People have been wondering on this site lately if there is still a role for psychiatrists. The short answer is maybe, if they can learn from us survivors. Currently, their best role would be to help people come off medication. Since they are allowed to prescribe medications and psychologists are not, we do still need a few around until this is changed. When and if psychologist are allowed to prescribe, psychiatrists will need to redefine their profession – these are my suggestions for how they can do this.
Principle # 1: Full disclosure: My thought is that psychiatric medications are best compared to painkillers: sometimes people need a short term temporary relief from their emotional distress. But the relief should come with full knowledge that the medication does not fix the problem, may worsen the problem, and should most likely be used short term. This complete disclosure might solve some of the problem, but maybe not, since opiod painkillers are theoretically prescribed with all of this information but still are one of the leading sources of prescription deaths.
Principle #2: Fully activated service recipients: Many enlightened doctors have told me, “I tell my patients all of those things and they still say, ‘I don’t care, just fix me, doc.'” Here is Wilma Townsend from SAMHSA’s Wellness Initiative saying this tackling this passivity is very important. And several of my friends have talked about when they were viewed as passive patients like that but came out of that role.
This might even include doctors selecting patients who are ready to work on recovery instead of maintaining an illness role for the rest of their lives. This is the opposite of what is currently done, where doctors say, “Do what I tell you or I won’t treat you.” The message might be, “Question everything, including me. That’s how you recover.” Check out the National Empowerment Center’s archived article by Judi Chamberlin, “Confessions of a noncompliant patient.”
Here are a few other possible roles for truly medication optimization informed psychiatrists:
- If they learned how to help us honestly use medications as a tool and with an evidence base (short term only with full informed disclosure), they could be a valuable partner in handling emotional distress.
- People who are on many meds and need to taper slowly need help getting smaller and smaller doses prescribed. Currently, most of the famous medication critics are on speaking tour and don’t have time for patients. Doctors who learn this information and know how to find patients who want it will have a busy practice ahead of them.
- Doctors who have learned basic biochemistry can use this to analyze the true literature sources just as we have done and start publishing their thoughts and conclusions. It doesn’t take much funding to put together a report of 10 or so case studies. There’s really not much more than this in the medication withdrawal academic literature currently and we desperately use doctors to pitch in here. Or anyone else.
- Doctors would be the best people to start UnDiagnosing Emotional Distress. People look up to the authority of doctors. The doctors I have heard talking about UnDiagnosing people have done a lot of good.
- It only takes 12 doctors to make a “board.” We could make a “Board Certified Medication Optimization” credential.
- Doctors can start advertising by how little medications they prescribe.
- Doctors can monitor their recovery outcomes and start advertising with those results. If the Open Dialogue program can get 82% recovery rates just by switching people from a disease model to a life situation model, than doctors who do this in their practice can start adding up some impressive numbers. It would only take 5 or so case studies of 20 or so patients with 80% recovery rates for someone to sit up and take notice. Especially if the survivor community was behind this doctor with some social media efforts.
- Psychiatrists could actually collaborate with psychologists again. In my whole career as a mental patient, this only happened once.
- Psychiatrists could hire peer specialists instead of nurses or physician assistants and give people their initial 3 consults with a peer. I bet this could cut their patient load in half because an educated peer could tell people they didn’t really need to see the doctor.
So, if we can figure out a way to ask psychiatrists for help in a way that doesn’t demonize them, we’d be a lot more likely to get some help. But, doctors need to listen to us, too.