Is Psychiatry “Salvageable”?

Alice Keys, MD
108
465

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)

***

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.

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,
      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.

    • 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.

    • 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.

  5. “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.”

  6. 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.

    • 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. 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

  12. 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.

  13. 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.

  14. 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.

  15. 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

  16. 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!

  17. 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

  18. 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.

  19. 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.

LEAVE A REPLY