don't care what the scilons say, psychiatry now a sick joke

[Bruce Dazzling]

Psychiatrists and psychologists are the referees of modern society, and anyone who exhibits thoughts and/or behaviors that clash with the prevailing culture are interfering with the smooth flow of the game, and will be penalized by the referees accordingly.

After all, we can't allow anyone to interfere with the game, now can we?

[compared2what?]

c2w? wrote:

What easy admissions? Psychiatrists and, in fact, doctors of every kind are increasingly fucked for the exact same reason that psychiatric patients and, in fact, patients of every kind are increasingly about a thousand times even more fucked than that.

Not sure I agree. Psychiatrists, if they're "fucked", are way less fucked than their patients are on average, as you seem to accept there at the end.

I don't "seem to accept" it. I emphatically state it in terms that make it plain that I view it as the real problem. And one of epic proportions.

Doctors and psychiatrists should be seen as a "dominated faction of the dominant class", to appropriate and tweak Bourdieu's coinage, but most of their patients would decidedly not be. Makes a difference.

They should? Okay. Why? By which I mean:

(a) On the basis of what reasoning or evidence?; and

(b) As a tactical, strategic or conceptual move toward the attainment of what end?

Admitting as Dr. Levin does that you don't take time to listen to patients in great need, and also that you treat them like cash machines are pretty stark admissions for medical professionals to be making [and I'm glad for those admissions, for sure], as are the rationalizations for why your retirement portfolio justifies performing this "sick joke" of a simulacrum of true psychiatric care.

They are stark. Also human and flawed. Admitting as Dr. Levin does, that he feels shame to be well-regarded by his patients under those circumstances kind of suggested to me that he was aware of that himself. The not-very-impressive maximum credit he's due appears to consist chiefly in two things: (1) There's no indication that he prescribes irresponsibly to patients whom he knows or thinks can't benefit from it at all; and (2) There's some indication that when he knows or thinks that a patient won't benefit without talk therapy, he works to get him or her a referral.

Which is pretty much praising him with faint damns, as the saying goes. But that notwithstanding:

My question was actually "What easy admissions?" Because "easy" was the word you used. And unless it was just your intention to choose an adjective that furthered the perception of any/all psychiatrists as inhumanly uncaring and facile individuals, I myself didn't really see what justified thus describing them.

It's all about the benjamins. And there are none. Psychiatrists are small fry in the grand scheme of the real powers that are at work here. And they're sure as hell not pulling the strings. Unlike PhRMA, actually. They are pulling the strings. They're just not pulling remotely the same strings that the evil-psychiatrists-are-drugging-your-babies narrative says they're pulling.

PhRMA is pulling the strings, we agree. But I think you may be imputing something to me that's not there, because I said "I'm happy to condemn the whole profession". It was meant to be humorous, but anyway, if what Dr. Levin described was in fact widespread and professionally encouraged, that's pretty condemnable, no?

If it were, yes, it would be. However, nothing in the article suggests that it is professionally encouraged. Or even professionally accepted as best or good or adequate practice. In fact, it's explicitly identified by everyone who addresses it as professionally profession-killing. And widespread.

The article plainly identifies the force responsible for it having become so several times. Can you spot the culprit?

Like many of the nation’s 48,000 psychiatrists, Dr. Levin, in large part because of changes in how much insurance will pay, no longer provides talk therapy





He looked for a psychiatrist who would provide talk therapy, write prescriptions if needed and accept his insurance. He found none.





Recent studies suggest that talk therapy may be as good as or better than drugs in the treatment of depression, but fewer than half of depressed patients now get such therapy compared with the vast majority 20 years ago. Insurance company reimbursement rates and policies that discourage talk therapy are part of the reason.





When he started in psychiatry, Dr. Levin kept his own schedule in a spiral notebook and paid college students to spend four hours a month sending out bills. But in 1985, he started a series of jobs in hospitals and did not return to full-time private practice until 2000, when he and more than a dozen other psychiatrists with whom he had worked were shocked to learn that insurers would no longer pay what they had planned to charge for talk therapy.

“At first, all of us held steadfast, saying we spent years learning the craft of psychotherapy and weren’t relinquishing it because of parsimonious policies by managed care,” Dr. Levin said. “But one by one, we accepted that that craft was no longer economically viable. Most of us had kids in college. And to have your income reduced that dramatically was a shock to all of us. It took me at least five years to emotionally accept that I was never going back to doing what I did before and what I loved.”

He could have accepted less money and could have provided time to patients even when insurers did not pay, but, he said, “I want to retire with the lifestyle that my wife and I have been living for the last 40 years.”

In short: These guys (and gals) went to med school, and married, and had families with the (at-the-time) 100 percent reasonable expectation that financially they'd be in a position to send their children to college and save enough money to retire on, while themselves living comfortably during their active working years doing something they loved doing for which there was a large general demand from the broad swathe of the population that then had health insurance. Which then covered talk therapy. IIRC, up to a certain dollar-amount cap, typically. But enough to make it affordable for most patients. As well as to make sliding-scale fees an affordable practice for most shrinks.

That's hardly what you could call predatory career planning. In fact, you could call it "making a very large investment of time and money for career training that would qualify you to establish a professional practice in the healing profession treating people who sought your help at very little expense to them."

When Dr. Levin found himself faced with a whole new set of rules at age 57, he apparently didn't feel equal to seeking employment in some field other than the only one he'd ever had any professional experience working in. He doesn't seem at all happy about that, to me. And I guess he could have just said "Fuck it" and gotten his realtor's license or something. And maybe should have, although if he'd done it in 2000, he'd probably be trying to drum up business for a private scrip-writing practice right now anyway.

But whatever. That's a human-sized story. And not a difficult one to understand. It's not very admirable, certainly. But it's not really very despicable either. Unless you start from the baseline assumption that all prescription of all psychiatric drugs to all patients under all circumstances is, in and of itself, despicable.

Which I don't. Because undiscriminating wholesale demonization has just never really been my thing.

According to the article, there are still some benjamins to be made. You can still access them by doing what the Levins are doing, though there's less money and accessing requires ever-more contortions of professional practices. This squares with my personal experience, drawn from conversations with two of my best friends, a psychopharmacologist leaving the profession to begin cognitive behavioral therapy, and a pharmacist who services long-term care facilities. The other route to the benjamins mentioned was treating the super-wealthy class of kleptocrats who will pay lots of money, apparently, to unburden their souls.

Yes. As I said, psychiatrists are fucked. Dinosaurs. A dying breed.  

PhRMA is pulling the strings, yes. But how tightly do they bind, and who did the tying, and why? PhRMA is an institution, representing one of the biggest industries in the world. Psychiatry, on the other hand is a profession. There's a chasm of difference that must be maintained as much as possible between the two, if the profession is to survive. If a profession is simply going to do the bidding of its carrying institutions, then why bother with the profession at all? Isn't that in fact what is threatened by acquiescence like Levin's on a large scale?

On a large scale? Yes. I agree with you. In the same sense that I would had you written:

If the citizenry of a country is simply going to permit its government to institute illegal and atrocious policies that include torture, indefinite detention without charges or recourse to law, and unprovoked acts of military aggression that result in near-genocidal numbers of civilian casualties, then why bother with democracy at all? Isn't that in fact what is threatened by acquiescence like [YOUR NAME OR MY NAME]'s on a large scale?

IOW, have a heart, ffs. No one person can really be condemned for his or her failure to act as part of an organized, unified resistance that nobody knew how to organize and unite successfully.

Quite apart from which, I don't think it's accurate to say that Dr. Levin is doing the bidding of his carrying institutions. I think he got caught in a squeeze play between the carrying institution he relied on (the health insurance industry) and its preferred (to Dr. Levin) partner in profitable crime (the pharmaceutical industry).

I mean, hello, bks, are you there? All doctors together are a very small, weak and poorly organized force compared to either, let alone both. And all psychiatrists together are diminishingly so. One lone psychiatrist -- ie, Dr. Levin -- is barely any more powerful than you or I or any other lone individual is. They don't make that much money. Most of them are probably somewhere around the middle third of the upper middle class.

There are ways out. Doctors of all stripes, for several years now, have been going to concierge practices which of course don't solve the big managed care problem, but at least represent a healthy first response to it.

Okay. Well. If you want to bring charges against Dr. Levin for negligent concierge-practice-non-joining, I'm certainly open to it in theory. What's your evidence? I mean, you know, your affirmative, applicable, and non-rhetorical evidence.

Which is why I do care what the scilons say. They've fucking won the battle for popular perception. And now people can't even see what's right in fucking front of them. I mean, who are you going to believe? The CCHR or your own lying eyes?

.

scilons a term for scientologists, I gather? I've never heard it before.

As I'm sure you know, Scientology is not the primary or best source of criticism of psychiatry in the second half of the 20th century. Academics like Michel Foucault and Erving Goffman and several others were making forceful, comprehensive criticisms of psychiatry 50 years ago completely independent of anything coming from L. Ron Hubbard, who isn't even an actual thinker as far as I know. Tarring criticism of psychiatry with the Scientology brush is a bit of a dirty trick, the CCHR notwithstanding. As would be assuming that criticism of psychiatry equals the wholesale rejection of it.

Scientology is virtually the only source for the popular criticism of psychopharmaceuticals, however. And if it wasn't for their tactical alliance with a few organizations fronting for the crypto-eugenicist Christian-nationalist extreme right wing, that would be so close to "only," the difference wouldn't be worth fighting over. And the OP (which concerned psychopharmaceuticals) elicited a very standard-issue hissing and tomato-throwing response directed at the CCHR-originated vision of psychiatry's unreserved and fully pre-granted willful evil and inhumanity, as well as at the CCHR-originated vision of all psychopharmaceuticals as pure poison, wittingly created to function as one, nothing more and nothing less.

And if I may say so: You do have to admit that there is absolutely nothing in that article that really merits those responses. I mean nothing that merits it on a prima facie basis. The article is about the pretty well advanced disintegration and collapse of talk-therapy-offering private-practice psychiatry in the United States that's jointly attributable to its non-reimbursability and the unwillingness of doctors to work for a lower income than a doctor's income, particularly when all the commitments they made when their prospects were rosier assumed the latter.

Not that you'd ever know that from this thread, though. Which I find frightening. But unsurprising. Because I have yet to see a single thread on the subject of psychopharmaceuticals here that used anything except recycled Scientology talking points. Sometimes several times recycled, granted. Because that's virtually the only kind the mainstream media uses. And the only kind, if you want to narrow that down to conspiro-friendly media, mainstream and otherwise.

Incidentally, I'm a fucking critic of psychiatry myself, as it happens. And of modern medicine generally. That's principally why I totally resent being unable to say three fucking words about my views without getting jumped on by one or both sides of the great big false fucking debate about the evils and/or non-evils of psychiatry and psychopharmacology.

Because I am telling you: It is literally impossible to have an intelligent conversation anywhere at all with anyone at all about either. It has been for years. People don't hear what you're saying. They only hear the parts that would be (or shouldn't be) in one or the other of the two sides of that debate. So they respond accordingly.

And then you are in that debate.

We are fucking doomed.

[compared2what?]

Actually, I agree with you, C2W.

Please don't bite off my head. >.<

You know I wouldn't do that, snookie. Or I guess you don't. But I wouldn't. And thank you.

[compared2what?]

And sorry to have just ignored Foucault et al, btw.

But maybe when you have the time, you can explain to me what part of Madness and Civilization supports the implication that Dr. Levin was just making shit up like Jayson Blair? Because it has been a while. And I guess I need a little bit of a refresher or something.

Also, I forgot to ask why you were paging Dr. Milgram. Whom I've always hazily thought of as a psychologist, not a psychiatrist. Though I could be totally wrong about that. In any event. WTF do the Milgram experiments have to do with the material in the OP? Do you see Dr. Levin as being unduly obedient to authority to the point of mindlessly following its commands to kill his fellow human beings without registering that that's what he's doing?

That's really a pretty strained analogy, if so, imo.

[Luther Blissett]

I had good, affordable talk therapy with a couples counselor a few years ago. She always agreed with me and I didn't expect meds.

[norton ash]

The method I'm seeing in my Canadian city is meds, an hour with a psychiatrist biweekly or monthly, ongoing contact with a 'case manager' (usually a nurse or nurse practitioner with specialization in psych/social work) and weekly organized group therapy focused on specific addictions/behaviours, and groups that incorporate 'emotional regulation' techniques such as breathing, meditation, self-soothing, pattern-breaking and rational-emotive therapy.

It's teams and peers taking on the epidemic here, and I think this may be the best possible way to address it. My estimate would be a psychiatrist and a nurse or NP can assist 40-50 patients (maybe more) with few patients ill-served, and fewer professionals burning out. Friendships form in the therapy groups as well-- some might be toxic, but I think the majority are really therapeutic.

Not as cost-effective as throwing pills at people, but I have read that some American HMO's are beginning to learn the value of teams and more community engagement.

[WakeUpAndLive]

It's all about the benjamins. And there are none. Psychiatrists are small fry in the grand scheme of the real powers that are at work here. And they're sure as hell not pulling the strings. Unlike PhRMA, actually. They are pulling the strings. They're just not pulling remotely the same strings that the evil-psychiatrists-are-drugging-your-babies narrative says they're pulling.

PhRMA is pulling the strings, we agree. But I think you may be imputing something to me that's not there, because I said "I'm happy to condemn the whole profession". It was meant to be humorous, but anyway, if what Dr. Levin described was in fact widespread and professionally encouraged, that's pretty condemnable, no?

If it were, yes, it would be. However, nothing in the article suggests that it is professionally encouraged. Or even professionally accepted as best or good or adequate practice. In fact, it's explicitly identified by everyone who addresses it as professionally profession-killing. And widespread.

The article plainly identifies the force responsible for it having become so several times. Can you spot the culprit?

I'd suggest reading the new health care bill. My brother in law and sister are both in the field, and it basically makes them a slave. Either you do what the bill says or you lose all your credentials. Psychiatrists, if they wish to receive any health care funding, are required to limit visits to 15 minutes. He specifically despises this bill because of the restrictions it creates and the way they enslave these doctors who must follow if they ever hope to get rid of their debt accrued through years of schooling.

[nathan28]

Bwaaah, what c2w said.

To start, your psychiatrist's job is, in fact, to prescribe drugs. He or she is an MD. If a psychiatrist ("pMD") is giving you "talk therapy", the talk therapy should be to recognize likely neurochemical issues and determine and adjust drug treatment. Neglected or ignored or otherwise heavily stressed as a young child? Guess what, that tends to have a similar impact on neurological function in most people in the US.

And talk therapy isn't a neglected, magic bullet. If anything, decades of it being widely used only show how impractical it is and how it is an adjunctive treatment, *just like psychiatry*. The illusion that taking an antidepressant will "cure" depression is that, an illusion. The possibility that it might mitigate some of the problems of depression, however, is not. Applying an allopathic model with the understanding that it supports broader 'help', rather than serves as the primary form of help, is simply not a problem, because at some level, all psychological problems are, in fact, neurochemical. That just doesn't mean they have a neurochemical 'origin', though. There are cognitive-behavioral and behavioral aspects, without doubt, as well as psychosocial and sociological ones. The last category will remain ignored until the end of time ("gee, black people face higher standards for jobs, routinely losing out to candidates with identical resumes, as has been thoroughly demonstrated? must be depression, or they're lazy! shouldn't have taken out all those subprime loans, yuk yuk!"), but whatever.

Ignoring for a moment the emergence of "atypical" "medicines" like Abilify and the possibility of flawed/fraudulent testing and cooked data--all of which are realities but the sort that you will hear about eventually, like with the increased suicidal thoughts many people got from SSRIs, which was a 'side effect' conveniently ignored during studies--Where the problems come in is with the $$$.

Psychiatrists are, in fact, doctors, often trained in the "experimental method". Many psychiatric drugs are, in fact, helpful. Like Haloperidol, which half this forum should be on. But that doesn't exclude confusion. If you want to see how confused doctors can be, asked them about something outside their specialty. Just because you were in surgerical school for ten years doesn't mean you could explain the science behind why a healthy track-and-field athlete takes high doses of asthma medications. Most psychiatric drugs, however, are NOT PRESCRIBED BY A PSYCHIATRIST. They are prescribed by GPs. Have you ever gone into a ENT's office and complained about back pain?

If you have "health insurance", I bet you have, because he's the only PCP or whatever your ins. co. calls it. Here's the next question: how's your back? Still hurt? Thought so.

So now you're taking fluxoxentidomidminaide, an SSRI from twenty years ago with known side effects that include constant diarrhea, severe dry mouth and intermittent suicidal compulsions. Why are you taking it? Because it's on the Tier I no-approval-necessary list that your GP spent exactly fifteen seconds looking at when you said "I think I've got depress--". Guess what? if you or the doctor want you to try any other compound once all those trips to the toilet start to bother you, the MD has to get approval. From a middle manager. With an associate's degree in business.

But to even get to that point you have to have a doctor who realizes that neuromedicine is a largely trial-and-error field prone to all sorts of idiosyncratic--IOW, individual patients who need individual assessment and individidual treatments--considerations. If you have a GP who spends most of his time treating sprained ankles, children's rashes and Münchhausen cases, he doesn't realize that or doesn't care.

[Nordic]

Most psychiatric drugs, however, are NOT PRESCRIBED BY A PSYCHIATRIST. They are prescribed by GPs.

What universe are you living in???

[norton ash]

Most psychiatric drugs, however, are NOT PRESCRIBED BY A PSYCHIATRIST. They are prescribed by GPs.

What universe are you living in???

Uhhh... the existing one? It's GPs who do most of the prescribing, Nordic. Here, there and everywhere.

[Nordic]

Not in my experience.

Maybe it's my insurance, maybe it's Los Angeles, but here the shrinks prescribe everything.

[Bruce Dazzling]

Not in my experience.

Maybe it's my insurance, maybe it's Los Angeles, but here the shrinks prescribe everything.

Before I stopped seeing him three years ago, my GP was constantly trying to prescribe antidepressants to me, as he chewed on the tip of his Pfizer-logo pen...

[Nordic]

Well I've gotten antidepressants from a GP, and in fact I've never been to a psychiatrist myself, but the people I know who do go to a psychiatrist get all their meds from the psychiatrist.

Your mileage may vary, I suppose .....

It seems the heavy duty stuff comes from the shrinks.

Unless ...

It would seem seriously fucked up to me if GP's were prescribing dangerous drugs like Ability and Seroquel to people ....... It's bad enough that the specialists do.

[Luther Blissett]

Any girl I've dated who was on meds, was prescribed them by a psychiatrist (who would see them for 15 minutes at a time).

[JackRiddler]

.

I also have no doubt, albeit from accumulated stories and personal experience, that GPs routinely prescribe psychopharmaceuticals and that the vast majority of these are probably prescribed by GPs. In fact, I've lost track of all the stories where people visit GPs for reasons unrelated to getting prescriptions for psychopharmaceuticals and get them anyway.

bks, I think you should grant c2w?'s points. Dr. Levin is not the villain here but a professional who originally trained (and took on debt and built a practice) with a very different idea of his future career in mind than what he does now that he is caught in the latest developmental stage of the capitalist health insurance industry in alliance with the capitalist psychopharmaceutical industry. It may seem brutal of him to play his present role, but he got there gradually. Also, it's been many decades since psychiatrists were routine providers of talk therapy. Their hours were always shorter than those of therapy-practicing psychologists.

Not that there's ever been much to defend in psychiatry as practiced since its beginnings, but I do believe that most practitioners entered that profession meaning to do the right thing, and not to play the villains of the first 3/4 of Shutter Island (or turn into the effective prison wardens exposed by the Rosenhan study).

c2w?, I think you need to block out the existence of Scientology for a moment and acknowledge that the critique of mainstream psychiatry and its cousins (the strictly bioneurological paradigm of "disorder" and the ambitious psychopharmaceutical regime for "treating" disorder) both predate Scientology (and its cousins and recyclers) and come from serious and sincere, non-cultish, and very often intellectually rigorous places.

Yes, it's tough. If you will allow the analogy, it's like trying to talk about 9/11 as someone with skepticism in everything the USG says and does (justified by historical study as well as self-evident problems with the official story and countering sets of evidence), and having to deal constantly with the fact that there are stupid cult-running niche-marketing fucks like Alex Jones out there who have already stolen all the oxygen and burned it on their fascistoid fantasy, and who also sucker many more genuine 9/11 skeptics into tainting themselves by entering alliances against the perceived common enemy.

.