A critique of the psych professions

[packsaddle]

Yes, I agree with Horizon. A teacher is free to state his/her opinion no matter how uninformed or incompetent they are to state that opinion. Parents are free to tell them they're not qualified to make those claims. Parents ARE in control, even though they might feel like they aren't in some situations. But they have to exercise that control and there are procedures to do this and laws to back them up. It is incumbent on parents to learn about these things and then to take the responsibilities that come with that control. I'm not delusional because I too have "been there and done that." We exercised our parental control and got the IEP that was needed. Everything turned out just fine as a result. If we had 'caved' to the unqualified opinions of others, I suspect the results would not have been successful.

Here's the catch. The parent MUST be willing to pay the price of independent, competent assessment. It takes the expensive investment of time and money and in my experience it also sometimes requires sacrifices that affect career and relationships. A parent who decides for whatever reason not to pay this price has made the decision nevertheless, that the price may be paid by the child.

I have seen successes and I have seen terrible outcomes. In most cases, teachers are not the ones who made the difference. In most cases it was parents who were interested enough to make the sacrifices...or not.

[Beavah]

I too have seen some very good success cases and those alone are sufficient to convince me that it is possible to alter brain chemistry in a way that is beneficial to the patient.

 

Yah, but that's not good science, eh? It's faith healing. Yeh point to the couple cases that seemed like they worked.

 

Good science looks at da cure rate vs. the worse-outcomes rate vs. what would happen if yeh just continued with ordinary measures. What kind of science is "counseling works, yeh just have to find the right counselor?"

 

BG

 

 

[Oak Tree]

I agree with Beavah that it makes sense to evaluate treatments scientifically. There is lots of research on drugs that shows that they are effective, to one degree or another. All of the medications have double-blind trials. A drug won't get approved for prescriptions if it's not. (this is not true for those "all-natural" cures you hear advertised on the radio). I think it's safe to say that the drugs have at least some beneficial short-term effect - and while I'm not sure what the long-term studies have been, I'm ok with the presumption that the drugs actually do something useful.

 

I'm not as sure about therapy. Is it any more effective than having a friend who will listen to you? A dog? It's hard to do double-blind experiments on therapy. There is little doubt that therapy in general is statistically effective - not necessarily for everyone, but on average. http://counsellingresource.com/types/effectiveness.html

[packsaddle]

Beavah, "Good science looks at da cure rate vs. the worse-outcomes rate vs. what would happen if yeh just continued with ordinary measures."

You haven't identified what constitutes 'cure', 'worse-outcomes', or 'ordinary measures'. A cure is also an outcome and you haven't distinguished 'cure' outcome from 'worse-outcome'. But even if I ignored the inherent risk of bias contained in such subjective terms, this is merely a statistical comparison. If you had stated a hypothesis, it might have appeared to be 'science' but really its best hope is to find a statistically significant difference - with no particular understanding of why there is a difference.

However, what you just described is a way to form a hypothesis that might lead to good science IF you did find a significant difference and IF you could identify an underlying mechanism that explained the difference.

 

The neuro-chemistry on which SSRI's and related medications are based IS good experimental science. When these basic neuro-chemical mechanisms are employed in treatments with success (like the cases I observed), that constitutes evidence that "it is possible to alter brain chemistry in a way that is beneficial to the patient."

I said it's enough to convince me. However, I can be swayed to the doubter side - I often note that I usually side with the null hypothesis.

So show me experimental evidence that SSRI's do not in fact operate in the way that has been shown experimentally and that the derivative medications do not in fact produce the effects I've observed, and I will gladly join you in your opinion. I'll also be available for the climate change doubters if relevant evidence comes to light.

[Beavah]

IF you could identify an underlying mechanism that explained the difference.

 

And yet nearly every text begins with da statement "Precisely how SSRIs affect depression isn't clear."

 

Da issue isn't that I'm not proposing a scientific hypothesis, it's that as close as I can tell the psych community isn't.

 

 

[packsaddle]

OK, to me the problem is the breadth with which fields are lumped into a single category. If you take aim with your critique at perhaps a smaller target, I might find stronger agreement. As it is, I see merit and validity to some of the fields that you've lumped into such a broad category.

[Beavah]

All of the medications have double-blind trials. A drug won't get approved for prescriptions if it's not.

 

Well, all of da medications have double-blind trials for a diagnostic group identified by skilled researchers. In an ideal world where da funding didn't subtly or overtly bias anything.

 

Problem is, close as I can tell as an outsider, that these things are frequently prescribed off-label, in combinations, doses, and to patients not considered in da original drug trials. I don't know if it's still the case, but for years we were seeing kids on psych drugs at camps where when yeh looked up the drug in da PDR you got something like "this drug has never been tested for use in treatment of conditions for those under 18 years of age". It's much harder for drug companies to comply with da informed consent rules for younger patients, so they don't bother.

 

So yah, I'm OK with lithium for well-diagnosed adult schizophrenics, eh? I'm not as sanguine about "legal speed" or da drug cocktails for 12-year-olds without much better studies of short and long-term effects. And I'm not sure why anybody would be, eh? Seems like we're running a whole mess of uncontrolled experiments on kids, and the only data we're really collecting is how da kid behaves in an office during a visit every now and then.

 

And da counseling for kids is an order of magnitude worse.

 

Beavah(This message has been edited by Beavah)

[Lisabob]

Beavah, I'm curious. You're clearly not an advocate of a medication reflex response for kids. Nor are you a fan of counseling.

 

Without a debate on the relative merits of medication or counseling, I would like to know: What do you think would be appropriate responses to kids who are having behavioral problems?

 

Note that I'm talking about responses within the structure and context that we actually find ourselves in - no going and changing the dominant norms of 21st century society (good or ill) to answer this because, like it or not, we don't single-handedly control those norms.

 

 

 

[dScouter15]

Very interesting thread, with a lot of interesting points. For what its worth, let me present a couple purely anecdotal cases:

 

When I was in the fourth grade, I wasn't what you'd call a model student. I rarely did my homework, didn't always pay attention in class, and kept my desk and locker a mess, so I usually couldn't even find the homework I never did. I did well enough on tests, and ultimately got A's and B's on my report card, and I didn't have any behavioral problems, but just wasn't really interested in a lot of the day-to-day responsibilities of a 4th grade student. So, my parents got me diagnosed with ADD, and hooked up with some Ritalin. I started taking the ritalin, and the couple months I was on it were not at all fun. As others have pointed out, Ritalin is a type of amphetamine, and has pharmacological cousins used recreationally as "speed." So, the side effects from the Ritalin I experienced were similar to what are experienced by your average speed fiend. It killed my appetite, so I hardly ate anything at school, which made more tired and irritable. My mouth was constantly dry, and I just generally felt on edge and uncomfortable. And, my school performance didn't really change - I still hated doing homework and was still very disorganized. On top of that, I was now mildly mentally altered, which made working through those problems that much more complicated. Fortunately, my parents recognized that Ritalin was not the answer, and stopped it after a few months. After a couple more years of growth, maturity and development (which Scouting played a huge role in), I worked out a lot of the issues with disorganization and prioritization that affected me in grade school.

 

Fast forward a few years, to when I was in college. I began experiencing bouts of depression in high school, and by the time I was in college it was starting to get more severe. I saw a general practitioner, a psychiatrist, a psychologist and a counselor. And received a prescription for an antidepressant. Actually I rotated through a couple of antidepressants. The first made my nauseous, and the second made it so I couldn't stay awake for more than 3 hours a day. The third, initially put my blood pressure at a dangerously high level, made me jumpy and made it difficult for me to speak. Eventually those side effects passed, and I stuck with that med for about a year. And it didn't really have any effect on my depression. Eventually I just stopped renewing the prescription, had a couple weeks of rough withdrawal, and got on with my life.

 

Fast forward a few more years to the present. Right now I'm a paramedic, and have worked in a variety of settings - an ambulance, the hospital, a college campus, and a couple more. And, I regularly volunteer my services at scouting events. And Scouting events deserve a little more discussion. At one particular annual week-long training event, I've volunteered as the health/safety officer for the past 4 years. Our policy at this camp is to collect all scouts' medications and distribute them from the health lodge (and before this thread is hijacked, I can assure everyone that this practice is quite legal and quite safe, and any discussion of medication policies would be welcomed in a new thread). Anyway, each year I make a list of each scout with medications, and the name of the medications they take. Each year, the number of scouts (aged 13-17) on antidepressants, ADD/ADHD meds, mood stabilizers, etc, has increased significantly. In recent years, the number of scouts on these meds have grown to a point that its making medication distribution a logistical problem in relation to our camp's program.

 

In the rest of the world, I work with a lot of mentally ill people. And, to put it bluntly, there are different kinds of crazy people. I've seen people who function well in the family and their job with the help medication completely fall apart when that medication is stopped. I've seen people with some underlying mental issues who are at least marginally functional in society completely fall apart when they are forced to take medications. I've seen attempted and successful suicides by people of all ages, regardless of whether they take antidepressants. I've seen Scouting-aged kids respond very well to psychiatric medications, and Scouting-aged kids on psychiatric medications who are just as badly behaved as ever.

 

You can draw whatever conclusions or opinions you want from all this. Mine are that, like anything else in medicine, people are misdiagnosed, mistreated, and susceptible to more harm than good done by medical professionals, who ideally we should all be able to trust. And other people are correctly diagnosed, correctly treated, and able to overcome numerous problems with the help of medical professionals and medications.

 

Other than the pshrinks, another population worth examining might be the Scouter-types with minimal first-hand or in-depth knowledge of a complicated issue, but try to shrug off those issues with over-simplified solution, coupled with an "I know best" attitude that diminishes the advice of those who actually do have some in depth knowledge and advice to offer.

[Beavah]

Each year, the number of scouts (aged 13-17) on antidepressants, ADD/ADHD meds, mood stabilizers, etc, has increased significantly. In recent years, the number of scouts on these meds have grown to a point that its making medication distribution a logistical problem in relation to our camp's program.

 

Yah, say what yeh want about us ignorant scouter-types, but it's hard to look at a statistic like that and conclude that it's anything other than medical quackery.

 

This is da reason it's important to have recourse to malpractice lawsuits in medicine, despite their occasional abuse by grieving families.

 

B

[packsaddle]

Beavah, it would have been better if you had answered Lisa's question in a thoughtful way. There's still an opportunity to do it.

[Scoutfish]

>

 

The damned down side to it is this:

 

While there are many, many cases of Dr's trying to do what is best for kids and people in general...too many ( in which case I think even 1 is too many) Dr's will follow the $$$$ before they practice good medicine. Sure, there are legit Dr's out there, and as far I know, the one I see is one of the honest ones. He tries other things before writing a prescription even for Strep throat or even more common ailments.

He gives you a full vist for $40.00. The next time he see's you, he asks how long X symtom tok to clear up and how are the kids.

 

Unfortuneatly, too many Dr's are under the influence of all those drug co reps who droop off tons of samples and maybe tickets to a ball game or a set of golf clubs too.

 

Mgazines and tv show ad after ad to the common person of drugs that have to be prescribed. Why show them to us? Because we will pre diagnose what we need to fix our ails and pressure the Dr to giving us that drug. The dr's who own their own offices will get kickbacks from the drug industry for this.

 

Ever wonder why a $.05 pill costs $10.00 here but only $.05 in Canada or Europe? Cause we pay for all that advertising and the extras the Dr's get for using that particular brand or type of pill.

 

So what do we have here? We have a situation where the majority of the doctors make the handfull of the good ones look bad.

 

Kinda like politicians: There are some good ones who go to office to serve the people in afair and just way. You just can't see them for the other idiots!

[vol_scouter]

Beavah said:

 

"This is da reason it's important to have recourse to malpractice lawsuits in medicine, despite their occasional abuse by grieving families. "

 

In the current discussion concerning mental disorders in children, the reason that there are so many medications prescribed is partly physicians protecting themselves. Psychiatrists are bound by the Diagnostic and Statistical Manual IV. So they interview the patient and match their list to findings to that in the DSM IV (same for major depression, schizophrenia, etc.). If the child matches a list then they have that diagnosis and the treatment is likewise outlined. If the physician follows the DSM IV, they are following the standard of care and a lawsuit will not be successful. So many children are placed on medications that are at least not beneficial and probably harmful. In the current medical and medical/legal climates, I see little promise of significant improvement which is a travesty.

 

Scoutfish said:

 

"The damned down side to it is this:

 

While there are many, many cases of Dr's trying to do what is best for kids and people in general...too many ( in which case I think even 1 is too many) Dr's will follow the $$$$ before they practice good medicine. Sure, there are legit Dr's out there, and as far I know, the one I see is one of the honest ones. He tries other things before writing a prescription even for Strep throat or even more common ailments.

He gives you a full vist for $40.00. The next time he see's you, he asks how long X symtom tok to clear up and how are the kids.

 

Unfortuneatly, too many Dr's are under the influence of all those drug co reps who droop off tons of samples and maybe tickets to a ball game or a set of golf clubs too."

 

Response: The samples go to the patients and are going away. No large gifts since the mid 80's have been allowed. Until a few years ago, the drug companies would have informational dinners at nice restaurants but those are going away as well. Most gifts are cheap pens that last 2-3 days and cheap notepads - wow what a bribe. To believe that individuals who make 6 figure incomes are bribed by a dinner, cheap pens and pads is ludicrous. Being able to provide a patient with a month's supply of a medication for free benefits whom? The patient.

 

 

"Mgazines and tv show ad after ad to the common person of drugs that have to be prescribed. Why show them to us? Because we will pre diagnose what we need to fix our ails and pressure the Dr to giving us that drug. The dr's who own their own offices will get kickbacks from the drug industry for this. "

 

Response: The companies market to patients because they will ask for a drug and be upset when they do not receive it. Physicians are in a business and want their patients to be happy. WE DO NOT GET KICKBACKS - THAT IS A LIE!

 

 

"Ever wonder why a $.05 pill costs $10.00 here but only $.05 in Canada or Europe? Cause we pay for all that advertising and the extras the Dr's get for using that particular brand or type of pill. "

 

Response: Canada and Europe are socialist states and do not allow the pharmaceutical companies to make a profit on their medications. The US and Japan provide ALL of the profits for the companies because socialism is disallowing it.

 

"So what do we have here? We have a situation where the majority of the doctors make the handfull of the good ones look bad. "

 

Response: Back it up with facts. The facts are that physicians work very hard, often not being paid to help their patients. There are a few bad apples but the vast majority are competent and try very hard help their patients.

 

I have practiced medicine for 25+ years and left because the government is increasing making it difficult to provide the best care and I have research opportunities. Where does your knowledge come from?

[Scoutfish]

"No large gifts since the mid 80's have been allowed."

 

Banks are not alowd to be robbed , nor are false insurance claims. Likewise, cheating is not allowed in sports, or college academics.

 

 

Guess that doesn't happen either.

 

So the drugs are cheaper in Canada because why?

 

You mean to tell me that when i open a magazine, and see a 3 page drug ad for product "X"....that the magazine ran that ad for free? In how many thousands of copies? Then add up all the different magazines, newpapers, newspaper fliers, internetads, etc.. for that same product - is all that free too?

 

Tell me why a drug that should be prescribed by knowledgable Dr's is ever waved in front of a group of people who know nothing of that mdicine - especially particular indications, uses side efects or applications - just to make them happy?

 

That is flat out ludicrous and stupid. The un trained public should not be suggesting to their dr's what drugs they need. If that's the case, screw the Dr's! I'll just let the ads tell me what i need for my condition.

 

Oh wait! The Dr wants to make me happy instead of saying:"Sorry Mr Fisher, that drug isn't what you need. Instead, you should cut back on the sugars, caffiene and acidic foods and junk food you eat!"

 

The Dr wants to make me happy while making the drug company happy. You can spell that with $$$$$$$$$$$$.

 

WEll, gosh! How would the Dr ever seel enough of thatdrug then? Why does the drug compani spend bilions in ads for something I cannot prescribe?

 

 

Like I said, there are great Dr's out there. But there are many more that are not!

 

Facts? Read the papers. Watch the news. Just live in America.

 

The same place where people are not allowed to take bribes or cheat or steal or kill, but do it every day. Just like Dr's get kickbacks!

 

Maybe not you. I comend you for that. But please do not say that - because you do not - that none do. I will laugh so hard that I may need a drug to stop !

[dScouter15]

There's a lot of accusations being made that apparently *can* be supported by evidence, but, on this forum anyway, have not been. Can anyone draw a correlation between "medical quackery" and incorrect medications prescribed? How are we all so certain that doctors are to blame, rather than ignorant parents, lazy parents, or the influences of a hyper-medicated society? Any substance for the accusation that the "bad" doctors greatly outnumber the "good" doctors?

 

I admit that my role in the health care arena is not particularly comparable to that of a doctor, but, from my own experience, I can see how some good doctors might be pressured into prescribing a medication against their better judgement. And it might not have anything to do with a "big pharma" conspiracy. Consider a grade school aged child with some attention span issues and some hyper behavior. For the sake of argument, let's stipulate that his school's budget cuts have eliminated gym classes and shortened recess periods. Maybe this kid's diet isn't the best, relying a lot of junk food and fast food, due to its convenience or low cost. His teachers begin complaining about the kid's unsatisfactory performance in his classes, and his rambunctious behavior. Mom and Dad know that a lot of kids his age have this "ADHD" thing, and take little Johnny to see his doctor to talk about it. Doctor says that maybe Jonny does have some attention span issues, and a lot of extra energy. Doctor says that maybe we should try improving his diet, increasing his daily physical activity, maybe even toughening up on the discipline and consequences for bad behavior. Mom and Dad say OK, and over the next couple months they make an effort to follow Doctor's advice. But, things eventually start to fall through the cracks. Dad's working two jobs, and Mom's working part time, and both are busy ferrying Johnny's older brother and sister to their scouting events, track practice and swim team events. So, Johnny's eventually back to packing his own lunch without supervision, and the high-sugar foods make their way back into his lunch box. Maybe Johnny's involved with cub scouts, but weekly den meetings don't provide much physical activity. His parents try to limit the video games, but Johnny doesn't have many friends who live close by that he could play outside with, so that's out the window. So Johnny's behavior doesn't really improve, and Mom and Dad go back to the doctor in another month or two saying they've tried EVERYTHING, and Johnny's still having issues. In this case, based on the information made available to the doctor, is he wrong for trying to help a kid by using recognized medication therapy for a diagnosed condition? Is he wrong for giving a prescription for, say, Vyvanse, regardless of whether or not it actually helps Johnny?

 

Or what about the kid with a mild case of OCD? He obviously is going to have a tough time being successful in a school environment. Whatever baseline difficulty he's facing as a result of his disorder is only going to be exacerbated when he gets to the age where bullying becomes more common. Maybe Mom and Dad's crappy insurance policy limits the amount of counselling and therapy the kid is eligible for, so the pediatrician decides to give some Zoloft a shot, hoping that it might improve things a little. Maybe it does, maybe it doesn't - either way, should we blame the doctor? If so, what would a more appropriate course of action be?

 

Now, I personally don't believe that medication therapy is the best choice in a lot of cases. But, I would caution that, first, its important to make sure that we are vilifying the right people, and doctors aren't necessary the only group deserving of our scorn. Also, sometimes medications, for all of the horrible side effects, actually are the lesser evil of all of the other options. If anyone is interested in this type of thing, I'd encourage you to check out this site: http://www.crazymeds.us/ -- its a rather politically incorrect, but accurate (IMHO) look at mental illness and medication treatment.(This message has been edited by dScouter15)