist (who should not be involved in diagnosis or therapy) should be only one of a multi-disciplinary team to treat a person. The psychiatrist should be the hub, drawing on all the other disciplines in making his final descisions. I didn't mean to replace the psychiatric with a neuropharmacologist. That's just plain insane. Sincerely - Cam W.
Posted by Eric on February 19, 2000, at 11:40:18
In reply to Re: Pharmacy v Psychiatry Psychology , posted by Cam W. on February 18, 2000, at 22:49:41
The answer to all of this is to formally dissolve psychiatry as a seperate branch of medicine and to give psychiatry back to neurology. Then what needs to be done is "psychiatric illnesses" need to be looked upon by the medical community as nothing but another neurological disorder like Parkinson's disease...diseases of the brain and the nervous system.
Then let the neurologists...or the neuropsychiatrists...do tons of scientific research into "mental illness" but from a neurological perspective. Break the brain and nervous system down into pure, hard science and come up with scientific conclusions. From this, newer, more aggressive ways to diagnose and treat mental illness could be developed. When Freud was alive, the science was not good enough to do that. But nowadays the science we have is good enough to study mental illness in a purely hard science or neurological perspective.
This is the answer to all of modern day psychiatry's problems and public relations/image problems. It wouldnt take long before word got out that they had finally started looking at mental illness in a scientific fashion rather than from a Freudian, old style, psychological mumbo jumbo perspective. Once word got out that this was happening, treatment of the mentally ill would have a lot more credibility and would move out of the dark ages into the 21st century.
Simply put, we need more scientific research of mental illness. This can only occur if the people doing the research have a very strong background in neurology. If depression really is a disease of the brain and nervous system, does it not make the most sense to give psychiatry back to neurology and make it formal?
After all, they are always saying "depression is a real illness or disease and it can be treated medically." Well, if that is really true why do psychiatrists have very little neurology background? Seems like a neurologist or neurpsychiatrist would be most suited for treating the more serious, severe forms of mental illness such as really severe clinical depression. After all, these problems are MEDICAL problems rather than "emotional problems."
Posted by Cam W. on February 19, 2000, at 11:59:22
In reply to Psychiatry needs to be given back to neurology, posted by Eric on February 19, 2000, at 11:40:18
> The answer to all of this is to formally dissolve psychiatry as a seperate branch of medicine and to give psychiatry back to neurology. Then what needs to be done is "psychiatric illnesses" need to be looked upon by the medical community as nothing but another neurological disorder like Parkinson's disease...diseases of the brain and the nervous system.
>
> Then let the neurologists...or the neuropsychiatrists...do tons of scientific research into "mental illness" but from a neurological perspective. Break the brain and nervous system down into pure, hard science and come up with scientific conclusions. From this, newer, more aggressive ways to diagnose and treat mental illness could be developed. When Freud was alive, the science was not good enough to do that. But nowadays the science we have is good enough to study mental illness in a purely hard science or neurological perspective.
>
> This is the answer to all of modern day psychiatry's problems and public relations/image problems. It wouldnt take long before word got out that they had finally started looking at mental illness in a scientific fashion rather than from a Freudian, old style, psychological mumbo jumbo perspective. Once word got out that this was happening, treatment of the mentally ill would have a lot more credibility and would move out of the dark ages into the 21st century.
>
> Simply put, we need more scientific research of mental illness. This can only occur if the people doing the research have a very strong background in neurology. If depression really is a disease of the brain and nervous system, does it not make the most sense to give psychiatry back to neurology and make it formal?
>
> After all, they are always saying "depression is a real illness or disease and it can be treated medically." Well, if that is really true why do psychiatrists have very little neurology background? Seems like a neurologist or neurpsychiatrist would be most suited for treating the more serious, severe forms of mental illness such as really severe clinical depression. After all, these problems are MEDICAL problems rather than "emotional problems."Eric - In the past, psychiatry has treated many disorders thought to be "diseases of the mind". For example, the dementia and psychosis seen in tertiary syphyllis before the discovery of antibiotics was treat by psychiatrist. Similarily, until we understood how vital vitamins were to the body, disorders from the lack of vitamins (eg beri-beri) or overdose of vitamins (eg vitamin A toxicosis - caused neurological symptoms when more than 2g of polar bear liver were eaten) were treated within the realm of psychiatry. Just wait your turn, and psychiatry will throw you guys a bone, as well (your time shall come). We will always need psychiatrists to diagnose disorders that will not fit into the cubby-holes our other disciplines make for them. Yes, neurology is often left out of discussion on treatment teams, but they should not be. The web of teams is larger than even we can comprehend, at times. Sincerely - Cam W.
Posted by judy on February 19, 2000, at 17:08:03
In reply to Psychiatry needs to be given back to neurology, posted by Eric on February 19, 2000, at 11:40:18
Eric,
Do I ever agree with you on this point! I was fortunate to recently get a consultation with a neurologist who is also a board certified psychiatrist. This is the first time in many years that I have felt completely understood (dxed with bipolar and panic disorders). I feel like I've struck gold. Hopefully the specialties will come together in the near future. Take care.
Posted by Eric on February 19, 2000, at 18:33:01
In reply to Eric- psychiatry and neurology, posted by judy on February 19, 2000, at 17:08:03
> Eric,
> Do I ever agree with you on this point! I was fortunate to recently get a consultation with a neurologist who is also a board certified psychiatrist. This is the first time in many years that I have felt completely understood (dxed with bipolar and panic disorders). I feel like I've struck gold. Hopefully the specialties will come together in the near future. Take care.Yes indeed, I have heard from several individuals that the best MDs they ever saw were one of the few who are "neuropsychiatrists." A term generally reserved for those who are board certified in both psychiatry and neurology. I too hope that psychiatry will head in this direction in the future.
If mental illnesses are truly diseases of the brain...then it makes the most sense for an MD with a background in neurology to treat it.
Eric
Posted by Gail on February 20, 2000, at 0:41:05
In reply to Re: Pharmacy v Psychiatry - Janet and medlib , posted by Cam W. on February 19, 2000, at 10:05:40
Funny, before I even finished reading your post on 2/18 (out loud to my husband) he said you must be a Pharmacist, & sure enough you are. He is a Pharmacist, (& Bipolar). I have read his Continuing Education for years now, though I found this site equally as helpful (if not more so) in coping with my Major Depression. I have been to Psychiatrists, Psychologists, (till I had nothing to talk about) & a Psychopharmacologist who said it's all just "trial & error," though, perhaps they can get a little more "creative" with the meds if need be. They don't have any other medications that a family Doctor has, so for me, I just go to my family doctor for my Wellbutrin, & just started seeing an endocrinologist for my Hypothyroidism, (always went to my family Doctor before). So far so good...I like to say Thank-you to Saint James for explaining the Psychiatrists/Psychologists education, I've always wondered about it, but never would ask. ~ Gail ~
Posted by bob on February 20, 2000, at 1:45:36
In reply to Re: Eric- psychiatry and neurology, posted by Eric on February 19, 2000, at 18:33:01
> > Do I ever agree with you on this point! I was fortunate to recently get a consultation with a neurologist who is also a board certified psychiatrist. This is the first time in many years that I have felt completely understood (dxed with bipolar and panic disorders).
But Judy, do you know what bipolar disorder is? I don't have a DSM-IV next to me, but the DSM-IIIR I just borrowed says nothing about the neurology of that disorder. And if you've read anything by Kay Jamison, considered to be one of the foremost experts on this disorder (as well as someone who has it), she refuses to call it bipolar disorder -- she believes the manic aspect of it and the depressive aspect of it are separate dimensions, where "bipolar" clearly implies they are two opposite ends of one spectrum. But this information on defining the disorder doesn't come from the results of precise neurological measurements -- it comes from clinical observation. So, was it the psychiatric training or the neurological training that primarily informed the decision-making process of your pdoc?
> If mental illnesses are truly diseases of the brain...
Sorry, Eric (geez ... I'm finding myself apologizing to you a lot in the last half hour ;^) but I STRENUOUSLY object to having what is wrong with me labelled as an illness or a disease. I don't have a cold, and I don't have an infection. My immune system is not going to produce some antigen that will cure me; similarly, I have seen no evidence to suggest that any chemical compound will cure me either, in the sense that I will take it for some course of time and, when I'm out of pills and refills, what's wrong with me will be gone.
Furthermore, there is no conclusive evidence to demonstrate that my disorder is purely neurological. There certainly is evidence that it has a genetic component that has produced "faulty wiring" in my head. That does not rule out that the "firmware" or "software" up there that I gained through my experiences is not a significant (even predominant) component of my disorder. Medical science is having a rough enough time right now chemically correcting those wiring faults that may result in mismanagement by my brain of certain neurotransmitters -- I don't even want to think about someone trying to rewrite my software through the application of chemicals, electric pulses, or magnetic fields.
It gets back to what Cam has said several times -- it takes an interdisciplinary team to come to a well-rounded understanding of mental disorders. To ignore or dismiss the perspective of an expert in the fit between an individual and her environment (physical and social) means blinding oneself to entire dimensions of the whole problem.
There may come a day, perhaps sometime soon, when a neurologist can run some tests, takes some pictures, and tell me just how my brain is malfunctioning. She may even be able to prescribe a chemical that will make up for my brain's deficiencies. But will the alleviation of symptoms as a result of ingesting that chemical produce a spontaneous remission in habituated self-destructive behaviors I've picked up as a result of that malfunction? Will it also cause the spontaneous emergence of more "healthy" or "adaptive" behaviors which I've never seemed to be able to pull off prior to being given this cure?
Call me a cynic, but I have my doubts.
cheers
bob
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