Disclaimer: some doctors have excellent bedside manner and a deep and compassionate understanding of the body’s physical responses to emotions. They take care to understand their patients’ life experiences and to look beyond the purely physical. While these doctors make a point of not pathologizing anxious patients, this article is about those doctors who are lacking in this department and who, therefore, cause patients to feel invalidated.
Clinical Tunnel Vision
The medical profession likes to pinpoint: it seeks reasons that underlie symptoms, and often bristles when one is not found. When patients show up at doctor’s offices reporting vague or difficult-to-describe symptoms, many doctors’ kneejerk response is to test, rule-out, scan, and try to whittle it down to an exact answer. While this is necessary in a scientific discipline such as medicine, human experience is much more nuanced, and not everything can be easily, scientifically, or clinically defined. When some doctors cannot pinpoint a physical problem underlying reported symptoms, their immediate fallback is often to blame the symptoms on the patient’s emotional state. Many patients will be left with conclusions like “it’s just anxiety” or “I can prescribe you Xanax, Clonazepam,” or something from the well of quick-fix anti-anxiety medications. The medical profession excels at diagnosing and prescribing: “here is the problem, here is the solution.” While doctors often investigate deeply into a patient’s physical state, this is less true of the patient’s emotional state.
What is missing in the medical profession is a compassionate understanding of the range of what human beings experience and how these experiences impact their physical wellbeing. Anxious patients, for instance, often experience a slew of physical symptoms including, but not limited to, accelerated heart rate, respiratory problems, hypertension, migraines, muscle and joint pain, and gastrointestinal discomfort. The medical profession fixates on clinical answers to these symptoms, often ignoring other contributing factors, such as what is occurring in patients’ daily lives, their level of overwhelm, the traumas they have experienced, and their ongoing stressors. Treating patients through a humanistic lens can provide a holistic view of their lives and help doctors to better understand why physical symptoms of discomfort may be present beyond the easily diagnosable and identifiable. Many doctors’ unwillingness to look deeper constitutes a clinical tunnel vision that is detrimental to patients.
The “Neurosis” Label
Doctors who struggle to see through a humanistic lens and jump quickly to concluding that patients without clear physical diagnoses are “neurotic” jump from A to Z and fail to take into consideration anything in between. For some doctors, when there is no clinical answer, the only answer is that the patient is emotionally disturbed. This type of harsh labeling of anxious patients is neither reassuring nor healing. Rather, it promotes shame, humiliation, and a sense of rejection from the very professionals to whom patients go for reassurance and a sense of safety. The very idea that anxious people are “neurotic” is an antiquated notion. Freud viewed neurosis as an unusual or extreme reaction to stress, which only served to further the belief that the neurotic person was behaving in a nonsensical or “crazy” manner. And, almost a century later, some medical professionals still view anxious clients this way: they are acting “crazy,” being “extreme” or “ridiculous,” or are out of touch with reality.
The psychological literature on neurosis dates back at least a half-century. In the first half of the twentieth century, for instance, the psychoanalyst Karen Horney authored two books with neurosis in the title, and there were scores of others written by a variety of psychologists, psychiatrists, psychoanalysts and medical experts. In these texts, neurosis was described as a disorder of hysteria, attention-seeking, narcissism, and irrationality. This designation and understanding persisted for decades and, in fact, it was only in the mid-1980s that the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) officially removed the term “neurosis” from its collection of psychological disorders. At the time, this resulted in an immediate outcry from many diagnosticians, particularly those from the “old guard” and the era of Horney and her contemporaries. Doctors who maintain this outdated view of anxious patients reveal their ignorance of the nuance of human life.
A Humanistic and Existential View
While Freud and Horney were on the right track in pointing out that stress and anxiety often underlie what they termed “neurotic” behavior, they failed to connect these underlying factors to normal human experiences. Had they done so, they might have cultivated a humanistic and compassionate view rather than a harsh and pathologizing one. Stress and anxiety are experienced by all humans; the daily complexities of our lives and of the world in which we live contribute to these common human emotions. Patients who are made to feel that these responses are abnormal, ridiculous, or neurotic are bound to experience clinical invalidation. We understand now that our physical systems respond to emotional stimulus to an extent that these early psychologists did not. Read Bessel van der Kolk’s The Body Keeps the Score, Peter Levine’s Walking the Tiger, or any of the recent titles on the intersection of the emotions and the body and you will recognize this undeniable connection. But not all in the medical profession have caught up. There are still doctors who view anxious patients as neurotics and who do not devote the time or the effort to investigating the important connections between life stressors and physical symptoms. Perhaps they feel it is “unscientific” or not aligned with the medical profession’s adherence to the model of investigate>diagnose>prescribe. Whatever the reason, this approach does a grave disservice to patients and promotes continued suffering.
Fears about disease, physical decline, and death are so common to the human experience that they hold a continued place in literature, art, film, song, and other expressions of our stories. There is an existential component to physical health that cannot be ignored. Disease and death are great unknowns: we know neither when they will happen nor what they will feel like. To deny fears related to illness and non-existence or to view them as “silly” is to invalidate the larger experience of being human. Yet some in the medical profession often do just that: those patients who are labeled as “just being anxious” are made to feel that this is abnormal; but seen existentially, feeling anxious is anything but abnormal. The medical profession’s rigid focus on the scientific method leaves little room for viewing patients’ lives and circumstances through an existential lens and connecting life experience to physical and somatic experience. This is not to suggest that doctors should double as therapists or philosophers but, rather, that a little understanding of how existential concerns impact peoples’ physical functioning can go a long way toward creating a validating environment.
Pathology vs. Humanism
Pathologizing normal and commonly-experienced human emotions should be considered a form of harm to patients and a direct violation of the Hippocratic Oath. While not as blatant as botching a surgery or missing a cancer marker, the psychological and emotional damage of rigidly defining and labeling human experience through harsh clinical and medical terminology can last a lifetime. Once branded a “hypochondriac,” a “phobic,” or a “neurotic,” a patient may become averse to necessary medical treatment or to dealing with doctors and live with lingering feelings of shame. Does this mean that all doctors should be required to take courses on humanism and existentialism? Not necessarily, but they should, in the interest of holistic and compassionate treatment, be aware of how these factors influence and affect physical functioning.
When medical professionals make a concerted effort to understand their patients’ life experiences and current circumstances deeply and compassionately rather than focusing only on physical symptoms, they are writing the most valuable prescription, one that says, “you are understood, you are heard, and I do not judge you for your body responding to your experiences in this uncomfortable way.” It is time that the clinical intersects with the human in the medical profession. If doctors can recognize that no patient wants or choose to feel anxious, overwhelmed, worried, or panicked, or to suffer the physical responses to these emotions, they might think twice before they rush to medicalization of commonly experienced problems.
Beyond “Diagnose and Prescribe”
Rigid adherence to the model of “investigate, diagnose, prescribe” limits patients’ treatment options to those that are mainly pharmaceutical. This is not to say that there is never occasion when a medicine intervention is helpful but, rather, that the frequent medicalization of commonly experienced problems can limit other interventions and be detrimental to patients. Patients who are hesitant to begin medications, particularly antidepressants, benzodiazepines, or anxiolytics are often viewed as being “difficult” or non-compliant. Doctors rarely investigate underlying reasons why patients might be medication-hesitant. And many do not mask their frustration with these patients. Further, some doctors balk at the idea that anything but medication can be helpful to patients. In truth, however, a number of other evidence-based interventions and therapeutic modalities such as Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, Mindfulness-Based Cognitive Therapy, Rational-Emotive Behavioral Therapy, and others can be as effective in the treatment of anxiety as traditionally prescribed antianxiety medications or can work successfully in tandem with these medications. But some doctors’ unwillingness to take this type of integrative approach, and their inflexibility in terms of their long-accepted diagnostic model can severely limit patients’ sense of autonomy in their own treatment.
The anxious patient is often unwittingly caught between the clinical and the humanistic. They are often immediately pathologized for self-reporting very human challenges, such as anxiety or panic, and backed into a diagnostic corner of being labeled and medicated. As a clinical social worker and psychotherapist, I have found throughout my career that, in many cases, it is challenging to consult with medication prescribers on patients’ behalf. Some are simply unwilling to cross their knowledge base with mine; others choose to view medication and psychotherapy as completely separate entities that cannot not work in concert; still others reject the idea that talk therapy can be as helpful as medication. Whatever their reasoning, these prescribers ignore an important opportunity to view their patients’ treatment options holistically and creatively.
Integrating the Clinical and the Human
A sea change is needed in the medical professions’ tendency to pathologize everything and anything that comes into a medical setting. For the sake of this article, let us assume that the opposite of pathologization is humanization. Pathology assumes and concludes whereas humanism seeks to understand and takes a curious approach. If doctors can work towards integrating both a patient’s unique life experiences and situations with a clinical understanding, patients will be left feeling validated and treatment can be designed with their best interests in mind.
While this type of integration might be an idealistic notion, sometimes a paradigm shift is necessary to realign the incongruencies in longstanding and rarely-questioned systems. Primary care and psychiatry have taken on an institutional stature in the United States, to such an extent that they are rarely, if ever, questioned or challenged to adapt. But, as our lives and experiences become ever more complex, the medical profession must honor this reality by continuously seeking adaptive means of treating patients with dignity, respect, and in the interest of support and healing rather than of labeling and pathologizing.
I hope the folks who understand all this do not pathologize the emotions of people who prefer the medical model. That would be a shame.
Some people need their medication for myriad personal reasons and no amount of lecturing on trauma or shamanic drumming or grubby mushrooms or keepfit or yoga or prayer may clense them of that wish.
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Nowhere in this article is it suggested that “shamanic drumming or grubby mushrooms” replace a medical model. Rather, that a medical model be conscientiously intersected with a humanistic approach.
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Grammar means something,
Though communication is more important,
though your reference to the “Medical model” was made in hindsight by the comment “I hope the folks who understand all this do not pathologize the emotions of people who prefer the medical model.”to who referred your article though your article did not specify with any particularity the “medical model”.
Where inclusion was most kind rather start an argument over weither or not you mentioned in the first instance a reference to “medical model”.
Nor:
“suggested that “shamanic drumming or grubby mushrooms” replace a medical model. Rather, that a medical model be conscientiously intersected with a humanistic approach.”
Where now that we clarified all that we get to my point that such contemporary references are made necessary in that Adam Smith’s Wealth of Nations can be correlated directly to Psychiatry where the divisions “of labour” exact their needs as required, as
“The perfection of manufacturing industry, it must be remembered, depends altogether upon the division of labour; and the degree to which the division of labour can be introduced into any manufacture, is necessarily regulated, it has already been shewn, by the extent of the market.” (Adam Smith Wealth of Nations) that creates such divisions for the sake of profits professional expediency.
“In the progress of the division of labour, the employment of the far greater part of those who live by labour, that is, of the great body of the people, comes to be confined to a few very simple operations; frequently to one or two.”
For example seeing patients for very brief periods and by prescribing pills (pushing pills) in the medical model that bypassing and dispenses with the patient as a matter of capitalist expedencency where patents become secondary in the medical model, as precision and expertise is often dispensed with in a “rush to judgment” that the “talk therapy” in what often fails to provide in its representations of capitalist medical health, mental health care.
In what must fail as “the understandings of the greater part of men are necessarily formed by their ordinary employments. The man whose whole life is spent in performing a few simple operations, of which the effects, too, are perhaps always the same, or very nearly the same, has no occasion to exert his understanding, or to exercise his invention, in finding out expedients for removing difficulties which never
occur. He naturally loses, therefore, the habit of such exertion, and generally becomes as stupid and ignorant as it is possible for a human creature to become. The torpor of his mind renders him not only incapable of relishing or bearing a part in any rational conversation, but of conceiving any generous, noble, or tender sentiment, and consequently of forming any just judgment concerning many even of the ordinary duties of private life. Of the great and extensive interests of his country he is altogether incapable of judging; and unless very particular pains have been taken to render him otherwise, he is equally incapable
of defending his country in war.” (page 664 Adam Smith, An Inquiry into the Nature and Causes of the Wealth of Nations Author: Adam Smith Release Date: February 28, 2009.”
Where AI (Artificial Intelligence) and computers will push the divisions of labor to widen to the point where machines will make humanity irrelevant, immaterial and redundant for it represents the disease not the cure in what is a dysfunctional dystopian society represented by its divisions not by a social existence for as a society they have not agreed on that either all while the ship sinks and more primitive forms of “barbarisms” excel.
Where “In the West, mental disorders are often seen as medical conditions that need to be treated with medication or other medical interventions. But in many traditional cultures, mental health problems are seen as spiritual issues that need to be addressed through religious or shamanic rituals.”
In what is antithetical to treatment (The Relationship Between Culture and Mental Health Therapy Brands)
in what I find all too convoluted where humorously we can ask which come first the “Narcissist or the Narcissism “? Where the political obstacles prevent treatment due to political concerns for the most rudimental needs where six hours in the emergency can cost the government over six thousand dollars without any determined cause or solution in what can easily be a daily problem that most can not understand as a question of treatment but of political economic stupidity.
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Genuine medications are used for treating conditions with a demonstrated physical etiology. Psychiatric neurotoxins, on the other hand, disrupt the normal functioning of the brain in order to suppress thoughts, emotions, and behavioral patterns regarded as “pathological,” “abnormal,” or “dysfunctional” according to social and cultural criteria prevailing at a specific moment in time. If certain people choose to undergo chemical lobotomies for “myriad personal reasons,” as you put it, they should have that prerogative, but let them first be made aware of the risks of such questionable therapy over the long term. This caution is especially advisable in the case of children who are being drugged by their parents for hypothetical conditions such as ADHD and oppositional defiance disorder.
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“Genuine medications are used for treating conditions with a demonstrated physical etiology.” It is now common to hear the complaint that antidepressants increase serotonin, but that there is no demonstrated lack of serotonin in depression. To a large extent, I agree. However, antidepressants were discovered by accident in the late 1940’s. Medicines given for tuberculosis were serendipitously found to improve mood. Other medicines being tried to help schizophrenia were also serendipitously found to improve mood. The benefits were seen long before any mechanism of action was proposed. The early experimentation revealed that a major effect of those “discovered by accident” antidepressants was an increase in monoamines, including serotonin. This, in turn, led to the hypothesis that depression was due to “not enough serotonin.” Joel, you are absolutely correct. There is precious little evidence that depression is due to not enough serotonin. But no well-informed psychiatrist any longer believes that extremely simplistic explanation. Depression involves inflammation, mitochondrial dysfunction, deficient BDNF, poor maintenance of neuronal structures, insulin resistance, glucocorticoids, and other such factors. In fact, antidepressants, even largely serotonergic ones, address those factors along with (perhaps even in spite of) increasing serotonergic activity in the brain. There is in fact a very large literature showing neurochemical and physiological aberrations noted above in Major Depression, and antidepressants address many of them.
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Depression most often involves having a shitty life. What is used to measure that, Scott?
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True. But a lot of people have shitty lives that don’t suffer depression, and I have heard more times than I can count, ” Things are so good in my life. Why am I so depressed.” It’s Biopsychosocial.
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“Depression” is not caused by one thing. That’s the first error of psychiatry – lumping all “depressed” or “manic” people together as if their behavior or emotions tell us what is wrong with them or what they need. Saying someone “has depression” tells us very little about why or what to do about it. “Treating” something makes no sense if that “thing” isn’t really a thing at all, but a phenomenon with many possible causes and solutions.
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I assume that you are familiar with Dr. Peter Breggin’s critique of so-called psychiatric medication, which he rightly calls neurotoxins (see “Toxic Psychiatry” and “Brain-0isabling Treatments in Psychiatry”). I would also refer you to the studies conducted by Danish psychiatrist Peter Gotzsche and British researcher Joanna Moncrieff, who have dispelled the pernicious myths of biological psychiatry.
I also assume you are aware that slightly more than 60% of the membership of the DSM panels that arbitrarily vote supposed psychiatric disorders into (and occasionally out of) existence have financial ties to pharmaceutical companies and ECT device manufacturers. I consider this conflict of interest morally repellent and yes, evidence of a “money-grubbing” mentality.
Lastly, you parrot the claim that various states of emotional distress can properly be labeled “psychiatric illness.” Apart from conditions such as dementia that have a conclusively demonstrable physical etiology, the hundreds of putative brain diseases listed in the DSM were NOT discovered through the rigorous scientific experimentation and testing that are standard protocol in genuine science and medicine. To cite one blatant example–prolonged grief disorder, which was classified as pathological behavior around 2010, if I’m not mistaken. Do “patients” who continue to mourn a deceased love one after an arbitrary limit of one year suffer from a verifiable “genetic predisposition” or faulty brain circuitry that needs to be “stabilized” with potent neurotoxic cocktails, insulin coma, electroshock, transcranial magnetic stimulation, or whatever else may be the latest fad promoted as the latest advance in therapy?
To me, at least, the harrowing stories of those numerous MIA contributors whose physical health and emotional well-being have been harmed, if not destroyed, by the treatments purveyed by the mental health industry, far from being a “patently absurd” tacit assumption as you claim, offer compelling proof of a thoroughly corrupt, duplicitous system (e.g. Dr. Ronald Pies’ defense of the chemical imbalance theory as a useful myth propagated to persuade patients to swallow toxic meds). I by no means exempt from criticism the overwhelming majority of psychologists and other credentialed “professionals,” who, for insurance billing purposes, base their diagnoses on the sham categories of the DSM. They too are complicit in the continued survival of this pseudo-scientific cargo cult.
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Something tells me you are not terribly open-minded about possible merits of psychiatry–or even a merit. Best of luck to you, Joel.
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It is true that there is a “very large literature” — but it’s largely false for many reasons that Robert Whittaker and colleagues have been ferreting out. Congrats to Phil Lane for a fine piece — which might be strengthened with a few concrete examples from his direct experience.
Peter Sterling@whatishealth21
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Scott, something tells me you’re not terribly open-minded or even interested in the numerous harms caused by your precious “biopsychosocial” psychiatry.
Nevertheless, watching the following video just might do you some good: “3 Criticisms of Modern Psychiatry”, courtesy Dr. Josef.
Best of luck to you, Scott.
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I would no more suggest replacing seroxat with drumming or spiritual healing than I would suggest a serious drinker replace a bottle of vodka a day with accupunture and walking holiday. I might however enquire whether the person wanted to enter into a conversation about when they started drinking so heavily and what was happening at the time, what its like when they don’t drink so much and whether they are concerned about the health impacts of the drink on them.
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“Let us assume that the opposite of pathologization is humanization. Pathology assumes and concludes whereas humanism seeks to understand and takes a curious approach.”
I agree. Pathologizing human suffering needs to end. It’s been proven to increase stigma and have horrifying consequences.
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Pathologizing patients is a way to make a very profitable living. Hippocratic oath be damned!
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It is suggested by the author that psychiatrists dole out medicine instead of taking the time to understand the “root causes” of mood disorders, particularly anxiety. As the disclaimer so well notes, many if not most psychiatrists do consider and address the full range of emotions and experiences a patients presents with. Indeed, this is not only human and compassionate, but also the biopsychosocial model that we are taught. The tacit assumption, held by many that contribute to this site, that psychiatrists are robotic, Big Pharma-driven, money grubbing monsters devoid in compassion, sensitivity, and basic humanity is patently absurd. In any case, the main reason a psychiatrist might prescribe medication for anxiety without first trying to ferret out the “root cause” is when the anxiety is so severe as to be disabling, and/or if the anxiety is so severe that it gets in the way of pursuing “root causes.” Medication can provide fast relief in such cases. This can often mean rapid restoration of being able to sleep, function at work, continue college classes, and manage one’s life. It can save marriages, careers, and educational pursuits. Importantly, there is no compelling evidence that such medication prevents subsequent consideration of why a person feels as anxious as they do. However, the reason I put “root cause” in quotation marks is that it isn’t true that anxiety is always due to some trauma or misperception of the world that a clever therapist can put their finger on and change. Some individuals are genetically predisposed to anxiety disorders. Moreover, whether due to genetic predisposition or not, many patients that suffer severe anxiety gain no benefit from psychotherapy. The literature has long shown that severe and resistant psychiatric illness responds best to a combination of medical treatment and psychotherapy. Along with comprehensive medical evaluation and treatment, that usually did include medication, I have always offered or referred patients to psychotherapy.
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I assume that you are familiar with Dr. Peter Breggin’s critique of so-called psychiatric medication, which he rightly calls neurotoxins (see “Toxic Psychiatry” and “Brain-0isabling Treatments in Psychiatry”). I would also refer you to the studies conducted by Danish psychiatrist Peter Gotzsche and British researcher Joanna Moncrieff, who have dispelled the pernicious myths of biological psychiatry.
I also assume you are aware that slightly more than 60% of the membership of the DSM panels that arbitrarily vote supposed psychiatric disorders into (and occasionally out of) existence have financial ties to pharmaceutical companies and ECT device manufacturers. I consider this conflict of interest morally repellent and yes, evidence of a “money-grubbing” mentality.
Lastly, you parrot the claim that various states of emotional distress can properly be labeled “psychiatric illness.” Apart from conditions such as dementia that have a conclusively demonstrable physical etiology, the hundreds of putative brain diseases listed in the DSM were NOT discovered through the rigorous scientific experimentation and testing that are standard protocol in genuine science and medicine. To cite one blatant example–prolonged grief disorder, which was classified as pathological behavior around 2010, if I’m not mistaken. Do “patients” who continue to mourn a deceased love one after an arbitrary limit of one year suffer from a verifiable “genetic predisposition” or faulty brain circuitry that needs to be “stabilized” with potent neurotoxic cocktails, insulin coma, electroshock, transcranial magnetic stimulation, or whatever else may be the sensational fad promoted as the latest advance in therapy?
Let me just conclude by saying that the harrowing stories of those numerous MIA contributors whose physical health and emotional well-being have been harmed, if not destroyed, by the treatments purveyed by the mental health industry, far from being a “patently absurd” tacit assumption as you claim, offer compelling evidence of a thoroughly corrupt system based on lies and an insatiable lust for power, prestige, and financial gain.
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“…the main reason a psychiatrist might prescribe medication for anxiety without first trying to ferret out the “root cause” is when the anxiety is so severe as to be disabling, and/or if the anxiety is so severe that it gets in the way of pursuing “root causes.”
Sounds great, except for the pesky bit that psychiatrists aren’t the ones writing most of the scripts.
Lemme tell you how this works from a patient perspective. Long time ago now, I was feeling pretty awful, hurt all over all the time, and had for a while. I suspected fibromyalgia, since I could think of nothing else. And yes, feeling like hammered crap every day and not knowing why can do a job on one’s head and mood. Anyone feel all happy-clappy when they have the flu? No, didn’t think so. So I went to my GP, a doctor I’d had for a while and who had experience with me for the usual small this and that. The day I saw him, I was feeling particularly bad, and was very very down. For that reason, I just didn’t have the energy that day to put on my public women-have-to-smile-all-the-damn-time face, and let him see how down I was along with the physical pain. Big mistake. Think somewhere in the 3-7 minutes range of how long I’d been in the exam room with him. He starts writing a script, then hands it to me. I knew what it was, and said. “This is an antidepressant. Why are you giving me this?”. His very careful reply (careful replies usually indicating someone tippy-toeing around not saying what they are REALLY thinking) “Well, people in your condition are usually depressed.” I shot back, “I’m not depressed! I’m PISSED OFF!!” And I was, pissed off and frustrated at not knowing what was going on, and instantly annoyed at im for trying to medicate me into what? Feeling better mentally so I could go forward and just ignore the pain?
So, based on 3-7 minutes with nothing more than looking NEAR tears (which can be sadness OR frustration), no previous visits with me being a sad sack or complaining of unpleasant mental states, and zero inquiries about anything else going on in my life (did my dog die, etc), he was all hot to medicate me into being happy while I hurt. One thinks he probably assumed my “depression” was CAUSING the pain. (I’ll leave off detailing my suspiscions as to how his assumptions about women probably impacted his prescribing) And yes, I declined to take the AD, because I knew I wasn’t depressed, I was in need of answers.
Eventually, I saw a rheumatoligist and WAS dx’d with fibro, and a neuro dx’d me with migraines (still not sure than one is correct, although I do have headaches of some sort) and then a mere few years later, the thing that brought it ALL into focus, even the fibro dx: An MS dx. (Fibromyalgia being more than three times as common in people who are later diagnosed with MS). And after a period of mental adjustment to a truly crappy dx, guess what? I’m still NOT depressed and still not on an AD.
So my GP experience was a real wake-up call for me. That time in his office was, in fact, what led me to MIA. Even back then it was clear that GPs – who are even more harried now – are not getting a full picture, yet are often passing out ADs like candy with a handy Pez dispenser. Given that everyone comes in with similar cultural assumptions, goes through similar medical training, and works under the same pressures imposed by for-profit medicine, I find it hard to believe that psychiatrists are SO different than GPs in their base assumptions and the way they approach patients. But I don’t know that for sure, since apart from a rollicking good time of a full neuropsych work-up after my MS dx, I have and will continue to assiduously avoid psychiatrists.
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Scott, your glowing depiction of psychiatry seems irrational to me since the reality is this: most psychoactive drugs are prescribed by general practitioners who don’t have the time to engage in meaningful dialogue with emotionally distressed people. You seem blissfully unaware of psychiatry’s many failures: its lack of informed consent regarding the possibility of iatrogenic harm and/or protracted withdrawal, to say nothing of the damaging effects of psychiatric labels themselves, labels that some leading psychiatrists publicly admit are bullshit.
The fact is handing out prescriptions for psychoactive substances comes with significant risks — no matter how many times you utter the term “biopsychosocial”.
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This is 100% the direction healthcare should take. The negative aspects of the human experience or the human condition should not be regarded as a disease process best treated with medications and procedures. However, this article implies the healthcare providers are to blame when in many cases their hands are tied. Forced to treat patients with minimal time but still do “something” lest the patient be unhappy with a lack of action; providers provide medicine as it is all they can do in such a short period of time.
It is also important to note the physicians and other providers are human as well. It is hard to take on the emotional problems of an entire panel of patients and be the perfect empathetic and compassionate listener. The expectation of a humanistic connection where physical symptoms are treated without medications but in the timeframe demanded by society is quite a heavy burden. And often not what the patient prefers.
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Agree. However, there is a problem. The trend here in the US is to promote efficiency and profit. Those currently seem to be the bottom line in health care. Health care seems to have become a “business” for making a profit. One sees ones physician and 15 minutes later walks out with a prescription without any discussion of possible underlying causes.
It might be convenient to point a finger at providers. However, few medical professionals, at least in my area, remain in private practice and can order their workload how they wish. Where I live, every hospital, every medical practice, has been bought up by a large medical organization. Everyone is “owned” by them. Not only are patients negatively affected, so are the providers, some of whom have the wherewithal to move to another location that focuses on patient care, not simply efficiency and profit.
To escape this medical monopoly, I go out of state for my medical care. (I live near a bordering State.) For years I have gone to a physician-owned clinic and have largely received good care. But the clinic was recently boyght by a large medical group out of a (very) large city in a third State. Providers are pressured to see more and more patients. My primary care physician has 1,500 patients – and yet he will take the time to listen, however long it takes. He is staying, yet some of my other providers have left the practice and gone elsewhere. One is being sued for leaving and going to a practice in a neighboring county.
So, yes, Phil’s observations are legitimate, and I would agree with his premise. We need a more humanistic approach, desparately. But with the current trend that focuses on efficiency and profit, treating healthcare as Big Business, providers are being screwed along with their patients. Somehow, somewhere, sight has been lost as to what really matters, as to what is actually important. And it’s NOT making a profit.
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I don’t see this as only a problem with the medical profession. From a CRT point of view (which I don’t subscribe to) it is a “white male” problem. I see it more as an educational problem in general and more specifically a problem stemming from the protector’s need to remain emotionally strong when faced with dangerous or terrifying situations.
From my training, emotions below the level of Antagonism are more appropriately “misemotions.” But you can never expect to assist a person by invalidating them (except in extreme situations). So my training involves skills to take into account “minus emotion” without invalidating it.
When a medical patient is stuck in fear or anxiety, even anger, a mental health intervention IS indicated. However, the current “mental health” system has no idea what to do with misemotion, beyond prescribing drugs, which is ignorant and destructive in the long term. The medical doctor is stuck in the middle.
We ALL need to learn more about emotions, what they are for, what causes them, and what to do about them. You would certainly expect professionals in the healing arts to have this training. Unfortunately, it is currently not widely available (though it IS available). In this case, I would not focus on medical professionals. This is a widespread human problem.
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It’s odd that you mentioned CRT without providing any context so out of the blue and then negate yourself.
However, it’s important to note that Europeans did not colonize much of the world solely through brute force (though they maintained their colonies in this manner afterwards), but also through psychological tactics that continue to influence medical systems (many of the medical great breakthroughs in US used blacks as subjects without their consent which anyone can look up) and the mental health paradigm today. It is important we do not put red roses on to the past with today’s perceptions. American past is even uglier than we want to see!
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“In any case, the main reason a psychiatrist might prescribe medication for anxiety without first trying to ferret out the “root cause” is when the anxiety is so severe as to be disabling, and/or if the anxiety is so severe that it gets in the way of pursuing “root causes.” ”
Other reasons psychiatrists might diagnose medication for anxiety without first trying to ferret out the ‘root cause’ could be that psychiatrists are pretty clueless or uninterested when it comes to recognizing autism (but also ADHD), particularly in women. Instead, psychiatry all too willingly and frequently misdiagnoses these conditions as bipolar 2, OCD or BPD. They need to do better and stop getting this so wrong. Cherry-picking from a person’s symptoms and coming up with a diagnosis they can medicate isn’t good practice. It’s misdiagnosis! Understanding autism and ADHD goes a long way toward reducing the depression and anxiety of an autistic person. A lot of psychiatrists are not interested in autism because there is no medication for it.
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“Pathologizing normal and commonly-experienced human emotions should be considered a form of harm to patients and a direct violation of the Hippocratic Oath”
This is spot on! Thanks for this great blog Phil. Doctors in general, and psychiatrists in particular, are often narrow minded and rigid thinkers. Many have a God complex. After given what turned out to be an overblown, bogus cancer dx in 2009 (and informed I had little chance to survive) my eyes were opened to how much corruption and abuse of trust and authority there is in ‘health care.’ When I decided to make decisions that were proven to be wise and best for me the doctors got their knickers in a knot. Because I declined their self-serving orders their egos could not handle it and they colluded to condemn me and pathologize me for that.
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I lose patience fast reading a “Disclaimer:” saying “some doctors have excellent bedside manner and a deep and compassionate understanding of the body’s physical responses to emotions.” They take care to understand their patients’ life experiences and to look beyond the purely physical.”
Is like saying some Psychopaths have less in common with Sociopaths than unruly middle school students in what does not begin to address the systemic failures of health care and and especially mental health care under one for of capitalist society or another, as capitalism best mimics Schizophrenia (CAPITALISM AND SCHIZOPHRENIA by Gilles Deleuze and Felix Guattari Translated from the French by Robert Hurley, Mark Seem, and Helen R. Lane). In what varies slightly from one clinician to the next depending on the chaos, corruption and criminality of their capitalist reimbursement system that defers payments from one RICO fraud to the next. In what is criminal in nature as was “enacted by Title IX of the Organized Crime Control Act of 1970 (Pub. L.Tooltip Public Law (United States) 91–452, 84 Stat. 922, enacted October 15, 1970), and is codified at 18 U.S.C. ch. 96 as 18 U.S.C. §§ 1961–1968):
Where the Financial head of what is now the prominent regional hospital posed a question as he claimed he in representing the hospital was only reimbursed twenty-five for every one hundred cents they billed where they could always explain why they were billing seventy-five cents more than they were getting paid in what is at best a tax scheme where they use creative bookkeeping and that twenty-five cents to perpetuate a tax or financial fraud while they write off 75% of their charges so they can defer a net loss fifteen years into the future in what the US IRS forty years ago called a write-off, as health care most often is reminiscent of a racket and crime.
Where doctors, clinics, and healthcare systems can not be expected to come close to what can be called healthcare when they are so very busy in their pretences as corporate clinicians who are expected to give of themselves so as to live a fairy tale life of altruism in the antithesis of capitalism economics.
Where some what have to the social model of of America subsidizing the failed aspects of capitalist medicine in the “Third world” and why? but for the same schizophrenic political model within which those like Dr. Ron Paul glorifies as their narcistic sociopathic existence where he claims he charged patients only three dollars for a five ten fifteen minute session where often the minimum wage only offered fifty cents an hour and doctors can be so clever to get others to work for them.
Where the federal politicians often design bottle necks based on block grants to 50 US states and 3000 plus counties, so as to the lack in a health care system based on political needs and concerns rather than patients where “free” universal health is an absolute need in California as much as it is with one foot over the border in Oregon, Nevada and Arizona, just as it is in New York, as much as it is likewise one foot over the border in New Jersey, Vermont and Connecticut. Where so many of the improprieties of health care providers are results of the irregularities of Health Care economics reliance on orgone energy and empirically deficient metaphysics, science, and humanity in what exists by design as part of the Tuskegee experiment abuses.
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“We” are the ones who’ve been pathologized (and not you and/or ones who prefer the medical model). “We” are the ones who -when we questioned the efficacy of pills we’ve taken passively for many years- were told (1) there is nothing else, and (2) no – we won’t help you try anything else – including even helping you with titrating off. “We” have been scorned by NAMI folks during peer-to-peer training for not supporting the “stay on your meds” routine. We are the ones denied access to IOP programs when we express unwillingness to consider medications. “We” are the ones who’ve sourced alternative treatments and found them very useful (and also never suggested by medicine). Yet “we” are the ones you scorn, because you align with the powers that be, while we have found flaws. So if you are uncomfortable knowing others find your status deeply troublesome … get a life. You were never the only fish in the sea despite your assumptions we never existed.
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The medical model is a failure in helping the patients because…turning to Szasz…psychiatry is slavery.
Looking back over USA history one sees so called enlightened slave owners. Problem? Slavery is slavery is slavery. All pills all talk all self pay all covered by private insurance or government programs…
Humanistic bio reductionist bio psycho social….
The many flavors of modern day slavery.
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I wonder about basic human needs, such as to feel we know each other’s state of being, which seems fundamental for survival. And then determine how the satisfaction of this need has varied through life and now. Wouldn’t the lack of this need explain a lot about all the various states of feeling people suffer from? When the mind would try making all kinds of feelings just to keep us alive? Then problem would usually not be from defects in the brain, but a result of the messed up culture we live in. Maybe when the brain works in that extreme, it does get to where it’s not working well. So psychiatry is the art of helping us to somehow live without our most basic needs.
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