Psychiatry vs. medicine from the patient's POV

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Francesca Allan
Psychiatry vs. medicine from the patient's POV

This morning, I went in for an EEG (electro-enceopholagram, I believe) which measures the electrical activity in the brain.  I have epilepsy and my neurologist wanted to check for new developments.  Anyway, it was at the hospital and I went there and had a good experience. The receptionist was courteous and the technician was respectful, thorough and well-informed.  

Compare this to my last visit to the psychiatrist.  I was in the waiting room observing all the obedient vegetables when this social worker comes to get me.  I took an instant dislike to her. I can't properly relay her tone in writing so I'll just refer to her as "nurse-y."  She talked slowly and patronisingly.

"So how are youooooo?

"Uh, fine."

"So how are you dooooing?"

"Uh, fine."

"Getting out and abouttttt, are you?

"Uh, yeah."

Then the psychiatrist comes in and we have our usual argument over biomedical psychiatry. As expected, he's convinced that emotional problems are simply reducible to brain chemical imbalances.  In order to fix that imbalance, you need chemicals.  You're better off on them, he always says.  "That's a fact," he says.

As usual, I refer to the research that shows outcomes are better without conventional treatment, that show that these drugs (atypical antipsychotics, usually) cause brain shrinkage and cognitive decline.  

Anyway, this is a longstanding disagreement between us and will never be resolved and I've strayed from my original point.  Ths social worker attended the meeting and nodded her head whenever the doctor spoke.  I found this extremely irritating.  Then she would interrupt our conversation to drop a profundity (not sure if that's a real word -- perhaps platitude is more like it) such as "There's two sides to every story."  She was useless and annoying and added absolutely nothing to the meeting.

So my question is:  How come there's such a difference between two medical specialties? How come I'm treated as an adult by a real doctor but a rather slow-witted child by the psyhiatric profession?  What is it about psychiatry that wants to infantilize its users?  Why the assumption that if someone has a mental illness you have to speak to them slowly and stupidly?

If she's there at my next appointment, I'm going to ask her to leave and I'll tell the doctor why.

Slumberjack

The Deleuzian approach suggests that the way psychiatry organizes itself is remarkably similar to how a society is structured in order to optimize control over its subjects.  The production and distrubution of complexes upon groups or individuals constitutes an initial consultation, followed closely by the repression and colonization of any desire attempting to exist outside of the given social construct.

6079_Smith_W

@ Francesca

I realize all professions have their trainings and protocols, but I think much of it also depends on the person and his or her own approach to healing.

Francesca Allan

6079, if by "person" you're referring to the professional (as opposed to the client), then I agree that much depends on the individual care provider  Still, it's uncanny how so many psychiatric professionals exhibit the same aggressive, authoritarian, belittling attitude. It makes me wonder what kind of person is drawn to the field or, alternatively, what education and training does to these people.

Caissa

The only psychiatrist I ever attended as a client was very professional with me. Our oldest son also had a meeting with a psychiatrist several years ago. Again, the psychiatrist was nothing but professional. Maybe NB has a better breed of psychiatrists.

Francesca Allan

I'm glad you had a good experience with them, Caissa.  I think the difference might be that most of my care has been involuntary (forced) whereas you could take it or leave it.  There's something about the power structure that brings out the worst in some people.

jas

Pretty sure studies have been done on this effect, FA. Certainly in social services we learned how our own approaches to people can dramatically affect the outcome of the interaction (i.e., can diffuse or aggravate an already volatile situation). And as a recipient of services I too have been caught in that dynamic. And it really can provoke. I remember an experience even with a dental office which, at its worst, led me to actually (and impotently) threaten to sue. I came away from that experience feeling crappy about my reaction, but that in turn made me feel crappy about the dentist, and I did not seek future services from him.

epaulo13 epaulo13's picture

The Inmates Are Running the Asylum Premiere

A documentry about radical mental health

3:30pm - 7:00pm
Saturday May 11 2013
Venue: Carnegie Community Centre

Address: 401 Main St

Cost: Free

Accessibility: Wheelchair accessible. Please email theinmatesarerunningtheasylum@gmail.com for more accessibility questions.

Come out for the first public screening of The Inmates Are Running the Asylum, a documentary about the Mental Patients Association: Vancouver's most radical and successful mental health group. 
 
MPA was founded in 1971 as a reaction to the dehumanizing experience many faced when they came out of psychiatric institutions. 
 
Unabashedly political, MPA was an advocacy and protest organization as well as a support group. They reclaimed the words used as slurs against them. MPA's "mad pride" philosophy was unfathomable to the psychiatric mainstream. But their approach worked. 
 
Forty two years later, MPA's story is being told. The film consists of interviews, animation and original music.
 
There will be two back-to-back screenings, both free. 
 
The first screening is at 4:00 pm, with a panel discussion after. The second screening is at 6:00.
 
Hope to see you there!

epaulo13 epaulo13's picture

..here's another project

Unlikely friends take documentary look at mental illness

In a compelling artistic partnership, a Canadian filmmaker tackles the story of a friend and hip-hop collaborator who is struggling to make music despite a diagnosis of schizophrenia

Jonathan Balazs and Khari “Conspiracy” Stewart make one of the unlikelier pairs anyone is ever apt to encounter.

Balazs, a compact 27-year-old of Hungarian descent, is a recent fine arts graduate from Ryerson University who, with his trimmed beard and waxed moustache, soft voice and thoughtful demeanour, seems every bit the Euro-artiste.

Stewart, tall, black and 35, with a large stud in his nose, an address in Parkdale and the layered, baggy uniform and hood of the street, cuts a much more imposing figure.

But the two men are friends. Close friends. Closer, probably, than most men ever get....

http://www.thestar.com/news/insight/2013/01/19/unlikely_friends_take_doc...

..the movie pitch

http://www.youtube.com/watch?v=6VUn6bB5mnY&NR=1&feature=endscreen

TMcDermott TMcDermott's picture

It is a struggle to find a compassionate, knowledgable psychiatrist who looks at treatment (medications or other methods) as a doctor patient partnership. I am fortunate that I have been under the care of such a doctor. I am doubly fortunate to live in Ottawa which has a very fine mental health hospital.

This post raises an issue that I have been ruminating about in the past few months. I think, actually I know, that over the years of treatment I have lost my sense of self. I no longer have a grasp on who I am, I often feel lost and fractured from life. The roles that I used to play, for example father, an employee recognized as key with a promising career, have fallen away. 

Where have I gone? Who am I now? What do I do to feel that satisfaction I used to have? Right now, I have no answers. I'm not sure I will in the future. At times hopelessness overwhelms me. Unhappiness, the loss of self-esteem and confidence are shadows that follow me.

Thanks for this thought provoking thread.

epaulo13 epaulo13's picture

..i came out of my childhood living in my head. a defence mechanism i figure that never went away. for many years i lived with this not even knowing what i was doing or that there was anything wrong. i was a round peg trying to fit in a square hole and all the time wondering why and thinking what's wrong with me.

..then in the 70's i came across a book called “scripts people live” by claude stiener. in one chapter of the book there were common scripts for men and women laid out. one described me perfectly. there was no doubt in my mind that this was me.

..the road, according to the script, was for me to go on holiday or fall in love and i would let out my child and for a short while live out in the real world. i would always come back though. i could go to a psychiatrist and head trip there for years..spinning my wheels. getting nowhere fast.

..my antithesis was to find a therapist who would prevent me from head tripping and encourage ways for me to engage with life. i was able to understand this intellectually but implementation was incredibly difficult. even finding a practitioner that didn't promote my tripping was extremely hard to find. over the years i made progress but more than 60 years later not much changed.

..until recently. i joined the reach health clinic here in van where you are treated holistically. they have doctors, counsellors, dietitians, dentist and even their own pharmacy under one roof. they communicate with each other re your needs. they treat the whole person.

..i met with the dietician whose position is that to deal with your food intake means you need to explore what is going on in your life in the moment. i was inspired by that so have taken everything i have learned about myself and am dealing. finally, after all these years, coming out of my head. once a week i meet with her and report my progress. she keeps me from head tripping and interacts with me on many different levels. this is what i needed all along. to bad it didn't happen earlier in my life but hey..better late than never.

Francesca Allan

TMcDermott, I really don't know what to say.  You raise so many important issues.  I, too, am overwhelmed by the losses: my home, my career, my marriage, many friendships, my self-identity.  One thing that has helped me tremendously is being aware of my own strength and resilience.  "I survived," I say to myself and now I'm in the process of rebuilding my life.  

Sineed

There are many people working in health care who shouldn't be, but are trapped by personal economic circumstances. Like another pharmacist said a few years ago, "I don't really like this job, but I don't know how do do anything else." 

And working in mental health really needs to be more of a calling than most other kinds of medicine. I mean, I had a surgeon who operated on me who was kind of an asshole, but I was unconscious when he did his work, so bedside manner was immaterial. But a psychiatrist who is an asshole will have a real and substantiative negative impact on the health of his patients.

Francesca, I think you would like this one psychiatrist who serves the facility where I work. She spends lots of time with the patients, often getting into discussions with them over theories of mental health and illness and treatment. She genuinely likes people and is never dismissive or patronizing, instead taking the time to hear people's stories.But here's the rub: because of the fee-for-service model of physician reimbursement she ends up getting paid less than those psychiatrists who rush patients through, pausing only long enough to write the prescriptions.

Also, burnout amongst health care workers is a complex and ongoing problem that leads to all sorts of mistreatment of patients.

oldgoat

Hi Francesca, I have a question.  In your experience, have you noticed any sort of qualitative difference between social workers, nurses, etc in hospitals and large institutions, vs the ones you encounter who work in smaller community based organisations.

 

As I may have mentioned, I'm a case manager for CMHA in Toronto, and I almost always see people in their homes, or places in the community of their choosing.  I am always mindful of power dynamics, and that I'm in someone else's space.

Having had major depression off and on since childhood, I've had three psychiatrists in my life.  One was hospital based, and was a bit of a dick.  Two were private practice, and while different in approach, I liked both of them.  I recall asking for prozac from one, and he actually had to spend several minutes fiding his prescription pad, and it had dust on it.  I discussed meds with the other, and he admitted not knowing agreat deal about that sort of thing, and would want to talk to a colleague.

Francesca Allan

oldgoat wrote:

Hi Francesca, I have a question.  In your experience, have you noticed any sort of qualitative difference between social workers, nurses, etc in hospitals and large institutions, vs the ones you encounter who work in smaller community based organisations.

I don't think so, oldgoat.  I've had good and bad ones in both settings.  Overall, though, I've found community-based treatment to be much more effective.  I have a pretty good team supporting me right now.

oldgoat wrote:

As I may have mentioned, I'm a case manager for CMHA in Toronto, and I almost always see people in their homes, or places in the community of their choosing.  I am always mindful of power dynamics, and that I'm in someone else's space.

Are any of your clients involuntary out-patients?  That's a pretty creepy arrangement.

oldgoat

No.  There is a team at our agency that has clients under ORB, but that's not me. Otherwise the service is voluntary with client driven treatment goals.

Francesca Allan

I just investigated ORB briefly and it appears to be part of the criminal justice system.  Do you have in Ontario outpatient commitment where people haven't broken the law?  Here in BC, you can be forced into outpatient commitment indefinitely with no hearing or representation.  

shartal@rogers.com

In Ontario if someone is found NCR by a Court they are remanded to the authority of the ORB. Unless they get an absolute discharge they will be reviewed yearly by the ORB.

shartal@rogers.com

In Ontario if someone is found NCR by a Court they are remanded to the authority of the ORB. Unless they get an absolute discharge they will be reviewed yearly by the ORB.

kropotkin1951

In another thread Francesca posted a link to the update to this story.  I live in BC and I was unaware of the unbelievable power given to Doctors in this province in the area of mental health. It is actually very scary. 

Quote:

Over 10,000 people were certified, incarcerated and treated against their wills under BC’s Mental Health Act last year, including 1557 on the south island from all walks of life. Countless more patients are simply told, “Do this, or else you’ll be certified…” 

And contrary to common belief, in BC, involuntary patients needn’t be “dangerous”—they need only be diagnosed with a mental disorder and be at risk for “deterioration.”

http://www.focusonline.ca/?q=node/463

Francesca Allan

kropotkin1951 wrote:

I live in BC and I was unaware of the unbelievable power given to Doctors in this province in the area of mental health. It is actually very scary. 

I was unaware, too, until I fell into their clutches in the late 80s when I was suffering from anxiety and depression at university. What's most amazing to me is all these people being coerced or forced into treatment "for their own good" and all this research into magic bullet chemical cures yet outcomes are still no better than they were 50 years ago.  Psychiatric medications appear to make people chronically ill -- since the advent of modern psychotropics, the number of people disabled by mental illness has exploded.  The only people benefitting from this trend are shrinks and nurses and stockholders and owners of huge pharmaceutical companies. All these people being told their brains are diseased, that they're chemically imbalanced, that they're losers, that they should forget their dreams and get onto disability income assistance.  It just pisses me off. I lost 15 years of my life to them.  Oh, you're depressed?  Then take this pill.  Oh, now you're manic, you must have bipolar disorder.  Here, take some more pills.  Try some electroshock.  Let's put you in an isolation cell and see if you calm down.  Fuckers, absolute fuckers, I hate them all and wish they'd burn in hell.  But, hey, that's just me.

TMcDermott TMcDermott's picture

I am checking back into this thread after a long hospital stay. I have to say it was overall an helpful time. Most positive was medication was just one part of treatment and the idea was to reduce not increase medication. It included among others mindfulness, yoga and cbt. 

However, I came away with 2 words that frustrate. One is 'victim' the other is 'survivor'. I am not a victim and not a survivor. I live with bipoar disorder (I am not bipolar) sometimes more successfully than other times but neither of these words apply. Just my own 2 cents and hopefully sense.

onlinediscountanvils

TMcDermott wrote:

I am checking back into this thread after a long hospital stay. I have to say it was overall an helpful time. Most positive was medication was just one part of treatment and the idea was to reduce not increase medication. It included among others mindfulness, yoga and cbt.

Welcome back, TMcDermott. I'm happy to hear that you found it helpful.

Francesca Allan

TMcDermott wrote:

However, I came away with 2 words that frustrate. One is 'victim' the other is 'survivor'. I am not a victim and not a survivor. I live with bipoar disorder (I am not bipolar) sometimes more successfully than other times but neither of these words apply. Just my own 2 cents and hopefully sense.

Glad you had a positive experience, TMcDermott. Welcome back.

I certainly understand you rejecting the words "victim" and "survivor," but please understand that when people in the psych rights movement use those words they are referring to the treatment, not the alleged disease.

Sineed

TMcDermott wrote:

Most positive was medication was just one part of treatment and the idea was to reduce not increase medication. 

The best psychiatrists (or physicians in general) use medication judiciously, increasing meds when a patient is worse, decreasing when better, and in general never writing what I call the "Shut the hell up and go away" prescriptions, of which I have seen all too many, and contributed to my burnout when I used to work as a retail pharmacist. 

Another problem I have seen, speaking from the treatment side of things, is clinical decision-making made on the basis of a doctor's personal ideology rather than on evidence-based medicine. I intervened in such a case today, where a patient with worsening mania was given a drug that is completely wrong for that, and may make things worse, because the doctor doesn't like to give the drugs that help because of addiction risk.

There have been many people mistreated because of care-givers who think they know better than anybody.

 

Francesca Allan

Sineed wrote:

The best psychiatrists (or physicians in general) use medication judiciously, increasing meds when a patient is worse, decreasing when better, and in general never writing what I call the "Shut the hell up and go away" prescriptions, of which I have seen all too many, and contributed to my burnout when I used to work as a retail pharmacist. 

In my experience, when you're better meds are not decreased, the doctor being in love with the idea that you're only better because you're on high levels of meds. Some of us are in the comical position of being preached to along these lines: "See you're better. It must be because of the meds" when, in fact, we stopped drug treatment ages ago. Such an experiment is impossible, however, when you're being forced to endure antipsychotic injections. Then you never get a chance to experience recovery.

Sineed wrote:

Another problem I have seen, speaking from the treatment side of things, is clinical decision-making made on the basis of a doctor's personal ideology rather than on evidence-based medicine. I intervened in such a case today, where a patient with worsening mania was given a drug that is completely wrong for that, and may make things worse, because the doctor doesn't like to give the drugs that help because of addiction risk.

I'm curious, Sineed. Was the doctor avoiding benzos? And what drug is completely wrong for worsening mania?

Sineed wrote:

There have been many people mistreated because of care-givers who think they know better than anybody.

Amen. 

Sineed

Francesca Allan wrote:
I'm curious, Sineed. Was the doctor avoiding benzos?

Bingo!

Francesca Allan wrote:
What drug is completely wrong for worsening mania?

There are a few, and stimulants are among them. Sometimes mania is mistaken for attention-deficit disorder (constantly talking, interrupting, energetic), so the physician was giving a stimulant for ADHD. Though as the psychiatric nurse pointed out, people with ADHD tend to be at a stable level of hyperactivity and don't get markedly worse or better over a short period. So if someone's "ADHD" seems to be worsening, probably it's not ADHD.

Speaking of stimulants, bad as it is, crack cocaine is especially terrible, horrible and awful for people with bipolar disorder. I've seen many a psychotic mania triggered by crack. I believe it's a major reason for people with bipolar disorder ending up in jail, though I haven't seen any stats for that.

Francesca Allan

Thanks, Sineed. This interests me because my mental illness is episodic -- when I'm well, I'm truly fine but when I'm unwell, I'm truly crazy.

I'm investigatng an Advance Directive with my doctor for any future cases of mania. My wish would be to be hospitalized and offered (i.e not forced into) Ativan or something similar. In the past, I've been told that it's an unrealistic treatment plan but I strongly disagree. In my opinion, most of the craziness we call "mania" is actually sleep deprivation. I'm aware that mental health is the only area of medicine where Advance Directives have no legal power but, even so, I think it would be worthwhile to have my wishes known ahead of time.

As for the effect of cocaine on bipolar disorder, sadly, I know this to be true. I only tried it once (with a fellow escapee) and I spent the next few weeks writhing on the floor screaming that my hands and feet were on fire. My parents came to see me and I was unable to recognize them.

Sineed

I'm sorry that had to happen to you; I try warning all the bipolar folks about how evil cocaine is for them. 

Ativan is one of the drugs for mania. I see from your prior posts you strongly object to antipsychotics, but there are also mood stabilizers like lithium or divalproex, in addition to the Ativan, in case of mania. (Your doctor has probably already mentioned these, I suspect.) These drugs are totally not anti-psychotics.

Some bipolar people manage by keeping themselves on a strict schedule, getting up and going to bed at the same time, eating meals at the same time, avoiding sleep deprivation. I read years ago that Margot Kidder manages her bipolar disorder this way.

Francesca Allan

Yes, there's certainly lots people can do to take care of themselves. Lots of outdoor exercise (even just vigorous walking) helps me a lot.

I think my best chance for staying well, however, is never to get depressed and then be recklessly and incompetently treated for depression. Based on my history, that seems to be the pattern. I get situational depression (usually when I've overextended, time-wise, financially or even, dare I say, spiritually) and then rather than helping me deal with those factors, my caregivers immediately jump to the beloved biochemical explanation and pump my (very) sensitive brain with toxic drugs and worse and then mania almost inevitably results. Rather than questioning his own paradigm of care, a psychiatrist will then blame me (Aha! So you must have been genetically predisposed to bipolar disorder and our treatment merely "unmasked" it) and then subject me to further drugs (I've been on 6 at a time).

In pretty much a decade in the system, I was not asked once, not once, how my life was going or if there were changes I could make to get myself happy. The personal costs of our system on me has been staggering but the financial costs to society are also a problem. When I was working two jobs and commuting two hours a day, wouldn't have it been more sensible to offer me some kind of stress leave/disability pay for a month while I made some serious decisions than to let the shit hit the fan and spend $1,000 a day to incarcerate me on a psych ward?

And, yes, I do know about the mood stabilizers but I was under the impression that they were for maintenance (as in not acute) treatment. Around here anyway mania is treated with forced antipsychotic injections. For myself, though, I know that enough Ativan to conk me out and let me get some sleep would do the trick. That's why I want the Advance Directive, even though it has no legal power to it.

Francesca Allan

A couple more gripes:

So I had to see the shrink today and I'm in the waiting room with the psych nurse waiting for the doctor to come and get us. A woman (case manager? social worker?) was behind the counter dealing with a client. This woman was patronizing, belittling and demeaning. The client turned to walk out and the woman said "Hey, I'm not done talking to you!" so the client came back and was patronized and belittled some more. After the client left, the worker and the security guard snickered together about how inappropriately the client had behaved. I said rather loudly to my psych nurse (whom I like) "You know, if somebody talked to me that way, I'd walk out too." I was pleased to see him in agreement but now I wish I had said that to the worker directly.

There was a resident sitting in at the appointment. I don't know how I take instant dislikes to people but invariably when I do my suspicions are confirmed as I get to know the person and this was the case today. For starters, she nodded in approval of everything my doctor said and I found this intensely annoying. This bitch of a resident then said that my brain is diseased (not good phrasing, I'm sure you'd agree) and that antipsychotics were just like insulin for diabetes. That particular analogy is over-used by the psychiatric industry and is like a red flag before a bull for me. So I said rather emphatically that no, it actually wasn't anything like insulin for diabetes as diabetes is a proven biological illness and the effect of insulin treatment is easily measured via blood sugar level. Ugh! I just hated her. My brain might be diseased but it still works well enough to know a crock of shit when it hears one.

epaulo13 epaulo13's picture

The Inmates Are Running the Asylum: Stories from MPA (36 min)

A documentary film about the Vancouver based Mental Patients Association: a radical mental health group founded in the '70s.

https://www.youtube.com/watch?feature=player_embedded&v=JwyaRU1svrA#at=551

 

Francesca Allan

Thanks, epaulo 13. I tried to watch but at about 12 minutes in the video froze and I couldn't do anything about it. I'll try again later. Vancouver currently has the West Coast Mental Health Network which is a similar sort of organization that serves over 600 people. The BC Liberals (through the Coastal Health Authority) have just announced they're cutting all funding as they wish to "concentrate on core services." This is a very silly way to try and save money because many studies have shown that outcomes (including rehospitalization rates) are vastly improved when peer support is available. But it's a beautiful sunny Saturday morning and I don't want to think about the BC Liberals.

epaulo13 epaulo13's picture

..hope you get to see it all francesca it's such an awesome film. there is no need at all to discuss the government. maybe how can we can organize/build community today.

epaulo13 epaulo13's picture

Photos Reveal What It's Like to Have Anxiety Issues

Photographer John William Keedy explores themes of anxiety and varied neuroses in his series titled It's Hardly Noticeable. Examining his own struggles with anxiety over the past nine years and drawing from other mental disorders, the images present an insightful look at behaviors that are deemed "abnormal" while simultaneously challenging ideas of normalcy. The serious topic is addressed in an intriguing fashion, one that offers small windows into the lives of people who suffer from mental illnesses. Each image is like a pocket of information that reveals a tiny corner of a bigger picture.

http://www.mymodernmet.com/profiles/blogs/john-william-keedy-its-hardly-...

epaulo13 epaulo13's picture

..what you spoke about francesca

Health authority pulls funding from west coast mental health groups

Vancouver Coastal Health will no longer fund a range of community-based mental health groups, in a decision that was reportedly based on VCH’s imperative to focus on “core health services”

Five community-based nonprofit groups on the west coast have lost their funding from Vancouver Coastal Health in an unexpected decision that the health authority says will increase focus on “core health services.” The affected organizations include: The Art Studios, Access Community through English (ACE) Program, British Columbia Schizophrenia Society, Mood Disorders Association of B.C., and West Coast Mental Health Network.....

http://www.columbiancentre.org/?p=5300

Francesca Allan

Hmm. I'm surprised to see that BCSS got the axe, as they are very maintream in promoting the brain disease theory of mental illness and are very pro-forced treatment. I would have thought Vancouver Coastal Health would have considered them at least an ally of "core health services." Anyway, it really is a shame about the WCMHN as they help over 600 people. I'm hoping they challenge this decision perhaps on the basis that peer-driven support is way, way, way more effective and inexpensive than what's currently the norm.

Goggles Pissano

Francesca Allan wrote:

My brain might be diseased but it still works well enough to know a crock of shit when it hears one.

Your brain is NOT diseased~!  Learn to trust your intuition. It is there for a reason and is always working for you on your own behalf.