Meds have use, but psychiatric system is fubar

I admit that I have mixed emotions about psychiatry and especially about specific psychiatrists. However, I am not one to be all-or-nothing regarding psychiatry. While I do believe there are horrific flaws in our current system, I believe that medications can be used responsibly by doctors who actually give a damn about humans.

I was thus motivated to address a comment that someone left for me regarding my statements on Abilify on the Bipolar forum. That individual implied that I didn't believe in meds, so I made the following post:

bipolar/topic110569.html

I think it's relevant on this forum because we should seek to get to the truth, that meds are not necessarily a bad thing, rather our current psychiatric system is fubar.

The drug companies own psychiatry.

Its all about $

The word is getting out slowly, this sites forum pages dont go back that many years but if you go on some other sites and go into a forum and read 10 year old posts you will see what I mean.

People posting "if you have a chemical imbalance you need meds..."


This is a good tool to look at way back stuff also http://archive.org/web/web.php

I too want to see the end of the "pharmacaust" and the start of good medicine.

The phamacaust is actually much more widespread than many of us would like to think. I don't mean to spark any potential conspiracy nuts out there, but I think it a fuller picture requires a wider investigation of "medicine" in general.

One of the best examples is cancer research - see what happened to the Gurson diet and many leading efforts. It's worth the time to see the coverups on cancer treatments that never went mainstream, that is, chemo, radiation, and surgery. The story of cancer treatment parallells psychiatric treatments in many ways. For example, the merging of pharma companies with each other, with government, and even universities - though some brave profs held out unusually long.

So how does this tie in to financial institutions? Why is money the key? Anyone who studies the life of JP Morgan will know how serious the financial leaders are about keeping their power. If you think that pharma is any less ruthless than JP Morgan, think again. I have reason to believe that the leaders of the top 5 pharma companies are much more viscious. I honestly think that most of our education system and the psychiatrists that it produces are not aware of what is going on behind the scenes. For example, read a LOT about Edward Bernays (Freud's nephew) and you will see how he helped media and industry to merge with governement via psychological incentives. It is actually incredibly brilliant how our society was changed from a "needs based" consumerism into a "convinience based" consumerism - and what is more convinient way to treat bipolar disorder than in a pill?

From the above picture, assuming you dig very deep for very long, I think anyone can see just how fubar our actual psychiatric system is. That's not a conpiracy, it is how money works in our current system. I wish I was making this up.

Ian Reynir wrote:I admit that I have mixed emotions about psychiatry and especially about specific psychiatrists. However, I am not one to be all-or-nothing regarding psychiatry. While I do believe there are horrific flaws in our current system, I believe that medications can be used responsibly by doctors who actually give a damn about humans.

I was thus motivated to address a comment that someone left for me regarding my statements on Abilify on the Bipolar forum. That individual implied that I didn't believe in meds, so I made the following post:

bipolar/topic110569.html

I think it's relevant on this forum because we should seek to get to the truth, that meds are not necessarily a bad thing, rather our current psychiatric system is fubar.

I agree but I get in nothing but trouble just reading that forum !

I realy like the title here. I started using that word fubar alot.

"###$ up beyond all/any recognition/repair/reason/redemption".

The nub of both of your crticisms is really that psychiatric remediation is relatively ineffective compared to other more successful branches of medicine such as general surgery. If psychiatry was able to produce full and permanent remissions in mental illness in all people with little or no adverse effects neither of you would be here moaning and complaining about psychiatry.

I would agree that psychiatric treatment is indeed relatively ineffectual, often a matter of hit-and-miss and the treatments are often fraught with adverse effects. I've been subjected to everything modern psychiatry has to offer: MAOI through to atypical antipsychotics, counselling through to bilateral ECT and I remain depressed -- my MDD is treatment resistant. Psychiatry has most definitely failed me. But reason and fairmindedness compels me to temper that conclusion with how others have faired with psychiatry and with the history of western medicine.

Many fellow depressives have benefitted from psychiatric treatments. I know that because they have told me and I have also witnessed remissions when I have been an inpatient. These people aren't on forums like this, they are instead living their lives so you never learn of their opinion. That is not to say that the treatments they received were not problematic, even when ECT produces a full remission it does produce temporary cognitive impairment which can be quite severe and maintenace ECT may be needed, so the cognitive impairment may continue.

So psychiatry is
(a) unable to treat all conditions equally effectively;
(b) unable to treat all people with the (apparently) same condition equally effectively;
(c) unable to offer treatment that has a favourable ratio of therapeutic benefit to adverse reaction for all patients and for all conditions.

Clearly we are far from an ideal psychiatry. But is there any good reason to claim malevolence or conspiracy in any of this? I think not. This isn't the first time in the history of medicine that a branch of practice has been inadequate. Consider venerology in the 16th C., that is, prior to antibiotics, antifungals and antivirals. The treatments for syphilis (http://en.wikipedia.org/wiki/Syphilis) were ineffective and harmful and it was a fatal condition. Mercury was a common treatment for syphilis from the 16th C. to the 18th C. (http://www.ncbi.nlm.nih.gov/pubmed/23485862) and they had no idea how congenital syphilis was acquired. The idea of microbes being a cause of disease did not become established until the 19th C. (http://www.im.microbios.org/0901/0901001.pdf) so the venereologists prior to that were groping in the dark. But they were operating at the limit of the science and technology of the day. What is the impediment to accepting that psychiatrists today are operating at the limit of science and technology?

The unsatisfactory state of psychiatry today is completely explicable with reference to available knowledge and technology. Postulating malevolence or conspiracy is -- in my view -- entirely superfluous. Also, implicit in these conspiracy theories is the strange notion that humans can and should know everything about everything now.

There is no super psychiatry somewehere on the planet that doesn't have deficiencies (a), (b) and (c). This is as good as it gets for the time being. The psychiatry that we have in the USA, UK, Australia and New Zealand is state-of-the-art, just as it was state-of-the-art to be injected with mercury in the 16th C. if you had syphilis. Eliminating deficiencies (a), (b) and (c) from psychiatry would produce a very high standard of remediation -- perhaps higher than that currently available from any other branch of medicine and this will eventually come. The history of medicine shows that we are slowly progressing towards more effective and less harmful treatments (treatments for STIs are a good case study) and this progress is also happening in psychiatry but admittedly it is happening quite slowly. But this does not entail that psychiatry (in the "Anglosphere") is "fubar". Yes, it is lacking, as were many branches of medicine and as some are today (eg. neurology). But iredeemably damaged? I don't think so.

^ What do you think of forced medication, or forced ECT etc?

(ECT on its own disgusts me, even voluntary, but then I know someone who basically had their mind erased because they became addicted to the short term "therapeutic" effects and continued to get treatments to the point of real solid memory loss - they really aren't even there anymore)

Psychology is a 100 or so year old science, and the brain is only the most complex thing known to man, so of course psychology is going to be primitive. I think part of the problem, with this in mind, is that like many other sciences, especially in practice, it doesn't like to fully admit the extent of the unknowns, the lacks, the uncertainty, and is somewhat arrogant in its confidence.

I immediately respect a medical doctor who rather than bluster his/her way through pretending to know everything, admits the grey areas and the knowledge/research boundaries, so you know where you stand. It would be nice to see a little more occasional intellectual/knowledge agnosticism in mental health. Perhaps openness to emergent ideas, new therapies and so forth for example. Mental health finds itself in a very fixed place for a science so young, about an entity so mysterious (the mind/brain).

It would be great for example, to see the practice of mental health, have the same sense of enquiry, openness and uncertainty as some of the newer research. In many jobs, its day in, day out, and it all becomes repetitive, and lets just get the job done, 1,2,3. But people in treatment deserve accurate representation of our real state of knowledge, and as many options in treatment as possible, ethically. And of course practice is always behind research as well, and theres alot of simple research that for corporate or funding reasons has not been done. In this respect in is similar to medicine, for all their initial good intentions, the staff are just not anywhere near as invested in the outcomes as the patient and yes that will always true, but the level of disparity is obvious to anyone in real need. I think actually that performance reviews from patients, like teaching, or something similar might be a good idea - something or anything just to re-invest doctors and psychiatrists/psychologists in patient wellbeing.

My biggest issue however, in general, is with forced medication/treatment, human rights etc. Perfectly reasonable to confine someone who is genuinely dangerously unbalanced, especially if its something that is checked upon, and updated, as it generally is. But the routine forced medication/treatment of inpatients, given that the medications do have physical negative effects, even health risks, that seems primitive/incorrect to me. People should only lose their volition as far as it concerns the welfare of others, and even then both parties welfares/concerns/rights should be carefully and continuously balanced, ethically/morally.

I don't think its entirely irrational to think about "a conspiracy". There are a number of academic papers on overdiagnosis of certain illnesses because pharmaceutical companies have been "selling the disease".

To that extent, from a big pharma point of view, that above diagram is not entirely inaccurate. And being this is something that people most likely organise and plan in private, that constitutes a "conspiracy".

That does not represent the efforts of researchers, clinicians, but at the same time, they are clearly being influenced by an economic model - there is profit in drugs, but not so much in non-drug therapies. Take borderline personality disorder - underdiagnosed - no drug treatment. Bi-polar on the other hand - overdiagnosed (alot of the former are usually classed as bipolar), lots of drug treatments - but little research on non-drug therapy options, despite some promising leads already.

Clearly, when it comes to the state of mental health, just as with medicine, money is a large factor at a patient level, in terms of how they are dealt with.

If all medicines were profit-free, all research state funded, both in medicine and in mental health, you can bet things would be quite different, wouldn't they? (Well, assuming equal investment, which wouldn't happen given countries tend to spend all that sort of money on bombs, not cures and food)

Its not exactly like brain drilling, mental health, its not like nobody is helped by mental health services, some are. But also many are hurt, and some are let down where they need not be. How many is arguable, and perhaps a side-track here.

With this all in mind though, questioning current practices is one way to get a bit of a shake-up in the practice and mindset.

The one thing I think we should be careful to admit, is that some people are helped, and not to black-and-white represent this situation.

We would not want people to avoid getting help, we only want people to be mindful of the form and way they are helped, and to generally allow the practice to be examined, evaluated and commented on.

Recovered45 wrote:^ What do you think of forced medication, or forced ECT etc?

Coercive treatment can only be justified where the person's condition represents a danger to others. However, because we have a welfare state (which is of course funded by the community) it becomes possible to justify coercive treatment where the person's condition represents a danger to themselves. These are the criteria for involuntary admission in my locale and I think they are justified. There are no other good reasons to force treatment on someone.

(ECT on its own disgusts me, even voluntary,

I've had RUL (Right UniLateral) ECT and bilateral ECT and I have read much on the topic. RUL ultrabrief (refering to the pulse width of the square wave) ECT is not that bad with regard to cognitive impact, it wasn't for me and the literature reports the same. Not all ECT is the same: the electrode placement, waveform, pulse width and amplitude have a very large impact on the extent and duration of the adverse cognitive effects.

Bilateral is comparatively very harsh on cognition. In my case the size of therapeutic effect did not justify the impact on cognition. By the fifth treatment I had forgotten some basic things and I was still depressed so I aborted the treatment and discharged myself. I was a voluntary admission so I was free to leave. Sure they tried to persuade me to stay and at least complete the basic six treatments but I (inarticulately because of the cognitive impact) declined. Both the research literature and my first-hand experience indicates that the adverse effect on cognition is temporary.

but then I know someone who basically had their mind erased because they became addicted to the short term "therapeutic" effects and continued to get treatments to the point of real solid memory loss - they really aren't even there anymore)

This is plausible. In the event that the bilateral ECT produced a good therapeutic effect but also produced the same cognitive impact that I experienced I would project that by the ninth treatment I would have been visibly forgetful and incoherent. Further, the maintenace bilateral ECT that would have followed would have prevented my brain from ever completely recovering from the initial set of treatments so I would have been condemned to a cognitively impaired state.

You should understand though that by the time I had decided to receive ECT there were no other options and I was (and still am) profoundly depressed. I would only recommend ECT if your options have been genuinely exhausted.

Protracted_Fermata wrote: These are the criteria for involuntary admission in my locale and I think they are justified. There are no other good reasons to force treatment on someone.

in my opinion, the only problem with this is that the decision to involuntarily admit someone is often subjective. There is no written down "if you do this_____, you will be involuntarily admitted" So what happens is that person x can be admitted for something relatively minor, while person y waits until something very serious occurs.

For example, when it comes to danger to oneself, some people will state that a person isn't taking a shower therefore is harming themselves and use this as a reason for involuntary admission. Of course there are several degrees of this, yet since it is highly subjective you do get some people who are involuntarily admitted with little to no cause.

For a situation such as this the story of Ray, comes to mind. He was involuntarily forced to receive ECT. Here's the FAQ, but you can poke around and read more of the story as you'd like.
http://www.mindfreedom.org/campaign/shi ... ndford-faq

Cheze2 wrote:So what happens is that person x can be admitted for something relatively minor, while person y waits until something very serious occurs

Why ? Insurance benefits. Title = "Psychiatric Coercion and Restraint " http://www.youtube.com/watch?v=2ifitvaIe7k Great comments by viewers.

Do you have insurance ? "No I don't" would be my awnser and then use it to pay the hosp bill later.