1 Boring Old Man

Yes, this is the major focus of concern for me. I am contemplating a multi-prong approach in the Boston area: Law- Attorney General, Martha Coakley, Media- Boston Globe ; WBZ, WGBH/PBS- and the ever popular *grass roots* activism permeating all local townships; colleges and independent child welfare professionals/advocates.

The “Gloves are off”— it is time to take the *bad boys* at HMS/MGH to task!

Wow! Katie, I wish you all the best in slapping those HMS/MGH crooks around.

Have a lovely wanderabout, Dr. Mickey.

Does it really matter now that nonpsychiatrists write more psychotropic prescriptions than psych MDs do? The damage is done, the only way to impact on more responsible prescription writing is for my colleagues to be sued for reckless, irresponsible prescribing to make them rethink writing for psychotropics like pez.

Yeah, like that is going to happen! Patients until proven otherwise who see me want meds first, later, and always. Here’s a tip to those looking for treatment, not just a quick fix: if you have failed several meds trials with no impact on your symptoms, and not in therapy, maybe that is an important element to care!?

That’s great Joel. I’ve been trying to get affordable, helpful talk therapy since the nineties, having solved many problems in the past through various kinds of counseling and psychological work I’ve done on my own. Somewhere around the eighties I started hearing that I should take antidepressants before we get started to “make counseling more effective”. I saw a couple of psychiatrists ONCE for this reason.

People often ask for pills because that’s all they’re going to get unless they have a fantastic insurance plan that covers mental health services and/or enough money to pay a hundred dollars or more per session to TAKE THE GAMBLE that that mental health professional is going to listen to them and help them instead of listening for key words and responding from whatever school of counseling they prescribe to.

Given a choice of spending more money than I make in a day to someone who can’t be bothered to struggle with what I am struggling with instead of boxing it up neatly and giving me middle class advice for my working life or staring at her nails the whole time I talking with a Prozac mask on her face— I’ll try a few pills and see how that goes or just stop trying.

have a pleasant trip

Well, Joel, I don’t think it matters who is writing more prescriptions or who is or has handed out psychotropics like pez. I think we have to level the playing field by establishing some fundamental values and guidelines with regard to the practice of medicine as it reflects scientific knowledge and both humanistic and ethical practice. Violating the trust of the public via fraud and making a profit from the exploitation of vulnerable people are criminal acts, NOT grounds for civil action and $$$ settlements/penalties.

Mickey, I agree with your criticism of direct-to-consumer advertising, but when you ask the question “Advertising products that people can’t even buy?” it also has to be emphasized that in most medical settings, as you know, no one ever “buys” a service or a drug.

How much does a month of Abilify “cost”? A month of Paxil? I have no idea. Neither does the patient, the pharmacist, or anyone at the insurance company. Until we change the fact that third parties pay for virtually all medical care according to some complex and opaque formula that we can’t even begin to understand, those entities who seek to profit will find some way to do so, which I can guarantee will not be on the basis of the outcomes they deliver. Along the way, people like Wiley will continue to look for what they want (and need) but will come up empty-handed because there’s no incentive for anyone to provide it.

Steve, “those entities who seek to profit” depend on prescribers. Prescribers depend on guidelines for treatment issued by medical researchers at academic medical centers. Academic medical centers depend on pharmaceutical $$ to fund research and willingly comply with numerous unethical practices dictated by PHARMA’s private research companies. Prescribers depend on medical journals, the APA, AMA, NIMH for dissemination of information re: treatment guidelines and standards of care to remain in compliance with health insurance guidelines for reimbursement.

“Those entities seeking to profit” have purchased the power to dictate the practice of medicine, though sorely lacking in the knowledge, skill or motivation to assist people in healing or actually curing diseases. PHARMA owns the practice of medicine – but when damages from their ineptitude exceed their profit margins, it will be doctors who bear the burden of responsibility for these damages.

No one profits without the complicity of doctors, who currently are under suspicion for having their own financial gain motives– inability to resist PHARMA $$$, or challenge the corruption within their own profession.

It’s not rocket science and it isn’t top secret information. And there are still dedicated, competent human beings who are motivated to provide for the needs of others who are suffering. Journalists and activists will be doing the teaching – for doctors who have forgotten what their profession is based on: outcomes !!

From Edward O. Wilson’s The Social Conquest of Earth:
“The successful scientist writes for peer review in hopes that “statured” scientists, those with achievements and reputations of their own, will accept his discoveries. Science grows in a manner not well appreciate by nonscientists; it is guided as much by peer approval as by the truth of its technical claims. Reputation is the silver and gold of scientific careers. A scientific reputation will endure or fall upon credit for authentic discoveries. The conclusions will be tested repeatedly, and they must hold true. Data must not be questionable or theories crumble. Mistakes uncovered by others can cause a reputation to wither. The punishment for fraud is nothing less than death – to the reputation, and to the possibility of further career advancement.”

If this is true, then why does it seem to not be applicable to the “science” of psychiatry? Why do the Nemeroffs and Kellers and Schatzburgs continue to thrive?

Per Peggi, because humility, shame, and sense of community died as the internet and other distant interactions by media, including the pervasiveness of phones when not sitting in front of a screen, took hold.

Also, greed and lust are basic human nature without boundaries. Besides, how many colleagues made the huge mistake of succumbing to the metastasis of the business model running health care, and grew to move beyond disgust of how the insurance and pharmaceutical industries just perversely profited from health care monies, and instead just jumped into the pool of “if ya can’t beat ’em, join ’em.”

Watch George Carlin’s rant at the end of his 1996 show “Back in Town” regarding why politics is doomed to fail us continuously. It is not the politicians, and in this case, the psychiatrists who suck, but, the public. People do not want to take a multifaceted approach to care. How ironic Carlin’s comment fits here too: garbage in, garbage out, to mean risking mutlichemical exposure and then dealing with multisymptomatic side effects.

By the way, the money argument about not accessing psychotherapy only goes so far. I’ve worked in numerous community mental health clinics over my 20 years, and I have met therapists who are committed and invested. Yeah, but it is not the patients who share that perspective more than not. Poverty is pervasive in what people lack in ability and access. And, believe the lies their alleged leadership sells, not only politically, but spiritually, culturally, and in basic community investment.

“If you want to get better, take a pill, but if you want to get it right, face the truth.”

Think you will read that in some form in any election slogan!?

“The truth?” Really?

Responding to Peg:

If this is true, then why does it seem to not be applicable to the “science” of psychiatry? Why do the Nemeroffs and Kellers and Schatzburgs continue to thrive?

There is no peer/colleague challenge within the psychiatric profession, aside from the heroic few who have stood alone in their shining moments of demonstrating both integrity and courage. The public has a more difficult challenge with regard to addressing the corruption in this elite field,. It is difficult to gain the ear and the investment of lawyers and politicians who show deference for MDs , only closely scrutinizing the corruption in the business practices of PHARMA.
Prof. David Healy’s latest book, Pharmageddon is proving an excellent resource for mental health reform-activist groups. There is, for us, a rather arduous education process required for intelligent and appropriate engagement on the basic issues – understanding psychiatry as it has evolved over the past 2 decades. I am not alone in concluding that psychiatry lacks the requisite science and clinical success to remain a medical specialty.

In response to Dr. Joel Hassman’s negative references to “the public”,above, I have to remind him that even if he has no natural compasionate sentiments toward the public, he might want to consider that his commentary is bad for the “business” he is in!

Thank you, Kara….I, too, am very much the “public”, just a concerned mother doing the best she can. I have worked at this “education” for six years. Is Pharmageddon “accessible” for a non-science person?? Bob Whitaker’s Anatomy of an Epidemic and Kirsch’s The Emperor’s New Drugs and many others are “accessible” but have been afraid of tacklind Dr. Healy’s. Do I need to read it too?

“You can’t handle the truth” occurs often in treatment. As at sites like this as well.

And by the way, working as both a private practice and community mental health psychiatrist for the past twenty years and watching the de-volition of care in mental health does give me some right to be critical and candid. You know what I don’t get at mental health blog sites since reading them for the past couple of years? Clinicians are quick to be attacked by non clinician commenters and then these “attack dogs” as I read them scream the loudest should someone take such antagonistic commenters to task. I know what it infers to me, why the blog authors permit it and sometimes almost cater to it borders on incredulous to me.

To end my last comment on this thread, patients who are interested in accessing the full gamut of treatment options seem to genuinely appreciate my offering such choices. I don’t get why people who have failed meds are so outraged, per what I have read at sites like this, just rage further at such non pharmacological options.

Some people just want to demean anything psychiatry or mental health in general have to offer, eh? God knows that is the agenda of Scientology.

Thank Katie Holmes for putting them back in the spotlight now!

Mikey, can you email me at fiddaman@zoho.com please. I changed email and forgot to bring yours across. Have some docs you may find interesting.

Joel, I am a clinician who believes that truth is discovered in the space created by meaningful dialogue–when all vested parties are seeking to achieve a greater understanding. The space is for processing what has been heard- no matter the issue or the emotional tone – hearing happens when everyone is equally respected and valued. Public forum, private practice, interpersonal relationships in general, all require the same acknowledgement of the inherent value and dignity of the lives of others–disagree with ideas or convictions, but refrain from becoming so arrogantly attached to your own views that you negate the validity of another person’s claim to their perspective. These are my values, beliefs that I am putting out here because there are clinicians who do not claim ownership of ‘the truth’, or look down on someone who disagrees or takes him/her to task.

I am also NOT a Scientologist, but have strong reservations about the viability of psychiatry based solely upon the conduct of the so-called leaders in the field and the apathy of the majority of clinicians toward taking THEM to task. You seem to be either uninformed or unconcerned regarding the crux of the issue of “medications”; that there is no scientific evidence for the biomedical model of psychiatry,:nothing scientific to support the propagation of brain disorders or chemical imbalances as causes for symptoms of “mental illness”. You can’t pin that whopper on the public’s hide!

I hope psychiatry does begin to offer accountability and a willingness to engage with the public in positive and meaningful ways. That’s how community building happens… “humility, shame and a sense of community” (as you wrote.) are exactly what is being asked of mental health clinicians … If you can’t demonstrate these human qualities, how can you reasonably expect anyone else to?

The days of wielding “medical” authority and brandishing theories that rank people according to a “members only- secret code” are coming to an end. You can’t overpower or out rank this reality… but you could slip away– into your own virtual world as 1 Grumpy Old Man.com— and moderate your private sessions to your heart’s content…

Nice projection, Katie, I’ll take the heat for the hypocrisy in writing this comment, but you illustrate exactly why I find these “forums” so exasperating. You don’t even know me and write in your above comment, “If you can’t demonstrate these human qualities…”, and I did not write in my original comment at the top of this thread any specific person I directed my comment to, yet you personalized it and then make insinuations that are just rude.

Again, I am entitled to an opinion as it has experience, you do not have to agree, and you can dismiss me if you want. To write direct insulting comments is just rude, so why don’t you step back and read your last posting here and then move on.

By the way, did not accuse you of being a Scientologist, just making a general observation that I have caught some in their lies of denial at moment one, and reluctant admission later. People need to know that that religion trolls the internet with fevered glee to attack any and all who speak positive of mental health care.

To all for my comment now, sorry for the hypocrisy. Hey, I’m human.

Joel (Dr. Hassman),

If I read you correctly, in your last words (addressed to Katie, above) you are offering a general warning, to readers, that: virtually anyone on the Net who broadly critiques providers of “mental health care” may be – secretly – a Scientologist. (You say, “I have caught some in their lies of denial at moment one, and reluctant admission later.”) You insist, “People need to know that that religion trolls the internet with fevered glee to attack any and all who speak positive of mental health care.”

Well, you may doubt me when I tell you I am no Scientologist (nor would I ever be one), but such is the truth. I am no Scientologist, nor would I ever be.

Meanwhile, what I think people should know, is that it is, potentially, quite dangerous to put ones life into the ‘care’ of psychiatry and/or into the ‘care’ of any ‘mental health’ professional who defers to the ‘wisdom’ (and dictates) of psychiatry.

After all, my understanding of (and, experience with) psychiatrists suggests to me, that: not infrequently, they’ll take on “patients” who’ll have no freedom to resist their ‘treatment.’ (In my view, that’s what makes psychiatrists much more dangerous than any other physicians.)

But, you’ve said, above, “You can dismiss me if you want”; so, I wonder: might you be amongst the extremely rare psychiatrists who do not treat “patients” against their will?

I imagine a good psychiatrist would be one who quite honestly says, to each and every prospective new patient, “You can dismiss me if you want.”

Finally, as to your confessing, “I don’t get why people who have failed meds are so outraged…” you might try reading the Internet message boards, where people are discussing their difficulties with the so-called “side effects” and withdrawal symptoms often caused by use of psych-meds.

J.

I agree with Joel Hassman, MD that doctors who screw their patients up with psychiatric medications should be sued. I disagree with Dr. Hassman that doctors are helpless in the face of patients demanding such medications.

The public is clueless and indoctrinated by advertising (until injured), doctors are supposed to have the clues and be informed by science.

A doctor refusing medication to a patient who doesn’t need it is performing a necessary educational service for the public health.

Surely there’s a way to do this that increases patients’ understanding of their conditions and the cultural environment that encourages them to ask for unneeded drugs. Just about everybody now knows how pervasive advertising is and how it gets you to do things that aren’t necessarily good for you.

Oh, when I said “just stop trying” I mean just stop trying to get help from a mental health professional, not just stop trying to deal with my problems.

Your welcome, Peggi ! Yes, by all means, read, Pharmageddon. David Healy’ has provided the history/background of PHARMA’s impact on the medical profession in a very accessable and thought provoking style of writing that is not the least bit intiimidating. There is the expected spot light on psychiatry, as this one specialty literally built it’s claim to fame paradigm of care on everything BUT science . Psychiatrist’s also have sealed their fate by denying adverse effects of psych drugs and even invented new disorders from the iatrogenic effects of the drugs.. Some psychiatrists have and will continue to whine; “PHARMA made me do it” or PHARMA misled us (doctors) ! —or WORSE, “We are pressured by the public to prescribe majic bullets!

Working with children and families in community mental health, and consulting in the foster care system, I have little by way of understaning or sympathy for psychiatrists. IF they weren’t in the equation from the moment Prozac hit the market in 1988— we would not be having this disucssion. Without psychiatrists aiding and abedding PHARMA— and forgetting everything the public believes is the duty and rresponsibility of a “medical doctor”, there would nothing for the “public” to grab on to—much less demand!

IMO, when a profession abdicates it’s responsibility to uphold the trust ; violates the trust of the public in a manner that causes harm and is linked to financial gain , we, the public need to demand criminal indictments. Law suits are just another way to redistribute the wealth amongst bottom feeding professionals. (I am borrowing that line from a member of the book discussion group with who I have been disccussing Pharmageddon 🙂

Since I have worked with psychiatrists for over 10 years, I am familiar with the type of responses made here by Dr. Hassman. He has already forgotten that in one of his early posts he inferred that it is thye public who “sucks”, NOT psychiatrists. Then, he says “Nothing personal”. There is a not so subtle tone of authority and arrogance in his use words that fuel conflict, while never actually addressing the issues at hand. I encourage everyone of my contacts to read Pharmageddon– and I maintain hope that psychiatrists and indeed, all MDs will step up to the plate and reclaim their profession.

I just finished Richard P. Bentall Madness Explained: Psychosis and Human Nature and highly recommend it.

The fundamental principle guiding this approach can be simply stated as follows: We should abandon psychiatric diagnoses altogether and instead try to explain and understand the actual experiences and behaviours of psychotic people. By such experiences and behaviours I mean the kinds of things that psychiatrists describe as symptoms, but which might be better labelled complaints, such as hallucinations, delusions and disordered speech. I will argue that, once these complaints have been explained, there is no ghostly disease remaining that also requires an explanation. Complaints are all there is. An advantage of this approach is that it does not require us to draw a clear dividing line between madness and sanity. Indeed, when constructing explanations of complaints it is not necessary to assume that they are always pathological. By ‘complaint’, I just mean any class of behaviour or experience that is singled out as sometimes troublesome and therefore worthy of our attention.

Now that bipolar disorder is the big money maker, PTSD and ADHD just disappears from anyone labeled bipolar. “Pressured speech” is what used to be “hyperactive” is what used to be just the way some people talked and not something identifiable as a “medical condition” needing treatment. The speech of someone truly in what is called “a manic psychotic episode” is nearly impossible for the best actors to mimic because of it’s intensity and lack of coherence— it is phenomenal. But now, talking quickly and fluently is “pressured speech”.

For psychiatrists willing to play the pharma game the sky is the limit. They can actually consider creating a mental illness label for “excessive bitterness” after the biggest financial crisis in the history of the world, because it’s impolite, if not a little crazy, to look behind the curtain or to blame predatory forces for what they’ve wrought..

It is both fascinating and pathetic sites like this allow the usual commenters to demonize psychiatry and psychiatrists alone for the problems that occur in the profession, yet it is outrageous to such commenters to bring attention to other variables to the problems, like, patients, other providers outside psychiatrists, insurers, and let’s not let other alleged innocents like family members, spouses, and work related contacts who get involved in patients’ affairs go unnamed. Let’s have a moment of brutal candor and honesty, for those who have the guts to put it out there! You want to attack psychiatrists because you want to keep us in check as we will by expectation remain stoic and quiet participants and just absorb your rude, extremist, narrow minded attacks and let the audience buy into your failed notion that the loudest attacker wins by having the longest threads and rudest comments.

I came back to write this because people who have been wronged by poor clinical interventions do not have the right to demean and deride every practitioner just because we do not echo your sentiments to the every “i” and “t” should we have an MD after our name. There was a questionable death of an innocent civilian in my city a few weeks ago by an off duty police officer, so by the logic some at sites like this spew, should we call for the end of the police department because one possible bad cop means all cops are bad? Can’t wait to read retorts that will claim this analogy has no applicability!

It is sad there are too many sites for mental health care issues that put up with the plain ugliness that gets printed by the antipsychiatry crowd, and that is what it is at the end of the day, antipsychiatry. Yes, there are too many physicians in positions of authority and political influence in the field who are whores and cowards, and it is a shame they are not dealt with by their equally lame and uninvested colleagues who just let silence go as acceptance. But really, when someone writes that there is more to treatment than meds and calls to task a sizeable element of patients just flock to prescriptions like moths to the blue light, I am “If you can’t demonstrate these human qualities, how can you reasonably expect anyone else to?”, or, “I have to remind him that even if he has no natural compasionate sentiments toward the public, he might want to consider that his commentary is bad for the “business” he is in!”, or finally, “He has already forgotten that in one of his early posts he inferred that it is thye public who “sucks”, NOT psychiatrists. Then, he says “Nothing personal”. There is a not so subtle tone of authority and arrogance in his use words that fuel conflict, while never actually addressing the issues at hand.” By the way, when you put a comment in quotes, it infers to the reader the comment was actually said, so please highlight that comment I made that said directly “nothing personal”.

This rant may end this thread, but it needed said. You can infer or interpret whatever the hell you want from what I write, but, when you make it personal by making inferences that demean and deride, get the helmet on folks, ’cause sometimes people are going to fling it back at ya! Probably none of you are Scientologists, but you sure write like you are in their choir!

Surprise, surprise, surprise, some of us physikeyatrysts are human and can be angry and tell you you’re wrong, because this is not a clinical forum, you are not my patients, we are all equals here, and some of you suck as much as you think I do.

I actually will sleep well now, thank you. Don’t think Mickey will appreciate what I wrote, but, maybe it might give pause and reflection to reconsider what should be the tone at a site like this. I call it as I see it, and I am more often right than wrong.

And when I am wrong, I acknowledge it. Shocking for some to read, eh? And, did I mention anyone’s specific name above? Frankly, I wouldn’t be surprised someone will claim so!

End of line.