We are a commune of inquiring, skeptical, politically centrist, capitalist, anglophile, traditionalist New England Yankee humans, humanoids, and animals with many interests beyond and above politics. Each of us has had a high-school education (or GED), but all had ADD so didn't pay attention very well, especially the dogs. Each one of us does "try my best to be just like I am," and none of us enjoys working for others, including for Maggie, from whom we receive neither a nickel nor a dime. Freedom from nags, cranks, government, do-gooders, control-freaks and idiots is all that we ask for.
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Sunday, April 6. 2014
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I agree with the quoted person. And really, is it such a bad thing if the mental health experts grab a piece of the pie for themselves? It's not a huge piece. Why should the lawyers have all the loot? I hate lawyers, don't you?
Surely, there is room in this fantastical regulatory construct for all of the experts? There is much at stake. Studies and regulations need to be honed and polished. Eventually, we can achieve simplicity, happiness and understanding.
If you are a cog in the machine and your job is to help sort people so they will slide into the proper slots in the proper sequence (so they can get the right treatment) what do you see as proper remuneration? More money of course.
But, should the mental health industry get more safeguards against lawsuits? A note of caution: If you ask for this, you will get it. And, you will also get more lawyers poking around in your rice bowl. They multiply like bedbugs.
No, I would suggest asking for mandatory time off for rest and recuperation. It's a stressful life pretending you can get inside other people's heads. Sorting the lies and illusions from the truth when there is no truth and everything is a lie, can cause stress. Time off to recharge your ability to suspend disbelief is critical for any smooth running cog. You have an important job, you administer the 'appropriate behaviour' portion of reality. Cruise ships are lots of fun.
Of course, you will need more mental health experts to help fill in during your absences. Sacrifices must be made.
One last thing. How does asking for more money and time off make you feel? Do you feel guilty? If so, you are already overdue for a much needed vacation. Jump on that cruise ship ASAP. Plenty of time for your other concerns next time. Your 45 minutes is up.
Dr. Bliss expresses the opinion of many experienced clinicians when it comes to using manuals for diagnoses. Originally, the DSM was configured to be used for research diagnostic criteria with the emphasis on research. The DSM 3 in particular was defined in that way by its main author, Robert Spitzer, and was not intended as a general psychiatric taxonomy.
Years ago, when I allowed myself to appear in court for a patient involved in a custody battle, his wife's lawyer brandished the DSM in my face and said' "this is your diagnostic bible, isn't it doctor?" I replied, "It may be the bible of the insurance company, but I have never found a patient of mine in that book." I don't go to court any longer.
For many doctors, there are physical signs of the problems they're working with.
For psychiatrists there are not (usually), which makes it a lot easier for them to invent diagnoses in order to generate more income for themselves.
A surgeon can only remove so many appendices from a patient before that patient gets suspicious and starts to wonder how many more he has.
A psychiatrist telling a patient he has to come back for more "counseling" every week for years on end and gets more and more pills to swallow every time (for which the psychiatrist gets a nice little kickback from the maker and the pharmacy) creates no such suspicion. In fact he gets lauded as "taking good care of our Anny" by Anny's family.
That a lot of Anny's problems may well be caused by that "counseling" and those pills in the first place, and a few different sessions and no or other pills for a shorter period would have solved her problems in weeks or months rather than years is a taboo subject to even mention.
A fine collection of very thoughtful comments. I have one question for clarification however for J.T.W. Is it really true that psychiatrists get kickbacks from someone for prescribing pills? I have heard about this, but I have seen no solid evidence. I suspect it is true judging by the level of enthusiasm the psychiatric community shows in dispensing pills. Can you provide a lead for the proof? TYVM
"Influencing Doctors' Choices
In 2007, the New York Times found evidence that payments from pharmaceutical companies can influence the drugs doctors prescribe. Reporters analyzed prescription data and payments from drug companies to psychiatrists in Minnesota. They found that psychiatrists who received $5,000 or more from the manufacturers of atypical antipsychotic medications issued, on average, three times the number of prescriptions for this class of drugs for use in children than did psychiatrists who received less than $5,000 from the companies.
However, it also reasonable to consider the possibility that the drug companies observed their data first and identified those doctors who seem to prescribe their drugs more than others. The companies may then have picked those doctors to be on their speakers' bureau or their advisory boards because they had more experience with the company's drugs. If so, the fact that the doctors are paid more than $5,000 would not have influenced their decision to write prescriptions for certain drugs, because they were already doing so.
This is a tricky problem because psychiatrists can help pharmaceutical companies design better drugs and judge their effectiveness. However, to avoid the appearance of conflict of interest, and to rule out any chance of conscious or unconscious bias or favoritism, the physician-consultants should not benefit financially from the success of the product."
I stole the above quote from a web posting about the issue of kickbacks. Apparently, it is a tricky problem.
I'm not convinced one way or another whether there is such a thing as mental illness. My libertarian friends say no, and they have a good argument. Certainly the huge volume of changes between the new DSM and the previous edition should make it obvious to all that most of the definitions of "conditions" in it are completely arbitrary.
But let's assume for the moment that mental illness exists. Even then, no self-respecting person would ever allow a shrink to examine him if he can possibly avoid it. This is true for two reasons.
First, if you have, or are believed to have, any mental "condition," the core parts of your very soul -- your reason, your good conscience, even your integrity -- are called into doubt. Or at least they become unreliable in other folks' view.
Second, and more importantly, if you are diagnosed, even with something mild and un-blameworthy such as anxiety or PTSD, your civil rights can be taken away without any due process. Even if they don't lock you up, they can appoint a conservator to run your life for you.
It's high time to separate medicine and the State so those things can no longer happen. But until they do, the shrinks are not our friends, even if their diagnoses are accurate.
I would think that the problem for the profession of psychiatry is not diagnosing a mental illness but rather the inability to know who will fail and who will succeed in life in spite of a mental ilness. Many, perhaps most people with mental illness go through life, get married, have children, have jobs, enjoy grand children and die in peace at the end of life. While others with what would seem to be the same exact illness become mass murderers or Democrat politicians and cause extreme problems for society. Everytime there is a mass shooting or some other human caused disaster the politicians call for more psychiatric help for those who are mentally ill but this may simply dilute the care available while at the same time waste billions that could be better spent. What is needed is some way to identify those who will harm themselves or others.