Wednesday, March 23, 2011

Help Us Write Our Survey on the Public Face of Psychiatry!

Please Read This and Contribute Your Thoughts!

The Shrink Rappers will be hosting a workshop at this year's annual meeting for the American Psychiatric Association. We'll be talking on The Public Face of Psychiatry and of course we want to discuss the role of new media: blogs and tweets and podcasts and more. Clink will be discussing something forensic, Roy something techy.

But what is the Public Face of Psychiatry? We all believe that stigmatizing the mentally ill is a bad thing and deters people from getting care. And we all have thoughts on what helps and what hurts, but what do we actually know? There's not a lot out there on the topic. And it's not just the mentally ill, it's us Shrinks, we aren't exactly portrayed as the most regular of citizens by the media. One thing we will ask our workshop participants (thanks, Barb, for the great suggestion) is how people react at a party when the participant says they are a psychiatrist.

So what do I want from you? Well, eventually, I want you to take a survey and blast it around the blogosphere about attitudes towards psychiatry. I want it short, maybe 5 questions, so people will actually take it, and I'd like you to help me think about what those questions should be. So I'm going to start and I'd like your feedback in our comments section. Are my questions good? Should they be worded differently? Something short you might like me to add or remove or ask differently?

So here goes, and remember, this is pre-rough-draft, off the top of my head and the final questions will not look like this:


Psychiatry a) helps people b) harms people c) encourages people to use diagnostic labels as excuses for lazy or bad behavior d) is just about handing out medications

Psychiatric patients are a) regular people b) are people I'd rather avoid c) are deeper thinkers and more creative than others

Psychiatrists are a) creative, interesting people b) weirdos c) it's just another job and stereotypes don't apply d) are pawns of the pharmaceutical industry

Psychotherapy a) helps people b) encourages self-centered navel gazing c) often makes people feel or behave worse then they did before they entered treatment d) does nothing.

Psychotropic medications a) help people b) cause more difficulties then they cure c) are the creation of a greedy pharmaceutical industry which has deceived the public

Criminally insane patients are a) badly behaved people manipulating the system to stay out of jail b) deserving of treatment c) have the potential to return to free society d) should not live on my street

Electronic medical records (this one is potentially for Roy).... a) should exist exactly as all other medical records do in psychiatry and giving them 'special protections' increases the stigma of mental illness b) should not exist for psychiatric illnesses and treatment c) should exist but should have separate and higher protection to allow confidentiality.

A psychiatrist uses electronic medical records that can be accessed by my other physicians and I cannot restrict this: a) I would see this psychiatrist for care b) I would not see this psychiatrist for care

Direct-to-Consumer advertising (commercials/magazine ads) of medications: a) decreases the stigma associated with taking these medications and is therefore good b) scares prospective patients with the lists of side effects c) should not be used because it provides incomplete medical information and the suggestion that patients should demand specific treatments without individual consideration of the patient and their problems

Psychiatric blogs: a) are useful sources of information and I have found them to be helpful
b) are biased and unhelpful

Blogs about psychiatry in general (including those by patients and those who may be disenchanted with psychiatry) have a) encouraged me to get treatment or to recommend treatment to others b) have discouraged me from getting treatment or recommending psychiatric treatment to others.

Obviously, I need your help. Thank you so much and do let me know your thoughts!

33 comments:

Anonymous said...

You do need help in survey design.

Rach said...

I was going to say is there a way to make it a survey with radio buttons? would be much easier to answer the survey. I think survey monkey still exists somewhere.

Dinah said...

The real survey will have radio buttons! I wanted some opinions on content, so no voting buttons here. And design will be more thoughtful.

Anonymous said...

What if someone has an answer you don't have as an option?

Anonymous said...

maybe you could add something on the psychotropic drugs - one of the answers could be "I think psychotropic drugs are a cure-all and a quick fix." That is a common misconception I hear.... wow, if only that was true. I WOULD LOVE a pill that takes all of my problems away...we all know that not to be true.

The question on the Direct-to-consumer advertising is good.... that is my biggest pet peeve, the Big Pharma advertising.

Anonymous said...

Psychiatry: helps people, though my opinion has greatly changed since I became involved as a patient.

Psychiatric patients: are deeper thinkers and more creative than others, but I may be a bit biased :)

Psychiatrists are: a bit of all four. I've encountered a weirdo, some very interesting and I've felt on one occasion that they can be too close to pharmaceutical companies.

psychotherapy: a bit of A and B. I think psychiatrists don't explain it well enough and we patients don't ask the questions we need to in order to understand it.

Psychotropic medications: help people....at least when we patients have reasonable expectations about what they can help and what they can't help.

Criminally insane people are: all of the above. I think society, culture and systems could all be better in preventing and dealing with the criminally insane.

Electronic records: should not exist for psychiatric illness and treatment.


A psychiatrist uses electronic medical records that can be accessed by my other physicians and I cannot restrict this: I would not see this psychiatrist for care

Direct-to-Consumer advertising (commercials/magazine ads) of medications: c) should not be used because it provides incomplete medical information and the suggestion that patients should demand specific treatments without individual consideration of the patient and their problems. I think public advertisements of drugs harm the way patients view doctors. I can elaborate on this if necessary.

Psychiatric blogs: a) are useful sources of information and I have found them to be helpful. I love them! I have more respect for my psychiatrist because these blogs help me see him as a knowledgeable professional who is also very human too.

Blogs about psychiatry in general (including those by patients and those who may be disenchanted with psychiatry) have a) encouraged me to get treatment or to recommend treatment to others. Psychiatric blogs, both the good and bad, pushed me towards treatment. Considering my illness, Bipolar I rapid cycling, and how terribly I was doing when I started reading blogs, I would be on the streets, in jail or dead. I appreciate all of the public blogs available.

I think a good question to also include is how one's views of psychiatry have changed and why. In order to remove stigma, one has to understand how and why stigma is removed.

Sunny CA said...

(1) I find your questions impossible to answer because they muddle all the issues together and don't allow an opinion on one clear topic.
Example:
Psychotropic medications a) help people b) cause more difficulties then they cure c) are the creation of a greedy pharmaceutical industry which has deceived the public

How about a question on whether the survey respondent thinks Pharma has excessive profits. Another question asking if the answerer has taken psych meds and that send the question answerer to a group of questions. Ask if they have taken a drug on which the benefit was worth enduring the side-effects. Ask if they have taken a drug for which the side-effects were worse than the benefit. Have another question which probes the dishonesty of the pharmaceutical firms, such as opinions on Pharma only releasing positive studies and burying the bad outcomes. Ask about Pharma hiding negative side-effects. Almost every single question has 3-4 topics all jumbled together and most do not allow for people who agree with more than one answer nor for there to be shades of gray.
Example:
Criminally insane patients are a) badly behaved people manipulating the system to stay out of jail b) deserving of treatment c) have the potential to return to free society d) should not live on my street
I would not want to live next door to Charles Manson or any serial killer. I would live next door to a Bipolar patient who was arrested for running down Main Street naked.

(2) Your questions seem to go off the main topic you presented of The Public Face of Psychiatry. Shouldn't a discussion topic be, "What can be done to decrease stigma?" I heard school teachers at lunch saying that any teacher who "had a mental breakdown" should never teach again, and I was sitting there having had a "breakdown". I actively hide my mental health background for fear of losing my job and having people treat me differently. One friend who knows my history will comment critically if I speak a single sentence "too fast". Aren't I allowed to be a hurry and need a quick answer and can't I be excited about something big in my life that is positive without having someone tell me I delivered the sentence "too fast"? I protect my employment and try to have normal relationships by not telling people ANYTHING. However, then I do not serve as an example of someone who is perfectly normal and living a good life post-breakdown (without being on psych meds). Even psychiatrists (especially psychiatrists!) seem to think that everyone once on meds needs them for life.

Anonymous said...

What about asking people their opinions on the 15-minute med check that most psychiatrists use as their practice model. Also, it would be interesting to get the public's opinion about the credibility and reliability of the scientific information psychiatry uses to choose treatments, etc. (I bring this up because there has been so much in the NYT in recent years about research being funded by pharma, publication bias, etc.). Also, it would be very interesting to know how much the public knows about the process of creating/modifying diagnoses in psychiatry (by DSM committee vote) and what they think about that.

Anonymous said...

You could also ask whether people feel psychiatrists tend to perpetuate stigma by assigning labels in order to get paid even though a diagnosis may not even exist for a particular person... and by calling people by their disease/disorder names. For example, on another widely-read psych blog, I often find that the clinicians who leave comments refer to their patients as "bipolars" or "borderlines" - all of which can be incredibly offensive to those who have these conditions. I think this way of speaking says volumes about the way these clinicians view their own patients.

Anonymous said...

Agree with SunnyCA. When I read most of the questions I think sometimes a, sometimes b, etc. There's no "one" answer.

The only one I can definitively answer is the one about medical records. I would not see a psychiatrist who used an electronic medical record. I don't want the dermatologist reading details about my personal life. No thank you.

Leslie

HappyOrganist said...

I think your questions are great. I do think some questions (if not all) should be set up such that a person can select multiple answers. But that's just my opinion. Do what you want ;D
(I actually really like the way most of your questions are worded - 'cause they're funny and show your personality. I think that makes it quite fun, actually. I love fun quizzes. ;D )

Dinah said...

This is really great, keep going!

Anon 1: people can write in comments, but I think we'd like data collection we can use in some pseudo scientific way. But hey, we might quote the comments in our talk if they help with our points.

Anon 2: Question about drugs: thank you so much, I will add one.


Anon 3: please come back and take the real poll when it exists. I'm thinking about how to incorporate the stigma issue. I may have to just have a separate "please comment" request that is not the actual poll, but see if it yields something useful.

Sunny CA: you are absolutely right about the murkiness of the poll and I thought this, too. The problem is that with a research instrument, they really do hammer you into corners to get data in usable ways. I think the anecdotal is sometimes more helpful, but we're going to try this. And your colleagues are dumb. What's a mental breakdown anyway? Sadly, it is sometimes in one's best interest to keep one's private life private.

anon ?: I'm thinking about this. I would like to know the opinion of the 15 minute med check, but I'm hoping for a broad audience to poll, and I'm thinking that the details of treatment aren't really a huge part of it's public face. It may show up. I don't think the general public (non patients/non shrinks) are overly concerned with the dsm squabbles, though it has had a lot of media coverage. Do Roy and Clink have thoughts?

Anon ?: We don't need a question for this, it absolutely is insulting for anyone to be referred to as if they are their disorder. I personally don't want to be the gall bladder in room three, much less the bipolar down the block.

Leslie and Sunny CA: can you think of a way to make the questions less murky and still be multiple choice on the same topic?

Thanks everyone. This is even more helpful than I thought it would be.

Sample Survey said...

Using radio button is the best way to survey this kind of people.

Anonymous said...

I agree with much of what has already been said. It would be interesting to have an option in one of the earlier questions that examines whether the longer one is in treatment the more one's identity becomes entrenched in the diagnosis. Did that make sense, lol? Another way of saying that might be "does long term psychiatric care make it more likely that one will lose their identity and become their diagnosis?" How does psychiatry address this? Another area that you could address is how do psychiatrists judge whether another psychiatrist is a good/effective clinician in terms of helping their patients? Is it the number of scripts written (hopefully not!)? Or is it the number of patients hospitalised per annum? Some of the "murkiness" attached to these issues may be contributing to the sometimes negative public view of psychiatry. Most people that I've met with a psychiatric diagnosis are incredibly careful about who they disclose that diagnosis to. Here in Australia, things like breast, bowel and prostate cancer have much less stigma attached to them than a mental illness :(

Kathy

Anonymous said...

You know the questions. people have sggested a few more. Again, you need more help in survey design than you can get here. Not because people here are not smart enough but because people take full year college and university courses on stats and survey design just to get the basics right. So if you want a survey worthy of using, get some help. It might cost money.It would be money well spent. You don't want your study or presentation to be ripped apart or taken as a joke.

Anonymous said...

The survey choices are all so black and white. They should be more gray. For example I know drugs help some people and make others worse. Therapy I know people who it has been invaluable too while for some continuously talking about trauma makes them worse. etc. I think most people think this way.

-R

Anonymous said...

how about something like psychiatric patients just need to toughen up or whine too much or need to get over it (whatever it may be) - some people think that to be the case (and maybe sometimes it is).

Also, how about something like "If I found out someone was taking psychiatric medications, that would change how I think of them" (yes/no)

Or psychiatric problems are not physical problems like high blood pressure or high cholesterol. (Y/N)

Anonymous said...

How about a question about access to psychiatric care and who should pay for it?

Anonymous said...

It was having to choose an all good or all bad answer that bothered me. Like R said, it's too black and white. That results in distorted data. Most people don't think in absolutes. A couple of psych drugs helped, but some left me a drooling space cadet. So, I could say they're helpful (at times) and harmful (at times). The answers are more complex than psychiatry is good or bad, psych blogs help or don't, meds help or hurt, and so on.

Leslie

Anonymous said...

I love polls. I did some political polling as a college student and it taught me a lot, particularly about bias.

Here's my issue with the last one. I don't agree with either statement. I just like reading the blogs because I find them interesting and enjoy the debates. But, they've neither inspired me to get treatment nor pushed me away from treatment.

When I read the last one I was reminded of a political poll I did once. (I didn't write the questions, I just read them to people). There were two statements that I read and the participants were supposed to say which statement they agreed with. Most people said they didn't agree with either statement, but this was not an option. So, we were supposed to tell people to choose the statement that they agree with more. People would get frustrated as it didn't represent their opinion, but were having to agree with one of the two statements.

When I later read the poll results in print, it was reported that 65% of those surveyed believe....and then they quoted statement a. But, that was completely false. That's not what people were saying, but they were forced to pick an answer.

Leslie

SidewaysShrink said...

You have to throw in there the old saw that shrinks just "go in to psychiatry to cure themselves" and see if anybody bites because the longer I am a shrink the more hilarious that idea becomes.
Also something political about the atomization/isolation/normalization of the individual through therapy (ala Christopher Lasch) might be good to see how many people have actually political objections to psychiatry as blaming the individual for societal maladies (either the worried well or symptomatic abuse victims--some say Freud did it first and best).

ClinkShrink said...

We can talk about the survey after podcasting.

Anonymous said...

From my experience....any deviation from so called normal keeps haunting a person even without incarceration or any sort of suggestion of anything much being wrong.
Electronic medical records presence has no significance in my life as people love to harress me whether it's ok or not.
Infact I am very worried about my kids future so much so that if I had even hint of these attitudes, I would never have had kids..

Sunny CA said...

I was surprised how little I changed when I looked closely at your questions and set about trying to make revisions. The most important change was pulling pharmaceuticals out of a couple of questions and making it a separate entry. I also merged the blog questions and removed some wordiness. I also added a few (e) entries allowing for some additional views. I think it would work well for a "light" amusing interview. If it helps, great, if not, oh well!

Choose 1 or more:

Psychiatry a) helps people b) harms people c) encourages people to use diagnostic labels as excuses for lazy or bad behavior d) is just about handing out medications

Psychiatric patients are a) regular people b) are people I'd rather avoid c) are deeper thinkers and more creative than others d) are unstable and a risk to society

Psychiatrists are a) creative, interesting people b) weirdos c) it's just another job and stereotypes don't apply d) are pawns of the pharmaceutical industry

Psychotherapy a) helps people b) encourages self-centered navel gazing c) often makes people feel or behave worse then they did before they entered treatment d) does nothing e) is not as good as a prescription for psych meds

Psychotropic medications a) help people b) cause more difficulties then they cure c) sometimes help and sometimes do more harm than good d) help at times, but sleep, good food and exercise would do just as well e) are not as good as quality psychotherapy

Pharmaceutical companies who sell psych meds: a) deceive the public for financial gain b) use psychiatrists as pawns to peddle their wares c) have changed psychiatry for the good since modern psych drugs have been available d) are indispensible in caring for psychiatric patients


Criminally insane patients are a) badly behaved people manipulating the system to stay out of jail b) deserving of treatment c) have the potential to return to free society d) should not live on my street

Electronic medical records (this one is potentially for Roy).... a) should exist exactly as all other medical records do in psychiatry and giving them 'special protections' increases the stigma of mental illness b) should not exist for psychiatric illnesses and treatment c) should exist but should have separate and higher protection to allow confidentiality.

A psychiatrist uses electronic medical records that can be accessed by my other physicians and I cannot restrict this: a) I would see this psychiatrist for care b) I would not see this psychiatrist for care

Direct-to-Consumer advertising (commercials/magazine ads) of medications: a) decreases the stigma associated with taking these medications and is therefore good b) scares prospective patients with the lists of side effects c) should not be used because it provides incomplete medical information and the suggestion that patients should demand specific treatments without individual consideration of the patient and their problems d) are good because consumers ask their doctor about conditions they may be afraid to mention

Psychiatric blogs: a) are interesting to read b) are useful and helpful sources of information c) are biased and unhelpful d) have made me feel I am not alone

Anonymous said...

One answer I would add to the psychotherapy question is something about how it depends upon if it's a good fit (not sure exactly how to word that).

Sometimes it's not about that the therapist or psychotherapy is good or bad, but it just may not be a good fit if that makes any sense.

Leslie

Anonymous said...

To improve your survey, why not review the literature for some ideas for questions and design in this area?

Realise that this only represents initial thoughts. Currently, this looks more like a poll that you'd present here rather than a survey for a professioanl presentation at a conference (not meaning to be rude but wanting to be helpful).

Anonymous said...

Criminally insane people are all of the above.

They are MEAN! FRIGHTENING! REAL NASTY! AND PIGHEADED!

Battle Weary said...

Maybe a Likert scale with a larger number of questions? I think it would help the issues of "murkiness", multiple answers, and as it's a scale, can add some "shades of gray".

You could still allow for comments.

pj1280 said...

Well, I'm glad to see that Hyundai Air Conditioner Compressor finds your survey interesting!!

lostinamaze said...

I like taking surveys. Depending on how some of the questions were worded I would have to answer 'all of the above'. I think it wouldn't be completely 'true' for me to answer some of the questions with a simple yes or no.

killjoy said...

You should include the option of "it depends on the psychiatrist/client/treatment." As for the question of meds I could only select "it depends on the intuitive gifts of and their application by the psychiatrist and which generic brand the pharmacy carries and how that particular generic brand effects the client."

What is the point of the survey? What if the majority see you as weirdos in the pocket of big pharm? Will there be a PR campaign or a peer survey to see if there is any truth to the public perception?

APA_member said...

Sorry that I cannot attend your Workshop. We have a lot of work to do on the Public Face of Psychiatry. Your survey is difficult to respond to since all of the choices are at least a little bit true. I would agree with a Likert scale asking for a score on each statement as "a little bit true" "very true" etc.

Dinah said...

Thank you all so much. I went through your comments as I made the survey.