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Old 03-10-2010, 05:00 AM   #1 (permalink)
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Psychology, Psychiatry & Mental Illness



Now this is from a piece titled 'Psychiatry: An Industry of Death', which I recognize as a ridiculously over-the-top piece of propaganda. But, I think there is something to this. Psychologists and psychiatrists (hereafter: psychiatrists) are treated by many with the same respect given to physicians. Should that be the case?

For those who don't know, the Diagnostic and Statistics Manual of Mental Disorders (DSM) is a book used by psychiatrists to classify mental illness. It contains a list of all recognized mental illnesses and the criteria used for diagnosing them in an individual. The basis for inclusion in the book however is by vote. By vote. Also, there is a great deal of overlap between diseases, and the same symptom set can be diagnosed many different ways by many different psychiatrists. Doesn't this seem uncomfortably fallible to you? It does to me.

Then, there is the lack of pathology. I'm not opposed to the idea that a person can have abnormal brain functions or chemistry that disrupt their emotional state or well being. I also recognize that the area of body we're talking about is the brain, and you can't just biopsy a person's brain, the risk is incredibly high and I don't think enough is known to be able to test functionality of a brain biopsy ex situ. That's the rub though, Psychiatrists are making claims about the way that a person's brain is functioning, without any diagnostic, only a manifestation of symptoms. They also prescribe medication based on their assumptions about an individuals brain chemistry.

I wouldn't be so crass as to suggest that mental illness does not exist. However, at what point does 'not normal' cross the line into 'illness'? I have heard it said that it's based on functionality, but any degree of any mental characteristic affects functionality. 'Normally' functioning individuals have mental characteristics that affect them negatively. How functionally deficient does a person have to be to be mentally ill?

Abstract of questions:
Are you comfortable with the DSM and it's use?
At what point does 'not normal' Cross the line into mental illness?
How functionally deficient does a person have to be to be considered mentally ill?
Do psychiatrists and psychologists deserve the same level of respect as physicians and other health care providers?

Until I have very good answers to some of these questions, I don't think I can take this field as seriously as the rest of 'medicine'. I also find it a bit absurd that these folks can have others committed indefinitely against their will with state support, or that they can affect criminal sentencing and cases so much.
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Old 03-11-2010, 05:20 PM   #2 (permalink)
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The voting is only one part of the process by which something is added, taken away or amended in the DSM. Voting is a part of the peer review system in psychology and psychiatry. As I'm sure everyone knows, peer review is vital to the scientific method. Voting only happens after exhaustive studies and research have been done. The studies and research are where psychology really moves forward and self-corrects as a science. The voting is just a final measure to ensure that the quality of the data and conclusions are beyond reproach.

I'll tell you what psychiatry and psychology are not: guessing games. Psychologists don't just go vote on whatever they want included or removed from the DSM. Even in the famous case of homosexuality, before the vote took place there was extensive research done which demonstrated that the current methods of treatment were harmful. It was only after the science took place that there was a vote and that vote was just as science should be: correcting based on empirical evidence and corroborating studies.

Are you comfortable with the DSM and it's use? Absolutely. The DSM represents the current best understanding of diagnosing and treating mental illness.

At what point does 'not normal' Cross the line into mental illness? That depends a great deal on the specific case. You might as well ask "At what point does not healthy become ill?" It's going to depend.

How functionally deficient does a person have to be to be considered mentally ill? Again, this has to be established on a case by case basis. Psychology and psychiatry aren't simple sciences.

Do psychiatrists and psychologists deserve the same level of respect as physicians and other health care providers? Yes.


A closing thought: psychology and psychiatry are routinely attacked in a way that's similar to the science of climate change or the evolution of life. While I would never suggest you should blindly follow whatever experts say, it's important to recognize that as a lay-person you may have have access to all the facts in a case like this. Don't start with the assumption that an entire branch of science is wrong. Remain skeptical, as a scientist would, until the positive claim (in this case, that psychiatry and psychology are bonk) can be established.
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Old 03-11-2010, 07:09 PM   #3 (permalink)
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The DSM IV (DSM V will be released fairly soon) is such a comprehensive manual that I would have serious concerns if an individual could not find one "disorder" listed among its 1000+ pages, that does NOT apply to them. I do not think this is necessarily a bad thing as it can give guidance to someone who genuinely struggles with a condition that is clearly a disorder and disruption for them, but may not be an issue with another individual. For example, the anxiety that one may feel towards a given situation can be distressful, yet be interpreted as exhilarating for another, even though both may feel essentially the same physiological activation.

Even the most questionable of entries in the DSM (restless leg syndrome, seasonal affective disorder) are truly disruptive conditions for a presumably minute section of the population. Yet the thoughts about having these conditions that typically would pass unheeded, are extrapolated by commercials, word of mouth, television, and elsewhere, creating mountains out of molehills and benefit pharmaceutical interests. There is an undeniable corporate interest in mental health, with an industry that is predicated on the morbidity of mental illness (and subsequent remediation). I think this stems from the subjectiveness of mental conditions and the ability to extrapolate minor disturbances into full-fledged conditions that require seeking help (and paying for resolution). Again, that's not to say that the conditions people experience are trivial and the pain associated with them are nonexistent, on the contrary they can be more distressing than an actual "physical" malady. People who typically wouldn't be disturbed by a certain condition end up paying an inordinate amount of time and attention to something that would otherwise be benign and create a monster.

This can be supported in some instances, for example, through some studies in hedonics (the study of happiness). One of the key components of hedonics is that people generally don't elicit happiness when actively seeking to produce it. Rather it is usually a byproduct of achievement and striving towards goals (the beautiful struggle), it can simply "comes to you" (contentment). Instead, people who dwell on their current state of happiness and are preoccupied with it often report lower happiness scores. Human beings are remarkably adaptable to their current situation which is why you unfailingly see people who are exceedingly rich report similar happiness scores to people who may be serving them their breakfast. Similarly, I believe people are much more capable of dealing with problems than we give ourselves credit for. Everybody needs help, sure, but not to the extent of prescribing medical assistance for many of the occurrences of that which makes us human and life worth living.

Also, rates of the use of SSRIs (pills used to treat depression) are substantially higher in the UK, than in Germany and France. People aren't any more depressed in UK (or in Rwanda) than in Germany. The use of antidepressants in the United States DOUBLED over a 10 year period from 1996-2005. It would be absurd to claim that Americans have become twice as depressed over such a short time, yet. I think this says a tremendous amount about the current state of psychiatry and mental health. Just like the practice of performing prefrontal lobotomies on the mentally ill during the mid-20th century now seems perverted to us today, I predict people 20 years will look back on today's practice of over-medicating people of all ages with pills will be looked back at with similar regret.

Last edited by essendoubleop; 03-11-2010 at 07:13 PM..
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Old 03-11-2010, 08:24 PM   #4 (permalink)
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I'm going to go on a different direction here: why is the fact that they vote on it so disturbing to you?

More importantly, why do you think the rest of medicine is so much more certain and less subject to arbitrary boundaries between health and disease?
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Old 03-11-2010, 08:34 PM   #5 (permalink)
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More importantly, why do you think the rest of medicine is so much more certain and less subject to arbitrary boundaries between health and disease?
Because it's such a reliable market.
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Old 03-11-2010, 08:43 PM   #6 (permalink)
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Because it's such a reliable market.
I'm not sure what is your point here, but antibiotics are as overprescribed as antidepressants.
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Old 03-11-2010, 08:59 PM   #7 (permalink)
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I'm not sure what is your point here, but antibiotics are as overprescribed as antidepressants.
That's a good point. I'd say it's because the notion of having a mental condition can be magnified to the point where it becomes life-debilitating until measures are taken to correct it. If I have Restless Leg Syndrome, then I will unable to sleep at night, which then affects my performance the next day and my quality of life, and will continue to do so until I seek treatment. By increasing the threat of any of the factors leading up to "I need to seek treatment for this," RLS becomes more serious of a condition. Downplaying the significance of mental illnesses or conditions is frowned upon while amplifying the awareness of potential conditions is accepted, even if that can have a direct result on the onset of the condition. Conversely, in "physical" medicine, no matter how much an ailment is hyped, it will not increase the morbidity.

I'm not intending to come off so anti-Psychiatry. But there are significant flaws within the field that are often exploited and people are unaware of. Remember, the placebo effect is the most cost-effective treatment anyone can undergo.
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Old 03-11-2010, 09:34 PM   #8 (permalink)
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Three points:
1) Psychologists don't prescribe antidepressants at all, so let's not lump psychologists and psychiatrists together on this issue.
2) The majority of antidepressants are prescribed by general medical doctors, not doctors of psychiatry.
3) You're less likely to get unnecessary antidepressants from psychiatrists because they have the psychology training dealing directly with depression in their education.
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Old 03-11-2010, 10:03 PM   #9 (permalink)
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Originally Posted by essendoubleop View Post
That's a good point. I'd say it's because the notion of having a mental condition can be magnified to the point where it becomes life-debilitating until measures are taken to correct it. If I have Restless Leg Syndrome, then I will unable to sleep at night, which then affects my performance the next day and my quality of life, and will continue to do so until I seek treatment. By increasing the threat of any of the factors leading up to "I need to seek treatment for this," RLS becomes more serious of a condition. Downplaying the significance of mental illnesses or conditions is frowned upon while amplifying the awareness of potential conditions is accepted, even if that can have a direct result on the onset of the condition. Conversely, in "physical" medicine, no matter how much an ailment is hyped, it will not increase the morbidity.

I'm not intending to come off so anti-Psychiatry. But there are significant flaws within the field that are often exploited and people are unaware of. Remember, the placebo effect is the most cost-effective treatment anyone can undergo.
If you are talking about how awareness of a condition leads to it becoming more bothersome/limiting/critical, you actually have as many if not more examples of this in the "physical" medicine than in mental health. I've already mentioned antibiotics, but there are several surgeries that have been overdone. Hysterectomies, episiotomies, surgeries to deal with carpal tunnel syndrome and even coronary bypass are seriously overprescribed in the US.

And I'm not doing this to attack medicine. I'm all for it. But there seems to be this "science vs non science" and "real vs mental" distinctions in this thread that really ignore how alike the procedures are in the two areas.
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Old 03-12-2010, 06:01 AM   #10 (permalink)
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Will: I'm not trying to undermine the entire filed of psychiatry. That would be silly, but I'm wondering if they are on the receiving end of what I'm going to call 'sufficient skepticism'. Psychiatrists say and are are treated as though any of their diagnosis as equivalent in reliability to that of any medical doctor. You say it's justified, I'm not so sure. I think it's important to recognize that psychiatrists have a vested interest you believing that their ideas are beyond reproach (this is true of any professional field).

It's the research itself that solidifies an idea as beyond reproach (at least as much any theory can be). The number of people who agree or disagree with the research have no bearing on it's truthfulness. Not to mention the individual biases or lack of knowledge of the voters. When you become a member of the APA you get a vote and you can exercise that vote whether you are knowledgeable about research in an area or not. Let's be honest, it isn't possible to be on the cutting edge of all psychiatry research, but you still get to vote as if you are. I fail to see how voting is the key step that solidifies and idea as beyond reproach.

I'll take evolution to use for an example, since it is so highly politicized and you brought it up. Suppose we were going to to vote on whether or not evolution is a valid explanation for the existence of diverse species on the planet earth. All the research is there, it's been played out to book length hundreds of times. We let everyone vote regardless of qualification. Does the vote matter? No. Does the qualification of the individuals matter? If we make everyone watch an hour long tv special presenting all the evidence, does that make the vote more impacting upon the truth? What if we required everyone to attend 8 years of specialized training before they could vote? Does the vote affect the truth now? That's why it bothers me so much. The vote ought to be irrelevant, the research is what's relevant.

Quote:
Originally Posted by dippin View Post
I'm going to go on a different direction here: why is the fact that they vote on it so disturbing to you?

More importantly, why do you think the rest of medicine is so much more certain and less subject to arbitrary boundaries between health and disease?
A distinct lack of diagnostics, or biomarkers to use the language of the APA. This is from a press release from the APA September 26, 2003. You can read the full text Here. (Warning: PDF).
Quote:
Originally Posted by APA
Research has shown that serious neurobiological disorders such as schizophrenia reveal reproducible abnormalities of brain structure (such as ventricular enlargement) and function. Compelling evidence exists that disorders including schizophrenia, bipolar disorder, and autism to name a few have a strong genetic component. Still, brain science has not advanced to the point where scientists or clinicians can point to readily discernible pathologic lesions or genetic abnormalities that in and of themselves serve as reliable or predictive biomarkers of a given mental disorder or mental disorders as a group. Ultimately, no gross anatomical lesion such as a tumor may ever be found; rather, mental disorders will likely be proven to represent disorders of intercellular communication; or of disrupted neural circuitry. Research already has elucidated some of the mechanisms of action of medications that are effective for depression, schizophrenia, anxiety, attention deficit, and cognitive disorders such as Alzheimer’s disease. These medications clearly exert influence on specific neurotransmitters, naturally occurring brain chemicals that effect, or regulate, communication between neurons in regions of the brain that control mood, complex reasoning, anxiety, and cognition. In 1970, The Nobel Prize was awarded to Julius Axelrod, Ph.D., of the National Institute of Mental Health, for his discovery of how anti-depressant medications regulate the availability of neurotransmitters such as norepinephrine in the synapses, or gaps, between nerve cells.

In the absence of one or more biological markers for mental disorders, these conditions are defined by a variety of concepts. These include the distress experienced and reported by a person who has a mental disorder; the level of disability associated with a particular condition; patterns of behavior; and statistical deviation from population-based norms for cognitive processes, mood regulation, or other indices of thought, emotion, and behavior.
It's all well and good to say that it's very likely that mental disorders will be proven to be disorders of intracellular communication, but it hasn't been yet. What has been proven is the action of some antidepressant medications, which modulate intracellular communication. Nobody knows what a normal serotonin release levels are, not in and individual or in the population at large. Nobody knows the extent to which serotonin release is modulated by a given dosage in a given individual. These are important facts which are not noted nearly enough.

Later in the release they go on to compare diagnosing mental disorders to high cholesterol. Cholesterol can be monitored in individuals, it's levels are known in the population at large, and a certain levels correlation with increased risk of heart disease is known. After medication is prescribed the effect of the medication can be closely monitored by blood test, and adjustments made. To compare the rest of mental disorder diagnostics to high cholesterol screenings is disingenuous if not outright deceitful.
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Old 03-12-2010, 07:40 AM   #11 (permalink)
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Several "physical" diseases also have a complete lack of "biomarkers" if you will. AIDS was diagnosed before they ever discovered the HIV virus. There are several diseases and conditions nowadays that that are diagnoses based solely on certain symptoms and not on an actual determination of a causing agent.

RSI, kawasaki syndrome, early rheumatoid arthritis, and a host of other diseases and conditions depend on what the patient tells the doctor about their symptoms and not necessarily tests for causes.
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Old 03-12-2010, 07:53 AM   #12 (permalink)
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This is definitely more an issue with the medical industry than medical practitioners. If you think the same kind of things aren't happening in physical medicine, you're sadly mistaken.

This report is 23 minutes long, but well worth the listen. (There's also a text article if you'd rather read.)

The summary: scientists created a term to classify, as they always do and must, and the pharmaceutical industry latched onto this term and decided to turn it into a disease that needs treatment. They created a drug, a detection technique, and now it is raking in the profits.
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Old 03-12-2010, 10:46 AM   #13 (permalink)
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I really believe the state of mental health is bad shape right now. The difference between mentally sound and mentally ill is still completely subjective, except in the case of the most obvious and severe disorders. I don't have any faith in the field at all. The solution is almost always to throw buckets of medicine at the problem, and the psychotropic drugs prescribed usually have very major symptoms. I don't support the drug culture that exists in either the mental health field or the regular field of medicine.

I often wonder what proportion of people given the drugs actually have any mental health issue at all. Look how prevalent drugs for anxiety or depression alone have become. I can barely believe they can even prescribe medicine to fix something that might be causing the problem. After all this time, they still can't tell us what causes most major forms of mental illness? It's sure not stopping them from shoving pills at people as the first line of treatment. As mentioned above, even general practitioners are getting in on the action, and they are not qualified to diagnose or treat mental illness.

I hope I see some major reforms in this are during my life time.
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Old 03-12-2010, 10:56 AM   #14 (permalink)
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If I told a doctor about all of my behavioral symptoms, I'd most certainly be medicated. But it's my understanding that certain behavioral patterns (e.g. personality disorders) cannot be medicated away. I wonder how many misdiagnose based on that and medicate anyway.

This is one of the reasons I don't seek medical help for head issues.
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Old 03-12-2010, 11:32 AM   #15 (permalink)
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Originally Posted by dippin View Post
Several "physical" diseases also have a complete lack of "biomarkers" if you will. AIDS was diagnosed before they ever discovered the HIV virus. There are several diseases and conditions nowadays that that are diagnoses based solely on certain symptoms and not on an actual determination of a causing agent.

RSI, kawasaki syndrome, early rheumatoid arthritis, and a host of other diseases and conditions depend on what the patient tells the doctor about their symptoms and not necessarily tests for causes.
Yes, there are physical maladies diagnosed primarily by manifestation of symptoms. In physical medicine they're the exceptions, not the rule. In psychiatry, diagnosis by symptoms is almost all there is. There are problems with diagnosis by symptoms, these problems apply equally to physical medicine as well as psychiatric medicine, which is why diagnostics for causative agents are preferred.

This is why when you go for an STD test the doctor doesn't look at your junk and tell you that you're healthy. You take a blood test also. In terms of the reliability of the diagnosis, being told you have herpes is not the same thing as being told you have an anxiety disorder.

Secret: Certainly psychiatry as an industry has it's problems, so does medicine in general. The people make the diagnosis shouldn't be the ones with a financial stake in the matter, neither should the people conducting the clinical trials for that matter. That NPR piece is a perfect example.

I would expect that professionals would speak up against the industry in defence of their field. When nobody is taking a stand and saying, wait a minute we aren't as certain as some say we, are I get suspicious. Especially when it seems quite obvious they aren't as certain as they say they are.
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Old 03-12-2010, 11:45 AM   #16 (permalink)
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I'll take evolution to use for an example, since it is so highly politicized and you brought it up. Suppose we were going to to vote on whether or not evolution is a valid explanation for the existence of diverse species on the planet earth. All the research is there, it's been played out to book length hundreds of times. We let everyone vote regardless of qualification. Does the vote matter? No. Does the qualification of the individuals matter? If we make everyone watch an hour long tv special presenting all the evidence, does that make the vote more impacting upon the truth? What if we required everyone to attend 8 years of specialized training before they could vote? Does the vote affect the truth now? That's why it bothers me so much. The vote ought to be irrelevant, the research is what's relevant.
Dude, it's peer review. The APA is made up of highly trained, highly experienced professional scientists. They are often the same folks who are publishing the finding of studies. They're peers, not just folks that happen to have a passing interest in psychology.

Just so we're on the same page, the scientific method—the best methodology in place in the progress of scientific knowledge—requires impartial peer review as a check to ensure maximum quality of results. While it's difficult for honest and capable objective scientists to make mistakes, it does happen from time to time. It's important to get as many objective takes on the experimentation and interpretation of results so that the conclusion can be verified.

By applying that understanding to the case of the APA voting on stuff, we can see that it's not just relevant, it's incredibly important! Without peer review, the results from scientific studies would be less reliable. In order for science to be the best science it can be, it needs to be impartially reviewed by other experts.
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Old 03-12-2010, 03:39 PM   #17 (permalink)
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Yes, there are physical maladies diagnosed primarily by manifestation of symptoms. In physical medicine they're the exceptions, not the rule. In psychiatry, diagnosis by symptoms is almost all there is. There are problems with diagnosis by symptoms, these problems apply equally to physical medicine as well as psychiatric medicine, which is why diagnostics for causative agents are preferred.

This is why when you go for an STD test the doctor doesn't look at your junk and tell you that you're healthy. You take a blood test also. In terms of the reliability of the diagnosis, being told you have herpes is not the same thing as being told you have an anxiety disorder.

Secret: Certainly psychiatry as an industry has it's problems, so does medicine in general. The people make the diagnosis shouldn't be the ones with a financial stake in the matter, neither should the people conducting the clinical trials for that matter. That NPR piece is a perfect example.

I would expect that professionals would speak up against the industry in defence of their field. When nobody is taking a stand and saying, wait a minute we aren't as certain as some say we, are I get suspicious. Especially when it seems quite obvious they aren't as certain as they say they are.

No one is taking a stand? Or no one you know is taking a stand? Those two possibilities are quite distinct, and I know of plenty of doctors aware and vocal about the problems.

Finally, the "exception" in "physical" medicine is significant, involving several types of viral infections, chronic pain and so on.
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Old 03-12-2010, 06:09 PM   #18 (permalink)
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For the purpose of this discussion, I'd like to just simply answer these questions as someone who has been in the mental health field professionally for 12 years and who is currently working on a PhD in clinical psych.

Quote:
Are you comfortable with the DSM and it's use?
The DSM has its use. Just like any other field of science, there has to be a set of guidelines. People get frustrated when guidelines and sets of scientific law are placed on people, functioning and behavior. It also has its limitations. Which is why it is constantly under review. I, personally, have learned to underdiagnose rather than put something in someone's medical record for life. Example: using "Anxiety Disorder, Not Otherwise Specified" rather than something that someone could meet criiteria for but maybe not totally, e. g. a panic disorder. I'm comfortable with the training I have and I'm receiving now to be able to responsibly use the DSM. Many psychologists won't take insurance so that the DSM codes will not be placed in a medical record and labeled.

Quote:
At what point does 'not normal' Cross the line into mental illness?
Normal is relative. You look at a person in their environment, assess their global functioning in all areas. No one is "normal." There is "common" or "like others" but I avoid "normal" in practice as do the responsible psychological professionals. When you're unable to function or function is significantly impaired that you or someone else is concerned, then it's time to evaluate. Yes, there is a set of guidelines and criteria. All of it is up for some level of interpretation.

Quote:
How functionally deficient does a person have to be to be considered mentally ill?
It all depends on the diagnosis. And the GAF score. That's the standardized method of determining functioning. Secret: We're ALL diagnosible. Every. Single. One. Of. Us. You can find yourself in the DSM... don't believe me? Try it. Difference is when a person educated specifically in how to use it appropriately and responsibly diagnoses you. You're all histrionic. lol.

Quote:
Do psychiatrists and psychologists deserve the same level of respect as physicians and other health care providers?
Damn skippy. I've got hella more education than an RN, already. More than some D.O.s. Comparable to a physician when I finish. I have to go through rigorous training, practica, APA certified internship and ONLY if I pass through a jury of my peers, do I have permission to call myself Doctor Noodle. Then, I have to get licensed in the state in which I choose to practice, follow up with continuing education to maintain that license, get malpractice insurance, fight with insurance companies, and argue for the best course of treatment for my patients. But, there are different levels of education and experience for both professions. I couldn't do what an RN does nor could I expect them to do what I do. We're currently fighting the APA for continued accreditation, even though my school is meeting EVERY mandate (which is more stringent than some med schools). In every profession, though, you're going to run into the International School of _______ that hands out degrees to cats and dogs. It's up to patients and clients to do research and make sure that whomever they are seeing didn't get their degree from a school that only exists on paper. And believe me, there are internal checks and balances in the DSM, the APA, and every single licensure board that we come into contact with.

A medical doctor may offer treatment that fails to "save" someone from their physical disease... but are they looked upon the same as a psychologist that tried a treatment that didn't work and their client committed suicide?


Just a side note:
Quote:
Originally Posted by Baraka_Guru
If I told a doctor about all of my behavioral symptoms, I'd most certainly be medicated. But it's my understanding that certain behavioral patterns (e.g. personality disorders) cannot be medicated away. I wonder how many misdiagnose based on that and medicate anyway.

This is one of the reasons I don't seek medical help for head issues.
Baraka, milove... you might be offered meds, but you'd never "be medicated." I respectfully disagree here. Some psychiatrists jump to medication because that tends to be their jobs. Psychologists can't prescribe meds in the U.S., I don't know about Canada offhand because I'm tired, but that's a "safer" option for those who want to be evaluated and have treatment suggestions without being shoved towards medication. Many diagnoses are not typically treated with meds, and some are treated with short term meds to provide a crises intervention type treatment. I hate that people avoid talking things out with a professional because they are concerned about meds. I have people that have approached me outright stating "my child will not be on meds." My response? "Okay, let's see what we can do." If there absolutely need to be medications involved, it's typically because there is a medical issue involved (e.g. extreme ADHD stemming from neuro insult) or because that person has become a danger to his or herself. But no one can force you to take medications. Or make that their only recommendation... if they ever want to earn your trust or see you again.

I'm taking a stand. The newer generations of psychologists are arguing the DSM and the coding practices that the health care system is requiring for billing purposes. We're using extensive standardized testing to look at every dimension of cognitive functioning and areas of concern. And challenging the ones that are outdated and inconsistent. Just because you don't see it, don't discount that it may be happening. You don't hear about drugs or medical therapies that don't make it through testing unless they're already on the market very often either.

Oh hell....
/soapbox.

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Old 03-12-2010, 07:18 PM   #19 (permalink)
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Three points:
1) Psychologists don't prescribe antidepressants at all, so let's not lump psychologists and psychiatrists together on this issue.
2) The majority of antidepressants are prescribed by general medical doctors, not doctors of psychiatry.
3) You're less likely to get unnecessary antidepressants from psychiatrists because they have the psychology training dealing directly with depression in their education.
On this, at least in OHIO and Arizona I have to disagree with you.

Being in the counseling field I see people all the time that have psychiatrists whose only function is to prescribe the latest anti-depressants to these people and then they go to psychologists for counseling. And very, very rarely do the 2 doctors even talk.

I am not a believer in psychotropic/psychiatric drugs. In a lot of cases the people are guinea pigs until the doctor can find the right mix and then the patient becomes immune or worse addicted.

I have always felt deep psycho therapy is the answer. If you drug the patient up and mask the problem they came to you for they are less likely to be open and truly work out the issues. They become reliant on the drug because it makes them "feel" better and they can continue to bury the problems. This is evident in not just psychiatry but physical therapy where pain killers are over prescribed, detox units like the one I worked at that mask the symptoms and pain of withdrawal and so on. Once the vast majority get their "fix" and feel better, they forget the seriousness of the problem the drugs were supposed to be a temporary help for.

And don't get me started on how Benzodiazapines (Klonopin, Xanax, Valium, etc.) are just devils and yet prescribed like candy. Other than alcohol that drug group is the only one so addictive it can KILL you if you try to go cold turkey getting off it. And because of their half lives you may not see symptoms for a week or 2. And that doesn't work well for many who say, "Hmmm I feel better. I must not need the drugs." and they stop taking them as many patients do at one time or another.

And in conclusion on this subject, the experience I have not just in my field but in my personal life, giving psychotropic drugs to addicts (and the vast majority of addicts suffer from more than addiction, usually depression in some form), allows them to "feel" better and abuse the RX or continue drinking or continue their other drugs believing that the RX is the answer they were looking for. This causes deaths like Heath Ledger, it appears Corey Haim, and so many people we will never hear about.

Again, in most cases it is a Benzo being mixed with an opiate or the suicide mix of Benzo and Methadone.

I do believe, that IF a psychiatrist actually counseled or worked in partnership with the Professional Counselor(LPC or LIPC)/psychologist and the focus was more on the psycho therapy and not masking the symptoms by medicating them away, we'd see more long term success stories.
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Old 03-12-2010, 08:50 PM   #20 (permalink)
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Quote:
Originally Posted by pan6467 View Post
Being in the counseling field I see people all the time that have psychiatrists whose only function is to prescribe the latest anti-depressants to these people and then they go to psychologists for counseling. And very, very rarely do the 2 doctors even talk.
Pan, please report these people to the proper bodies. There are systems in place which require reporting in order to maintain strict quality of care provided. The more these people are reported, the less likely they are to give in to the prescription drug industry. In other words, you're in a position to be part of the solution.

I'm not going to jump in and unequivocally defend antidepressants—I have heard from very reliable experts that antidepressants are overprescribed, but for the record overprescribed does not mean the same thing as ineffective. Antibiotics for example are overprescribed, but when used responsibly they commonly save lives. By my very best understanding, the science behind antidepressants is sound. That they're overprescribed does not change this.
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Old 03-12-2010, 10:27 PM   #21 (permalink)
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Baraka, milove... you might be offered meds, but you'd never "be medicated." I respectfully disagree here. Some psychiatrists jump to medication because that tends to be their jobs. Psychologists can't prescribe meds in the U.S., I don't know about Canada offhand because I'm tired, but that's a "safer" option for those who want to be evaluated and have treatment suggestions without being shoved towards medication. Many diagnoses are not typically treated with meds, and some are treated with short term meds to provide a crises intervention type treatment. I hate that people avoid talking things out with a professional because they are concerned about meds.

[...]

But no one can force you to take medications. Or make that their only recommendation... if they ever want to earn your trust or see you again.
I didn't mean to imply that I would have medication forced upon me; what I meant to say is that a recommendation and prescription of a course of antidepressants would be the likely outcome. In Canada, psychologists cannot prescribe medication, psychiatrists do. I would be open to going to a psychologist, but unfortunately only psychiatry is covered by public health care in Ontario. So the route I see is my GP referring me to a psychiatrist, who in turn would prescribe me an antidepressant. I don't think this would be forced upon me, no, but I do see this as the most likely outcome. At least 4 people in my immediate family have had an antidepressant prescribed to them.

I think the big hangup for me is that I read about my symptoms on the Internet, and it tells me it's depression. Yeah, I know this could be wrong. Internet symptom searches are usually a bad idea. But what do I do? Go to my GP and say, "Oh, hey, nothing hurts and my health is otherwise pretty good, but, you know, I'm pretty sure I'm suffering from depression. Do you think I should get a referral? I can't afford a psychologist, so how about one of those doctors who can prescribe the meds? I hear that's covered by the province."

/rant
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Old 03-13-2010, 05:14 AM   #22 (permalink)
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Ahh. This really is my soapbox area, I didn't mean to assume.

The other thought is finding a community-based clinic with time-limited treatment that can help one learn the steps to take to work with one's depression and then work forward from there, with or without further counseling support. I don't know of they have them there but most in the US have someone overseeing the place that has training. Not necessarily a psychologist, which is where my loyalty lies. I specifically did not choose psychiatry because I wanted to counsel people and NOT have to make 15'minute med management appointments and send th patients on their way. I enjoy the nitty gritty parts of the human mind and the deep, dark, "not normal" stuff that , in reality a lot of the time, the person next to them on the train is trying to deal with, too. We're all diagnosible in Mental Health Land.
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Old 03-13-2010, 06:54 PM   #23 (permalink)
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Originally Posted by Baraka_Guru View Post
I didn't mean to imply that I would have medication forced upon me; what I meant to say is that a recommendation and prescription of a course of antidepressants would be the likely outcome. In Canada, psychologists cannot prescribe medication, psychiatrists do. I would be open to going to a psychologist, but unfortunately only psychiatry is covered by public health care in Ontario. So the route I see is my GP referring me to a psychiatrist, who in turn would prescribe me an antidepressant. I don't think this would be forced upon me, no, but I do see this as the most likely outcome. At least 4 people in my immediate family have had an antidepressant prescribed to them.

I think the big hangup for me is that I read about my symptoms on the Internet, and it tells me it's depression. Yeah, I know this could be wrong. Internet symptom searches are usually a bad idea. But what do I do? Go to my GP and say, "Oh, hey, nothing hurts and my health is otherwise pretty good, but, you know, I'm pretty sure I'm suffering from depression. Do you think I should get a referral? I can't afford a psychologist, so how about one of those doctors who can prescribe the meds? I hear that's covered by the province."

/rant
That is the 2nd biggest problem here in the states, I believe. The fact that the vast majority of insurance companies AND government financed insurance will only cover at MOST 50% of any psychological treatments with a very low maximum lifetime allowance (and addiction treatment is sometimes less than that). Yet, the Psychiatric drugs are treated as all others and thus depending on the drug (generic or not) and the policy's deductible it is far, far easier to just get the pills. Plus, once diagnosed with a mental illness, you will ALWAYS have that diagnosis so good luck with "pre-existing" coverages.

I also think it shows that insurance companies and even the government care is in bed with the pharmaceuticals because anyone with half a brain would realize that maybe a year of weekly therapy and semi-monthly checkups, would be cheaper in the long run than paying out for a lifetime of expensive prescribed drugs that in the end need changed because of tolerances and trying to get the "right" combination

Even companies that have some type of EAP (employee assistance program) in place the number of visits is extremely limited, usually 5 or 6. Then, if your community has a funded place that goes by sliding scale based on income, the cost may not seem like much, but if you make too much or the percentage means you have to cut back on necessities, you can't afford it (Or you convince yourself you can't.)

Now, if you have any serious problems and need therapy, 5 or 6 appointments (and the first is mostly just the fricking paperwork and introductions) you aren't going to get far. For me personally, it took almost 2 months before I trusted mine enough to open up and start talking about the issues I needed to and according to him, this is very common.

Most people don't want to discuss their issues and problems for fear of being labeled, knowing they have limited time, are used to living with them and even though they may not like where the problems lead feel it is what they know and are ok with it. (Example: If every time you succeed, you self destruct, you may become accustomed to that cycle and won't want to break it because you know the "highs" will come. It isn't until the "highs" start shrinking and the "lows" are taking over completely, that you decide to go forth. Then, once it looks like your life is getting better and you can't afford to go, you stop and the cycles start repeating.

I truly believe that insurance AND/OR a national healthcare system needs to treat mental illnesses with the same effort as cancers, diabetes or heart disease and so on. Yeah, pumping meds out maybe cheaper but they mask the problems and eventually won't work. And yes, therapy maybe expensive but mental illness leads to physical illnesses such as hypertension, diabetes, obesity, attempted suicides, addictions (NOT just drugs and alcohol), malnutrition, and so on. Those end up costing the system far, far more in the long run.

Imagine if someone could go see a psychologist/ LPC/ etc and know that they have unlimited visits and that it's just not going to be meds thrown at them. That through work with individual and possibly group therapies, we may see long term improvements, fewer setbacks and a healthier society.

I just think society and the people making the money decisions have it backwards. It's NOT mask the problems with drugs and oh yeah... get a few counseling sessions in. It should be, get counseling and use the drugs as a tool solely to enhance the effort and effects of the counseling.
__________________
I just love people who use the excuse "I use/do this because I LOVE the feeling/joy/happiness it brings me" and expect you to be ok with that as you watch them destroy their life blindly following. My response is, "I like to put forks in an eletrical socket, just LOVE that feeling, can't ever get enough of it, so will you let me put this copper fork in that electric socket?"
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