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

[compared2what?]

Yeah.

The thing is, though, that there's this eensy little problem that you can't really see unless you back up enough to look at the context.

So let's do. Okay? Here:

GPs are not even remotely qualified by education or experience to treat "general" medical problems anymore. And practically haven't been since the 19th fucking century. Shoring up their inadequacies with a network of specialists doesn't really work because:

(a) There aren't enough good specialists to handle the traffic anywhere, even in major thriving metropolitan areas that are crawling with specialists (eg -- take a look at the fees earned by child psychiatrists mentioned in the OP);

(b) There are hundreds and hundreds of very common progressive illnesses, quite a few of which are serious or even fatal, that either never get diagnosed (I mean "until post-mortem examination") or that almost never get diagnosed until it's too late for preventative treatment because for years and years and years they're externally undetectable apart from what I believe are usually referred to as "vague symptoms" -- ie, low-level chronic or episodic GI distress, fatigue, joint and muscle pain, increased susceptibility to minor transient infections, etcetera -- which could be nothing and could be lots of things. Such as the hundreds and hundreds of very common progressive illnesses I was just now mentioning.

These aren't, like, arcane or bizarre conditions. Nor are they undiagnosable. You just can't diagnose any one of them unless you're specifically looking for it. IOW, unless you test for it specifically and interpret the test results with an eye to its possible presence or absence. If that happens, it's a matter of sheer random fucking chance most of the time. Because the expense of running every single test for every single illness that might be largely asymptomatic apart from some muscle pain (or, FTM, wholly asymptomatic sometimes) is prohibitive under the present system of costs and reimbursements. There probably aren't enough lab techs for it either, although I don't really know about that one way or the other. It just would make sense if there weren't.

The model used by, say, the Mayo Clinic (and a few places like it) is a lot less prone to misdiagnosis (or missed diagnosis) because it has every patient is evaluated by a team of specialists who consult and communicate with one another about him or her. But that model is mad fucking expensive at the Mayo Clinic and elsewhere. So almost nobody can afford it. Besides which, it's not used widely enough to accommodate more than a tiny percentage of the patients who might benefit from it anyway.

And that does have HUGE implications for psychiatric diagnosis and treatment. Because vaguely sick people who don't know they're vaguely sick nevertheless are vaguely sick. In that they don't feel well, but don't really have a readily identifiable (to themselves) complaint. So they do what all people do with all feelings, physical and emotional -- ie, they either seek a rational explanation for their feelings, then offer it up to others and to doctors; or they develop some system of coping mechanisms to compensate for their vaguely sensed deficits.

That often ends up looking, as far as the eye can see, like a psychiatric disorder. Most obviously Major Depression or Bipolar II. But you know. People are very complicated, as is human behavior. So it can look like lots of things. Which might very well also be -- and in some cases all but certainly are -- valid psychiatric disorders that it would be not just reasonable but also totally correct and helpful for a physician to diagnose and treat as such on the basis of the symptoms presented.
___________________

The health care system is just a fucking antique, top to bottom. Starting in med school. It's not designed for the practice of medicine in any way that has more than a glancing relationship to the present state of medical knowledge or science.

And that's what you pretty much have to call "a systemic problem." It's not the fault of psychiatrists or any other subdivision of medical practitioners. They're not in a position to observe or identify it. Or even really qualified to do so. Their training and orientation disposes them to an intense focus on the localized particulars that are meaningful within their area of expertise. That's basically what all doctors do. Because it's what they're taught to do.

And it's not really all that difficult to see how it might strike them and most of the world as a good and responsible and helpful thing to do. By all ordinary social standards and per the general understanding of such things, it is. Actually. The only thing that might prompt anyone to suspect that it isn't is that it doesn't fucking work. That's not any truer or less true for psychiatrists than it is for doctors working in any branch of medicine. Though I'm sure that each has its own set of specific drawbacks that are unique to the specialty or area of practice in question. Psychiatry's just the only one I know enough about for an informed consideration of its drawbacks to be partly within the scope of my capabilities.
__________________-

Anyway. You can go on thinking about it exclusively in reference to the two or three factors that are quite naturally going to appear to be enormous and enormously significant when they're the only two or three factors you're familiar with. If you feel like it. But you're just fucking yourself over by doing it, imo. It creates a smokescreen that obscures a whole fucking fleet of other, much more seriously threatening issues. I mean threatening to your health and welfare. And that of the community.

Though I can see how it might be the more personally gratifying choice in the short term, for sure.

[compared2what?]

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.

Believe it or not, I read the entire fucking thing back when they passed it, although I haven't looked at it since.

Those limitations are there because that legislation was dictated to lawmakers by the health insurance lobby. So I'd say the governing power behind it is still: The health insurance industry. Some doctors are more coopted by that than others, but it's kind of hard to judge any individual doctor based on what the AMA or the APA (or whatever) supported. Most of them don't have any more real say in the policy positions that their professional organizations take up for lobbying purposes than we do about the policy positions our elected representatives take up in response to them. And most of them are as susceptible to one of the standard party-line propagandistically effective justifications for supporting or opposing this or that broadly stated position that are offered up to them by voter's guides and the media as we are.

Which is to say: Very. Most of them are, as I've already said twice, just totally fucked. A lot of them won't be able to make a living in the not too distant future. They got conned. Happens to the best of us.

[JackRiddler]

.

c2w?, re: the post at the top of the current page.

Damn, you probably do intimidate people for being so goddamn smart, independently of whatever their conditioned or from-conviction reactions to your ascribed gender (or other characteristics seen as primary, such as ethnicity, educational level, profession, class or widely-hated city of origin) in the context of this particular society may be. In this case, it's nothing hard to understand, either. Just the clarity is a bit frightening.

(Necessary add: Which is said both in commisseration and urging you never to change a thing. Which is probably unnecessary to add, but phatic, no?)

.

[compared2what?]

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.

That's the rule not the exception wrt drugs prescribed for stuff like depression, which is treated sometimes treated with both Abilify and Seroquel.

I think those are very, very bad medications, personally. Atrociously bad.

But just for the record: When they're prescribed at the therapeutic doses for depression (as opposed to the much higher therapeutic doses used when they're prescribed for psychosis) the risk of developing the tongue-flicking thing you mentioned earlier is in the tiny-to-non-existent range, by and large. It's called tardive dyskinesia, btw. Should you ever wish to refer to it when speaking with a doctor or something.

Weight gain, on the other hand, is very, very likely with those drugs. But at depression-level doses, apart from that, most of the horrendous side effects are probably going to be cognitive not physical.

Which doesn't make them any more or any less horrendous, obviously. In a way it makes them worse because it makes them easier for both doctors and patients to overlook and minimize. Anyway. The only reason that's at all worth knowing is that if you're looking for incipient signs of tardive dyskinesia that are almost certainly not going to develop and that aren't really all that difficult to spot in time to be preventable in most patients who aren't lying disregarded in some urine-soaked back ward in a state mental institution, you're probably going to have less energy to devote to looking for signs of your rapidly accelerating inability to reason swiftly from A to B. Or whatever.

Forewarned is forearmed, basically.

[compared2what?]

.

c2w?, re: the post at the top of the current page.

Damn, you probably do intimidate people for being so goddamn smart, independently of whatever their conditioned or from-conviction reactions to your ascribed gender (or other characteristics seen as primary, such as ethnicity, educational level, profession, class or widely-hated city of origin) in the context of this particular society may be. In this case, it's nothing hard to understand, either. Just the clarity is a bit frightening.

(Necessary add: Which is said both in commisseration and urging you never to change a thing. Which is probably unnecessary to add, but phatic, no?)

.

Honestly, if you saw me in, let's say, an airport, you wouldn't even have to think twice before concluding that I was not, in fact, smarter than luggage. Because I'm not. And that's just one among many examples in just one among many categories of the complete idiocy of me.

This format and medium just give a very misleading impression of my smarts. And I daresay those of others, too. In both directions, no doubt. C'est la vie.

[JackRiddler]

Honestly, if you saw me in, let's say, an airport, you wouldn't even have to think twice before concluding that I was not, in fact, smarter than luggage. Because I'm not. And that's just one among many examples in just one among many categories of the complete idiocy of me.

This format and medium just give a very misleading impression of my smarts. And I daresay those of others, too. In both directions, no doubt. C'est la vie.

Well let's not make outlandish claims here. Of course you're not smarter than the luggage in an airport! It's been getting smarter and smarter, that luggage.

And hey, and not just speaking of you: If the outfit flatters, and if the home field is sure to cheer, why not wear it?

bks on the other hand is a lot smarter than the impression this format and medium may give.

[bks]

JackRiddler wrote:
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.

Granted. I'm not trying to paint Levin as a singular villain, and I think c2w? would agree on a lot more about psychiatry than we disagree on. I'm only interested in Levin's story to the degree it's representative of wider practice. And so let me stipulate that in all I say below, all (or most) criticism of Levin can be understood more broadly as criticism of the sort of mindset among psychiatrists that he exhibits, and criticism of the entire profession to the extent it mirrors his actions.

bks wrote:
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.

c2w? wrote:
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?

a) On the basis of the vastly superior monetary and social-capital resources the class of US doctors and psychiatrists has as a whole as compared to that of their patients, as a whole;

b) Nothing tactical and strategic about it. It's intended as an accurate description of the situation, nothing more. Doctors are not in the discursive situation their patients are in, nor are they in the financial situation their patients are in. As a class, which they should start to see themselves as, they are in a far better situation than the general public, even though I admit doctors face a daunting set of difficulties in improving their professional situation.

If [Levin's accommodations] were [professionally encouraged], 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?

So it is widespread, this practice, and profession-killing, and it's the professionals themselves who have acquiesced to it even though they hate it. But you maintain that it's not encouraged by the profession? Fine, I'll grant it. Encouraged or not, the profession is being killed, with the complicity of psychiatric professionals. If you think the insurance industry is the lone culprit, please make an appointment to see Dr. Milgram (see below).

c2w? wrote:
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?

I was [playfully] referring to the possibility that the author of the article made up the quotes, not that the Dr. or his wife were lying. Blair wrote false reports, so the analogy was to the person who wrote the article, not to Levin. And I'm not suggesting Levin made anything up, quite the opposite. Why would you make up stuff that makes you look bad? Which reminds me: 'easy admissions' may have been an unfair description, you're right. I shouldn't have said that. It just struck me that the quotes were sent from heaven, and Levin looks like he came from central casting. But no, I'm not saying they're made up.

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.

Milgram was a psychologist. I think he had a Ph.D. in social psychology, so I took the liberty of calling him Dr. Milgram.

I don't think any fair person would characterize what Levin is doing as killing people. Why the hyperbole?

Do you want to deny that Dr. Levin and wife would have been in the 62.5% of Milgram's initial subjects who pressed the lever until the highest voltage was reached (and then continued to press it)? He's telling us that he would have been in 10 different ways in this piece. [And by the way: so may I have been. I'm not necessarily speaking from a position of superiority here, so let's just get that out of the way].

You may be missing, or just unintentionally misrepresenting one of the key findings of the Milgram studies: it wasn't that people didn't "register" what they were doing [or, if you like, what "they" were doing]. All of his subjects understood that when they depressed what they believed was a shock-delivering lever, a scream of pain came from the "learner" as a direct result of it. The key point was that the interjection of a command from authority to keep doing it helped the subject feel less responsible for the action. 

I hear an strong echo of this in Levin's and his wife's comments about stock markets dropping and kids in college. On one hand, it makes sense. You're doing something you have no desire to do, at the behest of someone else. So you don't feel responsible for it. On the other hand, it's still you that's doing it, and you understand full well that the only reason it's happening is because you can't keep yourself from doing it. I think that kind of dual consciousness describes Dr. Levin pretty well.

What's off-putting about those remarks is that they're intended as mitigation, and he should really shut the fuck up about them because as a justification for treating patients in a way he wasn't trained to and which can do harm pretty easily, they're pretty worthless. Particularly for a medical professional. Let his son take out loans to pay for college, god forbid, rather than a single person be misdiagnosed because you only have 45 minutes to make one. Where is that sentiment from Levin?

I take the line about Levin's refusing to disclose how much money he makes to be the writer's registration of a mild objection to Levin's rationalizing.

“I’m good at it,” Dr. Levin went on, “but there’s not a lot to master in medications. It’s like ‘2001: A Space Odyssey,’ where you had Hal the supercomputer juxtaposed with the ape with the bone. I feel like I’m the ape with the bone now.”

Here we come to the crux of the matter, the psychiatrist as ape (Sent from heaven! Just kidding). Levin admits that pretty much anybody with basic training in medications could be doing what he does about 95% of the time. What goes unsaid is that that's the reason why he and his profession are going along with the new regime. They understand that if they don't "play the game", those pulling the strings will eventually find some other ape who will. Isn't that where this is headed, anyway? If doctors like Levin are going to have the temerity to continue to insist on a living wage for their services, eventually the insurance industry will just figure out a way to bypass them altogether and train the next generation of apes to dispense medication to their policy-holders. For all they care, Levin can go stand in line with the latest wave of laid-off public employees for an unemployment check if he doesn't like it.

I suspect psychiatrists understand this in their bones. They're understandably hanging on by their fingernails. The sad irony is that by 'playing the game' this way, they're risking the destruction of the profession.

[compared2what?]

JackRiddler wrote:
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.

Granted. I'm not trying to paint Levin as a singular villain, and I think c2w? would agree on a lot more about psychiatry than we disagree on. I'm only interested in Levin's story to the degree it's representative of wider practice. And so let me stipulate that in all I say below, all (or most) criticism of Levin can be understood more broadly as criticism of the sort of mindset among psychiatrists that he exhibits, and criticism of the entire profession to the extent it mirrors his actions.

IOW: Oh, no, I'm not trying to paint Dr. Levin as a singular villain. I'm trying to paint him as a representative villain.

And possibly we do agree about most things. But assuming that you don't have a reading comprehension problem, one of the things we'd disagree about is the permissibility and advisibility of reading villainy and other moral flaws into the characters of people you read about in newspapers whose motives are totally unknown to you.

bks wrote:
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.

c2w? wrote:
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?

a) On the basis of the vastly superior monetary and social-capital resources the class of US doctors and psychiatrists has as a whole as compared to that of their patients, as a whole;

Honestly, that depends on who their patients are. But it's a moot point in any event. Because I really don't think that there's ever been a single dominant-ideological model that includes doctors in the dominant class. They're obviously not a part of it. They're not usually even part of the "affluent" class or "the rich" -- ie, the second sector, right below "ruling," "dominant," or "elite," whichever term is being employed.

They're typically part of what you could variously deem "the upper middle class," "the professional classes," or "the professional and managerial classes." Thought some of them might just be plain old "middle class."

In short: I know of no evidence that doctors and/or psychiatrists as a class do indeed have "vastly superior monetary and social-capital resources" relative to their patients. Assuming that their patients have insurance (and that it's not Medicaid), they're actually highly likely to be at the upper end of the same social class as their patients.

And they definitely don't have much social capital. To speak of. They did used to. In the 19th century. And arguably in smalltown America between the 1930s and 1960s or so. Not now, though. Not any more than the vast majority of lawyers and accountants do. All of whom, generally speaking, earn their income, rather than live off their assets.

(b) Nothing tactical and strategic about it. It's intended as an accurate description of the situation, nothing more. Doctors are not in the discursive situation their patients are in, nor are they in the financial situation their patients are in. As a class, which they should start to see themselves as, they are in a far better situation than the general public, even though I admit doctors face a daunting set of difficulties in improving their professional situation.

Well. However it's intended, it's not accurate. Therefore, whether intentional or not, I'd say your wrong about that tactical/strategic thing. Because from the perspective of someone to whom it's useful to paint one or more of them as villains, it has the tactical advantage of making them seem much more empowered than they are.

If [Levin's accommodations] were [professionally encouraged], 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?

So it is widespread, this practice, and profession-killing, and it's the professionals themselves who have acquiesced to it even though they hate it. But you maintain that it's not encouraged by the profession? Fine, I'll grant it.

That's very generous of you, given that that's how it is.

Encouraged or not, the profession is being killed, with the complicity of psychiatric professionals. If you think the insurance industry is the lone culprit, please make an appointment to see Dr. Milgram (see below).

Yeah. Okay. Allow me repeat myself:

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.

That's not complicity. Or acquiescence. It's choicelessness. Or powerlessness, if you prefer. The rug got pulled from under him. As the article makes totally and lucidly plain.

c2w? wrote:
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?

I was [playfully] referring to the possibility that the author of the article made up the quotes, not that the Dr. or his wife were lying. Blair wrote false reports, so the analogy was to the person who wrote the article, not to Levin. And I'm not suggesting Levin made anything up, quite the opposite. Why would you make up stuff that makes you look bad? Which reminds me: 'easy admissions' may have been an unfair description, you're right. I shouldn't have said that. It just struck me that the quotes were sent from heaven, and Levin looks like he came from central casting. But no, I'm not saying they're made up.

Oh, good.

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.

Milgram was a psychologist. I think he had a Ph.D. in social psychology, so I took the liberty of calling him Dr. Milgram.

I don't think any fair person would characterize what Levin is doing as killing people. Why the hyperbole?

I was trying to come up with an explanation for the reference that was compatible with the text in which it occurred.

Do you want to deny that Dr. Levin and wife would have been in the 62.5% of Milgram's initial subjects who pressed the lever until the highest voltage was reached (and then continued to press it)? He's telling us that he would have been in 10 different ways in this piece. [And by the way: so may I have been. I'm not necessarily speaking from a position of superiority here, so let's just get that out of the way].

You may be missing, or just unintentionally misrepresenting one of the key findings of the Milgram studies: it wasn't that people didn't "register" what they were doing [or, if you like, what "they" were doing]. All of his subjects understood that when they depressed what they believed was a shock-delivering lever, a scream of pain came from the "learner" as a direct result of it. The key point was that the interjection of a command from authority to keep doing it helped the subject feel less responsible for the action. 

I hear an strong echo of this in Levin's and his wife's comments about stock markets dropping and kids in college. On one hand, it makes sense. You're doing something you have no desire to do, at the behest of someone else. So you don't feel responsible for it. On the other hand, it's still you that's doing it, and you understand full well that the only reason it's happening is because you can't keep yourself from doing it. I think that kind of dual consciousness describes Dr. Levin pretty well.

I didn't miss anything. Or unintentionally misrepresent anything. The Milgram subjects didn't register what they were doing as having the meaning that (as far as they knew) it had. Of course they "knew" that they were delivering "electric shocks" to unseen people who screamed and then, in fact, stopped responding altogether, suggesting that they were D-E-A-D.

If you hear a strong echo of that in Levin's and his wife's comments about anything, I submit that you may have missed something about the Milgram experiments. For example, what "authority" and "obedience" are.

]What's off-putting about those remarks is that they're intended as mitigation, and he should really shut the fuck up about them because as a justification for treating patients in a way he wasn't trained to and which can do harm pretty easily, they're pretty worthless. Particularly for a medical professional. Let his son take out loans to pay for college, god forbid, rather than a single person be misdiagnosed because you only have 45 minutes to make one. Where is that sentiment from Levin?

You have no reason at all to think that he's doing his patients harm. None. Zero. That's all prefab propagandistic spin, brought to the story by you.

I take the line about Levin's refusing to disclose how much money he makes to be the writer's registration of a mild objection to Levin's rationalizing.

To say that that would be very much frowned upon among writers of that kind of story is putting it mildly. So I doubt it very much. I take the line as the writer's way of letting the readers know that he (or she) didn't just forget to put that information in, he (or she) was unable to obtain it. Because it would be natural to assume that readers would want to know that information if it was available.

“I’m good at it,” Dr. Levin went on, “but there’s not a lot to master in medications. It’s like ‘2001: A Space Odyssey,’ where you had Hal the supercomputer juxtaposed with the ape with the bone. I feel like I’m the ape with the bone now.”

Here we come to the crux of the matter, the psychiatrist as ape (Sent from heaven! Just kidding). Levin admits that pretty much anybody with basic training in medications could be doing what he does about 95% of the time. What goes unsaid is that that's the reason why he and his profession are going along with the new regime. They understand that if they don't "play the game", those pulling the strings will eventually find some other ape who will. Isn't that where this is headed, anyway? If doctors like Levin are going to have the temerity to continue to insist on a living wage for their services, eventually the insurance industry will just figure out a way to bypass them altogether and train the next generation of apes to dispense medication to their policy-holders. For all they care, Levin can go stand in line with the latest wave of laid-off public employees for an unemployment check if he doesn't like it.

I suspect psychiatrists understand this in their bones. They're understandably hanging on by their fingernails. The sad irony is that by 'playing the game' this way, they're risking the destruction of the profession.

That's very moving.

[justdrew]

I bet I could setup a study that would "prove" that a treatment plan consisting of: "giving the patient $150 per month free to spend in whatever way they think would make them happy, for six months" would be as or more effective than most drugs.

anyway, the complaint that a psychiatrist is nothing but a glorified drug pusher is one that goes back at least three or four decades, it's not new. As has been pointed out, it's their job, prescribing drugs is what they do. but these days there's nothing to it. they don't seem to generally do the initial diagnosis. patients come in with one or more ICD9 codes, and from that the list of drugs to "try" can be determined from a list, in order of most likely to work to least. A computer program can do the job, take into consideration other factors such as other medications/conditions/etc, feedback provided by standardized patient reactions... "makes me sleepy" - then for that diag, switch drug A from item 1 to item 2 in the list. In fact I bet most psychiatrists already use such expert systems to aid them, they've been around for more than ten years.

It's a pity that the many many health conditions that result in non-specific complaints, as C2W points out, are not even generally tested for. Tests are oh so expensive after all, and ordering unnecessary tests will get docs in trouble, yet... They're perfectly happy to run a series of tests on your brain chemistry, by prescribing psych drugs... "try this for awhile, if it doesn't work, we'll try a different one. heck, we may have to try a variety of drugs over the course of years before we find something that will cause you to stop reporting these symptoms."

Personally, I would bet 50% or more of "depression spectrum syndrome" would respond well to up-regulating the patients' metabolism, giving the person enough of a lift to get past much of the symptoms and get into activity/exercise again. Ah but wait, no patent medicine involved there. too bad.

oh, and if your GP is prescribing psych meds, consider yourself lucky, because you're also like to be getting that script from a Physician Assistant (not the same as a resident, this is like a Nurse Practitioner but trained "in the doctor culture rather than the nursing culture")

[compared2what?]

As I more or less said on the autism/vaccine won't-go-away thread, depression is both overdiagnosed and underdiagnosed. So it's kind of hard to figure the percentages. Further, it's a disorder that comes in what you might call different flavors wrt stuff like age of onset and so forth. Some of which bode less well than others wrt prognosis and treatability.

But fwiw, there are some categories of depressed patient who are almost certain to derive long-term benefits from a short-to-medium course of antidepressants. And others who would get about the same benefit from meds or talk therapy (in which case, imo, they should have that choice). And others who have little to gain from the meds. In which case, obviously, they shouldn't be taking them.

It's my opinion that none of those hypothetical patients (or any others) should be taking SSRIs or any other psychopharmaceutical drug with absolutely no other treatment or monitoring or other medical oversight. It's probably safe, but that's a pretty fucking dubious advantage if it's not effective treatment.

That's just horrible clinical practice. Horrifying too. However, as I believe I may have already kinda mildly, gently hinted, I think it's a waste of time and energy to focus on the inadequacy of meds and/or their overprescription as if those things were the be-all and end-all of the problem. They're not. And it is a serious problem. Mental disorders are real disorders. People who have them should get okay treatment when okay treatment for what they have exists. It's ridiculous that they don't. And very sad. They're sick.

[JackRiddler]

Granted. I'm not trying to paint Levin as a singular villain, and I think c2w? would agree on a lot more about psychiatry than we disagree on. I'm only interested in Levin's story to the degree it's representative of wider practice. And so let me stipulate that in all I say below, all (or most) criticism of Levin can be understood more broadly as criticism of the sort of mindset among psychiatrists that he exhibits, and criticism of the entire profession to the extent it mirrors his actions.

IOW: Oh, no, I'm not trying to paint Dr. Levin as a singular villain. I'm trying to paint him as a representative villain.

And possibly we do agree about most things. But assuming that you don't have a reading comprehension problem, one of the things we'd disagree about is the permissibility and advisibility of reading villainy and other moral flaws into the characters of people you read about in newspapers whose motives are totally unknown to you.

I'm surprised at the fallacy here, leaving aside the question of whether it's more in response to rhetoric from bks or a strawman from c2w?.

"Villainy and other moral flaws" in "the characters of people you read about in newspapers" and their personal inner "motives," known or not, are often immaterial to the question of whether these same people are fulfilling a role we may choose to characterize as villainous -- or if you prefer, find morally wrong, even as we avoid the loaded label of "villain."


"It's not who we are underneath, it's what we do that defines us." Says a fictional billionaire, a guy who can do whatever the fuck he wants in a cartoon universe where evil and good are easily identified.

I can have no certain idea and sometimes no evidence pertaining to the character (a potentially vague term) or motives (quite a bit clearer but often unknowable, even to the one who has them) of countless people I've never met.

Yet I know that many of these people I don't know hold roles in enterprises that I feel qualified to judge as wrong; roles that should be rejected when offered, and not just by students considering hypotheticals in an ethics class. Pentagon war planners, Mubarak thugs, police enforcing the drug war, middle managers and workers at arms factories, the legal and psy-war teams for Monsanto and Bank of America and, relevant here, Pfizer and United Health... these are just a few such roles.

The people usually aren't pulling triggers, or even pushing a button at Milgram's request. They're usually working at desks, like the friendly Mubarak thug-dispatchers at the Interior Ministry. They may be really nice to befriend, generous to charity, avid readers of Proust, gentle to children. They may greatly regret what they are doing, and yet do it because it's their job and so they are "powerless." They may have genuinely noble motives and persuade themselves that what they are doing is necessary.

Many thousands of people who fit these examples are neither rich nor economically autonomous nor members of anything like an upper class. With so many Pentagon war planners planning so many current and potential wars, thousands of them are just replaceable office salary-grunts. The PR teams for the big corporations are also full of salary-grunts, and even the top "creative" is usually just a contractor who can be shown the door (at sometimes minimal severance, depending on the contract).

You may find that many of the things done by these groups -- or by the Dr. Levins on the 15-minute psychiatric session assembly line, prescribing pills that they know to be likely useless and sometimes harmful to recipients who have not even been diagnosed properly -- are regrettable, but not of their making. (There's the central debate here, more below.)

You may believe it outrageous to compare any given one of these activities to pushing a button the button-pusher believes delivers an electric shock to a victim who is screaming and, by all audible appearances, dies as a result. That may be true; I'd still argue a range of routine professional activities performed by members of the above groups are as bad as pushing that button, or worse.

Notwithstanding... none of that changes the upshot of Milgram's experiment, which is that 62 percent of the randomly chosen white male Connecticut-dwelling experimental subjects kept pushing the electro-shock button to the very end when a man in a white coat identified as an authority calmly asked them to do so, although they were free to go and no personal incentives were offered to them to continue. And while we can argue whether and by how much that share in any other given group today would vary, I would at least go into that argument with the position that for cohorts drawn from most groups, something like the same majority would still respond in the same way in comparable situations today.

(Allowing that the experiment would have to be different, since a good number of them today would see through the rickety style of the Milgram study if repeated in identical fashion. Okay, my optimism says that the number would be a bit lower today, because both blind obedience and authority have eroded somewhat. Well, okay, the number would be zero today, thanks to the inevitable veto from the Human Subjects Research Committee. Unless we did it in Africa on a Gates grant. But I digress.)

I would argue (sorry about the conditional, but the actual argument would require a book-length post I prefer not yet to write) that the conditions of our society and of the human world as a whole provide rich evidence that the Milgram findings are robust, indicative of the human condition, and still true. I would argue that much if not most of what is considered "gainful employment" in fact implicates people in varying degrees of Milgramian button pushing, and that everything Dr. Levin is quoted as saying and is described as doing in the Jayson BlairNew York Times article suggests he'd be among "the 62%" and not "the 38%."

Hell, let's just say Dr. Levin doesn't even exist, and think of him as a hypothetical stand-in for psychiatrists who do what he is reported as doing -- a large set of whom does, in fact, exist! Again, you'd have to come up with a different, not strictly comparable experiment to snag the Dr. Levins into the 62%, since a Dr. Levin of today no doubt knows about Milgram.

Wait, I got it! I have a proposed experimental design: We will ask a randomly selected group of American psychiatrists if, given recent developments in the insurance and pharma industries entirely beyond their control, they are willing, in exchange for their continued economic security, to hold 15-minute sessions to prescribe pills known possibly to be useless, or even harmful, to patients known not to have been adequately diagnosed?

Meanwhile, I would expect people from "the 38%" of today (whatever that % really is) are far likelier to be found among Dr. Levin's patients, as a subset of those who come to him with general and persistent but vague symptoms of depression mixed with dread; a subset who sort-of know they wouldn't push the Milgram button but also know they have no idea what they should be doing in this mess of a world, hence the lining up to see if there is a dosage and combination of pills that makes it all better.

Finally, Dr. Levin. Yeah, it's unfair to over-villainize him, but to call him powerless? Please. Only in the sense that we are all mortal and bleed when cut. I think c2w?'s description of where he fits in class society (at the top of the middle) is truer than bks's (at the bottom of the top). Either way, that means he has room to give up a lot of things and still (likely) live by a material standard that 80 percent of Americans would consider better than their own. Not that there's no risk involved in that -- he could end up worse off than that -- but I do see some people take even greater risks in defense of what they believe is right, or in defense of their own dignity and integrity. (Even given some material self-interest invariably mixed in; right now I'm thinking of the Wisconsinites who choose to fight for pride and living wages at the risk of personal disaster, instead of sacrificing dignity for relatively higher job security.)

All of which doesn't mean I condemn or villainize him, or would act differently. (I would act very differently, actually, but for reasons not to be covered now and not necessarily noble or admirable.) Hell, I'm not coming to a moral judgement here, after all that. I can't even go on, after producing so much just in response to a paragraph from each of you. I'm merely seeking to clarify terms and perhaps dispense with a few misleading concepts of what is.* In the hope that this was the case,

I come always as friend to both of you,

"JR"

PS - Notwithstanding that we are all in an experiment right now, not Milgram's but Rohrschach's, since we're working with impressions from uncertain and sparse data. But hey, that's what discussion boards are at their best: get to play things out all serious like, in what remains a game-space.

* - One of my unfortunate conclusions being that the Milgram findings more than not characterize the human condition. Which I can understand wanting to deny.

.

[American Dream]

Cross-posting here, at Jack's urging

http://brucelevine.net/thinking-critica ... heir-feud/

Thinking Critically About Scientology, Psychiatry, and Their Feud

By Bruce Levine on September 10, 2008


For many Americans who gain their information solely from television, all critics of psychiatry are Scientologists, exemplified by Tom Cruise spewing at Matt Lauer, “You don’t know the history of psychiatry. . . . Matt, you’re so glib.” The mass media has been highly successful in convincing Americans to associate criticism of psychiatry with anti-drug zealots from the Church of Scientology, the lucrative invention of science fiction writer L. Ron Hubbard.

However, Americans who gain their information outside of television and beyond the mass media may be aware of a secular, progressive tradition that is critical of how psychiatry has diverted us from examining societal sources of our malaise. This secular, humanistic concern was articulated, perhaps most famously, by the psychoanalyst Erich Fromm (1900-1980).

In The Sane Society (1955), Fromm wrote:

“Yet many psychiatrists and psychologists refuse to entertain the idea that society as a whole may be lacking in sanity. They hold that the problem of mental health in a society is only that of the number of ‘unadjusted’ individuals, and not of a possible unadjustment of the culture itself.”

Is American society a healthy one, and are those having difficulties adjusting to it mentally ill? Or is American society an unhealthy one, and are many Americans with emotional difficulties simply alienated rather than ill? For Fromm:

“An unhealthy society is one which creates mutual hostility [and] distrust, which transforms man into an instrument of use and exploitation for others, which deprives him of a sense of self, except inasmuch as he submits to others or becomes an automaton.”

Fromm viewed American society as an increasingly unhealthy one, in which people routinely experience painful alienation that fuels emotional and behavioral difficulties.

Unlike Tom Cruise, Fromm would not have been terribly upset that actress Brooke Shields found happiness in antidepressants. No genuinely humanistic critic of psychiatry believes that adults who choose prescription psychotropic drugs should be mocked, shamed, or prohibited from using them. Rather, humanist critics of establishment psychiatry advocate for informed choice about all treatments.

The essential confrontation for Fromm is not about psychiatric drugs per se (though he would be sad that so many Americans nowadays, especially children, are prescribed psychotropic drugs in order to fit into inhospitable environments). His essential confrontation was directed at all mental health professionals — including non-prescribers (such as psychologists, social workers, and counselors) — who merely assist their patients to adjust, but neglect to validate their patients’ alienation from society.

Those comfortably atop societal hierarchies have difficulty recognizing that many American institutions promote helplessness, passivity, boredom, fear, isolation, alienation, and dehumanization for those not at the top. One-size-fits-all schools, the corporate workplace, government bureaucracies, and other giant, impersonal institutions routinely promote manipulative relationships rather than respectful ones, machine efficiency rather than human pride, authoritarian hierarchies rather than participatory democracy, disconnectedness rather than community, and helplessness rather than empowerment.

In The Sane Society, Fromm warned:

“Today the function of psychiatry, psychology and psychoanalysis threatens to become the tool in the manipulation of man. The specialists in this field tell you what the ‘normal’ person is, and, correspondingly, what is wrong with you; they devise the methods to help you adjust, be happy, be normal.”

In the “adjust and be happy” sense, there is commonality between establishment mental health professionals and Scientologists. Neither Dr. Phil nor Tom Cruise are exactly rebels against the economic status quo; and their competing self-help programs, though different, are similar in that they instruct people on how to adjust, be happy, and be normal within our economic system.

The source of the mutual hostility between psychiatry and the Church of Scientology, as depicted by the mass media, centers around psychotropic drug use; but my sense is that the root cause of their feud is a fierce competition between them. Both establishment psychiatry and Scientology are competing for the same people — those more comfortable with authority, dogma, and insider jargon than with critical thinking.

Both the teachings of L. Ron Hubbard and psychiatry’s DSM (the official diagnostic manual in which mental illnesses are voted in and out by elite psychiatrists) have much more to do with dogma than science. Both Scientology and psychiatry embrace science fiction techno-babble that poses as scientific fact. In Scientology’s “auditing,” the claim is that the Hubbard Electropsychometer (E-Meter) can assess the reactive mind of the preclear by passing a small amount of voltage through a pair of tin-plated tubes that look like empty soup cans which are wired to the E-Meter and held by the preclear. But psychiatry is no more scientifically relevant, as its trendy chemical-imbalance theories of mental illness have shelf-lives of about a decade, with establishment psychiatry most recently having retreated from both their serotonin-deficiency theory of depression and the excessive-dopamine theory of schizophrenia.

While Scientology can claim auditing adherents, and psychiatry can claim even more antidepressant advocates, neither treatment has been shown to be consistently superior to a placebo. And rather than validating their treatments with legitimate science performed by independent, financially unbiased scientists, both Scientology and psychiatry rely on what amounts to a well-funded public relations apparatus.

Scientology and establishment psychiatry have something else in common. They are both orthodoxies that deal harshly with their ex-insiders who have come to reject them. Currently, psychiatry is the more prevailing orthodoxy, and, as George Orwell explained, the mainstream press does not challenge a prevailing orthodoxy. Orwell wrote:

“At any given moment there is an orthodoxy, a body of ideas which it is assumed that all right-thinking people will accept without question. . . . Anyone who challenges the prevailing orthodoxy finds himself silenced with surprising effectiveness. A genuinely unfashionable opinion is almost never given a fair hearing, either in the popular press or in the highbrow periodicals.”

It is my experience that psychiatry, Scientology, and fundamentalist religions are turnoffs for genuinely critical thinkers. Critical thinkers are not so desperate to adjust and be happy that they ignore adverse affects — be they physical, psychological, spiritual, or societal. Critical thinkers listen to what others have to say while considering their motives, especially their financial ones; and they discern how one’s motivation may distort one’s assumptions.

A critical thinker would certainly not merely accept without analysis Fromm’s and my conclusion that American society is insane in terms of healthy human development. Perhaps a society should not be labeled insane just because it is replete with schools that turn kids off to reading, for-profit prisons that need increasingly more inmates for economic growth, a mass media that is dishonest about threats to national security, trumped-up wars that so in debt a society that it cannot provide basic health care, a for-profit healthcare system that exploits illness rather than promoting health, etc.

A critical thinker would most certainly point out that there have been societies far less sane than the United States — and Erich Fromm made himself absolutely clear on this point. In the barbaric German society that Fromm fled from, disruptive children who couldn’t fit into one-size-fits-all schools were not forced to take Adderall and other amphetamines, but instead their parents handed them over to psychiatrists to be euthanized. Fromm, however, knew that just because one could point to societies less sane than the United States, this did not make the United States a sane, humanistic society.

[bks]

having just read jack's new post above, some of this might be redundant now, so apologies.

c2w? wrote:

And possibly we do agree about most things. But assuming that you don't have a reading comprehension problem, one of the things we'd disagree about is the permissibility and advisibility of reading villainy and other moral flaws into the characters of people you read about in newspapers whose motives are totally unknown to you.

Motives? I think I've limited my discussion of his motives to what can reasonably be inferred from what he says they are. He had kids in college, or else he probably wouldn't be assembly-lining, remember? He doesn't want to move backwards in terms of monetary compensation, remember? Those are expressions of what is motivating him.

Morality has nothing to do with it, if you want to get technical. We're talking about ethos. The spirit of what he's doing frankly sucks. Obscuring that does no one any good, and acknowledging it doesn't entail foreclosing on the man's humanity or anything.

I think it's a better idea in these matters to look at what people do, rather than what motivates them, anyway. Practice is the product of character, and character is the product of habituation, deliberation, trial and error, more deliberation and on and on and on. If you mean to do 'good' and consistently don't, it just doesn't amount to much in most cases, no matter what Kant might think.

I didn't miss anything. Or unintentionally misrepresent anything. The Milgram subjects didn't register what they were doing as having the meaning that (as far as they knew) it had. Of course they "knew" that they were delivering "electric shocks" to unseen people who screamed and then, in fact, stopped responding altogether, suggesting that they were D-E-A-D.

If you hear a strong echo of that in Levin's and his wife's comments about anything, I submit that you may have missed something about the Milgram experiments. For example, what "authority" and "obedience" are.

Care to explain this bolded section? AFAICT, this means "they didn't understand that they were responsible for the shocks". If not, then what does it mean?

If you're accepting the responsibility of Milgram's subjects, why won't you allow Levin the responsibility for his actions? The echo I hear refers to the shifting of responsibility for decisions and actions that are his onto external factors which are of course influences on him, but which are not the sole or even primary locus of responsibility.

I'm not saying Levin is demonstrating obedience, or out of obedience at all. I'm saying that the psychiatric professionals who have adjusted their practices to reflect what's described in the article, are probably able to do so more easily after they'vemade a series of psychological adjustments about what they're doing. Those adjustments are self-serving, and ironically, they're also more serving of the interests which are happy to see the profession destroyed.

And the word "unseen" isn't entirely accurate re" Milgram's study. The "teachers" met the "learners" before the experiment, when as far as the "teachers" knew, it had not been decided who would be the "teacher" and the "learner".

You have no reason at all to think that he's doing his patients harm. None. Zero.

I think I said "can easily do them harm". If you think there is "no reason at all" to believe that prescribing psychoactive mediation on the basis of a misdiagnosis can do harm, then please say so. Because that would seem to be at odds with what you said to drew here:

It's my opinion that none of those hypothetical patients (or any others) should be taking SSRIs or any other psychopharmaceutical drug with absolutely no other treatment or monitoring or other medical oversight. It's probably safe, but that's a pretty fucking dubious advantage if it's not effective treatment.

"Probably safe" meaning it probably won't cause them to commit suicide? Yeah, you're right. Or "probably safe" meaning it won't have any significant health effect (mental or otherwise) which could reasonably be called harm? Far less clear. Anyway, when did "probably safe" become the standard for acceptable practice? It's pretty shitty practice, as you acknowledge, and which is the bigger point. In a well-functioning system it would first be required to prove pharmaceuticals are a good treatment for any particular malady as compared to other kinds of treatment. Under certain circumstances that can be demonstrated, yes, as you've said. But it's a long distance to proving that SSRIs, for instance, are a good treatment option for severely depressed people to giving anyone who exhibits the slightest behavior that departs from some institutional norm a psychoactive drug.

If the reply is that i could be making the complaint about any branch of medicine, point taken, but I'd still argue that psychiatry is a special case given the irreducible reliance on translating feelings and other fleeting aspects of experience into something concrete.

I come to this discussion from the standpoint that the more we're ready to medicalize behavior, the less we'll be willing to make accommodations for people who don't fit those norms, or who chafe under normal conditions (in schools, for instance, where a neighbor of ours apparently may get medicated because, while everyone acknowledges he's a delightful, smart kid, he gets up and walks around the kindergarten classroom at times he's "supposed to" be sitting down). We should be looking for environmental remedies for mental suffering/anguish before we resort to the label of mental illness, which carries with it a stigma and also suggests the existence of something that is entirely internal to the person and which gets carried around with them wherever they go, no matter what circumstances they find themselves in.

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.

Isn't this an exaggeration? So Peter Breggin is a Scientology source? Even though he's completely disavowed any connection between him and them from 1974 onward?

And what about David Healy? Him too? I never heard anything like that about him. He's an academic historian, and his work plainly stands on its own, for good or ill.

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.

. . 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.

Yeah, I think I'm guilty of that too. But I'm grateful you're willing to have the discussion with someone who has a lot to learn in this area.

[Bruce Dazzling]

Bruce Levine:

Those comfortably atop societal hierarchies have difficulty recognizing that many American institutions promote helplessness, passivity, boredom, fear, isolation, alienation, and dehumanization for those not at the top. One-size-fits-all schools, the corporate workplace, government bureaucracies, and other giant, impersonal institutions routinely promote manipulative relationships rather than respectful ones, machine efficiency rather than human pride, authoritarian hierarchies rather than participatory democracy, disconnectedness rather than community, and helplessness rather than empowerment.

Yes!

By fucking god, YES!

[compared2what?]

Sigh.

I didn't respond to the thread for which that article's the OP because I didn't want to rain on your parade, A_D. Which I still don't.

But fwiw, my problem with that essay is not that it's critical of psychiatry, but that it's so free of critical thinking about both of the outfits under consideration that it's practically a cruel, sick joke. And that makes me sad.

I guess that if anyone feels a truly urgent and burning need to know on what grounds I base that judgment, I'll share them. But otherwise, I'd rather just take a pass, honestly.