Sunday, October 23, 2011

More on How Lousy Psychiatrists are at Determining Prognosis



A few days ago I put up my post on the Clinical Psychiatry News website on Rethinking Bipolarity.  I talked about how we've expanded the diagnosis so that now it captures so many problems as to make the diagnosis imprecise and I talked about how we really can't predict prognosis.  In the same vein, the front page of the New York Times has an article about people with schizophrenia who do better if they keep busy with busy careers, even if they are very stressful.  In a High Profile Executive Job as Defense Against Mental Illness, Benedict Carey writes:

Now, a group of people with the diagnosis is showing researchers a previously hidden dimension of the story: how the disorder can be managed while people build full, successful lives. The continuing study — a joint project of the University of California, Los Angeles; the University of Southern California; and the Department of Veterans Affairs — follows a group of 20 people with the diagnosis, including two doctors, a lawyer and a chief executive, Ms. Myrick.


The study has already forced its authors to discard some of their assumptions about living with schizophrenia. “It’s just embarrassing,” said Dr. Stephen R. Marder, director of the psychosis section at U.C.L.A.’s Semel Institute for Neuroscience and Human Behavior, a psychiatrist with the V.A. Greater Los Angeles Healthcare System and one of the authors of the study. “For years, we as psychiatrists have been telling people with a diagnosis what to expect; we’ve been telling them who they are, how to change their lives — and it was bad information” for many people. 

It's a good article, but I have one gripe with it (...ah, for me to have only one gripe with an article by Mr. Carey is close to amazing).  He makes it sound like people with schizophrenia have chosen less stressful jobs because that's what doctors recommend.  I think some people with schizophrenia lose their motivation to work at any job because it's one symptom of the illness.  Like bipolar disorder,  schizophrenia and schizoaffective illness seem to play out differently in different individuals.  As a field, our crystal balls don't seem to work very well. 

20 comments:

Anonymous said...

I also read this article. I found it inspiring that someone with schizoaffective disorder was functioning so well in society. But I question whether her job is actually high stress - my reading of the article was that she is the chief executive of a small organization comprised primarily of persons with some sort of diagnosis. I don't think it's fair to suggest that someone with a diagnosis should be able to handle a high stress position.

Knot Tellin said...

Fascinating. I'd like to know more about the study. Do you have a link or citation to the study itself?

Milo said...

I was told that I was schizophrenic for 12 years and I will forever remember the negative remarks I recieved from psychiatrists. It was horrible... I was even scared of myself. I would not wish a minute of it on dog.

rob lindeman said...

[Back to comment moderation?]

Someone once said the best therapy is a job and a paycheck.

I wish I could find the source of that quotation. Carey's piece is living testimony.

So is Milo's.

wv = cardnes. Lesser known French cathedral town

Andrea said...

I think it is good when psychiatrists are realistic but optimistic. When say or suggest things that may stifle a patient's growth, that can be damaging. No one really knows a person's true potential. People with various disorders may end up surprising many people with their success--including themselves.

Sunny CA said...

"He makes it sound like people with schizophrenia have chosen less stressful jobs because that's what doctors recommend. I think some people with schizophrenia lose their motivation to work at any job because it's one symptom of the illness."

I think it is possible you don't know what is going on inside other psychiatrists' offices. I don't have schizophrenia, but I was hospitalized with a one-time-only psychotic break at age 54, initially diagnosed as bipolar, because psychosis is the "defining symptom". After more than 20 years running a very stressful business I was told by both the psychiatrist I had in the hospital and the one I had immediately after, to quit my business and just take it easy. The medications I was prescribed made that mandatory since my short term memory was severely affected, and I lost my creativity and emotional connections which were essential to photographing which was essence of my business. As a result of the doctor's instructions I quit my business (and the medications, not the "disease"). When I switched psychiatrists, to my current psychiatrist, he encouraged me to go off the medications and resume a full life, and he disagreed and still disagrees with the bipolar diagnosis. Alas, it was too hard to resurrect a business I had abandoned, since it meant pretty much starting over, so I changed careers. Starting over meant returning to graduate school, which I did at age 55 (which was stressful). This job is more stressful than my business was. I've had no indication that I will ever have another psychotic break and my psychiatrist thinks I won't. If I had stayed with the advice of the original doctor, I'd still be left without good short term memory or emotions and I guess I'd be unemployed or serving coffee somewhere. As an aside, the psychologist who I saw at that time along with the med-psychiatrist was similar to the social worker who commented a few posts ago. She refused to discuss any "issues" in my life, and felt it her job to "brainwash" me each session that I needed to "accept my diagnosis" and "take medications for life". That was the sum total of months of 'talk therapy' with her. It was completely useless as far as I am concerned.

My current psychiatrist and I started from the beginning of my life and discussed all past and present issues at great depth. He did not dismiss or disregard me because of my diagnosis and just stick me on meds with instructions to lay around the house. Instead he approached me with an open mind and attempted to grant me the fullest, best life possible. It has been over 6 years since my one and only psychotic break and I am now over 60. Even if I were to have another psychotic break, I would not regret going off medications and living a stressful, but satisfying life in the aftermath of hospitalization. Life as a lay-about without decent short term memory robbed me of the essence of who I am.

Dinah said...

Anon & Sunny & Milo: We don't what people can do until they try. SunnyCA: You're right that I don't know what goes on in other shrinks' offices.
Sometimes we guess...so we might say that someone with dementia probably should stop doing brain surgery sooner rather than later...the surgeon might do just fine with most (or even all) of the surgeries, but who wants to find out?
Rob: I agree, people should push themselves to be as productive as they can and it's hard sometimes to tell when people can vs. won't. But some people can't and they really can't. I worry that our current disability system holds people back from trying.

Rob: comment moderation, I put it on in the hopes of slowing a huge influx of spam...going to our older posts...but it's at least a dozen of day of the robo-spam varieties.

SteveBMD said...

When I first read your headline, I thought this article would be about "lousy psychiatrists"!

But I digress...

I have to agree with Rob. A productive life-- a sense of meaning, which many, if not most, people obtain through work-- can be extraordinarily therapeutic. At the very least, it "normalizes" those who are otherwise disenfranchised from society.

Sort of throws a monkeywrench into the whole concept of psychiatric "disability," too.

Jane said...

That social worker really made an impression. I noticed Sunny brought her up. Though I will say this, I have seen worse on the internet. Someone on The Last Psychiatrist started making fun of the "badass kids" she works with on an inpatient unit. And then made fun of all the "normal kids" who somehow wound up there for acting out and how they'll probably go on Maury someday and cry about it. And I know they are "basass kids" who are obviously troublesome, but I just couldn't help but think that she really needs to not work in that setting anymore. I bet she rehabilitates those kids pretty well with that attitude!

Milo said...

@Dinah and Rob
stressfull?
I became a nanny. If I am ever good enough to get cuddles from my little ones, I guess I could also forgive myself and move on.
I went back to school after coming off Clozepine (on my own. did not tell the psychiatrist coz he said he would lock me up)
I graduated with honours from a reputable cnacer research institute. I worked 13 h days sometimes. and I loved it. I am putting in applications for a PhD at the moment (please wish me luck!)
I am broken, but try to put things together one step at a time (it is really slow sometimes, i get frustrated and angry!)
as far as i am concernen:
I have not done too bad for someone who climed her way out of the loony bin. not too bad at all!
and psychaitry(only the ones who did this to me) could kiss my fat Clozepine a#!.
Milo

jesse said...
This comment has been removed by the author.
Anonymous said...

Rant. Rant rant rant rant. Rant. Rant, rant. Rant: rant. Rant; rant. Rant rant--rant. Rant! Rant, rant? Rant.

Are you happy now, dear?

Anonymous said...

Who's the dear, dear? Which dear? Witch dear? Oh, dear. You are dear.

No, I never requested, nor wanted, a series of rants.

I worry about you. You've turned into someone so far from the person I once knew.

Liz said...

fascinating indeed...and i, too, would love the link

http://pocketshrink.blogspot.com

Anonymous said...

Funny. It has been my thought for awhile that you are the person who is so different than the person I knew.

Yes, I'm different too, I imagine. There are things here that have changed me.

But enough of all that.

Anonymous said...

Perhaps I am different than the person you imagined-- or wanted-- me to be.

I don't know what you want, and it's been so long that there is no going back so it doesn't really matter. I worry...you appear (what do I know, anyway?) to have withered. You hate where you are, and rather than move to a more comfortable setting, you've turned it in to your own Gilligan's Island...no phone, no light, no motor car....

Anonymous said...

feel better having gotten that out your system? some days an anon blog post is a great swathe of chrysanthemums beneath your window on a gorgeous fall day. some days it is a flower pot of pansies falling off your window ledge on a rainy Tuesday. you got pansies. but today is sunny and home depot is having an end-of-season chrysanthemum sale....

Jane said...

@the last anons and their convo:...Most surreal discussion board thread I have ever witnessed...Congratulations. You are master trolls and have won the internets.

Anonymous said...

@jane, I can't wait for the next installment of ... The Days of Our Shrink Rap.

FrankandMary said...

I find that I meet people who believe I am either a bag lady or a person attending a day hospital by bus. Actually, I drive my Mercedes to my very comfortable apartment. ~Mary