So I’m in Raleigh to hear my daughter sing Elijah with the Raleigh Chorus [she’s got the solos] and we meet for coffee this morning. She’s a Clinical Psychologist and she’s talking about an anorexia client of hers she’s mentioned before [a ‘young’ 19 year old]. My daughter says, "She stopped her Prozac and her Concerta on her own and said now she’s stopped having suicidal thoughts and she’s got her appetite back." There’s more, but that part made me wince inside. Later we met her friend for breakfast. Somehow, my profession came up. Later, she was querying me and I could tell there was something she wanted to ask, but was beating around the bush. It was, "don’t a lot of people have trouble getting off those antidepressants, and don’t people get suicidal on those drugs sometimes? I thought they were supposed to help?" Second internal wince. Then my daughter talked about having had trouble finding a Psychiatrist to refer to. Wince again. I’ve learned to not stand on a chair and scream, "I’m not one of those!" But that’s what I feel like doing. And I’ve learned what to say in those circumstances, because they come up all the time. But I really shouldn’t have to be in the situation of having to actually actively not feel defensive of a profession that I chose because it was so challenging, and responding to people who, if they were honest, would ask, "How come you people see patients for fifteen minutes and prescribe them drugs that make them sick?"
All of this was easily predictable twenty-five or thirty years ago when it all started. Most of you reading this could talk about the coming of Managed Care, and the rise of the less than ethical people in the profession that sold out to PHARMA, and all the corruption that blossomed therafter. But that doesn’t really explain it, it just describes it. The sad thing about what my daughter said is that mainstream psychiatry actually agreed to be a "back-up" profession, backing up the mental health others and primary care physicians who are seeing the patients up front now. But psychiatrists aren’t even being very good "backer uppers."
I volunteer in a clinic for kids and adolescents [mostly Medicaid insured]. When I first started there, the therapists scheduled them for 15 minutes. I balked. It took them a while to figure out that I actually wanted to take my own history and collaborate in treatment [the name of the clinic is Collaborations]. Now they’re happy about it, but they just weren’t used to that such. They were used to short visits and inevitable meds. Then they had to get used to the idea that I didn’t want to take over the cases as "boss" either. It’s taken two years to get things right – to collaborate. It’s a lot more fun [and productive] for all of us now, but again, getting it that way was like swimming upstream. If I’m going to be a "backer-upper," I’d at least like to be a competent "backer-upper."
Don’t be so hard on yourself. Psychiatrists get a bad rap but the truth is they do help a lot of people. We love our son’s psychiatrist and my son loves him too. He has given my son his life back. We are now incorporating Chinese medicine and acupuncture into our son’s life in conjunction with the Western medicine and that seems be a good combination.
It is not a leadership vacuum, but a leadership black hole. The pervasive poor judgment by so many colleagues in positions of control and mentoring training has gone beyond tarnishing the profession, but has set it up to be rendered useless as fairly much anyone, who a state deems “responsible” to prescribe, can practice psychiatry. They almost literally suck the life force out of anyone who comes into contact with their limited and selfish vision. And there are other factors to how we came to be relegated to “hydraulic lift operators”, as one colleague wrote in a piece in Psychiatric Times a few years ago, that go beyond insurance and big pharma. People just don’t want to say less than pleasant things about other professions, but it is not just psychiatrists who have dumbed down mental health care. I am not afraid to call it as it is, and mental health care is dying.
Ummm, is it just me, but how can it be, just a few months after the Arizona shootings, we reading about more cuts to mental health care funding in states all across the country, Arizona included? Face it, the mental health community, that being patients, their families, and providers as a whole, don’t vote. So, why should politicians care about our opinions if we do not speak them at the voting booth!?
I hear your pain (or your cringe). I recently did a consult on an inpatient at a prestigious university hospital and wrote up my report. The resident and medical student came up to me afterwards and said: “Jeez, thanks Doc. We knew nothing of her childhood or developmental history before we read your report.!” Talk about cringing. And wincing. And crying.
While I’m a Licensed Psychologist, my PhD is in School Psychology, not Clinical Psychology. And my choir is the NC Master Chorale.
As far as your profession, You get to be in the good guys group, since you refused to put up with that kind of crap. If I called you about a patient, I think you’d talk to me and listen as well!
Psychiatry isn’t the only ‘specialty’ with a glaring absence of leadership. About the time you were witnessing the medicalization of mental illness treatment, other venues were succumbing to the same sort of pharma pressure. I’ve written to you before about the diabetes ‘epidemic’ and how the ‘leaders’ all succumbed to the ‘latest and greatest’ treatment of diabetes with rDNA genetically-engineered insulin. Doctors (at the time) rapidly changed treatment to this new formulation of ‘insulin’ with no long-term evidence that rDNA insulin was “just like” natural HUMAN insulin. Patients who clamored to retain their treatment of choice were denied voice. When patent applications for the new product(s) stated unequivocally that BEEF ULTRALENTE was the gold-standard for basal control, it stunned many patients to see this was the first product pulled from the market. Today, the only way U.S. patients can obtain natural insulin is to use a personal import exemption and look for sources outside the country (or steal their animal’s veterinary products).
Were endocrinologists too busy . . . or too gullible . . . or too well-paid to stand up for their patients? Have the new ‘latest-greatest’ insulin-like products improved the lives of diabetics? Or have they just made tons of money for the manufacturers and prescribers?
As I said, psychiatry doesn’t stand alone with questionable KOLs serving corporate rather than patient interests.
Good post,
I wonder, continuing this theme of iatrogenicity, have you read Whitaker’s ‘Anatomy of an Epidemic’ and if so what you thought of his arguements?