Is Psychiatry “Salvageable”?

Alice Keys, MD
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A reader in the commentary here asked me if I think “psychiatry is salvageable.” This is a timely question that requires careful consideration.

First, I’ll examine this question with regard to my personal life. Then, I’ll explore this question from the broader perspective of psychiatry as a profession. Finally, I’ll move beyond the topic of psychiatry.

I doubt that the practice of psychiatry is “salvageable” for me. The practice of psychiatry, within the medical systems of today, no longer holds the original appeal it had for me.

When I first opened my private practice in 1989, I enjoyed therapeutic relationships with my patients. I had fun exploring creative approaches to improve each individual’s life. Few medicines were available.  Patients paid me. Third party payment schemes were between the patient and his insurance company.

All of medicine has been transformed by two intertwining corporate maneuvers: the takeover of the practice of medicine by medical service provider corporations and unrestricted drug marketing campaigns. By these two powerful forces, the practice of psychiatry (and all of medicine) has been transformed.

Over the past twenty-five years, my role as a psychiatrist has been changed by the impact of these conjoined twins. I was one half of a doctor-patient relationship then. I’ve been re-formatted into an interchangeable cog inside medical service provider corporations. My function is limited to pushing the stream of pills from manufacturers to consumers.

The heart of the therapeutic relationship was ripped out of modern psychiatry. It was replaced by “preferred provider panels” and pre-authorization clerks on 800 numbers. Drug marketing campaigns caused an explosion of demand for pills.

The practice of psychiatry is now a factory job with nothing but prescriptions to offer strangers.

To say that this is dispiriting work for me would be an understatement.

If I still had my old federal student loan enforcement friends chomping at my heels, I would feel more compelled to hunker back down with my prescription pad. But I’ve spent my entire adult life sawing myself free. Those of you that still carry two-home-mortgages-worth of student debt with you into every life decision know what I mean: debt shackles.

There’s still an ocean of suffering to relieve. Allowed only my prescription pad and a time clock, I’m inadequate to the task. I drown when I try.

That’s me.

Now for a bigger picture.

When I was asked if I thought psychiatry was “salvageable”, the question caught my attention. I had to think more about this question than just my own small self, embedded in medical systems.

I had one of those “a-ha” moments.

Psychiatrists are not the only providers trapped in the dance of prescribing psychiatric drugs. More and more psychiatric prescribing isn’t done by psychiatrists.

Along with the ramped-up demand for pills caused by direct public and direct physician advertising, there has been a decades-long marketing campaign to promote the idea of a “psychiatrist shortage”.

I’ve been hearing about this “psychiatrist shortage” as part of the “doctor shortage” story since the early 1980′s when I finished medical school. After residency there was stiff competition for paying patients, hourly contract jobs and salaried employment. Just like today. I saw no evidence of a shortage.

This “psychiatrist shortage” was the rationale given for licensing nurses to be “prescribers” in Oregon. I was told they would work in under-served areas and that they would take the “easy” patients so that overworked psychiatrists would have time to manage the more difficult cases.

A commenter in an earlier blog said that they use physician’s assistants and nurse practitioners where he works for “prescribing” because they cost half as much as psychiatrists. “Prescribing” is what psychiatrists do there. These other “prescribers” are cheaper. Choosing a cheaper “prescriber” cog is a simple financial decision for a corporation.

Most “prescribing” in Portland mental health clinics is done by nurse practitioners and physician’s assistants, not by psychiatrists. Is this different anywhere else?

There has also been a methodical shifting of mental health “prescribing” out of the mental health clinics to primary care doctors and pediatricians. This movement is pushed by shifts in government funding. These patients no longer have access to non-pill mental health treatments.

Both social workers and psychologists have lobbied for “prescribing privileges” in Oregon. Both lost round one. Social workers and psychologists might charge less than nurses to write prescriptions. If it’s “cheaper” to have non-medical “prescribers”, money will do the talking.

Psychologists in two states and in the active duty military can now prescribe psychiatric drugs. It could be an interesting piece of research to discover how much of the funding for these initiatives came from drug companies.

Psychiatrists are completely disposable today.  In their diminished role as “prescribers”, psychiatrists are interchangeable pill pushers. Every psychiatrist could vanish tonight and there would be no change in the workings of the machine. The other “prescriber” cogs with their prescription pads would keep the pill-laden conveyor belt moving from pharmaceutical factories and down the waiting American throats of all ages.

Pharmaceutical profits would continue. Prescriptions would be written and refilled. Plus, there are social workers and psychologists clamoring for “prescribing privileges”, ready to help.

Psychiatry as a profession is finished.

What has happened to psychiatry is one small piece of what is happening throughout the field of medicine. The practice of medicine is one step behind psychiatry on the conveyor belt to the scrap heap.

Most physicians are now employees of medical corporations; either direct hires or members of provider panels. They are being downgraded into “prescribers” as well. They have had the heart of the doctor-patient relationship ripped out. They obey rigid formularies made up by the medical corporation bosses in their “prescribing” decisions and race to the time clock.

“Prescribing” as fast as they can, physicians can’t keep up with the artificially created demand for pills. Medical corporations have their own cost saving “prescriber” extenders to help them with this “physician shortage”: nurse practitioners, physician’s assistants, nurses, midwives and expanding pharmacist scopes of practice. Medical assistants, secretaries and software programs authorize refills working from standardized guidelines.

Last year, lucky for overworked Oregon physicians, naturopaths, with their newly expanded “prescribing privileges,” can join as full-fledged corporate cogs at the pharmaceutical conveyor belt.

 

Thanks for reading and thinking and writing.

Best always,

Alice

Related Items:
Utah Supreme Court Allows Lawsuit for Psychotropic-Induced Murder (Psychotropics prescribed by a nurse practitioner)

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

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108 COMMENTS

  1. Thanks again, Alice, for your perspective.

    I hasten to add that it isn’t just the drug cos, institutional medicine, and competing providers that are at work here.

    At core, we get the system we request – simple prescriptions (double meaning intended) for often complex problems.

    Patients come in looking for a quick fix – and a pill prescription fills the bill. Patients want less expensive care – lower cost providers fit the bill, as does institutional medicine, which can (but often does not) reduce costs.

    More involved talk therapy & other modalities require more from a patient, and many aren’t that patient (again, double meaning intended).

    We have the system we have because we are the people we are. Quick fixes, lower costs – but we still want high quality. As many of us are aware, you can often get 2 out of 3, but rarely all three – time, $, and quality, take your pick.

    The advent of evidence-based medicine will have light to shed on this all – and so far, pills work for some – but not all. Various therapies work for some, but not all. A combination often is best. We are all guinea pigs in an ongoing effort to find solutions to common problems, as well as individual ones. So far, in mental health, effective & efficient approaches are still hard to find and evaluate on a system-wide basis.

    Hence, we try least cost alternatives first, and hope that significant numbers of patients improve. Then we try the next, and the next, and the next, alternatives. Plenty of other places in medicine where trial & error is the practical mode, as in many other areas of life.

    We shouldn’t expect anything approaching perfection from medicine, or anything else.

    • Mark,
      Thanks for your thoughtful approach to this issue.

      You would have us step back further than I did and take an even wider view. Beyond our corporate approach to medicine and psychiatry, there is this culture of ours it is all embedded in. The systems and corporations and organizations have sprouted from the soil of our own country.

      Nine out of ten calls in my private practice came in search of pills and nothing else.

      You say we can only have two out of three of the following:
      quick fix
      low cost
      high quality

      Fast, good, cheap. Pick two.

      I’ve got it. But sometimes we get only zero or one.

      Thanks for putting your spin on this. More thinking together is good.
      Best,
      Alice

    • Mark,
      People request what they do because what they know about mental health is learned from drug commercials on TV, and the popular culture that has grown up around the incredibly effective marketing and PR campaign done by Big Pharma (you can hear this in any office: “Oooops, what are you DOING? Forgot to take your meds today? Hahahaha!”). If I learn that modern medical science has discovered that I have a broken brain and that a pill will fix it, by god, I am going to ask my doctor if it is right for me. I find that an incredible amount of what people are learning comes from advertisers (including political advertisers) and it’s all for the exact same ultimate aim: concentration of wealth. This is achieved to the detriment of all life on Earth. It is amazing and horrifying to me that this trend, this tendency, is so difficult to overstate.
      Lowry

  2. Sounds like someone begrudges losing their artificial government monopoly on being the gatekeeper of psychiatric drugs, while at the same time bemoaning how useless the role of ‘prescriber’ is anyway, which seems incongruous. I’m all for more and people getting prescribing privileges, any privilege a psychiatrist formerly held dear, being diluted, is a diminution of psychiatric prestige and the psychiatrist’s utility in the public’s eyes. Any trend in public policy that can be seen as the rotting carcass of psychiatry rapidly losing blood is something I can get behind. Eagerly.

    Is psychiatry salvageable? And all we hear is a familiar cry about evil ‘corporations’ and timeclocks etc… not a single mention of psychiatry’s central weakness, that it’s model of “mental illness” is fundamentally flawed, that is has a shocking human rights record that continues to worsen, that it’s ‘diagnostic system’ is in perpetual crisis, that it’s documented ‘clinical’ outcomes get progressively worse decade on decade, that its false ideology is single-handedly responsible for millions of people being on disability who otherwise would not be, that the people in whose lives it meddles are dying earlier than their time, none of this… just that Alice Keys doesn’t find it fun anymore, and that corporations are screwing up what 20 years ago was a fun job.

    PS no one put a gun to anyone’s head when it ever came to student debt.

    “The practice of medicine is one step behind psychiatry on the conveyor belt to the scrap heap.”

    I tend to disagree. I’m constantly amazed and in awe of the insight real doctors have into my actual human body and its functioning whenever I have a genuine physical medicine complaint. They run objective tests, and heal me. What’s more, they ask for my consent rather than assaulting me and imprisoning me and forcing ridiculous brain blaming lies on me. I truly respect them as people, I know they’ve not spent their lives bullying distressed people and carrying out forced drugging assaults, and I marvel at the fact they actually put what they learned about the human body in med school to use when they investigate my health, unlike the unsalvageable quackery that is psychiatry these people really are physicians, not just in training and name only. What they practice each day really is medicine, in stark contrast to psychiatry’s messianic cult of labeling brains they’ve never proven diseased, diseased. The difference is night and day, psychiatry is David Koresh to real medicine’s Ignaz Semmelweis.

    I’m pretty sure psychiatry was still a steaming pile of pseudoscience in 1989 too. In fact I know plenty of survivors whose lives were smashed on its wheel in the 80s.

    When my head was filled with lies, my body poisoned, and my identity stigmatized, my human rights abused, and my future all but sealed had I not woken up to the lies, the last things I would have thought to blame was corporations of naturopaths getting prescribing privileges.

  3. I think the most important thing psychiatrists who feel out of synch with the direction of their profession can do with their training and experience is help the many thousands of people out there who want to come off psychiatric drugs safely. I get many requests from people who are desperately looking for psychiatrists who understand how to do this and are willing to do it, and there are so few.

    • I agree Darby. I suspect that the reason more psychiatrists don’t pursue tapering as a new professional direction is that it seems counter intuitive from a business perspective (the new M.D./M.B.A.’s)to purposefully reduce your patient base/source of income. Those who buy into the chemical imbalance model could remain with a prescribing doctor for years, even decades, while a very slow taper from one drug may only require 3 to four visits total, assuming no major setbacks. Although, as you mentioned and from what I’ve read, it appears that there is and will continue to be a steady stream of people in desperate need of assistance with tapering and managing withdrawal.

      • Ruby,
        It’s easy to make assumptions about rationales for the professional decisions of others. It’s also easy to get things wrong.

        When I did handle “tapering” as a professional direction (I did that already years ago), what I found was that most patients who said they wanted to taper were actually shopping for another supplier. It put me in the situation of continuing prescriptions for people I would never had started on the drugs in the first place. I stopped doing this for drugs started by other doctors because it did not go well.

        Perhaps things would be different today. I couldn’t presume to say.
        Alice

        • Dr. Keys,

          I don’t believe I said that my conjecture applied to all doctors or to you in particular. I never write from the position of a doctor, only as an intelligent and observant person who has worked with them.

          I imagine that it’s also easy to deny that doctors just like many other professionals factor revenue stream into their decision making process (if memory serves a number of people on this blog have mentioned medical school loans on a number of occasions and how they color perspective on practicing medicine). And, like other professionals doctors are also susceptible to greed. In the city where I live, “suppliers” as you call them get paid a full fee for fifteen minutes of their prescribing time and those that I’ve encountered have no problem continuing and/or adding on to prescriptions from another doctor.

          Also, given that so many psychiatrists are unwilling or unable to acknowledge side effects and the reality of withdrawal why would those people see a need or have any interest in monitoring tapering? Why taper a drug if you can convince the patient that the drug isn’t causing the problems?

          Thankfully, there are some who will take on tapering meds prescribed by other doctors–mine did. Most of the people I’ve communicated with who want to get off of these meds aren’t “shopping” for more medication, however other meds with longer half lives and less heinous side effect profiles may be prescribed to ease the process. I assume that any medical professional who believes it would not be ethical or in the best interest of the patient to prescribe any specific medication at any time has the right and obligation to refuse.

          If you would like to get an idea of the number of people trying to taper off of these meds, you can easily find a wealth of information here:

          Alt Therapies for Bipolar
          Alternative to Meds (Safe Harbor)
          BenzoBuddies — Benzo Withdrawal
          Med Free or Working on It
          Paxil Progress (SSRI withdrawal forum)
          Surviving Antidepressants (help withdrawing from all psychotropics too)

          • Hmmm, and I really don’t understand why anyone would pretend to taper off of an anti-depressant in an effort to score more drugs from a “supplier”, when they can simply ask for a new prescription to address whatever symptoms they are experiencing since new prescriptions are readily available through prescribing psychiatrists. However, I can understand how someone could attempt to taper, get very sick, panic and then ask to go back on medication or on a different medication to manage anxiety and sleeplessness–and so the cycle continues.

          • Ruby,
            Sorry to misinterpret what you wrote as being a suggestion that I (or another psychiatrist like me) pursue medicine tapering as a line of work. Folks misintepret what I write as well. It is one of those foibles of using only the printed word to communicate without the other non-verbal and vocalizations. Perhaps there are other psychiatrists reading here who could work this into their practice.

            For sure. Money colors decisions for every person. Money is a fact of modern living. Of course, greed exsists. I’d be a real polyanna if I said it didn’t. No one group has the market cornered on greed. I remember the doctor “across the river” who kept his schedule full of cash-and-carry ten minute prescription appointments till the state pulled his license.

            I have no idea what kinds of people would be presenting to me today if I made myself available to do tapers. I can only report my personal experiences as a psychaitrist who did make myself available to do this in years past. I can’t assume to speak for the experiences of anyone else but myself or for any time but then.

            There were people that called me asking to be “tapered off” (believe it or not) that took higher than the doses prescribed to them, that got medicine and sold it to other people, that had been “tapered off” by their usual prescriber without actually stopping, that “collected” a stable of “prescibers”.

            I’m glad you found a doctor to work with you on your slow taper. You are fortunate.

            It sounds like you are good at collecting resource lists. Others here are as well.

            All the best,
            Alice

          • Alice, your May 15, 2012 at 8:30 pm response is very confusing.

            I think you might be talking about benzos or Z sleep drugs, which have street value. People might take a “higher than prescribed” dosage because they get physically addicted to these drugs.

            That doesn’t mean the person is a scuzzy addict type. Physical dependency on GABA-ergics can happen to anyone.

            Requesting the assistance of a doctor for tapering off benzos at any dosage is entirely legitimate. Unfortunately, few know how to do it.

            Antidepressants and antipsychotics don’t have any street value (although I heard a rumor that there’s a market for Seroquel); it’s ridiculously easy for anyone to get prescriptions for them. There’s no need to pretend to be tapering to get your hands on Zoloft.

            Benzo tapering can be tricky. Tapering any psychiatric drugs on your own can be very difficult for a patient as dosage changes in themselves cause confusion, brain fog, inability to concentrate, etc. They turn to doctors because they believe doctors are there to help with prescription drug problems.

            After reading thousands of stories of people suffering withdrawal symptoms, I have not seen a single person crow about scoring a benzo. Usually, they are (rightfully) terrified of becoming addicted to them.

            It’s quite common for people to be physically dependent on both a benzo and antidepressant, as many doctors as a matter of course prescribe a benzo for antidepressant side effects such as sleeplessness, nervousness, anxiety, jitters, and akathisia. (The proper treatment would be to reduce or discontinue the offending drug.)

            I can’t see *tapering* being a particularly successful strategy for an addict to get a benzo prescription from a gullible doctor.

            Claiming insomnia or anxiety would work much better; doctors love to prescribe those addictive drugs for those symptoms.

    • Ditto. We have looked for years for a psychiatrist willing to safely guide a family member, who suffers from side effects, off a cocktail of medications. We found not one. However, we found a naturopath with prescription rights willing to help. This doctor is using prescription rights to help people discontinue dangerous medication. Medication insisted on by psychiatrists. In fifteen years, not one psychiatrist, social worker or therapist would acknowledge the side effects of the medications. Are naturopaths the only folks in a position to listen and observe?

    • Darby, you know I’m with you on that.

      Gianna Kali has a blog post here: http://beyondmeds.com/2011/12/04/helpheal/

      “A plea to prescribing physicians and psychiatrists: please help us heal”

      December 4, 2011 By giannakali

      Thanks to Rossa at Holistic Recovery from Schizophrenia, who highlighted some of the below paragraphs from the Irish Examiner.

      The plea to MDs comes after the excerpt.

      The article is about the need for patients to be made aware of the dangers of psychiatric drugs. These paragraphs highlight what Dr. Browne said to the Irish newspaper:

      Speaking to the Irish Examiner, Dr Browne, now a counselling psychotherapist, said there is so much evidence about the dangers of psychiatric drugs that it cannot be ignored.

      “I think it is going to force change, but that means breaking the power that big pharma has over doctors who get perks for prescribing the drugs,” Dr Browne said.

      “Psychiatry has all the power and unless we get this message through to them it is very difficult to see how things will change. But I feel sorry for psychiatrists because all they can do is prescribe medication, but there is an urgent need to look at different ways of doing things.

      “You do find the odd psychiatrist who is willing to engage and I am trying to talk to them,” he said.

      “We don’t have alternatives in place for people and drugs are damaging long-term. We need to treat people as humans and not patients who have a long term sickness. And we shouldn’t call what we do ‘treatment’. There is no way I can say to a person ‘I will treat you and make you better’. I can only guide the person. They themselves have to do the work.”

      Dr Browne said 60%-80% of his work is helping people to slowly get off drugs. “At the moment I can’t keep up with the numbers of people trying to come and see me.

      ————
      The article ends with that final statement which I have bolded because the fact is there is a huge niche opening up for psychiatrists and other prescribing physicians who want to take the opportunity. People want and desperately need COMPETENT professional help in coming off of psychiatric drugs. We need prescribers to make the transition easier.

      This is an invitation for prescribing doctors to think about stepping up to the plate and perhaps even undoing some of the harm they’ve maybe helped cause.

      This is not to be taken lightly. Many people come off meds with relative ease. Some of us, though, become crippled with iatrogenic illness. You will need to educate yourselves. Once you start making it be known that you can help — those of us who’ve been seriously and gravely harmed will start appearing on your doorstep. Most doctors never see (or recognize) us because once they deny our reality those of us who understand what has happened to us don’t hang around to be further abused. The doctors then move forward believing we don’t exist and spread that dangerous misconception to other doctors. It creates a treacherous world for those of us who are very ill with nowhere safe to go.

      Please, it’s time that doctors learn how to help us. Some of you have unintentionally helped create the iatrogenesis that is now limiting our lives so much more than any “mental illness” ever did. Please start helping us heal now. We need you.

      For some discussion on various forms that withdrawal syndrome can take see here: Dyesthesias: abnormal pain from psych drug withdrawal (and info about other sorts of withdrawal pains and symptoms too) MDs — please take a look at this…these are syndromes you rarely know anything about! We’ve got thousands of people reporting them, however. Please look at it. Please educate yourselves. Please.

      Some of what I’ve learned with thousands of others online about psychiatric drug withdrawal with links to additional resources here: Withdrawal 101.

      I suggest everyone reading this post, email a copy to all the doctors you know.

      If you’re a blogger feel free to copy, paste and publish this too.

  4. I got my very first perscription of woderful Zoloft from my medical doctor and I must admit that I was the one who went to him and begged for the “pills.” This was before I ever got into the system and didn’t know anything about anything. I was even a recruiter for the cause to get more people on the pills. I am ashamed of my stupidity and lack of insight. Alice is right, as a nation and a society we all want quick, simple fixes for very complicated and important issues. Life has never been simple or easy but we are determined to make it easy for ourselves one way or another. We don’t want to deal with difficulties or be shouldered with problems. So, the drug companies have only given us what we wanted. Remember the old adage, “Be careful what you pray for because you just might get it!” I think it holds very true here. When it came to psychiatrists I was under the delusion that most of them still did psychotherapy and actually listened to the people they worked with. It took getting tangled up in the system to bring me down to reality. I’d worked in hospitals alongside them but until 2005, was never on the receiving end of “treatment.” I still have a use for psychiatrists, the ones who are willing to walk with people on their journeys of the dark night of the soul, the ones who aren’t afraid of huge emotions, the ones who care enough to actually listen to the people in their care, the ones who realize that the “expert” in a person’s life is only that person, the ones who let people drive their own cars and care, the ones who minister to people out of their own humanity and who are transparent enough to admit that they don’t know everything, the ones who are humble and know that even they can learn some valuable things from their patients. However, as Alice pointed out, this kind of psychiatrist is not valued by the system and they don’t get good jobs nor salaries that they can live on. So, the question I have is, how do we take things back from a crazy system that’s run amuck? How do we smash the power and control of the large drug companies and their monoply on our government and our society’s attitudes? How do we go about educating the public? I’m afraid that nothing we try will have any effect until our society as a whole stops trying to turn life into a fantasyland.

    • Stephen,
      Wow. I wish I’d written this piece. You write very clearly with plenty of personal experience to back it up.

      1. “the ones who are willing to walk with people on their journeys of the dark night of the soul, the ones who aren’t afraid of huge emotions, the ones who care enough to actually listen to the people in their care, the ones who realize that the “expert” in a person’s life is only that person, the ones who let people drive their own cars and care, the ones who minister to people out of their own humanity and who are transparent enough to admit that they don’t know everything, the ones who are humble and know that even they can learn some valuable things from their patients.”

      You are right. There is no place for psychiatrists like this in the current systems. Neither is there room for any “service provider” like this.

      2. “Be careful what you pray for because you just might get it!”

      I was thinking this when I was writing about all those that have lobbied for “prescribing priveleges” and thought they would be winning a prize. “Prescribing priveleges” is the fastest path I know for social workers, psychologists and naturopaths to lose everything else they now do. They can do this. But they may not like when they end up.

      I don’t know where to break this cycle. It has already eaten psychiatry.

      I hope that those who habitually scapegoat and vilify psychiatrists as the root cause of all this can step away from their anger and target practice long enough to find answers, if not for systems, then for themsleves.

      All the best,
      Alice

    • Yes, psychiatrists have been caught in a trap. Their profession hasn’t turned out the way they thought it would when they were in college.

      A lot of people have had their professions yanked out from under them in the last 20 years.

      Still, there is an ethical path for psychiatrists: To help patients get untangled from the errors of the discipline. Patients are real, their injuries are real, their need is real, and there are very, very few doctors to help them.

      • Ruby,
        Funny you should mention this. A few years backI left my dog with a house sitter. She wasn’t so good at getting her outside to the bathroom. When I discovered this, she told me the dog was depressed and the vet wanted to put her on prozac.

        If I wanted to make money on this, I’d be out there doing it. This is, indeed, the land of opportunity. They can also prescribe ANY psychiatric drug. All of them.

        Thanks,
        Alice

    • John,
      Do you think we sould start an anti-GP movement then? (Sorry. Bad joke. Not a joking matter at all.)

      I’m sure the GP’s have been just as persuaded by the marketing hype as all the various “prescribers” in the US. I had heard rumor from UK that GP’s are required to refer to other treatments before starting antidepressants (ex. exercise, counseling). Any truth in this?

      Thanks,
      Alice

  6. “Psychiatrists are completely disposable today. In their diminished role as “prescribers”, psychiatrists are interchangeable pill pushers. Every psychiatrist could vanish tonight and there would be no change in the workings of the machine. The other “prescriber” cogs with their prescription pads would keep the pill-laden conveyor belt moving from pharmaceutical factories and down the waiting American throats of all ages.”

    But without psychiatrists at the academic level there would be no more “science” supporting the use of these drugs at all. I can hardly imagine society letting family doctors and counselors convince them that they have a “brain disease.”

    • EAC,
      Family doctors and counselors do this “brain disease” convincement every day in this country. The biggest pressure I used to have in my private practice (behind the direct cold-call demands from patients) to prescribe psychiatric drugs came from counselors, therapists and family doctors. They have also been convinced of the “brain disease” model and spread it around. All psychiatrists could vanish tonight and this would live on.

      I don’t know what percentage of “research” of psychiatric drugs is done by “academic psychiatrists”. Certainly academics must “publish or perish” in every branch of medicine,in every branch of academics. During my brief attempt in academics I was unable to get funding for a study of group therapy in A and D treatment from the feds. I didn’t know, then, of their funding sources or priorities. Pif. That was it for me and academics. I was a stupe (I discovered 25 years later).

      There are private clinics that do a lot of these “studies” for money. Look around for the ads for patients/subjects. I know of one in Portland. There is a psychiatrist (to validate the “research”) and many other clinicians to process the research subjects. There will always be those willing to perform if the money is there. This is not limited to psychiatry or medicine. Every field has them.

      Thanks for reading and asking questions. It keeps me thinking and writing.
      Best,
      Alice

      • But you missed the point. Nobody, not society or the government, would dare let a counselor or a doctor make such bogus claims about brain diseases in the first place. It was psychiatry that created the “mental illnesses” that allowed the brain disease explanation to be used for life’s problems in the first place. If psychiatry disappeared, so too would it’s diagnostic manual, and so too would the “diseases”, and so too would the rational for psychotropic drug use to deal with mental problems. A family doctor just simply could never succeed in transforming a life’s problem into a brain disease. Only psychiatry ever had the power to do that.

        • I disagree. My own GP gave the pills to me with the little talk about my broken brain and all that. As a chaplain working in hospitals and a large retirement center/nursing home I saw GPs handing out not only antidepressants but antipsychotics, especially in the nursing home. If a resident got fupset or fiesty the nurse would call the doctor who was the director of the nursing home part and he’d tell the nurse go get out the needle with the haldol in it! This is an epidemic among doctors of all kinds and not just psychiatrists. The entire medical establishment has accepted the broken brain stuff and it’s the same drug reps who visit the psychiatrists who visit the medical doctors. Their job is to get as many doctors perscribing this stuff as possible; their salaries and bonuses depend on it. former drug reps who’ve confessed and come over “from the dark side” tell these things all the time. They were told to get all doctors into the system, period. Yes, psychiatry fouled its own nest by hooking into this crap, but the problem goes far beyond them. it’s entrenched in our society.

          • Stephen,
            Thanks for your reminder that this pill epidemic is not a psychiatric problem alone. It is a medical problem and a cultural problem.

            Your personal experiences match my own.

            Best,
            Alice

          • Stephen, even you missed the point. If not for psychiatry’s efforts in all of these years, the drugs would not even exist for GP’s and “chaplains” to prescribe them. It would be nothing more than psychotropic drugs to deal with life’s problems, which is still today viewed as an unacceptable evil in this country and there are laws against it.

          • EAC,
            I presume you are in the US (I can’t always tell).
            I haven’t watched TV since 2002. I understand there are some pretty high end commercials out there for prescription drugs. I’ve heard of a bouncing blue face that really sold an anitdepressant. I’ve seen a couple drug ads by accident when there’s a TV in a waiting area. Do you think the marketing campaigns have had any influence on the popularity and widespread use of these drugs?
            Thanks,
            Alice

          • EAC,
            You’ve missed the point.

            Even if psychiatry had never exsisted (no cheering out there) drugs would have been invented and marketed. If you’ve seen no parallels among the Primary care drugs of over-prescribing and later discovery of bad side-effects (ex: cholesterol lowering, antibiotics, bone hardening, hormone replacing, allergy relief, anti-inflammatory,weight loss, blood pressure lowering, GERD drugs) then you haven’t done your research yet.

            And the for-profit medical service provider organizations would have sucked up the practice of medicine just as they have today.

            Keep reading, thinking and writing,
            Alice

          • @Alice, let’s just take the case of Thorazine and neuroleptics. When the phenothiazines were found useless in surgery, psychiatrists found them useful in quieting crowded mental hospitals. Had psychiatrists not have started using Thorazine in this way, then neuroleptics would have vanished off the face of the Earth quite quickly. In fact, as Whitaker shows in his books but is perhaps even better detailed in Elliot Valensteins Blaming The Brain, psychiatry spent the first decade or two in this era STRUGGLING to protect these drugs from being banned or from being considered unethical. Patients didn’t want them, the harm they were doing was obvious, and as the very first NIMH studies showed the relapse rates were higher for drug treated schizophrenia patients than they were for placebo treated patients. It hard to believe that if psychiatry had never existed, that family doctors would have somehow succeeding in getting a million children on neuroleptics and turning that class of drugs into a top seller.

            Besides all of that, the rational for using such drugs in the first place comes from psychiatry’s school of though that chemicals in the brain can be blamed for negative mental and behavioral states. I again can not envision a reality where psychologists and family doctors would ever be able to convince people of this. It took a branch of medicine claiming specialty in this regard, and then producing bad and fraudulent science, for this to happen. If no medical specialty existed with this school of thought, no rational for medical psychotropic drug use would have ever existed. Big Pharma couldn’t just create it themselves and sell the pills. The medical and ethical justification had to be there and psychiatry was the only branch of medicine “Qualified” to provide it.

          • EAC,
            I see your point with the antipsychotics. I wonder if this holds true with all the psychoactive drugs. It seems the benzodiazepines and stimulants (diet pills and “Bennies”) were very popular among GP prescribing long ago (60’s-70’s) without much encouragement from psychiatry. Valium and tranxene. Antidepressants? They may have had a good go with the GPs and with no psychiatric help as well.

            Thanks,
            Alice

          • I totally agree. I had mentioned in another comment that a doctor I saw essentially demanded I see a psychiatrist when I was expressing frustration at the failure of current treatment in which she didn’t seem to have an answer to. It was quite clear that she thought I had a chemical imbalance which I found extremely frightening.

            Also, on most new patient forms, people are asked about psychiatric history even when it has no relevance to the current situation. In my opinion, anyone who is honest about this, is a sitting duck for extremely poor treatment.

            I foolishly was honest with this doctor and paid the price big time for that. Live and learn.

          • AA,
            Some people came to my private office and paid cash out of pocket rather than leave a paper trail of their treatment in insurance land. As long as they never admitted to anyone and never signed a release of information I could never say a word to anyone.

            I also was careful to keep personal details out of the medical records text. Only the minimum necessary. Insurance companies have access to your records if they are paying. Sometimes the employer is also the insurance company.

            Privacy tactics are necessary in general medicine as well. I met a slim healthy young man (not a patient of mine) who was having trouble sleeping. His primary care doc sent him for a sleep study. He has “sleep apnea” only if sleeps in one specific position. This requires no treatment. He was given the “sleep apnea” diagnosis. Now, as a consequence, he cannot purchase private health insurance.

            Any time your medical information is written down anywhere it will be used.

            Here’s a related tangent:

            Having huge medical service delivery and insurance corporations owning the doctors, hospitals, clinics, labs, test equipment pharmacies, pharmacists, nurses and “members” is filled with enormous potential financial and information conflicts on interest. The insurance company in charge of approving government payments for treatment also owns the treatment providers. Do anti-trust laws come into play here?

            Best,
            Alice

  7. Not only are there way more prescriptions of psychiatric medications prescribed by primary care doctors and other prescribers, but they are prescribed in less time and with less follow-up, and with poorer results. Focusing on psychiatrists will have limited success, as we really do not influence things as much as others have thought. To me, the real issue is the system we work under (see my Part 1 column on managed care and human rights). So, so many psychiatrists would like to spend more time with patients and prescribe less medications (even though we are not hearing from the patients who have done well with judicious prescribing). The system and psychiatry must take a lot of the blame for hurting both the public and psychiatrists, though I certainly apologize for what I have done wrong (with good intentions) along the way.

    • Steve,
      Thanks for reading and responding.

      Thanks for pointing out that focusing on psychiatrists will have limited postive results. It will have results. They may not be be those hoped for.

      I’ll bet the patients and other psychiatrists that have had good results with judicious prescribing wouldn’t dream of poking their heads up here. There are times when being a psychiatrist writing here is rather like painting a target on myself and walking into a firing squad. I have also seen people who have had good experiences within mental health treatment systems take it pretty rough when they spoke up.

      Don’t get me wrong. There are lovely, supportive and thoughtful replies. There are just a considerable amount of the others.

      Thanks for writing here.
      Alice

      • All I want from the system is the chance to choose what happens to me; I want to chose what treatment I have. I’m not here to tell others that they can’t have the drugs. As long as it’s their choice, a real informed choice, then more power to them. But I don’t want anyone telling me that I have to take these drugs, or else. I want free choice for all; I want people to be able to have alternatives to the drugs. I can never assume that my way of doing shtings is the only way and I will never try to force anything on anyone. I don’t have that right. I also feel that doctors should not have that right, whether they be psychiatrists or medical.

      • I understand perfectly why some of the responses to your writing are of the “stinging” nature. I don’t think that most of them are directed at you but of course I can’t speak for anyone posting here except myself. I am not against you, for you seem to get the huge problem here. Many people entering the system did so because of terrible trauma in their earlier lives. We’re finally understanding that almost 80% of all people in the system are there due to some kind of truama. The Trauma has caused a disconnect. Then, while in the system they are re-retramautized by many of the very people who are supposed to be “helping” them. It’s a terrible form of betrayal and it’s carried out under the guise of “good treatment.” The system tramautizes them to no end. Most are forced into treatment and not even the people responsible for their care even bother to listen to them. It’s frightening and disturbing to say the least. You are treated less than instead of being reapected as a human being. It is absolutely awful and is condoned by the legal and medical and social systems. This is one of the few places that people can talk about what was done to them rather than for them. Of course there are going to be some very pointed and barbed responses because I don’t think anyone can truly understand what it feels like unless you’ve been locked behind the locked doors with no recourse to help of any kind. I was lucky in that I was able to stand up for myself and had a doctor who went along with my deciding my own course of treatment. I’m stubborn and bull-headed and somethings that’s the only thing that saves you and your sanity when you’re in that locked unit. I keep saying that people here who post about their real, lived experience have no obligation or reason to trust any psychiatrist. I think that many have come to the point of trusting you somewhat and they value what you have to say, but they will speak out when they disagree and sometimes they do so very pointedly. I understand perfectly because I lived behind the locked doors.

        • Stephen,
          Thanks for the thoughtful and understanding post. I do know that people here only know me by what I write, my name and the initials after my name. I choose my words as carefully as I can. When people come to inaccurate conclusions about me I first I look at what I’ve written. Sometimes I’m not as clear as I thought. I take into account the experiences people have had. I always learn something from them.

          There is a huge problem here. I may not get all the details but I get it that there is a huge one. It’s way bigger than me or anything I can do about it alone.

          So I write.

          Thanks again,
          Alice

          • Thanks, keep writing and thinking. Every person counts in all of this. Communicating through social media is not always great becasue the written word doesn’t carry the body language and facial experessions that always accompany a person’s spoken thoughts and messages. I think you do pretty well for yourself, all things considered. I’m impressed that you don’t watch television and haven’t for the past ten years! Hang in there, even when the responses are pointed and “stingy,” we will all work it out somehow. Notice that your posts get a lot of response so something interesting and good is going on here. I’m also impressed that you actually answer each and every rresponse that you get. Dr. Healy could take some lessons from you!

          • Stephen,
            I miss responding to some posts. When there are alot, I lose track of the threads. Some are obviously meant for another responders

            I do the best I can to keep up with the conversations. People that read and think and respond are the important “rest of the story”.

            I’m happy that people are reading what I write. Even the strong disagreements mean folks are reading and thinking.

            I agree that it will take all of us to make meaningful changes in how mental health works in this country.

            Thanks for the encouragement,
            Alice

    • Dr. Moffic, thank you for the sincere apology.

      Although primary care physicians are by now the sorcerer’s apprentice, overprescribing psychiatric drugs as if zombified, endorsements by psychiatrists and papers produced by research psychiatrists legitimized the fallacious “one drug per symptom” paradigm the PCPs follow.

      Although psychiatry might be on its way out, the greater tragedy is not that psychiatrists are losing their foothold in medicine but that patients are being injured by the paradigm psychiatry put into play.

      When psychiatrists complain about the system and say “What can I do?” with a shrug, I say there are things you can do. You can help patients get off psychiatric drugs safely. You can educate primary care physicians about the risks of psychiatric drugs. You can learn how to treat iatrogenic drug damage. You can assist in creating recovery-oriented clinics.

      If psychiatry were honest, research would be doing long-term efficacy studies instead of shoring up “add-ons.”

      Concerned psychiatrists need to turn their attention away from the crumbling of their hegemony and towards truly taking care of patients. If this had been the focus of the profession all along, it wouldn’t be in the pickle it’s in now.

      • Altostata,
        Honestly. Reseach goes where the money is. There is no money for long term research. Turning out drugs for short term profits is what the for-profit corporations do. That and enormous ad campaigns.

        I presented a research proposal in my short-lived attempt in academics. Since it was for a prospective study concerning the efficacy of group therapy in A and D treatment, there was no money.

        No federal grant money. No drug company money. No research. No academic position. No job.

        Yes. There should be long term research. There is no money in this country for it.

        Best,
        Alice

        • Alice, the meat of my comment was this:

          Concerned psychiatrists need to turn their attention away from the crumbling of their hegemony and towards truly taking care of patients. If this had been the focus of the profession all along, it wouldn’t be in the pickle it’s in now.

          • Altostrata,
            I hear what you’re saying:
            “Concerned psychiatrists need to turn their attention away from the crumbling of their hegemony and towards truly taking care of patients. If this had been the focus of the profession all along, it wouldn’t be in the pickle it’s in now.”

            I agree all doctors need to turn toward truly taking care of their patients. How that would look or transpire for each individual doctor would be beyond me to dictate.

            The second half is much too narrow a view of the causes of the pickle. It hands doctors more power than they ever had.
            Best,
            Alice

  8. Personally I think we will always need psychiatrists but psychiatry will have to change and it is changing already here in Britain where I live. Psychiatrists have started working closer together with psychologists and therapists at long last. Much more needs to be done yet to really emotionally suport brokendown people who have ended up in hospital but, I think, we will get there with ex-patients’ telling psychiatrists what’s what. They don’t always like it of course but the young ones do listen. After all, Psychiatrists have not always been just pill-pushers. And yes, GPs are often as bad;often they think that the patient is after some magic pill when all they want is reassurance.
    Another thing: Gps and psychiatrists need to relearn what the previous generation of doctors knew, before pills came in fashion.

    • Alix,
      Thanks for your thoughtful post.

      You’re right. Psychiatrists have not always been psychopharmacologists (“pill pushers”). I was trained by psychoanalysts, hypnotherapists, a great gestalt therapist, gorup therapists, A and D treatment therapists and CB therapists, all psychiatrists. I was also trained by teachers from every related field. But my best teachers have always been my patients.

      How can we begin teaching a broader range of skills to psychiatrists? How can we put the time back in the day to use them?

      I was taught by an excellant old-school neurologist that there are times when the only thing you can do is be there and hold your patient’s hand. This is good for all of us to remember. We doctors want to do something, give something. It’s good to remember that this is something that can be given.

      Thanks. Your thoughts help me think more.
      Alice

  9. Dr. Keys,

    The few psychiatrists (online) who have asked this question publicly seem to answer it in much the same way…

    How psychiatry has changed – largely in reference to the “good-ole-days” of building relationships with patients, followed closely by third-party payments.

    And on the flip-side are those of us who are non-medical, who are pro-recovery – who are much more concerned with a paradigm shift – a transformation inlike any we’ve seen in this country.

    We tend to look at the conventional model and hope that it dies, so that it can be replaced. Not for the good of psychiatry, but for the good of each other – ALL of us – ex-patient, consumer/user, survivor, professional, non-professional… children, elderly, veterans… ALL of us.

    In short, many of us are not concerned whether psychiatry survives… we are MUCH MORE concerned with how it is replaced if/when it dies.

    And some of us (myself included) believe that the profession (as it exists today) will not survive, and should not survive.

    With every death comes an opportunity for new life, renewal.
    IMO the conventional model will have to die before the recovery model will take root and grow.

    Duane

    • Re: Bio-psychiatry, as practiced today… “chemical imbalance” theory, labels, drugs, ECT, incarceration, seclusion… all the other nonsense.

      Not all psychothery, counseling, etc.
      But this is best done by those without any pre-concieved notions about the “mental illness”, “disease management” model.

      Duane

      • Every time you use the word the oppressors chose to name their version of solitary confinement, ‘seclusion’, you give oxygen to the lie that this is not solitary confinement. It is the oppressors that came up with that name, not the human beings caged in such cells. They wanted to sanitize it for the public, and they succeed every time you use their chosen word.

        Realtor sign ‘secluded getaway’… vs. ‘seclusion’… vs. truth = brutal solitary confinement proven by mountains of research to drive even prison inmates into states labeled ‘psychotic’. Yet the quacks seem to think it is ok to use solitary confinement as a therapeutic tool against drug resistors.

        Down with the quacks.

    • Hey Duane,
      I’m not so personally concerned about whether psychiatry survives either. I was asked what I thought and answered as best I could.

      I am here writing because I’d like to imagine that I could have an impact on making things better. That’s all. Maybe I will. Maybe not.

      I had hoped that looking at the “bigger picture” would help us all understand the forces we’re up against and where best to point our energies.

      I do believe that the loss of the therapeutic alliance has taken the heart and soul out of psychiatry in the process of the transformation into a pill model of care. There were not “third party payments” to me in my “good old days”. If my patient got good value from my work, he/she paid me. This seemed fair.

      Thanks for checking in on this one.
      Alice

  10. I appreciate your honesty Dr. Keys. I’m waiting for the next blog or maybe the one after that, because I think you’re at that fork in the road regarding future career path. Don’t we all want to be involved with vocational efforts that are meaningful and fulfilling? I can see how the profession has changed so dramatically that some just wouldn’t want to keep doing it anymore.

    • David,
      Right now I’m a writer and a mom and a wife. I haven’t worked as a doctor in nine months and my dance card is pretty full. I’m not looking for another career path. Will one find me? Will I want it?

      Maybe I’ll pack up the kids and head off to Africa where doctors can still be doctors. I could brush up on tropical infectious diseases, baby birthing, bone setting and sanitation. I was a pretty good wound stitcher in my time (This is mostly a joke.)

      Thanks for reading and commenting,
      Alice

  11. Is psychiatry salvageable? It depends on what you mean by “psychiatry.”

    I work in a training program where the trainees unfortunately aren’t exposed to anything other than the rapid-throughput med-management style of practice that you describe above. (I wrote about this bias here.) To many of these individuals, “talking” is nice but not an essential component of good psychiatric care, and the intricacies of human development, different schools of psychotherapy, social science, biostatistics, ethics, learning theories, spirituality, nutrition, etc. are minor distractions– important for Board exams or trivia contests but not much else.

    Little do they know that what they do could be done more easily by people with lesser training– or even by a machine. But most of them assume they will walk into a comfy six-figure job prescribing the latest name-brand drugs to an eager and grateful public. As of today, those jobs do exist but are disappearing rapidly.

    I, myself, have been looking for a job that expects me to think and to cultivate relationships with my patients. (That’s what worked for me as a patient, and that’s what– philosophically and even biologically– I believe works best.) Those jobs are few and far between. I may have to open my own practice, where I’ll have far less of an impact on the overall status quo, but at least I’ll be able to serve my patients in good faith and using my skills and life experience to its greatest benefit.

    • Steve,
      It’s what I did for 14 years 1989-2003). It quit working financially in about 2001.I could pay everyone except me those last two years before I closed up shop. I also (by virtue of enormous federal debt) had to pick up hourly clinic “prescriber” work to pay the loans every month.

      I doubt you’ll find what you’re looking for in a “job”. You’ll have to invent something on your own. An employer will not pay you to “think and cultivate relationships with your patients”. Yes, this is what works. It’s the right thing to do.

      Best to you,
      Alice

  12. Dear Alice,

    I’m a psychiatrist and ACT therapist, and encourage you to learn about the thoroughly science based approach to human behavioral problems which lies within contextual behavioral science – see http://www.contextualpsychology.org Functional contextualism which underlies ACT and RFT allows us to have a scientifically grounded, non-reductionistic, approach to the effects of drugs on human behavior which is entirely different to the biochemical reductionism we’re taught in psychiatry. You’re fortunate in Portland to have excellent ACT practitioners and trainers who can teach you basics of ACT which is curiously the best way toward learning about RFT and FC. See http://www.drluoma.com and also http://www.portlandpsychotherapyclinic.com and please also email me direct for more information about ACT, RFT, FC and FC Pharmacology. Psychiatrists are needed to move forward FC Pharmacology – AND i believe that academic psychiatry worldwide is presently unsalvagable due to ties with the Pharmaceutical industry, partly caused by the financial structures of universities as they have developed over the last 30 years, also of course naked self-interest and greed. All the best in your journey, and thanks for your blogging.

    Best wishes, rob purssey
    functional contextual psychiatrist
    brisband, australia

    • Rob,
      I am familiar with ACT model. I worked half-time for six months a couple of years back with a start-up FACT (forensic community action team). This evidence-based treatment model seems very much like the old multi-disciplinary treatment team appproach I remember that offered way more than pills. I wasn’t looking for work at the time but when they described the level of support available and the resources we could offer people, it made sense for me to do it. We were able to help people with housing, food, clothes, support to manage the legal system, access to medical care, personal and A and D counseling, vocational support, financial support in addition to medicines. We could go pick them up and give them a ride to an appointment if that was what was needed. This is waht I remember the “old days” of community mental health to be. Much less about pills and more about the whole person and situation. That specific team is no longer around.

      Thanks. There are excellant ACT trainers in Portland. I have met some of them and done trainings.

      Thanks,
      Alice

  13. Is Psychiatry “Salvageable”? Here. I’ll demonstrate:

    “I think I have some problems. Help.”

    What’s your first thought? If you’re in any way an honest and up to speed person, if you’re in any way COGNIZANT of the reality …

    Your appropriate response to the above statement would be throw up your hands, admit defeat – and cry

    Because you know it’s a real mess, and telling anyone that you can “help” them would be the equivalent of lying.

  14. It as interesting way to tackle the question, to talk about wider changes in the politics and economics of health care provision. I rather fancy the person asking the question wanted to know: Given all that there is on ‘mad in america’, where illness have little validity and treatments do more harm than good, can psychiatry really have anything legitimate to offer?

    Of course what you write about is very important. I was a doctor in the NHS in the UK. I was party to similar changes in the political economy of health care provision, where one suddenly became answerable to the health care providers, to the commissions, to NICE guidelines, to meeting targets. One had to keep reminding oneself that all of this existed for the patients benefit as it wasn’t always entirely obvious.

    I’ve now left the UK and work in Finland. Not that it is much better. Please don’t imagine that it is all ‘open dialogue’. Saddly that is a very local service. The rest of the country is not so enlightened. Interestingly Open Dialogue was set up in a place where there was no psychiatrist, by a psychologist. Psychiatrists in the rest of the country I think feel very threatened by it,because if no doctors and no medicines are involved, then what the hell is their role going to be should ‘open dialogue’ be extended around the country?

    • Good. I hope the bioquack shrinks in Finland are shaking in their boots. Their ill-gotten prestige is flowing down the drain at a rapid rate as Finland becomes world famous in these circles for EVERYTHING BUT what the biopsychiatrists of Finland get up in the morning and do every day, terrorizing people forced against their will into the ‘mental patient’ role, ordering nurses carry out forced drugging attacks, sitting scared young people down in state hospitals and indoctrinating them to believe they have a hopeless brain disease for the term of their natural life, getting lunch bought for them by drug companies, that sort of thing. Oh and don’t forget the middle aged ladies who’ve been told nothing but biopsychiatry lies their whole life who are now desperate and misguided enough after 28 ‘antidepressants’ to sign up for electroshock.

      It’s a wonderful life! throwing your life down the toilet to specialize in quackery and flush a perfectly good medical degree down the drain! It’s a wonderful life for us! It’s a wonderful life for us! Da da da woe is me.

    • Jeremy,
      If we could get non-medication open-dialogue treatment that helps people here without medicines I am all for this. I could learn to do this kind of treatment or I could go drive a cab and cheer things on from the sidelines. Good patient care and patient choice comes first.

      Why would a psychiatrist be precluded from providing this kind of treatment? I have years of experience and much training in non-pill therapies, individual and group. Sadly, there has been no request for these other treatments. I asked and suggested to administators for years if I may run therapy groups or provide counseling. I finally stopped asking.

      I love providing other types of care. Sign me up for open-dialog training.

      I can’t imagine being “threatened” by good care that works.

      Best,
      Alice

  15. It’s a sad state of affairs when medicine is redefined as having prescribing privileges. It’s a distortion of what medicine is about. That, though, is precisely what psychiatry has made of itself.

    The author rather nicely skips over a singularly important point: She herself was one of those prescribers. And she seems to be questioning the issue of drugs in psychiatry only now that it looks like psychiatry itself is finished – only because prescribing these poisons is now ceasing to be the exclusive domain of psychiatrists.

    The problem with psychiatry isn’t the loss of exclusive rights to prescribe psychoactive drugs. It’s the fact that psychiatry CHOSE the path of drug prescribing (along with pseudo diagnosis) as the central technique of its profession.

    Psychiatry should die, and it’s rather humorous to see its demise be a result of its own choices.

    • As we look back on trends in psychiatry, we see that it is not a very old field of medicine. Even when it was not really “medical” and was psychoanalytic in nature, it was a parallel medical model that wasn’t necessarily biological, that is, the psyche was “ill”.

      Freud’s patients were hysterics for the most part, women who fainted for some unknown reason.

      It was going down the tubes in the 1970’s when State hospitals were closing. Drug companies began to design new drugs and psychiatry was revived and was once again a prestigious profession.

      It looks to me like MD’s who were in medical school during the “revival” years were swept up in the wave of new, hopeful “cures”, starting with Prozac and the me-too SSRI’s, and when Clozaril came out it was the cover story of Newsweek– about a prom given for schizophrenics who missed their high school proms and now were “functioning”. Such hope!

      There was an author (forget his name, sorry) who desperately wanted the Eli Lilly trials of Zyprexa to be speeded up so that his son could have it. He should have spent the time and energy with his son, who committed suicide anyway.

      Psychoanalysis was a fad in the 1950’s, still colored the lenses in the 1960’s, and was passé by 1980’s.
      Drugs began to be part of treatment along with talk therapy after that, then it morphed into drugs only but I think it has reached the peak and is coming down the other side.

      It is unfortunate that it takes so many years for a trend or belief system to change. I just think you have to see where a psychiatrist was in life historically, and not try to “re-write history” as if any of us knew what would happen.

      People with the energy of the author who fought for the Zyprexa trials are coming out of the closet so to speak and are fighting against such things, through lawsuits and publicity.

      John Nash, the schizophrenic genius in A Beautiful Mind, was portrayed as being helped by “the new drugs” in the movie, which is not even true. The script writers had to put that in the movie because that is what is expected by the deceived public.

      The one myth I REALLY want to die is that drugs “DO help some people,” because that also is not true. If they help you get a good night’s sleep for a few days and then you get off of them, maybe. Even that would take careful monitoring, for risk of addiction, and the sleep isn’t natural or refreshing.

      Has sleep deprivation induced psychosis ever been studied? Nearly every patient I’ve known says their problems started when they couldn’t sleep at night.

    • I first heard of the word anosognosia reading Peter Breggin’s works. I think he refers to it as “Spellbinding” now. It’s when the effects of a drug on a person are not fully realized by the person. This word seems to have been hijacked by those who want to force treatment (usually meds)on individuals because they just don’t know how sick they are…strange twist.

  17. HI Alice,
    RE: Rob,
    “I am familiar with ACT model. I worked half-time for six months a couple of years back with a start-up FACT (forensic community action team). This evidence-based treatment model seems very much like the old multi-disciplinary treatment team appproach”

    What you are referring to has the same acronym, but is quite unrelated to Acceptance and Commitment Therapy – please check the links from my prior post especially http://www.contextualpsychology.org and if curious to learn more (and i’d encourage you to do so) email me direct.
    all the best

    rob

  19. Unfortunately anosognosia is being used in psychiatry as an explanation for lack of insight, and to my mind It’s poor, lazy medical misapprpriation that keeps people thinking there is a brain injury (in the frontal lobes in this case).

    Anosagnosia is actually related to pareital lobe injuries following stroke, brain tumour and head injury etc and should never be used in conjunction with psychiatric patients where no brain lesion has ever been found including the prefrontal cortex. Lesions here have a very different presentatin al together.

    In the UK I worked with Alzheimer’s patients and they have a profound lack of insight at times. My musings on this was that it was actually a sign of how the brain works normally i.e. to stitch reality together as conciousness into one seemless whole. In that way lack of insight in psychosis could also be a sign of underlying brain health.

    There is a book going round called somthing like “I am not well, I don’t need treatment”…. Burn it!

  20. anosognosia is a narrative in psychiatry to support the myth that most people “deny their illness” and must “accept their illness” in order to comply with meds and therfore get better. It follows that misleading the patient for his own good is justified.
    In fact anosognosia, even in stroke patients is generally an adaptive reaction, and a sign of a healthy personality. Consider this: how many spinal cord injured soldiers will eventually walk again? The ones who accept their illness or the ones who deny it? Neural plasticity consistantly disproves what we believe we know, even in cases of obvious structural damage to the brain. At our current level of understanding it seems at least reasonable to attempt to deny limitations, or have faith in resiliance. each are defenses and powerful, faith and denial.
    I think that “narratives” are examples of “memes”, which have been called a “virus of the mind”. Therefore, in this very discussion: “we are the virus”
    I am very grateful for these discussions

    • marcellas,
      I, too, am grateful for these discussions. I’m learning all sorts of things. Thanks for your lovely post. I was stuck on how this “anosognosia” word got to be used in psychiatry. I hadn’t run into it. But then, I’ve never been great with big words and doctor-speak. I have to translate them into plain-speak (as you’ve done a good job of doing with this) before I can understand things.

      I’ve always been a big believer in believing. It is core to making a life.

      Best,
      Alice

  21. I think a few things are missing in this description. The MAIN reason prescribing rights have been extended is because psychiatrists asked for it to happen. They pushed the pill solution, they pushed GP’s, family doctor’s, whatever you want to call them treating people as a form of early intervention. 20 years ago it was incredibly rare for GP’s in Australia to prescribe any of these drugs. They might prescribe a low dose of an antidepressents. The college of psychiatrists here, did a mass education campaign and insisted on the government educating GP’s about the importance of prescribing these drugs. That involved 7 hours of training, once off. The push here is for GP’s to prescribe them more and more and more. And for the GP to ONLY refer to a pscyhiatrist AFTER they have tried a number of different drugs, and multiple combinations!! My understanding of the US is that psychaitrists have not put up that big a stink about psychologists and others have prescribing rights. Doctor’s have a whole have questioned it, more because it takes away there doctor status, but psychiatrists have had the opinion that it will increase treatment rates!!

    As for what people come in and ask for, they ask for what they are educated to believe they can get. We are now told that being sad is a disease just like any other and that we have pills that can fix that disease. When someone tries to tell us there are better ways of treating it, we think they are crazy as the media bombards us with information about how effective these drugs are, and that these are real diseases, just like asthma, diabetes or the like. It used to be fashionable to see a therapist, that changed by psychaitrists. Equally though I don’t know that therapy is going to solve all the ills. We are not doing anything at all to change what is happening for people, we just tell them to talk about it all, tell that they have defective brains, we say that we can teach them how to think properly?? How can a person think wrongly. They think what they experience. Don’t like what they think, give them something else to think about, don’t just tell them they need to think differently!! But of course the faulty thinking comes in hook, line and sinkeer with the defective brain theory and it blames the patient, and that is much more socially acceptable, than anything else.

    • bjcirceleb,

      As each new addition of “prescribing priveleges” has come along in the Oregon, I was told it was to cure a “shortage” of psychiatrists in “undereserved” areas. Any questions I raised were shut down with accustions that I didn’t want any competition for my cash cow or “trough”.

      I did not “ask” it to happen or requests this. Check who paid for the potilical campaigns. Not me. Follow the cash trail. The “blame” is easy to place on psychiatrists in retrospect (A lot of this happens). But I was there. I am here.

      I have finally learned to shrug (rather than spend my time defending myself against accusation of greed) and say “Go ahead. Get “prescribing priveleges” for your profession (most recently for naturapaths, psychologists and social workers). I told anyone that would listen that they would NOT like what happened when all their professional skills were reduced to this one final common “prescriber” pathway.

      Becoming “prescribers” guts out and destroys all other professional skills.

      Psychiatry was gutted of all other skills when we were taught (and bought) that “prescribing” was the thing that made us “special” and meant we could “charge more” than other mental health providers. These are the same “baits” being offered to other professions to take on this “presriber” role.

      It was once rare for primary care doctors (GP, family practice) doctors to prescribe psychiatric drugs in the USA as well. This “prescriber of psychiatric drugs” role by GPs has been pushed by drug marketing and by the medical service provider corporations as “cost saving” and providing “accessible care” (back to the old “shortage” story).

      I feel sad at the situation we are trapped in. Wait a moment. Isn’t there a pill for this? 😉

      Thanks so much for the perspective from Australia.
      Alice

  22. Enjoyed reading this – thanks Alice. I graduated from my nurse practitioner program in 2011 and I’ve been so frustrated and unhappy with the care I’ve been giving at the few places that I’ve worked already. I would love just to have more time with people and really get to know them. I feel like a pill pusher and patients are more understanding than I think they should be sometimes. I want to help, otherwise I don’t want to do it.

    • Go ahead. That’s what Liberty is all about. Liberty seeks no permission and no approval. Liberty is self-directed action. Be Liberated. Embody Liberty.

      You can care for people and treat them and take care of them. There isn’t anything in your way. Just go ahead and do it.

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