Poverty of Thought

Steve Balt wrote a post about some of his take-away thoughts from the American Psychiatric Association conference.

Commenters responded with thoughtful, illuminating insights about the gestalt of extant American psychiatry.  I was gratified to read that David Healy‘s Pharmageddon book is being cited as important.  He emphasized understanding the history of how capitalistic forces have emerged as the predominant force in shaping psychiatry and in shaping policies and practices which directly affect patient treatment (I refuse to use the word, care, relative to psychiatry and mental illness treatment, because it has specific meaning in the helping professions, and it is absent here.) and patient outcomes.

Steve’s post and your response, along with Emily Deans’ highlights a type of “poverty of thought” rampant in organized psychiatry. One cannot successfully treat people without the people. The old adage, “the surgery was successful but the patient died,” is apt for this field, too.

From assessment – how do you know you’re asking the right, germane, and appropriate questions? (glaring example: asking patients about suicide plans instead of about intolerable psychache and unbearable distressors. The first results in patients’ loss of civil rights and incarceration/observation, etc., the second SHOULD result in an urgent/emergent treatment intervention to lower the levels of immediate distress and to devise a treatment plan to reduce/eliminate the causative distressors. But that would mean knowing the patient, his living conditions and intervening where social justice is required. Ew. Messy. Takes longer than writing a prescription.)

To patient relationships – currently based on legal coercion, deception, and adverserial threat

To treatment – psychotropic medication, invasive surgery, inducing seizures and electrical stimulation, plus a dollop of who-knows-what talk therapy

To outcome goals – treatment adherence (do patients name their goals of being that of treatment adherence? /derisive snorting) which are unrelated to patients’ perceptions and functions in quality of life

Everything. Everything is oriented toward the psychiatrist. These are psychiatrists‘ interests at work. Patients are simply objects upon which to act, and are the means toward psychiatrists’ rewards: professional reimbursement, the source of research funds, the means to publication, and fodder for career recognition and success.

It’s Alice down the rabbit hole or through the looking glass.

It’s wrong.

But that it’s making more psychiatrists increasingly uneasy and uncomfortable is a good thing.  Eventually, that uneasiness will increase until it becomes an unbearable, distressing force, and action will become inevitable, if not impulsive. (Yes, I’m making a sarcastic swipe at extant suicide risk assessment, but I’m not going to advocate for incarcerating the poor psychiatric victims – in this case, the psychiatrists.  Maybe a little cognitive behavioral therapy so that they can recognize their distorted thoughts, and a round of ECT to jolt them out of their depression about their situation…)

4 thoughts on “Poverty of Thought

  1. Lmao at the ‘jolt of ECT.’ Good idea. I left a comment on Dr. Balt’s site, the gist of which says, my ‘takeaway’ from it was that while on one hand, he seems to recognize his profession’s shortcomings, he also admits accepting them, As you say in your article here (good one!), “uneasiness will increase until it becomes an unbearable, distressing force, and action will become inevitable, if not impulsive.” We patients, in the meantime, are stuck with the monthly med handoff, and at least where I go, by shrinks who don’t stay long enough to get to know you at all, let alone long enough to ponder the ‘unique nature’ of our distress. In the meantime, uncertainty is getting old, and some days, it seems like a better idea to just say to hell with all of this crap, and just go contemplate my Navel.

    • I think he’s got deep conflicts. Every time I read his posts, I feel both empathy for his plight and frustration that he is (so far) unable to have insight about the state of his profession and his role in it. So I limit my exposure to his writing. He’s got plenty of people with lead ropes showing him the water, but until he decides to dunk himself…

      As a fellow naval gazer, I sympathize, and I share your frustration. Today was a day to endure – and the night looms long and large. It’s not right, and it’s telling that no “experts” make appearances here, save Dr. Nardo, when I link here from his site. And he scrams promptly back to his Georgia woods.

  2. aek, i have new email addy. Wouldn’t more folks post here if you post on their sites? Isn’t that how blogging works? (Note – I only post on them, I don’t have a blog so I don’t know.)

    • I used to comment on many blogs. Rarely, if ever, does that result in readers/commenters here.

      I have come to think that there is a large disconnect between the expressed concern about suicide and the actual willingness to engage in helpful engagement and action around suicide. It’s too scary, painful and fear-inducing for “professionals” to do anything other than ask the rote “suicide assessment” questions and go directly to restraint, incarceration, intrusive observation and segregation. No emotional commitment, no patient engagement, no risk on their part.

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