tag:blogger.com,1999:blog-26666124.post8356935338660426844..comments2024-03-18T03:28:36.581-04:00Comments on Shrink Rap: The Top Ten or More Things That Annoy Me About Psychiatry HatersUnknownnoreply@blogger.comBlogger63125tag:blogger.com,1999:blog-26666124.post-51793861577676221362011-06-29T11:39:13.853-04:002011-06-29T11:39:13.853-04:00Anon, does Walker imply that the patient was happy...Anon, does Walker imply that the patient was happy to enjoy hospitalization as long as he didn't have to pay for it himself, and miraculous got better when he could no longer use other peoples' money?moviedochttps://www.blogger.com/profile/03617061594621924756noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-64086440387725236412011-06-29T11:20:45.156-04:002011-06-29T11:20:45.156-04:00"I have been inpatient at Sheppard Pratt seve..."I have been inpatient at Sheppard Pratt several times and have insurance through Carefirst. They have ALWAYS paid by the day and, interestingly enough, since I have always had 21 days of inpatient coverage, I have always been "cured" on day 20. It's amazing. Am I missing something?"<br /><br />Sydney Walker III MD makes this claim in "A Dose of Sanity". He said patients were held for as long as they had medical insurance and then "cured" just before it ran out.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-33463332169146062892011-06-22T17:45:11.346-04:002011-06-22T17:45:11.346-04:00Roy, I have to take issue with what you say about ...Roy, I have to take issue with what you say about how hospitals are paid in Maryland. I have been inpatient at Sheppard Pratt several times and have insurance through Carefirst. They have ALWAYS paid by the day and, interestingly enough, since I have always had 21 days of inpatient coverage, I have always been "cured" on day 20. It's amazing. Am I missing something?Tawnynoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-23297080141488687182011-06-22T14:51:18.457-04:002011-06-22T14:51:18.457-04:00Carolyn, I disagree with your statement that peopl...Carolyn, I disagree with your statement that people who have good experiences with medication treatment are quieter than those with bad experiences because of stigma. People who have poor results are also afraid of stigma. I only posted on here as an anonymous about my poor results with psychiatry because of stigma.<br /><br />I only know people who had poor results with meds because I hang out with people who all need social workers, so by definition, we're the ones who failed treatment (if the pills worked, we wouldn't need a social worker, right?)<br /><br />I post about my bad experiences on meds to counterbalance the billions of dollars in advertising and the costant mantra that "you can live a normal life with (insert severe mental illness here) if you take your meds." Unless normal means you can't hold down a job or clean your house and you can't have kids or the state will take them away because you can't take care of them.<br /><br /> I am absolutely appalled that antipsychotics are being handed out to so many people. I had the worst time with those drugs, but at least I actually have severe mental illness so the risk was worth it, if they had worked.<br /><br />Anyway, people who dislike the meds probably post more on blogs and such, but people who don't like their Net10 cell phone service also post more than those who do like it. <br /><br />Good to know that there is an emphasis on therapy where you are. In my area, the psychiatrists are mostly 15 min med checkers pushing the latest and greatest antipsychotic.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-5562323346900707752011-06-21T09:14:41.136-04:002011-06-21T09:14:41.136-04:00I hope this doesn't annoy you ;-)
I don't ...I hope this doesn't annoy you ;-)<br />I don't believe psychiatrists, as a whole,would have had reason to know that pharma was deceiving them. However, I do question why so many were willing to take what were, in effect, bribes to change their prescribing practices.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-47802106286972176432011-06-21T02:27:59.715-04:002011-06-21T02:27:59.715-04:00[warning: gratuitous book plug coming...]
This is...[warning: gratuitous book plug coming...]<br /><br />This issue of extending stays, etc, is interesting. In Maryland, hospitals generally get paid for an episode of care (DRG), not by the day. So, we get paid a flat rate whether someone is in the hospital for 3 days or 23 days. This incentivizes efficient care. But no matter how long or short the stay, I suppose some would criticize us for kicking people out too early or for keeping them in too long. The reality is that we try to keep the stay as short as possible while providing safe and effective care. Most of us care and always try to do our best. I am sorry that not all have a good experience.<br /><br />We do address these money issues in our book, btw. We discuss incentives and billing and DRGs and such... chapters 9 & 10.Royhttps://www.blogger.com/profile/08735111026336537653noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-15289667392678840732011-06-21T01:51:35.746-04:002011-06-21T01:51:35.746-04:00If you're hospitalized against your will, you&...If you're hospitalized against your will, you're probably best off if you have health insurance because they will help get you discharged quickly. <br /><br />But, if you've got Medicare you could be in for a much more difficult fight to get out. They can keep you a long time and take your social security check, too, while they're at it. e.g. if you followed the Elizabeth Ellis forced ect situation in Minnesota - they have posted the bill per day by the hospital and it's almost $1000/day or approx $30,000/month to treat her against her will. Big bucks, and to help pay it they took her social security check and I imagine the rest is via Medicare. I suspect if she had had health insurance her stay would have been much shorter.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-57268481214616890642011-06-20T22:01:50.271-04:002011-06-20T22:01:50.271-04:00Anonymous, I think the mental health system is so ...Anonymous, I think the mental health system is so broken that singling out hospitals and psychiatrists for extending stays misses the point. The insurance company wants you out. Preferably, they don't want you in at all. Many hospitals aren't even set up for lengthy stays. It's all "crisis stabilization." Sometimes, the MDs are fighting for a longer stay because the patient needs it. I don't think this system can be said to have been designed for anyone's benefit.Alexisnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-9837968075311150912011-06-20T22:01:23.866-04:002011-06-20T22:01:23.866-04:00I'm sorry I'm on a roll here. Psychiatris...I'm sorry I'm on a roll here. Psychiatrists do benefit by over prescribing meds. They get paid. If a psychiatrist tells a patient they don't need meds they need therapy they lose business. Psychiatrists are under a tremendous amount pressure to make money just like anyone else. Also if a patient isn't sick enough to need a med, then insurance companies probably won't pay for them to see a psychiatrist. It's crazy how screwed up our health system is.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-46697986349607270482011-06-20T21:57:34.725-04:002011-06-20T21:57:34.725-04:00I don't think people are harmed by meds but th...I don't think people are harmed by meds but there is definitely an over reliance on them. A patient comes in, says they want a med. They might benefit from a med but what they really need is therapy. For whatever reason the patient can't access therapy so they just cycle through monthly 15 minute med check type appointments. The sad state of psychiatry and our health system is embarrassing.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-20642450710456340292011-06-20T21:51:42.144-04:002011-06-20T21:51:42.144-04:00Unfortunately the part about psychiatrists benefit...Unfortunately the part about psychiatrists benefiting from prolonged hospital stays is true in my experience. The hospitals view patients as heards of cattle. They get paid per patient per day and want patients to stay as long as possible. There are some psychiatrists who work hand and hand with these hospital administrators to maximize hospital stays and profits. One example might be a malingerer they could easily stay in the hospital 2 weeks or more if not confronted. My buddy walked into a situation like this. He greatly improved the quality of care but the administrators were frustrated because he cut the bed days. Go figure.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-85642127801798086952011-06-20T12:16:38.723-04:002011-06-20T12:16:38.723-04:00It's interesting that the idea that I am Annoy...It's interesting that the idea that I am Annoyed (which is not a terribly strong word) by insults, or one-sided sensationist views, then gets interpreted as being unwilling to hear criticism of the any area of our field.Dinahhttps://www.blogger.com/profile/09227988351623862689noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-62503942039076920322011-06-20T11:43:37.326-04:002011-06-20T11:43:37.326-04:00I believe part of what feeds this kind of negative...I believe part of what feeds this kind of negative thought toward psychiatry is that many people taking psychiatric medications stay very quiet about it, due to the stigma related to taking these medications. I am always surprised by how many people around me have taken or are taking a mild antidepressant or mild anti-anxiety medication to maintain functionality during difficult times in their lives. But these folks aren't going to announce it to the world, so the only public voices we hear are the ones of people who have had a real problem in their system of care. I know many people who have found psychiatric medications to be a Godsend- it helps them get better faster and maintain a higher quality of life. I even took notes in my psychopharmacology class in grad school so I could remember which medications sounded good to me in case I ever found myself in extreme personal need and needed to talk to a psychiatrist myself. <br /><br />As far as involuntary care goes, I find it ironic that this is an issue because in my own backyard, working with minors with severe symptoms, its hard to even get them admitted and once they are, its hard to let them stay there as long as they need to. For as many people have been involuntarily admitted, there is another group of people clamoring at the doors to be let in who are turned away because they don't have the knife to their wrists right then. This is due to our state's huge budget problems. I am not trying to deny this issue, just saying I have seen more of my clients turned away than I have sent to the hospital against their will. Also, and I work only with minors, so bear with me, most of them report it as a pleasant experience, even vacation-esque, because they get to be in a quiet place where they feel calm, watch movies and play video games, and nice people come and check up on them on a constant basis, which is way better than the environment in their actual homes. <br /><br />I am likely biased because the psychiatrist I work with (in fact all the psychiatrists I've worked with) have held therapy as the primary mode of treatment and medication as the secondary, and they have worked closely with me to be sure my clients get appropriate services. Many parents ask for a psychiatric evaluation, and my psychiatrist denies then due to a lack of evidence, or evidence that the child's problems have more to do with environment than a biological mental illness, and they get referred back to me. I have referred children as young as 3 to our psychiatrist (not because I thought they needed it, but because parents have a right to request a psychiatric evaluation whether I agree or not) and I know I can trust my psychiatrist to deny medicating any children under 6 years old unless there are some kind of extenuating circumstances. <br /><br />I am sorry for the folks who have had bad experiences with inpatient and outpatient care, or have come across uncaring, unfeeling mental health professionals. Narcissism, anti-social behaviors, and ignorance are not absent from our professions just because we have graduate degrees. I recommend you read up on your rights as a patient/client and take advantage of those rights, because you have A LOT of them. Malpractice is a huge deal and you have the power to threaten the licensure of a mental health professional who has acted unprofessionally. All mental health professionals answer to a board for ethical and best practice decisions, and many lose their licenses or certifications every year for infractions. There are watchdogs on us to keep us honest. For MFTS and Social Workers in CA, we answer to the BBS. Every state and profession answers to somebody. I recommend taking complaints to a higher authority; you might be surprised at the results. <br /><br />Lastly, thank you for being a psychiatrist who continues to learn and perfect her craft in order to provide best practice. I sure there are many silent, grateful voices who simply don't feel comfortable with a public forum.Anonymoushttps://www.blogger.com/profile/14266127396351211649noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-70490022963029821852011-06-20T04:52:35.464-04:002011-06-20T04:52:35.464-04:00Jesse,
You said,
""At times anti-psych...Jesse,<br /><br />You said,<br /><br />""At times anti-psychiatric positions are touted that in effect are denials that our field has any validity, and these strike me as quasi-religious stances masquerading as scientific. These are harder for others to address as they are not what they purport to be. This seems to me much worse than using "borderline" in a tongue-in-cheek way.""<br /><br />As someone who has greatly appreciated alot of your posts, I have to take issue with this one.<br /><br />I feel that with the stigma that people with borderline personality disorder already experience in the medical field, that using something even in a tongue-in-cheek way by someone in psychiatry is offensive. Thankfully, Dinah and Movie Doc recognized that.<br /><br />If this person had compared psychiatry haters to people with schizophrenia in a tongue and cheek way, I don't think you would have found that acceptable. So why is this situation any different?<br /><br />Regarding people questioning your field, critics of the upcoming DSM have been psychiatrists who are concerned that you are labeling every human experience as mental illness. So in a sense, they are questioning the validity of your profession.<br /><br />"The public needs to know that psychiatry is a field in its infancy, and as such, skepticism is warranted"<br /><br />http://www.psychologytoday.com/blog/learning-play/200912/dsm-v-plea-skepticism<br /><br />By the way, I find this discussion of the black and white issue ironic. As I keep pointing out in my posts, you (generically) make it seem like psychiatry haters are the only folks who are criticizing psychiatry. I keep pointing out that with various examples that isn't the case.<br /><br />So who really has the problem with black and white thinking?<br /><br />AAAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-38326081187959147812011-06-19T23:38:26.831-04:002011-06-19T23:38:26.831-04:00This post was so ludicrous it's beyond rationa...This post was so ludicrous it's beyond rational fathoming... <br /><br />This Psychology Today shill is a glaring example of exactly why psychiatry is once again being viewed with growing skepticism by the general public as the pseudo medical snake oil salespersons they are.<br /><br />Just another bait post...I assume you're going to take the responses to your next APA meeting as another cheap stunt & unscientific paid presentation.<br /><br />Can hardly wait for the profitable misleading drug ads to begin appearing on this site...<br /><br />If nothing else, Miller has validated & strengthened the evidenced criticisms of the psychiatric practices today. <br /><br />Thank you once again...Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-51292539365180412922011-06-19T22:05:23.198-04:002011-06-19T22:05:23.198-04:00Zoe, you wrote "I put myself totally in their...Zoe, you wrote "I put myself totally in their hands" in regard to the psychiatrists. Others have written somewhat similar words in other posts. <br /><br />You yourself have become expert in an area of life most people know nothing about; it is easy to see how, faced with the changes in your body and feelings you described, you would be baffled, frightened and feel a need to put yourself totally in their hands. <br /><br />What I think all of us psychiatrists would agree with is that our work with our patients is more a joint exploration than trusting someone with complete knowledge. A good part of the anger expressed in these blogs results from the fact that knowledge in psychiatry is anything but absolute; at times the people in authority are aware of their limitations, at other times they are not. <br /><br />Even for the best of us we do things which don't go as intended. We can only do what we can with the knowledge we have.jessehttps://www.blogger.com/profile/11077223398907532291noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-47712134021016972782011-06-19T22:03:22.503-04:002011-06-19T22:03:22.503-04:00The implication that we can foresee that medicatio...<i>The implication that we can foresee that medications will cause side effects, adverse effects, or be ineffective...</i><br /><br />I would say that this is an exaggeration with some basis in fact, though I would also say that psychiatrists are far from the only medical specialty with this problem. I have felt like I was not warned of side effects which, though not necessarily foreseeable in my specific case, were common enough to deserve a mention. I have also felt like I wasn't taken seriously when I complained about some of those side effects (weight gain is my particular problem). <br /><br />I feel like there is a culture where we tend to believe that the benefits of medication outweigh the side effects, even if they are not life threatening, and doctors do not always understand a patient who does not find the trade-off acceptable.Alexisnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-2160889445583169212011-06-19T22:03:15.048-04:002011-06-19T22:03:15.048-04:00Jesse - thank you for taking my comment in the way...Jesse - thank you for taking my comment in the way it was intended. I was referring to the trait of splitting black and white, as I tried to explain by the example. I was not making a diagnosis, or attempting to label all anti-psychiatry people as having Borderline Personality Disorder.Shrink2Bhttps://www.blogger.com/profile/06641627132872279262noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-83958744432315852392011-06-19T21:51:07.936-04:002011-06-19T21:51:07.936-04:00This comment has been removed by the author.jessehttps://www.blogger.com/profile/11077223398907532291noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-66252390166834610692011-06-19T21:29:28.763-04:002011-06-19T21:29:28.763-04:00Whoaa! Shrink2be put "borderline" in quo...Whoaa! Shrink2be put "borderline" in quotes, as "borderline." That was not making a diagnosis but rather noting that many of the Haters characterize things in a black and white way - she said "like politicians" and we all know that is the most pejorative comparison one can make.<br /><br />Let's go back to Aqua, the third poster.<br /><br />Aqua has "bought in" (and I'm not saying from Shrink Rap) to the idea that only symptoms and suffering that result from absolutely provable brain changes are not her fault; others are her fault, her responsibility, and any suffering she has results from her not having tried hard enough to change. And she's working hard to rid herself of these attitudes. <br /><br />Aren't psychiatric patients burdened enough by guilt that we should try not to increase it? So to Dinah's list I would add number 0.5, "Psychiatry is not a valid discipline."<br /><br />At times anti-psychiatric positions are touted that in effect are denials that our field has any validity, and these strike me as quasi-religious stances masquerading as scientific. These are harder for others to address as they are not what they purport to be. This seems to me much worse than using "borderline" in a tongue-in-cheek way.jessehttps://www.blogger.com/profile/11077223398907532291noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-43602082644640568442011-06-19T21:18:20.321-04:002011-06-19T21:18:20.321-04:00Thumbs up to anon#5, re comment: "Psychiatris...Thumbs up to anon#5, re comment: "Psychiatrists must avoid accidentally putting themselves in the role of a new kind of authoritative abuser by being aware that they are authority figures and some patients fear them. Perceptions are everything."<br /><br />Definitely agree. <br /><br />BTW, I suggested the "hater" term, rather than anti - psychiatry, to differentiate critics of psychiatry (and the three of us have criticisms, as well; we recognize many imperfections) from the "haters", ie, those who sees no positive aspects whatsoever, think that all psych meds should be banned despite benefiting some people, and always steer the conversation to the same points... the extremist views that another commenter referred to.Royhttps://www.blogger.com/profile/08735111026336537653noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-35048186498493559262011-06-19T20:59:34.027-04:002011-06-19T20:59:34.027-04:00your spam filter is eating posts, again. Also, shr...your spam filter is eating posts, again. Also, shrink2b - are you really a person studying to be a shrink who just labeled a whole population as <i>borderline?</i> I sincerely hope you have many more years of training and life lessons before you are qualified to work with psychiatric patients.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-77822690676105351982011-06-19T20:44:40.799-04:002011-06-19T20:44:40.799-04:00Personal, non-confabulated story:
I had a most di...Personal, non-confabulated story:<br /><br />I had a most disorientating experience in 2005. A change of sex.<br /><br />Anyone who perceives this to be happening should obviously seek psychiatric help (and I did).<br /><br />It turns out to be 3-beta-hydroxysteroid-dehydrogenase deficiency (3BHDD), we think now. All the symptoms match anyway, and such changes are *far* more common than I'd appreciated at the time. Rare, but they happen.<br /><br />I thought they were plain impossible, hence my perceptions had to be askew with reality. Having others confirm that they saw the changes too just meant my delusion was more extensive than I thought... until even I couldn't believe that, not without doubting all perceptions whatsoever.<br /><br />I've since found out the scope of the neurological changes that must have occurred over that time, due to the hormonal chaos. 3BHD is the necessary catalyst that aromatises cholesterol and a few other precursors into (eventually) cortisol, estrogen, testosterone, progesterone, mineralocorticoids etc etc so if 3BHD is deficient, the body's whole endocrine system is out of whack. The natural feedback systems try to cope, and keep the patient alive, but in the meantime pretty much anything can happen. I lost 1/3 my body mass for example before HRT stabilised things.<br /><br />Anyway... given the chaos, any drug intervention at all was inadvisable. I had to ride it out, somehow keep functional. My feelings were untrustworthy, I had to ignore them and think "OK, now what would a *sane* person do in this situation"?<br /><br />It helped that I'd been Gender Dysphoric all my life, so the change was a massive relief (though of course that provided extra evidence to me that I'd gone off my rocker in some kind of delusional wish-fulfilment psychotic episode, and increased my disorientation).<br /><br />My attitude towards my psychiatrist was absolute honesty. I reported what I felt, trying to be as dispassionately objective as I could, figuring that without honest data, they couldn't arrive at a good diagnosis, let alone prescribe good treatment. I put myself totally in their hands.<br /><br />Had I known then what I know now about psychiatry... I'd still have done the same, but been far less confident of their ability to diagnose, let alone help.<br /><br />I have a lot of sympathy too for the first psych I saw (who blew it completely). This kind of thing is rare, he would have been completely out of his depth. I didn't know that at the time.<br /><br />Anyway, I'm too busy living now to mull over it. There's exams to mark, a thesis to write up, my son wants to play a game with me.... though I do wonder how anyone could go through an experience like that and retain any semblance of sanity. Others do though.Zoe Brainhttps://www.blogger.com/profile/13712045376060102538noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-13121862340570651952011-06-19T20:31:53.352-04:002011-06-19T20:31:53.352-04:00I am not a fan of the "borderline" thing...I am not a fan of the "borderline" thing-- it feels like hurling insults-- Please see:<br /><br />http://psychiatrist-blog.blogspot.com/search/label/personality%20styles<br />and<br />http://psychiatrist-blog.blogspot.com/2008/09/borderline-or-bipolar.html<br /><br />The "hater" post was absolutely not directed at one person. We've had haters since the beginning---in fact, I had some vague sense of an anti-psychiatry movement of people who picket the APA, and I've certainly had patients who complained about their former psychiatrists, but until Shrink Rap, I had no idea of the venom people have towards psychiatry. One of the people in our publishing house was reading Shrink Rap and said to me, "I thought psychiatry was just a medical sub-specialty." Yeah, me too, until Shrink Rap. It's been an education, and I'm still here blogging.<br /><br />Shrink2B: welcome to Shrink Rap. May I make a gentle suggestion? In psychiatry we don't say things like "Seems to me that psychiatry haters are all borderline." For a whole slew of reasons, this will not make you a popular shrink.<br /><br />I did not mean to offend anyone with this post, though I did mean to stir and heat things up. And the fact that I don't perceive my relationships with patients as being adversarial (...hmmm, who wants an adversarial shrink?...I thought I was supposed to be kind, non-judgmental, listen and be helpful), does not mean that I discount or invalidate the bad experiences others have had with shrinks.Dinahhttps://www.blogger.com/profile/09227988351623862689noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-49748573652211491572011-06-19T20:04:43.891-04:002011-06-19T20:04:43.891-04:00Rob: kal vachomer. LOL, who knew? Oy, oy, oy.Rob: kal vachomer. LOL, who knew? Oy, oy, oy.Anonymousnoreply@blogger.com