Shrink Rap Today

There's a new twist. Recently advocates of sporkiatry (combined psychotherapy and med management have suggested it's wrong for psychiatrists to do medication management without psychotherapy. Is this now a moral/ethical question as well as a question of what treatment the patient needs and who might best provide it? Might we ask whether it is wrong for an orthopedic surgeon to do physical therapy along with surgery, a rheumatologist to do physical therapy along with prescribing?

Of course it's OK, provided the psychotherapy offered matches the illness treated, its purpose is treatment, not just for satisfaction of patient and physician, and it really is psychotherapy, not just "getting to know" the patient or getting the physician paid by insurance for extra time to take care of administrative chores.

Psychiatrists are in short supply?

Since When!

Psychiatrists abondoned their hippocratic oath years ago.
"First, do no harm" has been replaced with "First, put the patient on drugs."

Psychiatrist Loren Mosher, M.D. had the right idea when he made a clean-break from psychiatry -

http://www.moshersoteria.com/articles/resignation-from-apa/

We do NOT need more psychiatrists in this country...
Any "doctor" can write a prescription for a psychoptropic drug, especially one who chooses to ignore the hippocratic oath.

We need more REAL doctors.
And real doctors get the the root cause of problems, symptoms in the body, brain, mind. Real doctors help people heal and recover.

Psychiatry is not based on the scientific method.
Psychiatric drugs cause more harm than good for the vast majority of people who take them for the long-term.
Psychiatrists are NOT real doctors!

Duane Sherry, M.S.
discoverandrecover.wordpress.com

I'm not sure why anyone would feel that a psychiatrist is in a better position to provide counseling than a licensed therapist...

Especially, considering the grave harm involved in the prescribing of psychiatric drugs - especially, for the long-term, for those diagnosed with "severe mental illness"...

A timeline for "antipsychotics" (neuroleptics)... A must-read for anyone who is considering seeing a psychiatrist -

http://www.madinamerica.com/madinamerica.com/Timeline.html

"Going to a psychiatrist has become one of the most dangerous things a person can do." - Psychiatrist, Peter Breggin, M.D.
(www.breggin.com)

Duane Sherry, M.S.
http://discoverandrecover.wordpress.com

Not "real" doctors? As the child of a psychiatrist -- and, more generally, a reasonably well educated individual -- I seem to recall that psychiatrists do show up for med school and residency training, if not additional fellowship work. It is not the only field that combines lifestyle management/psychological-emotional health approaches with medicine. I have had severe migraines for 25 years, and my neurologist blends the prescribing of medication with stress management techniques and discussions about my lifestyle. The body and brain are complex and, shocking as it may be to some, actually interconnected.

I'm not critical of physician's decisions to only provide management of medication for mental health, but it seems to me that mental health issues do not occur in a vacuum. Show me the person with depression or schizophrenia or PTSD or anxiety whose brain chemistry issues are not associated with challenges meriting supportive talk therapy (whatever the approach: CBT, analysis, etc.). Having worked with both models -- having a team that included a psychiatrist for meds and a psychotherapist for therapy, and a psychiatrist who provided both -- I will always choose the latter (providing s/he is skilled at both). Having the benefit of a skilled diagnostician who can help monitor the meds' effects/benefits as part of an integrated psychotherapeutic approach seems to offer the physician with more and richer data on which to base decisions about medicine and offers the patient with a tighter network of support.

And yes, Moviedoc, I'm already anticipating your argument that psychiatrists shouldn't enable their patients by providing support. Sigh. I'm a professor and I provide support to my students -- not to be dependent on me, but to help them develop the capacity to lead their lives more effectively. I regard my physicians -- whether for my back problems, migraines, or depression -- as working with me to build my capacity to be stronger and healthier.

Are there psychiatrists doing therapy to make extra money? Perhaps, but if money is really the bottom line interest, wouldn't these individuals have become anesthesiologists, orthopedists, or neurosurgeons? And no, I'm not accusing these skilled physicians of entering their areas of specialties just for the money, I'm just pointing out that the decision to provide therapy does not seem to be the most effective leverage point for increasing revenue.

Does the field of psychiatry merit active discussion and, perhaps, reform? I'm sure. But much of the problems seem to be rooted in the healthcare system writ large, the power of the drug companies, and the stigma still attached to mental illness. As with the field of education, I wish we could have a more nuanced discussion that took into account society's values and how the field reflects those values, rather than fighting out whether or not a psychopharmacological or therapeutic approach is good or bad.

I don't think anyone would argue that psychiatrists go through the rigors of medical school, residency, board certification, etc... In fact, I think it's fair to say that very few people have the physical stamina, emotional energy and smarts to do so.

So, you make a good point.

The question is what do they have in their medical bag at the end of all that education and training?

They have NOT MUCH.
That's what they've got.

They had (some still use) lithium.
Lithium has lots of fallout to the thyroid and kidneys.

They have anti-convulsants that they use for "mood stabilization"... once again, with lots of fallout.
Moods are not brain seizures. Period.

They have benzodiazapines.
Highly addictive.
Hard to get off... they take years to taper off for many.

They have antidepressants.
Clinically no better than placebo.
They leave people fat and asexual.
They leave people feeling numb, caring less.

They have antipsychotics.
The second generation are no better than the old ones, in fact they take an additional 12 years off the average lifespan, and shrink the frontal cortex by 1 percent per year.

They have Electroconsulvive Therapy (ECT).
Brain concussions.

That's what they have in their medical bag.
And that's it.

Go here - Psychiatrist, Peter Breggin, M.D.
http://breggin.com

Duane Sherry, M.S.
http://discoverandrecover.wordpress.com

As someone who identifies as a mental health consumer/survivor, I have sat across from "several" psychiatrists. I tended to like them, but found in general they had little to contribute to my recovery path. A kind hearted grandmother, or teacher, would have helped me more, and a team of knowledgable consumers who were further along the recovery path would have really helped.

As a matter of fact, when a shrink labels me before he sits down, he defines his perspective and needs, not mine. Of course, as trauma consequences have fought their way into psychiatric practice, there are parts of modern psychiatry that are useful.

A psychiatrist would be useful if he could define the disease, prove that it existed, showed that the "medications" cured the problem, or in therapy had tools to help lost and traumatized poor people
Hugh