“Dr. H. Otto Kaak: How Did Child Psychiatrists Become Mere Prescribers of Pills?”

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In the Lexington Herald-Leader, psychiatrist H. Otto Kaak of the University of Kentucky’s Center for Trauma and Children discusses his years working with juvenile delinquents and his shock and dismay at discovering how most of these boys “were receiving four, five or even six psychiatric medications.”

Kaak writes that one young man asked him with puzzlement, “Are you a psychiatrist?” and then commented that, “No psychiatrist I’ve ever seen has really talked to me before.”

“How sad that many of our patients see us only as pill prescribers,” writes Kaak. “How, in a generation or two, has this narrow view of child psychiatry emerged?”

Dr. H Otto Kaak: How did child psychiatrists become mere prescribers of pills (Lexington Herald-Leader, February 22, 2015)

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17 COMMENTS

  1. This is true of psychiatry in general. As long as the focus of psychiatry is on profits and the quickest way to achieve them is through the prescription pad, the status quo will persist. There could however be another reason for this as well. It has been my observation that many psychiatrists themselves seem to be somewhat socially awkward and naive. Its as if they grew up as outsiders to their peer group and developed a curiosity as to why they never fit in and why people think the way they do. The social status of a nerd is a painful one growing up. These kinds of people do well on standardized tests but lack common sense. Unfortunately, one can not produce a book on common sense.

    The lack of insight or “street smarts” common among psychiatrists makes them vulnerable to the charms of the slick, socially successful pharmacology sales rep. As long as psychiatry continues to attract the wrong kind of people into its ranks it will not improve.

    • That was my experience, too, the psychiatrists don’t seem to have any common sense. And they think those of us who have common sense, have “millions of voices.” An inner voice of common sense, however, is not “millions of voices,” it’s a good thing.

      I thought about going into psychiatry in college because the couple psych classes I took were quite interesting. But I was wise enough to realize that listening to people’s problems all day long would likely be a depressing job. And I didn’t have any psychological problems of my own that I wanted to investigate further. My gut instinct is you’re right, those who personally have psychological problems are likely the ones who end up going into the field.

      My recollection in college is that those who went into psychiatry were the students not intelligent enough to get into the architecture / engineering, business, or computer schools.

      The psychiatrist concludes by saying, “It seems a shame what has happened to our profession. I am embarrassed. But I will use that embarrassment to speak out for altering the procedures and policies that have led us to this state.” I agree, the psychiatrists should all be not only embarrassed, but ashamed of themselves. And, of course, repentant to all those they’ve harmed.

      • But of course, psychiatrists mostly DON’T listen to people all day – they ask a few “symptom” questions and write a prescription. They should, indeed, be ashamed.

        As to common sense, baseball announcer Tim McCarver once said, “I don’t know why they call it ‘common sense.’ They should call it ‘uncommon sense,’ because if it were that common, more people would have it!”

        — Steve

  2. A well starched narcotics dispenser could do their job – an average chimp would probably be better (if it’s in the right mood you can cuddle together or something). This is how pathetic it has become – not that psychiatry has had a shiny track record thus far but still.

  3. This article seems misinformed or misguided. Very few psychiatrists are trained to be psychotherapists, for child or adults. The average clinical psychologist and even the average Marriage and Family Therapist or Clinical Social Worker has had more training, and better-quality training in psychotherapy than almost any psychiatrist. I admit there are a few exceptions to this rule, but not many.

    In addition, psychiatrists generally expect to make $250 to $400 per hour for their services. The average psychotherapy session is about an hour long. No health insurance company is willing to pay for psychotherapy at this rate. Very few individuals are willing and able to pay out of pocket for psychotherapy at this rate. Some child psychiatrists are willing and able to have occasional brief therapy meetings with children or their parents, but there’s no reason to believe they will be more effective than other professions. They will probably be less effective.

    Child psychiatrists are pretty good at making diagnoses, given that the diagnostic categories for childhood mental disorders are a dreadful mess. They are pretty good at choosing the right psychiatric medication, at the right dose, for the right reason. There is nothing wrong with this. Thirty years ago, very few psychiatric medications were routinely prescribed to children. Now, a couple of dozen medications are routinely prescribed. This is a difficult task, which requires a well-trained child psychiatrist.

    • I know many psychiatrists. Most have a sincere desire to help their patients, just like doctors in any other medical specialty. They also want to make money, just like anyone else, in any occupation or profession.

      Most stockbrokers, bankers and lawyers are “in it for the money.” This is also true of some doctors, but only a minority.

      The health care system in the U.S. is irrational and needs fundamental reform, but individual doctors of any specialty, are not the enemy.

        • I would add that even the ones who have a sincere desire to help their patients don’t actually know how to do it. They’ve been given a hammer as their only tool, and so every problem is a nail. Most psychiatrist have limited to no training in psychotherapy, and have also been given rafts of bad information about “chemical imbalances” and genetic underpinnings of “mental illnesses” that are both inaccurate and helpful. Beyond this, the DSM (which was created primarily by the profession of psychiatry) is taken WAY too seriously and seen as representing real “diseases” when the document itself says that there is no clear line between normal and “disordered” and that any two people having the same disorder may have totally different causes and totally different needs. The serious application of this document causes great harm, even when the person doesn’t mean to, because it tends to focus all the attention on the client’s symptoms and conveys some mystical understanding of the situation that simply doesn’t exist.

          If psychiatrists really mean to do no harm, they would need to start with a much more humble attitude, admitting to their clients that mental health problems continue to be very mysterious, that many people find many different things helpful, and that they are interested in understanding the problem from the point of view of the client. To say that this is rare is a gross understatement, in my experience. Most people experience a professional categorizing them via the DSM, telling them that their brain is broken, but that there are treatments “like insulin for diabetes” that can make the situation much better. They also tend to convey that the client him/herself can do little or nothing about the situation themselves, and invalidate or minimize the importance of environmental factors and past emotional experiences as possible causal or contributing factors to their problem. In short, regardless of their intentions, the practitioners who follow the script they are trained to follow will not only fail, they will do damage and not even realize they are doing it. Only the more antiauthoritarian types who question the dominant paradigm will find their way to being helpful, and honestly most of those people would stay very far away from psychiatry, as it appears to be one of the most rigid and authoritarian fields one could possibly study.

          The road to hell is paved with good intentions.

          —- Steve

  4. One name— Dr. Joseph Biederman— a man responsible for the fact that infants have been prescribed drugs for “childhood bipolar disorder”. There should be a special place in hell for this man. We will never be able to account for all the damage he’s done, even if someone were bother to try to do so. The fact that he has been able to make a career of promoting the drugging of children while completely ignoring the well established knowledge of child development is evidence of psychiatry’s obsession with becoming a real science, human reality be damned; and our society’s real feelings about children, especially the spite and fear of teens hiding behind romantic myths of the wonders of being and having been young.

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