Community Psychiatry And Its Unintended Consequences

What impact can psychiatry have on the health of a community?

For three years, I have worked part-time in a non-profit psychopharmacology clinic, treating a wide range of individuals from a poor, underserved urban area.  In a recent post, I wrote that many of the complaints endorsed by patients from this population may be perceived as symptoms of a mental illness.  At one point or another (if not chronically), people complain of “anxiety,” “depression,” “insomnia,” “hopelessness,” etc.—even if these complaints simply reflect their response to environmental stressors, and not an underlying mental illness.

However, because diagnostic criteria are so nonspecific, these complaints can easily lead to a psychiatric diagnosis, especially when the diagnostic evaluation is limited to a self-report questionnaire and a 15- or 20-minute intake appointment.

Personally, I struggle with two opposing biases:  On the one hand, I want to believe that mental illness is a discrete entity, a pathological deviation from “normal,” and presents differently (longer duration, greater intensity, etc) from one’s expected reaction to a situation, however distressing that situation may be.  On the other hand, if I take people’s complaints literally, everyone who walks into my office can be diagnosed as mentally ill.

Where do we draw the line?  The question is an important one.  The obvious answer is to use clinical judgment and experience to distinguish “illness” from “health.”  But this boundary is vague, even under ideal circumstances.  It breaks down entirely when patients have complicated, confusing, chaotic histories (or can’t provide one) and our institutions are designed for the rapid diagnosis and treatment of symptoms rather than the whole person.  As a result, patients may be given a diagnosis where a true disorder doesn’t exist.

This isn’t always detrimental.  Sometimes it gives patients access to interventions from which they truly benefit—even if it’s just a visit with a clinician every couple of months and an opportunity to talk.  Often, however, our tendency to diagnose and to pathologize creates new problems, unintended diversions, and potentially dire consequences.

The first consequence is the overuse of powerful (and expensive) medications which, at best, may provide no advantage over a placebo and, at worst, may cause devastating side effects, not to mention extreme costs to our overburdened health care system.  Because Medicaid and Medicare reimbursements are better for medication management than for other non-pharmacological interventions, “treatment” often consists of brief “med check” visits every one to six months, with little time for follow-up or exploring alternative approaches.  I have observed colleagues seeing 30 or 40 patients in a day, sometimes prescribing multiple antipsychotics with little justification, frequently in combination with benzodiazepines or other sedatives, and asking for follow-up appointments at six-month intervals.  How this is supposed to improve one’s health, I cannot fathom.

Second, overdiagnosis and overtreatment diverts resources from where they are truly needed.  For instance, the number of patients who can access a mental health clinic like ours but who do not have a primary care physician is staggering.  Moreover, patients with severe, persistent mental illness (and who might be a danger to themselves or others when not treated) often don’t have access to assertive, multidisciplinary treatment.  Instead, we’re spending money on medications and office visits by large numbers of patients for whom diagnoses are inaccurate, and medications provide dubious benefit.

Third, this overdiagnosis results in a massive population of “disabled,” causing further strain on scarce resources.  The increasing number of patients on disability due to mental illness has long been chronicled.  Some argue that the disability is itself a consequence of medication.  It is also possible that some people may abuse the system to obtain certain resources.  More commonly, however, I believe that the failure of the system (i.e., we clinicians) to perform an adequate evaluation—and our inclination to jump to a diagnosis—has swollen the disability ranks to an unsustainably high level.

Finally—and perhaps most distressingly—is the false hope that a psychiatric diagnosis communicates to a patient.  I believe it can be quite disempowering for a person to hear that his normal response to a situation which is admittedly dire represents a mental illness.  A diagnosis may provide a transient sense of relief (or, at the very least, alleviate one’s guilt), but it also tells a person that he is powerless to change his situation, and that a medication can do it for him.  Worse, it makes him dependent upon a “system” whose underlying motives aren’t necessarily in the interest of empowering the neediest, weakest members of our society.  I agree with a quote in a recent BBC Health story that a lifetime on disability “means that many people lose their sense of self-worth, identity, and esteem.”  Again, not what I set out to do as a psychiatrist.

With these consequences, why does the status quo persist?  For any observer of the American health care system, the answer seems clear:  vested interests, institutional inertia, a clear lack of creative thought.  To make matters worse, none of the examples described above constitute malpractice; they are, rather, the standard of practice.

As a lone clinician, I am powerless to reverse this trend.  That’s not to say I haven’t tried.  Unfortunately, my attempts to change the way we practice have been met with resistance at many levels:  county mental health administrators who have not returned detailed letters and emails asking to discuss more cost-effective strategies for care; fellow clinicians who have looked with suspicion (if not derision) upon my suggestions to rethink our approach; and—most painfully to me—supervisors who have labeled me a bigot for wanting to deprive people of the diagnoses and medications our (largely minority) patients “need.”

The truth is, my goal is not to deprive anyone.  Rather, it is to encourage, to motivate, and to empower.  Diagnosing illness where it doesn’t exist, prescribing medications for convenience and expediency, and believing that we are “helping” simply because we have little else to offer, unfortunately do none of the above.

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37 Responses to Community Psychiatry And Its Unintended Consequences

  1. doctorz says:

    Excellent post, as usual. In my own experience, it’s distressing to have witnessed over the last 20 years what began as an exciting era of neurobiological clinical research with the advent of the “decade of the brain” in the 90s, but then regressing to the dismal state of affairs currently…what I believe will ultimately be regarded as our greatest betrayal to the public trust as a profession; ie, the massive exploitation of millions by an enterprising pseudoscientific industry under the guise of progressive mental health care. And certainly the unholy alliance between big pharma and academic psychiatry facilitated its creation. When all the numbers are tallied in direct and indirect costs of this colossal wasteland, we may not survive, and perhaps we shouldn’t. It’s particularly saddening that the very same practices are being applied to our children, who unfortunately are not in a position to give informed consent, and are truly victims of a very impaired system.

    • duanesherry says:

      Dr. Z,

      Thank you for offering a voice of (much needed) dissent in your field.

      You closed your comment by saying that children are not in a “position to give informed consent”.

      I agree.
      As do many others.

      The antidepressants, benzodiazepines, and antipsychotic groups should be off-limits to children.

      Also, ADHD “medicine”.
      There are safer and more effective treatments.

      Parenting can be improved in many cases –

      http://www.loveandlogic.com/

      Also, looking at the whole body, for such things as sensitivies (cerbral allergies), particularly with foods, culprits that create symptoms, an poor nutrition overall –

      http://www.foodforthebrain.org/content.asp?id_Content=1631

      “ADHD” may have more to do with intestinal absorption, the gut, rather than a “brain disorder,” as Natasha Campbell-McBride explains –

      http://www.gaps.me/

      Mary Ann Block, D.O provides Congressional testimony, where she discusses the pseudo-scientific diagnosis of “ADHD” along with a more holistic approach –

      At the end of the day, ADHD “medications” are nothing short of amphetamines…

      They often serve as “gateway” drugs for children, who later abuse the street-variety.

      Passionately,

      Duane Sherry, M.S.
      http://discoverandrecover.wordpress.com

      • Jackie says:

        Duane Sherry, you seem to be using Dr. Steve’s blog to promote Scientology.

        First you bring in Peter Breggin, now Ann Brock. And then your own web site — and yes, I can google and see that you have associations with CCHR, the anti-psychiatry wing of Scientology.

        Now, maybe Dr. Steve doesn’t mind these promotions on his blog (that’s for him to decide) but a full disclosure here is necessary.

      • duanesherry says:

        Jackie,

        Are we back there again?
        scientology….

        I have NO associations with scientology.
        I am a cradle-Catholic.
        In fact, the Sherry name comes from the McSherry’s in Ireland, where there have been many priests who have served the Church.

        I find this to be inulting, actually.
        Not that I am ashamed of my faith…
        But that I find myself having to “prove” I’m not a scientologist!

        I was baptised in the Roman Catholic church, first-communion, catechism, confirmation, marriage…. and have raised my sons in the Church. We attend mass….

        Enough!

        I testified in Austin, Texas during the legislative session in 2009, along with John Breeding, Ph.D. We were there to prevent the “over-diagnosis” and “over-prescribing” of psychiatric drugs in Texas, particularly in the state’s Medicaid, foster care, and juvenile justice programs. We testified before committee hearings in both the Texas house and senate.

        Does that make me a scientologist?

        I have no idea what religion Dr. John Breeding is… I never asked! I figure it’s not my business to ask!

        SteveBMD is a big-guy…
        He can monitor his blog as he sees fit.
        If, at any time, he considers my comments to be too much, I’m sure he’ll monitor them, and/or ask me to stop posting them.

        In the meantime, is that the best you’ve got?
        Really?

        Is that you’re best shot.

        I don’t even consider myself anti-psychiatry.

        I am –

        Pro-freedom.
        Pro-wellness.
        Pro-recovery.

        I get to define myself in terms that I feel best define me.
        Not you.

        Duane Sherry, M.S.

      • duanesherry says:

        Jackie,

        It’s my understanding that Peter Breggin, M.D. is Jewish.

        There was a time in our world history when people of Jewish ancestry, and/or faith were targeted.

        What do I think of your litmus-test?

        I think it’s disgusting!

        Duane Sherry, M.S.

      • duanesherry says:

        In defense of Peter Breggin, M.D. (who is not here to defend himself) with the bogus ‘scientology’ charge –

        “My name does not sound Jewish and not everyone at first glance recognizes me as Jewish. So I wanted to inform him as soon as possible about my religious and ethnic identity…”

        – From, ‘The Art of Being Helpful: Emathy and the Creation of a Healing Process’ (page 109)

        “I am white and Jewish. It feels like a special honor to work in close association with African Americans on behalf of human liberty and mutual respect.”

        – From his website.

        Enough.

        Duane

      • duanesherry says:

        ‘Heart of Being Helpful’ – typo

  2. A 15 or 20 minute INTAKE?

    I personally would never agree to work for anyone who demanded that, since it is GOING to lead to misdiagnosis and all the other problems you mention in this post in a sizable proportion of the patients evaluated. And I’ve never had to take such a job, and I usually get what I demand. If administrators offer resisitance, I still refuse, and if they tried to put the screws on me, I would tell them to go find someone else – if they can.

    I don’t agree with you that individual practitioners can not make a difference. We are a shortage specialty. If even a sizable minority of psychiatrists refused to accept these absurd restraints, they would disappear. Time for all of us to all get a backbone and stand up for our patients.

    I believe that if society does not want to provide us the funds to treat mental illness, we should not be enabling them at our own expense. Some patients may be hurt in the short run if we refuse, but right now they are all being hurt. Trying to constantly do more and more with less and for less is a fool’s errand.

    • stevebMD says:

      Admittedly, I’ve never timed them with a stopwatch (!). But let’s see: 7- or 8-hour workday; average of 30 patients/day, including 2-5 new pts/day. (Don’t forget time writing Rx’s, making calls, troubleshooting the EMR, etc.) Thus, average visit length 10-15 minutes, with intakes only slightly longer.

      I agree, it’s unfair. But, on the other hand, if the patient’s already on an SSRI from his PMD, or if he’s been given a “bipolar” diagnosis (and a Zyprexa script) by a crisis clinic or the ER, or if a case manager reports “she talks to voices at night,” that often counts as the assessment.

      The system is set up for quantity over quality, and for assembly-line mentality over careful evaluation and monitoring. The problem is, if one provider resists or walks away, a less thoughtful one comes in to replace him, and we’ve only perpetuated the problem.

      • David Allen says:

        Personally, I would never agree to see even 30 follow-up, med management visits in one day – unless they paid me time and a half for overtime. Three follow-up patients per hour is my maximum, and that is sometimes stretching it. It takes a few minutes to read the previous chart note and write the new one. I may have to return a phone call or go to the bathroom.

        Shorter visits are why, for instance, many patients are left on anti-depressants for years when they should have been tapered of long before. It is also why a lot of previous psychiatric records are worthless in planning patient care. (Drugs are often changed and no reasons are given, and there is almost no mention of specific target symptoms).

        I suppose there are a lot of doctors, many of whom I would consider unethical or spineless, who are willing to work under these conditions, but at least around here the mental health centers are having a harder and harder time finding them. We need to shame these folks into saying no to unreasonable demands. Otherwise, like I said, we are enabling the mistreatment of patients.

    • stevebMD says:

      BTW, re: “I believe that if society does not want to provide us the funds to treat mental illness…

      But they do want to provide us with the funds. That’s the problem. They (lawmakers, public health officials, the public, even the patients themselves) think we’re providing a valuable service.

      For a more cynical view, see this post by TLP.

      • David Allen says:

        From what I can see, the public mental health system is the first thing that governors cut when times are tight. Republicans in particular have declared war on the mentally ill ever since Reagan started to close the state hospitals in California and then did not properly fund the mental health centers.

        And it’s only gotten worse: see: http://www.psychiatrictimes.com/display/article/10168/1855575

        I’ve seen that TLP post and I agree that the rise in psychiatric disability – that has been used by Whitaker as evidence for the nonsensical proposition that psych drugs are making everybody worse – is actually caused by the factors cited in that post. True bipolar patients should almost never be on permanent disability because it is a very highly treatable illness, and they are normal when euthymic unless they have a personality disorder.

      • stevebMD says:

        If anyone asks me where to cut, I have several suggestions.

    • moviedoc says:

      Dr. Allen is right. An initial psychiatric evaluation takes 60 minutes, more for a complicated case.

      Read the cautionary statement in DSM: http://behavenet.com/capsules/disorders/cautionary.htm

      Diagnosis and disability are separate concepts. Neither implies the other.

      If someone comes for help after a normal reaction to a life event, what diagnosis would you give that takes away hope?? If you don’t think they’re ill, tell them so! If they still want help, they may have to pay for it themselves.

      And what’s a “powerful” drug? If it doesn’t help more than it hurts, why would a patient keep taking it?

      • stevebMD says:

        moviedoc,

        (1) Initial evaluations can indeed take as little as 15-20 minutes.
        (2) Disability does not equal diagnosis, but it’s a very common sequela thereof.
        (3) If I tell a person he’s not ill, he complains to management (who then come to me and tell me to diagnose & prescribe anyway).
        (4) Patients continue taking a drug (or not, they’ll take their Prozac “when they feel like it”) because of what it symbolizes, not because of whether it “helps.”

        Please note, I don’t condone any of these practices. In no way do they represent how I was taught to practice psychiatry. But it is the status quo in many places, and it’s surprising how few people seem to care.

  3. Johanna Ferman, M.D. says:

    Steven —

    How fortunate that a dear friend sent me your immensely thoughtful piece; it is as though you were reading my mind.

    As a public psychiatrist, I have for many years been swimming upstream of this mess to build systems of care that actually ‘break the cycle.’ Yet, the institutional forces (and very much the vested interests in creating and reinforcing dependence) and narrow mind-sets are in themselves tremendous barriers to change.

    Where are you practicing?

    I am currently the Director of Behavioral Health in Ambulatory Care in one of California’s larger counties — but see the same conundrum you’ve pointed out in both private and public sectors unless there is sustained leadership and a community culture that demands something different.

    While the integration of mental health into primary care (which is what I have been engaged with now for some years) does not in itself eliminate any of the problems you’ve outlined, it gives an opportunity to think out of the generation of ‘chronicity’ model that our mental health and addiction systems have largely backed into.

    What I have found most important is the advocacy role of the community itself — if feasible to build bridges and assist in educating the community as far off a goal as it may seem.

    I know how terribly draining this can be — but in the end, it is the only path I know to remain truly alive and vital with the work.

    I would be happy to correspond and know more of what you are doing to address the issues you’ve outlined.

    Johanna F.

  4. moviedoc says:

    (1) Initial evaluations can indeed take as little as 15-20 minutes.

    Even 20 minutes is not adequate for an initial psychiatric evaluation.

    (2) Disability does not equal diagnosis, but it’s a very common sequela thereof.

    What this implies is not that we should not diagnose, but that disability determination is flawed.

    (3) If I tell a person he’s not ill, he complains to management (who then come to me and tell me to diagnose & prescribe anyway).

    A physician who allows “management” or anyone else to dictate how they practice is a shill and should have her license revoked or be ostracized by the profession.

    (4) Patients continue taking a drug (or not, they’ll take their Prozac “when they feel like it”) because of what it symbolizes, not because of whether it “helps.”

    I cannot dispute that some patients take drugs with no adverse effects because of what they “symbolize,” but I would like to see evidence. I do believe many patients take drugs because they like the way they make them feel. I believe this especially applies to benzos, opiates and stimulants.

  5. moviedoc says:

    “As a lone clinician, I am powerless to reverse this trend.”

    That’s a cop out. Even by resigning you have power to reverse the trend. By working in such a system you enable it to continue.

  6. Gloria says:

    Thanks for sharing your experiences working for a non profit that provides med management for a SMI populaton probably in California I would assume. I read this with much understanding about your concerns.
    First of all, I have a son who has schizophrenia and suffers terribly from the paranoia and fixed delusions but is still a very intelligent person who is my hero and what has driven my passion as an advocate. Finding a psychiatrist who specializes in treating schizophrenia and really has had great success at finding the righ combo of meds is extremely rare. I gave up my 30 year career in radiology to work for a community mental health dept. in the east bay in California. I took a big pay cut to become the second person hired in the state of California as a couselor and guide for families dealing a mentally ill relative who is over 18 when the families are cut out of the clinical picture by the privacy laws if the patient does not want them included even though many are living at their family home or very dependent on them for support and help. What I experienced with these families over the last 12 years is material for a book about the hidden victims of mental illness which are the families and caregivers. I also acknowledge that some families are dysfunctional because some are also experiencing symptoms of mental illness and also substance abuse but mostly I came in contact with families struggling to get the proper help for their loved one to hopefully get them on the road to having a meaningful and productive life. The stigma and shame of mental illness is pervasive in our society so most of the families are afraid to speak out about what chaos they experience on a daily basis and suffer in silence without the support of friends or other family members. Even if the person who is suffering from the symptoms of an illness like schizophreia does get the best combination of meds to aleviate the symptoms, there are not decent rehab programs or supported housing for them in their communities please as you say, most do not have any primary or dental care. I want to thank you for speaking out about what I feel is an extremely important issue. My son now lives at a residential program near Orlando, Fl which is amazing. Please take the photo tour at http://www.lakewoodcenter.org

  7. Jackie says:

    Dr. Allen wrote: “True bipolar patients should almost never be on permanent disability because it is a very highly treatable illness, and they are normal when euthymic unless they have a personality disorder.”

    It’s my understanding from reading medical journals that bipolar is very hard to treat — and even in the euthymic phase there can be sub-syndromal symptoms (like somnolence) that are debilitating.

    We’ve certainly been trying to get the right treatment for my son for eight years now to allow him to lead a somewhat normal life and, no, none of us have personality disorders.

    • David Allen says:

      Jackie,

      Bipolar disorder is only hard to treat in a very small minority of true bipolar patients. What you’re reading about is most likely written by psychiatrists who believe that anyone with a “mood swing” of any duration has bipolar disorder, which is complete nonsense. If you try to medicate patients who have behavioral problems, they become “hard to treat.”

      Obviously I wouldn’t begin to hazard an opinion about your son’s diagnosis. I can say that a somnolent bipolar patient is most usually an over-medicated bipolar patient.

      See my blogposts about the overdiagnosis of bipolar disorder: http://davidmallenmd.blogspot.com/2011/02/stupid-study-and-even-stupider-headline.html

      and http://davidmallenmd.blogspot.com/2011/03/debunking-de-biederman.html

      • Jackie says:

        Dr. Allen, thank your for your reply.

        However, I am reading the legitimate psychiatric journals, including “Bipolar Disorders”, in which DSM-IV criteria are used.

      • Jackie says:

        Duane, seriously, you are moving into stalker territory. Enough.

      • duanesherry says:

        Jackie,

        I left a comment (below)… Accidently put it in the wrong place.

        I need to respond, to the charge of “moving into stalker territory”.

        First, you ask me if I’m a scientologist, and now you bring up the term, “stalker”.

        I would like to explain to anyone who reads your comment that I have in no way “stalked” you. This term has legal implications. I have done nothing other than put up comments on this blog, some sent to your personally, some to others. This is NOT “stalking”.

        I have no history of violence, and have not threatened you in any way. Period.

        At first, I was tempted to send a comment to SteveBMD, the author of this blog, asking him to take your comment off the site. After some thought, I think it best he leave it up. It serves as a good illustration of how quickly psychiatrists are ready to lablel. With the labelling comes dismissal of the person being labelled.

        “Stalker”

        I would have preferred you call me an “idiot”…. A name I’ve been called by a psychiatrist along the way (whose name I won’t mention)… I would have preferred you challenge my comments. I would have preferred any other term that was personally offensive, but not illegal.

        But, you chose “stalker”.

        So be it.

        Let the readers decide if my comments were “stalking”…. comments on a blog, public domain… free speech territory.

        Your comment will be in cyberspace forever… There’s no way to permantly erase it. Tough for me. But maybe good for others, who might be considering having their sons or daughters go in for “evaluation” and “treatment”…. good for them to read just how easily psychiatrists label, and how when they make mistakes, they tend to be big mistakes, and those mistakes cause great injury and harm.

        SteveBMD,
        Leave the comment from Jackie up.
        Others need to read it.

        Oh, by the way, I put the links up to help you… I found them to be helpful to our family… In fact, they saved our son’s life –
        http://www.pharmalot.com/2007/09/the-juvenile-bipolar-juggernaut/

        We were asked to appear on an upcoming piece by Diane Sawyer… Our son decliined… I don’t blame him… He’s moved on with his life now, symptom-free, for five years.

        On the misplaced comment (below), I said I was hurt, and would not be back to this site. I may. I may not. If the blog author wants to ban me, that’s his decision.

        In the meantime, I remain passionate with what I’ve learned along the way, what I’ve come to believe, based upon research, and personal experience.

        Duane Sherry

  8. duanesherry says:

    If you feel this strongly, why don’t you make a clean-break from conventional psychiatry and offer something new? –

    http://www.moshersoteria.com/articles/resignation-from-apa/

    I’ve met many people who were diagnosed with severe mental health conditions, who made the clean-break from conventional psychiatry, and went on to live full, productive lives.

    Surely, if these folks are able to call on their own inner spirits to this level, a professional such as yourself can do the same thing.

    Interesting, that you talk the talk.
    Are you willing to walk the walk?

    Duane Sherry, M.S.
    http://discoverandrecover.wordpress.com

  9. duanesherry says:

    To clarify,
    The question is addressed to the blog author, SteveBMD.

    Yours are some of the strongest statements I’ve heard from a conventional psychiatrist… One who hasn’t already made the clean-break…

    And so, I ask you…

    Duane Sherry, M.S.

  10. duanesherry says:

    There’s a lot of work that needs to be done, should you decide to make a clean-break.

    Clinics set up to help people (especially children, elderly, military service members) get OFF psychiatric drugs – slowly and safely.

    There are opportunities to work closely with peer-run respites, overseeing their work… to provide good information to patients, parents, family members about options… to refer patients to integrative providers (for treatments that offer hope).

    The Executive Director, Mike Fitzpatrick of NAMI makes $200,000 per year, with some pretty decent benefits. We need to have an alternative in this country to NAMI… So people can find real answers on how to heal, recover.

    The sky’s the limit here.
    But it’s gonna take some courage.

    It’s going to take the same courage that many psychiatric survivors have shown… Being ridiculed, mocked, laughed at by your professional peers and colleagues.

    But at the end of the day, you’ll have truly helped people.
    You will have lived a good life, and done the right thing, in spite of how difficult it was to do.

    I challenge you…
    Why don’t you make the clean break, and try something new?

    Duane Sherry, M.S.

    • stevebMD says:

      Duane,

      I wish we could move beyond the idea that a path like the one you describe represents a “clean break” or requires “courage.” In other words, providing effective, compassionate care to our patients is not an all-or-nothing phenomenon.

      The truth is, I have seen the miracles of modern psychiatry, and the immense benefits of psychiatric medication, and I am proud to consider myself a psychiatrist. At the same time, however, I believe (as you do) that many people have been inappropriately labeled or have been promised the false hope of a biological “cure” for their ills. In the majority of these cases, psychiatric treatment is a minor diversion, and our interventions are little more than brief trials of drugs or other therapies that “amuse the patient while nature cures the disease” (my apologies to Voltaire). In other cases, though, our misplaced enthusiasm can cause extreme harm, in various and unexpected ways (as illustrated in this post).

      I do wish psychiatrists would be open to alternative approaches– mainly those which (a) respect the patient’s wishes, and (b) have been shown to provide the greatest benefit at the least cost. In some cases, medications are indeed the answer– even if this might require involuntary commitment or mandatory administration of drugs. In others, a Soteria-like philosophy would pay significant dividends, as it celebrates the unique abilities of each individual.

      The two are (in my mind) not mutually exclusive. Unfortunately, it may require the collapse of this profession as we know it (very well described in doctorz‘s comment above) before we start thinking fairly and honestly about what each individual needs and deserves.

      • duanesherry says:

        We agree on some of this.
        In other areas, we do not.

        I read doctorz’s comment.
        I agree wholeheartedly.

        Psychiatry will collapse.
        It is simply a matter of time.
        It has run its course.
        It’s days are numbered.

        I tend to think the Open Dialogue Approach in Lapland, Findland, and other like it will take hold.
        I also believe that peer-run respites will be on the rise, and that FINALLY we will see enormous recovery rates.

        If these types of programs were combined with integrative (I don’t care for the term, “alternative”)… well-researched integrative methods will rule the day.

        Psychiatry, as we know it today is on its last breath.
        It will die.
        It will be replaced by something much better.

        History will get the last word.
        And I strongly feel that history will not be kind, to a profession that caused such horrific harm.

        Bloodletting.
        Psychiatry will go down like bloodletting went down.

        Duane Sherry

      • duanesherry says:

        Steve,

        A poem, ‘Recovery’ –

        http://www.kaleidoscopes.co.za/html/recovery.html

        Duane Sherry, M.S.

  11. duanesherry says:

    Jackie,

    The links were put up to help you, with some information that helped our family –

    http://www.pharmalot.com/2007/09/the-juvenile-bipolar-juggernaut/

    I’m only human.
    First, you ask me if I’m a scientologist.
    And now, you bring out the word, “stalker.”

    I’m not made of cast-iron.
    Flesh and blood.
    Human.

    Your words hurt.

    I won’t be back.

    Duane Sherry

  12. stevebMD says:

    Duane and Jackie,

    I would ask you (mainly Duane) to tone down the name-calling and personal attacks, please.

    I hope the blog can be a place to share ideas, not ideologies. Duane, many of your comments do sound like they’re informed by Scientology. Whether they are or not (and thank you for sharing that they’re not), I think all opinions are worthy, and I think more psychiatrists need to listen seriously to those who challenge their way of doing things. But if you or anyone else is trying to use this space as a platform for a belief system and not your own personal opinion, then I may censor those comments.

    [I need to do precisely that on my Nuedexta post. It seems like many of them are written by Avanir shareholders (coming via links from finance websites) trying to promote the use of their product. That’s not cool.]

    Sorry for the lack of posts this week — I’m at the APA meeting in Hawaii. But I’ll put more up when I have a chance.

    Steve

  13. duanesherry says:

    SteveBMD,

    I understand.

    I would quickly like to say that my opinions do not reflect the Catholic Church (hardly)… They are my own. The only reason I brought up my religion was due to being called a ‘scientologist’.

    Duane

  14. […] I’ve spent at least part of my time working in community mental health (and have written about it here and here).  Before that, though—and for the majority of my training—I worked in a private, […]

  15. Freeeeeee Freebies…

    […]Community Psychiatry And Its Unintended Consequences « Thought Broadcast[…]…

  16. […] see us, not because we truly believe there’s a diagnosable “mental illness”), and allow them to keep coming in—for free—to get various forms filled out and to refill medications that cost a fortune and […]

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