No, I haven’t gone over to the dark side, but I still have no reason not to like this new APA President yet. I wonder how long the honeymoon will last. He’s in an odd position, following people who are brain crazed [Schatzberg, Lieberman] or not particularly effective [Oldham, Jeste] in a land long slumbering under the spell of PHARMA, Tom Insel’s unrealistic fantasies, and the neo-Kraepelinian DSM-whatevers. But he does get through a paragraph without saying words like brain, biomarkers, genome, proteonomics, neuroimaging, connectopathies, etc. Whether or not he will try to lead psychiatry out of its biomedical stupor into the healthier and reality-based eclecticism that fits the patients we actually see [or he even wants to] remains to be seen. We’ll certainly be watching.
What his predecessors have failed to notice is that a growing number of psychiatrists refuse to operate in the world created for them by Managed Care and insurance reimbursment, and that’s not all about money. Many make less by staying off the grid, myself included. A lot of it has to do with being unwilling to have practice dictated by excel spreadsheets in the offices of bureaucrats, the marketing departments of a corrupt industry, or the moguls of the APA and NIMH. Many avoid the APA like a plague. And many who still work in that system would be glad for a chance to change it into something more compatible with the real reasons they chose this specialty in the first place.
Gee I thought “internecine battles” were part of the process of good science. But let’s not challenge silly diagnoses and uberbio because the APA is following the promotional and ethical model of the National Association of Realtors.
Poor Paul Meehl is turning over in his grave:
http://www.tc.umn.edu/~pemeehl/099CaseConferences.pdf
No Dr. Summergrad, in fact there’s too goddam much getting along and not enough BS meters going off in psychiatry.
Wow, that is a great word there, “internecine”, think I will note this in my blog in the coming post. For what it is worth, how often have we seen someone be trotted out to give the illusion there is negotiation and compromise, but at the end of the day the same old message of “it’s our way or no way” is revealed? Does anyone here who knows the hierarchy of the APA really think they will allow their figurehead President to get away with harming the agenda by the “mullahs” that rule the APA with an iron fist?
We might actually see someone get impeached before the term is up, boy, wouldn’t that be fascinating and defining to witness?!
Dr. O’Brien,
Realtors and used car salespeople, along with many others, have much better ethics than the APA. They are legally bound in most cases not to deceive the public.
I just finished Systems of Survival and can see in this case how our expectations of a fair and ethical response from the APA have once again been put to the test. The APA has leveraged its position to deceive the public and medical community for profit, any changes will be slow in coming and long in the proof.
Steve Lucas
I’ve just posted some thoughts in response to this blog post. Overall I agree with 1BOM here, but it seems to me that the profit-seeking nature of the current system will be hard for a professional organization like the APA to overcome.
“… the profit-seeking nature of the current system will be hard for a professional organization like the APA to overcome”
Psycritic
While you are undoubtedly correct about the difficulty, I’d prefer that we give it a try rather than continue to be swept down the river. Decent psychiatric practice is not only low tech, it’s comparatively low cost. I personally think that the aspirations of being more like “the rest of medicine” have been both misguided and counter-productive.
One thing I’ve learned in a volunteer charity clinic is that even infrequent visits to see someone who knows you and is engaged in your struggles begins to pay off over time. I’ve been pleasantly surprised with how many patients slowly incorporate small insights into their lives over time. I began to work there initially to try to help patients get off of the crazy bags-full-of-pills they were taking, but I’ve stayed because now, almost every time I work, I can see visible changes in patients who I only see every 2 or 3 months in spite of the “clinic” nature of the contacts. Even a ballpark understanding of a patient’s central tangles delivered on the right day for it to be heard is a potent force for change – something as simple as ‘why do you let him keep …?‘ Little things mean a lot in our low tech universe…
Liten things mean a lot in our … universe …
Yes, dr Mickey, I believe you.
I’m reminded of a woman, former inmate in one of the harsh, northern camps of the Soviet Gulag, telling the Russian author Svetlana Aleksievitj that the kindness of ordinary people saved her life.
Basic, simple kindness that everyone can practice, if they’re not too busy, too important…
One issue we all need to recognize is the changing nature of all advocacy groups. While they may start with good intentions after the first group of starry eyed visionaries leaves the professional fund raisers and managers start to look at ways to improve revenue i.e. their incomes.
We took apart some patient advocacy groups on another blog and they had all become money making machines with little relationship to patients other than lip service. Organizations I know or belong too in other areas of my life have followed the same route.
The old everybody does it phrase is alive and well in medicine and society.
Steve Lucas
I see that in that speech he is prattling on about stigma, as if it’s 1975.
Memo to APA: Tony Soprano effectively killed off what’s left of stigma. Stigma is not why the seriously mentally ill are served poor by public health. It’s because they don’t bundle political campaigns and generally don’t vote. It’s the same reason kids get bad public education in big cities. And there’s no stigma against kids.
I would actually like to see a comparison poll on who is distrusted more, psychiatric patients or KOLs in academia. Start by polling doctors.
Forget it Jake, we know the answer but it doesn’t matter because it’s Chinatown.
Thanks for mentioning the obsolescence of the APA’s brave fight against stigma.
Actually, the current hysteria about stopping the mentally ill before they kill somebody has revived stigma, if not witch-hunting, and nobody has done more for stirring up this with false claims of psychiatric efficacy than the APA.
I strongly urge everyone here to read that 1973 paper by Meehl that I linked to. It’s long but it’s worth it. I believe Meehl defined the original sin that is behind all the problems this blog ferrets out with the get-along careerist culture in academic and organized psychiatry. Which gets back to this article. When a professional organization claims 300 or so mental disorders with no markers and a Jackson Pollock Venn Diagram of cormorbidity, and elects Presidents and editors who are the very definition of KOL conflict of interest, we need more not less internecine warfare.
The other APA now has a rival organization because of questionable guild ethics and antiscientific positions, I don’t see why we can’t replicate what the psychologist did.
BTW, Steve, the NAR is far from ethical, they have always tried to monopolize the MLS and were sued for it:
http://www.justice.gov/atr/public/press_releases/2005/211008.htm
The former head of NAR ridiculed those who warned about a housing bubble in 2005. He also wrote a book promoting Internet stocks right before they crashed at the turn of the century.
http://www.fool.com/news/commentary/2006/commentary06060918.htm
Reminds me of those promoting mandatory mental health screening as a solution to all of society’s woes.
I hope Summergrad doesn’t become a cheerleader with his hands out.