Fuck Doctors

[compared2what?]

SZASZ SETTLES SUIT FOR $650,000

I just try to keep my eye on the ball, that's all. And I really do strongly object to the thoughtless demonization of medications that are -- like it or not, and I personally do not -- the only thing keeping a large, underrepresented, very vulnerable part of the population alive.

Incidentally, one reason I don't like it is that it's not fucking good enough to just keep people alive (though possibly hampered or even sidelined by unpleasant side effects) and call that medical care. But there are others. Believe it or not.

Thanks for this, c2w, and for all your contributions to this thread, I didn't know that about Szasz's fine, but it doesn''t really surprise me. I picked up one of his later books recently and put it down again very quickly. It is is amazing how an originally humane impulse can harden into a callous habit, or how an intelligent insight can become an obstacle to thought.

Praise from Mac is praise indeed. Thanks. I blush.

I had a somewhat similar experience with Szasz. (Read The Myth of Mental Illness long ago, loved it, cannot contemplate his work today without feeling pain and a sense of betrayal.)

I don't think I heard about that settlement more than maybe ten years ago myself. Now that you mention it. Which is a little distressing, in view of his fame, my interest in the subject, and his close association with a scary, suppressive and highly litigious organization. I mean, it happened in 1990 and has evidently been publicly known since 1996. And that's not the first time I've looked for it online, either.

I actually don't want to be too harsh to him, though. It's obviously not very becoming or admirable of him not to express any sympathy or sadness or professional regret about the treatment failure. But it really might not have been malpractice. To be fair.

[compared2what?]

[
I am looking at a much longer trajectory, in which the concept of Against-Medical-Advice could be used as a cudgel. The infrastructure is slowly being laid, along with the corresponding indoctrination, for tracking minute health decisions and using them as a way to deny care or extract higher premiums, or even worse. Think about the onerous social stratification caused by the credit rating, and then imagine how much worse it will be (and yes it's coming) when we have an analogous rating system for our health choices.

Obviously we are both talking about the same ultimate fate - denial of care - but I'm looking at the system being put in place to make healthcare a dystopian panopticon that, along with the usual medical blackmail, becomes a larger tool of social control. This is a process I can see very clearly from where I sit, though it is hard to document (I could give some specific examples but they would out me more than I wish at this point).

I think I know what you mean, though. Good point. I'll try to be on the look-out for signs of it.

[slomo]

[
I am looking at a much longer trajectory, in which the concept of Against-Medical-Advice could be used as a cudgel. The infrastructure is slowly being laid, along with the corresponding indoctrination, for tracking minute health decisions and using them as a way to deny care or extract higher premiums, or even worse. Think about the onerous social stratification caused by the credit rating, and then imagine how much worse it will be (and yes it's coming) when we have an analogous rating system for our health choices.

Obviously we are both talking about the same ultimate fate - denial of care - but I'm looking at the system being put in place to make healthcare a dystopian panopticon that, along with the usual medical blackmail, becomes a larger tool of social control. This is a process I can see very clearly from where I sit, though it is hard to document (I could give some specific examples but they would out me more than I wish at this point).

I think I know what you mean, though. Good point. I'll try to be on the look-out for signs of it.

This evening it strikes me that Michel Foucault is a good starting point for examining the underlying mindset, both his first work, Madness and Civilization, and also his most famous, Discipline and Punish. I'm no humanities scholar, so I can't speak to criticisms or context, but they do strike me as relevant for documenting the worldview that makes this trajectory possible. And, needless to say, they do nothing to document the current state of affairs. I'll have to be on the lookout for specific examples as well. (I just read something about cell-phone usage being used for credit prediction, which would supposedly illustrate mission creep in the use of personal data to establish societal rankings, but in this story it is clear that these models are being used in data-poor environments overseas.)

[compared2what?]

Michel Foucault

He's a very smart and clever genius and everything. So I'm sure the fault is all mine. But he gets on my nerves.

Just one of those things.

[MacCruiskeen]

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[MacCruiskeen]

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[MacCruiskeen]

Actually it strikes me that a good doctor is one who can sympathise, or empathise, with his patient. And these are merely long words for love. But who can make a living from love*? It's a lifelong task, and it can only be done freely, not for a fee. But what else can possibly cure chronic misery? So, if you encounter chronic misery, and if you can't offer lifelong love (who can?) and if you have a symptom-alleviating pill at your disposal, and if you have another patient coming in ten minutes later, what kind of shit would you have to be not to offer that pill? What's your personal alternative?

It's no wonder physicians are top of the charts when it comes to alcoholism and suicide.

*Prostitution is something else, namely the opposite of love, namely business.

[Nordic]

I just had an interesting experience with a pair of Doctors, both trying to figure out what was wrong with my son, who had been suffering for over three weeks.

One of them sucked, was condescending to us, refused to do any real tests, and was convinced that she knew what was wrong.

The other one looked at the situation with an open mind, ran a bunch of tests, figured out within 24 hours what was wrong with him and prescribed a very low-cost and simple method to fix what was wrong with him. Within about 12 hours, my son was all better.

The first one literally could have resulted in my son being gravely ill or worse. She was convinced she knew what was wrong, and she was just absolutely fucking wrong and had quite the attitude when I tried to suggest (very diplomatically I might add) that what she was saying didn't seem to make sense. I'm really pretty pissed at her.

I've had pretty good luck with doctors lately. For myself. Other people I'm close to, not as much. One person has had some real bad luck (not my son).

Luck of the draw for the most part.

However I will have to say that maybe it's the person I'm close to that has these issues, but psych doctors in my experience are almost universally fucked up. We've had those conversations here before, I don't want to start a repeat of those conversations, although this thread could easily veer that direction, since it's basically based on that same subject. In my experience, psych doctors (and maybe I'd have better luck if I was trying to find one for myself) are about 85% drug-pushing shams. I mean HOW can someone responsibly not do talk therapy???? But no, they're all into the meds. No talk! It's unreal. They're leading millions of people into serious drug addictions and lives that are destroyed by basically having people treat themselves as guinea pigs, throwing all the meds at the wall and seeing what sticks. It's outrageous, just absolutely fucking outrageous, and psychiatrists should simply not be ALLOWED to do ONLY drug therapy on their patients.

[slomo]

I just had an interesting experience with a pair of Doctors, both trying to figure out what was wrong with my son, who had been suffering for over three weeks.

One of them sucked, was condescending to us, refused to do any real tests, and was convinced that she knew what was wrong.

The other one looked at the situation with an open mind, ran a bunch of tests, figured out within 24 hours what was wrong with him and prescribed a very low-cost and simple method to fix what was wrong with him. Within about 12 hours, my son was all better.

The first one literally could have resulted in my son being gravely ill or worse. She was convinced she knew what was wrong, and she was just absolutely fucking wrong and had quite the attitude when I tried to suggest (very diplomatically I might add) that what she was saying didn't seem to make sense. I'm really pretty pissed at her.

I've had pretty good luck with doctors lately. For myself. Other people I'm close to, not as much. One person has had some real bad luck (not my son).

Luck of the draw for the most part.

However I will have to say that maybe it's the person I'm close to that has these issues, but psych doctors in my experience are almost universally fucked up. We've had those conversations here before, I don't want to start a repeat of those conversations, although this thread could easily veer that direction, since it's basically based on that same subject. In my experience, psych doctors (and maybe I'd have better luck if I was trying to find one for myself) are about 85% drug-pushing shams. I mean HOW can someone responsibly not do talk therapy???? But no, they're all into the meds. No talk! It's unreal. They're leading millions of people into serious drug addictions and lives that are destroyed by basically having people treat themselves as guinea pigs, throwing all the meds at the wall and seeing what sticks. It's outrageous, just absolutely fucking outrageous, and psychiatrists should simply not be ALLOWED to do ONLY drug therapy on their patients.

Talk therapy takes too long, is too expensive, and its outcomes too uncertain. There is a sense in the psychiatry profession that it really "doesn't work" (of course the counseling profession thinks otherwise). My own personal opinion - it's an opinion, and it's not professional since I have little expertise in psychiatry - is that talk therapy often doesn't work because its models are usually inherently wrong, it doesn't address the spiritual dimension of life (or at least not quickly enough), by which I mean questions of meaning and relatedness, which our society with its reductionism steadfastly denies. On the other hand, psychopharmaceuticals are completely consistent with reductionist approaches, they demonstrably "work" (in quickly generating measurable changes in behavior) and so there you have our system.

My fundamental complaint about pharmaceutical use in the US is exactly the issue of addiction. All drugs for chronic conditions are addictive. It is necessarily so because your body acts to achieve homeostasis, and so your body will eventually adjust to whatever regular inputs it is receiving. Physical systems are energy-minimizing entities, so that if a certain sub-system is functioning by acquisition of external resources, no extra energy will be expended to achieve the same result by other means. That's fine if your systems are so perturbed that there is no other way to "get them back" to where they should be, but for systems that are only slightly off, a regimen of a certain drug will produce unnecessary dependency. And the problem I have with dependency is that, in the US, it's a Faustian bargain. How can you be sure that you will continue to have the insurance necessary to keep buying the drugs? The anxiety creates economic dependency in other areas, and It becomes like heroin, debasing the spirit so that you are forced to do things you would otherwise never do.

Personally, I'd rather have a shorter life with full autonomy than a longer life beholden to large, malevolent systems.

[Nordic]

You make an excellent point, and that is exactly how addictions to pharmaceuticals often spin wildly out of control, by the industry controlling them so tightly (in their own stupid counterproductive way) that the patients often are so terrified of running out before they'll be allowed to refill that they often start doctor-hopping and getting backup prescriptions. This then turns into a recipe for abuse, because suddenly they realize they can get all they want if they're careful about not using the same pharmacy or running the extra scrips through insurance.

Then, due to the body's natural ability to adjust to the drugs, they have to take more and more to get the desired affect, and soon they've got a full-blown, life-destroying addiction on their hands.

All to supposedly "controlled" substances.

I've watched this happen and its ridiculously easy, especially in a big cith where there seems to be a virtuall unlimited number of doctors and pharmacies.

Benzos are the worst for this. Doctors will hand then out like pocket change to their children. Its out of control.

[compared2what?]

Actually it strikes me that a good doctor is one who can sympathise, or empathise, with his patient.

I could not agree with you more. However, that would require them to know their patients, which would in turn require them to spend more than ten to twenty minutes evaluating them. Most non-psychiatric doctors don't do that. And no single doctor who did would be able to see and treat enough patients for it to amount to full coverage for the whole population even if it were standard practice for every doctor (which it's not) and medical care was universally free and/or affordable (which it's not).

The system needs an overhaul that acknowledges and seeks to compensate for the systemic problems created by (among other things) the above factors, even when the factors themselves aren't very readily susceptible to change via practical reform.

And these are merely long words for love. But who can make a living from love*? It's a lifelong task, and it can only be done freely, not for a fee. But what else can possibly cure chronic misery? So, if you encounter chronic misery, and if you can't offer lifelong love (who can?) and if you have a symptom-alleviating pill at your disposal, and if you have another patient coming in ten minutes later, what kind of shit would you have to be not to offer that pill? What's your personal alternative?

You speak beautiful and soulful truths that obtain under all circumstances, in one form or another. But it's not always that straightforward. As I know you know.

It's no wonder physicians are top of the charts when it comes to alcoholism and suicide.

Word.

[Project Willow]

Talk therapy takes too long, is too expensive, and its outcomes too uncertain.

You're reflecting this pervasive attitude:

There is a belief in some quarters that psychodynamic concepts and treatments lack empirical support or that scientific evidence shows that other forms of treatment are more effective. The belief appears to have taken on a life of its own. Academicians repeat it to one another, as do health care administrators, as do health care policy makers. With each repetition, its apparent credibility grows. At some point, there seems little need to question or revisit it because "everyone" knows it to be so. 

The Efficacy of Psychodynamic Psychotherapy
http://nvpp.nl/JonathanShedlerStudy20100202.pdf

Which is not supported by the research (including other modalities than Psychodynamic).

Effectiveness of Long-term Psychodynamic Psychotherapy
A Meta-analysis

Results According to comparative analyses of controlled trials, LTPP showed significantly higher outcomes in overall effectiveness, target problems, and personality functioning than shorter forms of psychotherapy. With regard to overall effectiveness, a between-group effect size of 1.8 (95% confidence interval [CI], 0.7-3.4) indicated that after treatment with LTPP patients with complex mental disorders on average were better off than 96% of the patients in the comparison groups (P = .002). According to subgroup analyses, LTPP yielded significant, large, and stable within-group effect sizes across various and particularly complex mental disorders (range, 0.78-1.98).
Conclusions There is evidence that LTPP is an effective treatment for complex mental disorders. Further research should address the outcome of LTPP in specific mental disorders and should include cost-effectiveness analyses.
http://jama.ama-assn.org/content/300/13/1551.short

Additionally, as Shedler mentions, psychotherapy has recently been subjected to a new kind of standard/paradigm, EST, arising out of the ever increasingly specialized influences of big pharma and the insurance companies.

Empirically supported treatments in psychotherapy: towards an evidence-based or evidence-biased psychology in clinical settings?

The development of these kinds of paradigms was motivated by the emergence of a “managerial” approach and related systems for remuneration also for mental health providers and for insurance companies.

To date, the effectiveness of psychotherapy for the functional treatment of many mental disorders is empirically well demonstrated. Using an ‘‘evidence-based medicine’’ viewpoint, psychotherapy, in comparison to other medical treatments such as pharmacology, can be considered as one of the most effective therapeutic approaches.
http://www.frontiersin.org/psychology%20for%20clinical%20settings/10.3389/fpsyg.2010.00027/full

Beyond “ESTs”: Problematic assumptions in the pursuit of evidence-based practice.

There has been much confusion in the literature of psychotherapy between the broad concept of evidence-based practice and the narrower set of criteria that have been employed in designating certain treatments as “empirically validated” or “empirically supported.” In contrast to the appropriate concern with examining the evidence for the efficacy of various approaches to therapy and for the theoretical assumptions that underlie them, the “empirically supported treatments” movement has been characterized more by ideology and faulty assumptions than by good science. This paper examines in detail the scientific and logical limitations of the “EST” movement and aims to place the empirical investigation of theory and practice in psychotherapy on a sounder basis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

http://psycnet.apa.org/journals/pap/27/3/251/

Ironically this process may have contributed to a potential renaissance of psychotherapy, especially Psychodynamic therapy.

Future perspectives in psychotherapy.
Schnyder U.

Department of Psychiatry, University Hospital, Culmannstrasse 8, 8091 Zurich, Switzerland. ulrich.schnyder@access.uzh.ch
Abstract

To date, the effectiveness of psychotherapy for the treatment of most mental disorders is empirically well documented. From an "evidence-based medicine" viewpoint, psychotherapy, as compared to other treatments in medicine, can be regarded as one of the most effective therapeutic approaches. The superiority of psychotherapy over pharmacotherapy is particularly pronounced in long-term treatment outcome studies. It is especially cognitive behavioral approaches, such as exposure response management and cognitive restructuring that have shown strong evidence of their efficacy and effectiveness in various populations and settings. However, evidence-based medicine is by definition oriented toward the past, as it only informs us about the well-established, empirically supported treatments. If we rely only on the currently available scientific evidence, new developments will be blocked. Since, for instance, many patients decline treatment, or do not seek professional help at all, there is a need for improvements regarding acceptance of established therapies. In addition, there ought to be scope for new, creative approaches, for which scientific evidence is not yet available. Promising developments include the mindfulness-based therapies, well-being therapy, the use of cognitive enhancers such as D-cycloserine, and Web-based therapies. There is also a trend in psychotherapy training toward teaching specific, disorder-oriented protocols or modules rather than universally applicable therapies. Finally, given the globalization of our societies, culture-sensitive psychotherapists should try to understand the cultural components of a patient's illness and help-seeking behaviors, as well as their expectations with regard to treatment.

http://www.ncbi.nlm.nih.gov/pubmed/19876669

Post caveat: I am not an expert and all of this material was produced in barely over 45 minutes of research.

[compared2what?]

My fundamental complaint about pharmaceutical use in the US is exactly the issue of addiction. All drugs for chronic conditions are addictive. It is necessarily so because your body acts to achieve homeostasis, and so your body will eventually adjust to whatever regular inputs it is receiving. Physical systems are energy-minimizing entities, so that if a certain sub-system is functioning by acquisition of external resources, no extra energy will be expended to achieve the same result by other means. That's fine if your systems are so perturbed that there is no other way to "get them back" to where they should be, but for systems that are only slightly off, a regimen of a certain drug will produce unnecessary dependency. And the problem I have with dependency is that, in the US, it's a Faustian bargain. How can you be sure that you will continue to have the insurance necessary to keep buying the drugs? The anxiety creates economic dependency in other areas, and It becomes like heroin, debasing the spirit so that you are forced to do things you would otherwise never do.

That's wholly valid for people whose systems are only mildly perturbed by a chronic condition, as well as for those whose systems are perturbed by a chronic condition in some way that's amenable to resolution via non-pharmaceutical treatment.

Or, stated another way: That's wholly valid for all people who are fundamentally healthy, as well as most people with type 2 Diabetes and a few other roughly comparable complaints.

But....What recommends considering all the millions and millions of other people with severe chronic conditions and/or diseases that can be treated or alleviated with pharmaceuticals in terms of their addiction potential?

That's an innocent question, btw. I don't understand what you're saying.

[slomo]

My fundamental complaint about pharmaceutical use in the US is exactly the issue of addiction. All drugs for chronic conditions are addictive. It is necessarily so because your body acts to achieve homeostasis, and so your body will eventually adjust to whatever regular inputs it is receiving. Physical systems are energy-minimizing entities, so that if a certain sub-system is functioning by acquisition of external resources, no extra energy will be expended to achieve the same result by other means. That's fine if your systems are so perturbed that there is no other way to "get them back" to where they should be, but for systems that are only slightly off, a regimen of a certain drug will produce unnecessary dependency. And the problem I have with dependency is that, in the US, it's a Faustian bargain. How can you be sure that you will continue to have the insurance necessary to keep buying the drugs? The anxiety creates economic dependency in other areas, and It becomes like heroin, debasing the spirit so that you are forced to do things you would otherwise never do.

That's wholly valid for people whose systems are only mildly perturbed by a chronic condition, as well as for those whose systems are perturbed by a chronic condition in some way that's amenable to resolution via non-pharmaceutical treatment.

Or, stated another way: That's wholly valid for all people who are fundamentally healthy, as well as most people with type 2 Diabetes and a few other roughly comparable complaints.

But....What recommends considering all the millions and millions of other people with severe chronic conditions and/or diseases that can be treated or alleviated with pharmaceuticals in terms of their addiction potential?

That's an innocent question, btw. I don't understand what you're saying.

C2W, i've already stated that I support the use of pharmaceuticals in many settings. I've said that in other threads and I've said it in this one. I don't think I've been unclear at all, so what is the problem here? Is there some fundamental misunderstanding on your part?

What I object to the use of pharmaceuticals in situations that are not life-threatening and where there are clear alternatives that retain autonomy for the patient, and I especially object to mandated use of pharmaceuticals (which, for example, essentially occurs when young children are prescribed medications for ADHD - so diagnosed as a result of symptoms that are often essentially normal behavior for children - and their parents are essentially threatened by social services when they don't comply - a topic which has not yet come up in this thread but is very relevant to the issue).

I also think that the statement that "[patient autonomy is] wholly valid for all people who are fundamentally healthy" has a Trojan Horse: the definition of "healthy". Am I "unhealthy" because my cholesterol runs over 200 but I otherwise have no symptoms of CVD, am weight-appropriate-to-height, etc.? Does that mean I must accept a prescription of statins, with the attendant risks? Who decides? Does my insurance have a right to deny me coverage if I reject a statin prescription and I go on to experience a heart attack next year? What if reject statins now, accept them 5 years later, and have a heart attack one year after that? Should I be denied care because of my "preexisting condition" for which I "refused to accept treatment" years before? These are real issues that are on the horizon.

[slomo]

You make an excellent point, and that is exactly how addictions to pharmaceuticals often spin wildly out of control, by the industry controlling them so tightly (in their own stupid counterproductive way) that the patients often are so terrified of running out before they'll be allowed to refill that they often start doctor-hopping and getting backup prescriptions. This then turns into a recipe for abuse, because suddenly they realize they can get all they want if they're careful about not using the same pharmacy or running the extra scrips through insurance.

Then, due to the body's natural ability to adjust to the drugs, they have to take more and more to get the desired affect, and soon they've got a full-blown, life-destroying addiction on their hands.

All to supposedly "controlled" substances.

I've watched this happen and its ridiculously easy, especially in a big cith where there seems to be a virtuall unlimited number of doctors and pharmacies.

Benzos are the worst for this. Doctors will hand then out like pocket change to their children. Its out of control.

I'm not just talking about pain-killers and psych meds. I'm talking about all drugs. One particularly stark example is NNRTIs. I'm never going to tell somebody who is HIV+ to not go on meds, because there are proven benefits, both personal and social. However, once you start, you had better never stop. So, if you're going to do the anti-retrovirals, you had better be sure you can always access them. For the rest of your life. And given the way healthcare works in the US, that means you had better stay in your shitty job or else make sure there are no "pre-existing condition" clauses in the insurance policy that covers you in your next job.