Anatomy of a Psychiatrist

James Moore
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This week on MIA Radio, we interview Dr. Sandy Steingard. Dr. Steingard is Medical Director at Howard Center, a community mental health center where she has worked for the past 21 years. She is also Clinical Associate Professor of Psychiatry at the College of Medicine of the University of Vermont. For more than 25 years, her clinical practice has primarily included patients who have experienced psychotic states. Dr. Steingard serves as Board Chair of the Foundation for Excellence in Mental Health Care. She was named to Best Doctors in America in 2003 and writes regularly for Mad in America. She is editor of the book Critical Psychiatry, Controversies and Clinical Implications due in 2019.

In this episode we discuss:

  • What led Sandy to her career in psychiatry and her particular interest in the critical aspects of psychiatry and psychology.
  • That Sandy’s initial interest was in biomedical explanations of psychotic experiences.
  • How, in the late 80s, the advent of new antipsychotic drugs caused an initial excitement because of the promises made about safety and efficacy, but that Sandy came to realise the problems with the drugs.
  • How she witnessed the over-promotion of the drugs and that the promotion was markedly different from the results of studies and her observations of patients that were taking them.
  • How a series of disappointments and recognition of some inherent flaws in psychiatry led Sandy to her interest in alternatives.
  • That the book The Truth About the Drug Companies by Marcia Angel, MD, had a big impact on Sandy’s view of the drugs during the 2000s.
  • Other influential books were The Daily Meds by Melody Petersen and Side Effects by Alison Bass.
  • That reading Anatomy of an Epidemic and particularly the problematic aspects of the long-term use of antipsychotic drugs caused Sandy to question how she was practicing.
  • That she found colleagues were sometimes angry at the conclusion that antipsychotic drugs might not be safe or lead to better outcomes for patients.
  • That this led to the investigation of alternatives such as Open Dialogue, training with Mary Olsen at the Institute of Dialogic Practice and discovering the Critical Psychiatry Network and the work of Dr. Joanna Moncreiff.
  • How Sandy approaches practicing from a critical perspective, particularly when expectations are in line with the dominant biomedical narrative.
  • Her book, Critical Psychiatry, due in 2019, which aims to help clinicians apply transformational strategies in their clinical practices.
  • That psychiatrists would be well served by welcoming lived experience input to their daily practice.
  • Why informed consent should be viewed as an ongoing process rather than a one-time agreement.
  • The problems that arise in clinical studies where experience is translated into a numerical form.

Relevant links:

Critical Psychiatry, Controversies and Clinical Implications (due 2019)

How Well Do Neuroleptics Work?

What We Are Talking About When We Talk About Community Mental Health

The Truth About The Drug Companies by Marcia Angel, MD (video)

Our Daily Meds by Melody Petersen (review)

Side Effects by Alison Bass

Open Dialogue

The Institute for Dialogic Practice

The Critical Psychiatry Network

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James Moore
James Moore has experienced the psychiatric system and psychiatric drugs firsthand following a stress-related breakdown. Believing himself to be fundamentally broken, he spent many years on psychiatric drugs before awakening to the reality that psychiatry has few answers for human difficulties. James produces and hosts the Mad in America podcast, in which he interviews experts and those with lived experience to challenge some common misconceptions about psychiatry, psychiatric drugs and the bio medical model.

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