A critique of the psych professions

[vol_scouter]

Scoutfish,

 

On this post, I largely agree. It goes back to my post as to what constitutes normal and abnormal. Classically, the two overlap which is what I believe is going on here. I believe that children need more time to develop and work through issues of conecentration.

 

You are dead on on parents must be parents and not friends to their children.

[skeptic]

Advertising in medical journals and doctor, hospital related periodicals should be allowed; but why to the general public. Not sure why, but certainly it is at least a factor in the increased cost of the drugs. For years it was not allowed, and then someone decided it would be a good idea. To me, it is a legitimate concern that the general populace is being at least somewhat dis-served by putting "ideas" into their heads that they need certain drugs. And the people with real problems, often called hypochondriacs, definitely do not need these added misunderstood symptoms being pushed on them.

 

Another negative issue, from my perspective, is the "type" of drugs that are most common in TV ads, as well as why some are allowed to be shown in prime time. This has been touched on in other threads I believe.

 

If not advertising to the general public could save even a small percentage of cost for drugs, it would be worthwhile.

 

As far as kids, and possible over diagnosing certain syndromes, it is likely a reality to some extent. I see it in the schools, and a few times in the scouts. Much of it could be solved by finding better ways to run our educational system, and reemphasizing "real play" and the arts, rather than taking them away. They all add to the quality of education, and likely draw on other parts of the mind, as well as allowing physical release from pent up stress.

 

JMHO

 

 

[Beavah]

Beavah - when you started this thread you reckoned you'd learn something - what do you think thus far?

 

I reckon I'm more depressed about da situation than I was.

 

Lisabob, I think it's possible to evaluate da current practice as unsuccessful or harmful without having an alternative in mind. Just means yeh should begin by stopping da current practice. I also don't think your question is informative, eh? A bit like asking "How should you address behavioral problems in a troop?", only broader. What behavioral problems? For which child and family?

 

This old furry fellow isn't such a fool as to think that he can make a general statement about how to respond to all kids with behavioral problems, or come up with a "just follow the DSM IV" set of rules that will work for everyone after one office evaluation. Nor is an exhaustive list of all of the possible ways of addressing behavioral problems particularly helpful.

 

I reckon this thread is mostly just positing "first, do no harm".

 

But yeh seem to have a notion yourself, so don't be coy. What do you think is the set of appropriate ways to address a behavioral problem, without expecting (too) much of parents, kids, professionals, society, or whatnot?

 

Beavah

(This message has been edited by Beavah)

[dScouter15]

Beav - How can you look for complex, specific solutions when you don't hesitate to generalize and over-simplify the problem?

[Scoutfish]

Oh definantly on advertising in medical journals, and such. Let the Dr's know when a new product comes out or if a particular company might have made a better version of an existing product. I'm completely cool with that!

 

But magazines like you buy at the news rack or Waldenbooks? Nah, no need for that.

 

The kicker of it is this: The one page ad for the mdicine is only 1/4th of the cost. It's the 3 pages of disclaimers and side effects (that happen to be worse than the original issue) that cost the most part.

 

4 pages of ad space for a product that I have no ( or shouldn't) say or control over is being flaunted in my face by a company that is telling me I NEED it.

 

Too bad truth in advertising laws do not require counter ads that tell people to go to the Dr and let the Dr be a Dr, instead of a pharmaceutical consierge service.

[Beavah]

Beav - How can you look for complex, specific solutions when you don't hesitate to generalize and over-simplify the problem?

 

You're mixin' things up, dScouter.

 

Yeh can evaluate the effectiveness of a public policy or general practice. I'd argue that it's necessary to evaluate the effectiveness of a public policy or general practice. That is generalizing and over-simplifying at some level, eh? But it's still both valid and important.

 

Yah, real solutions to individual cases may at times be complex and idiosyncratic. I'm fine with making exceptions to da rule here and there when appropriate. That's not part of medical research practice, though, eh? In medical research, yeh average da outcomes. A few people cured and a few people killed means no drug approval. First, on average, do no harm.

 

That's the point I was makin' with packsaddle, eh? A few cases of success is not sufficient to make a claim that a general practice is valid. Any faith healer or quack can point to a few cases of success. Evaluation of a policy or practice must be broader, and take into account costs and negative outcomes, both short and long term.

 

Beavah

 

[vol_scouter]

Skeptic and Scoutfish,

 

I totally agree with the advertising comments. The warnings are mandated by the FDA so the pharmaceutical companies must include these pages. My belief is that they are seldom read in the journals. They are more likely to be read when prescribing the drug for the first time. The current trend is for the access to physicians to be increasingly limited which encourages more marketing to the public. I and I think nearly all physicians would like there to be no advertising to the public.

 

Beavah,

 

The most discouraging thing about the current situation is that it will likely encourage the next generation to find medicating their children even more acceptable.

As to what to do now: be supportive of children who are having difficulties, do not allow their issues to in someway 'handicap' them or to give them a special status, make them (and all youth) earn their ranks and badges, understand that children learn at different rates, understand that children excel unequally in different areas.

For another group of children, do not hold the bright and driven children back, especially when for convenience.

[Scoutfish]

Something I have always wondered about:

 

If a psychologist, psychoanalysist, or psychiatrist.....or whoever it would be..was to sit and talk to me for a few hours - what would they think? but more importantly, what would they base that opinion on? What science or education or training?

 

My point here being: I am a unigue individual. There is nobody at all on earth who is like me. Every single day of my life has had an effect on who I am as wellas why. Every single interaction, event, action has had something to do with who I am...even the tiniest ones.

 

So, what do you compare me to? How do they decide how far from normal I am based on what? If they did not know me before, what do they compare to.

 

And then let's be honest: we are all human. try as we might, we all have our own personal interpretation of things. Kinda like 20 people could see the exact same event, and you get 20 different interpretations. So our own personalities and our own little inconsitancies alter or taint our judgemment.

 

Kinda like a crzy person never doubts their own sanity, yet a sane person will wonder if they are going crazy sometimes. Nice catch 22 !

 

I'll be the first to say that I am already an oddity: My normal baseline body temp is 97.3 If my temp reads 98.6, then I actually have a fevor.

 

I had cancer less that a year ago, A tumor the size of two chicken eggs on my neck. Yet, after surgery, every scan, every bit of pathology cannot find 1 shred of evidence I had it at all. It was in my lymph nodes too.

 

The Dr said there are just no stats to go with my situation.

 

I like to think I am a very reasonable person, thoug I admit - at least while typing - I cannot always express myself adequately. I try to see things from the other person's perspective and try to view it through their experience.

 

But do all therapists, and all the psych's do that?

 

What effect does their own raisning have on how they judge others?

 

If they grew up in a no-nonsense home devoid of lafter and joking, do they see comdians as trying to escape reality and possibly think they are wqsting their lives?

 

 

What if a psychologist grew up in an untracompetative home. Does he see those who do not feel the need to compete as weak or inferior?

 

OKay, what about Freud? although I try not to use blanket statements, the man had a thing for his mom. He wanted her in carnal ways. but his denial came out in his judgement of others: he (blanket statement part ) said people hated their mothers. Or wanted to have relations with them.

 

Was that his way of making himself feel normal?

 

Nah, I'm not scared that I will need or have to be judged anytime soon. I just wonder how anybody can come up with any set of standards to judge others when it comes to the mind.

 

I know I'm off my rocker a little bit, but that's what makes me fun!

 

 

[dScouter15]

Beavah - sure, but wouldn't it maybe be more worthwhile to also examine how and why that policy or general practice came to exist?

 

As I've posted previously, my own opinion is that medication therapy is overused today, and that I'm skeptical benefits of medication vs. non-medication. However, in my opinion, the root of the problem is NOT that a bunch of doctors have suddenly become more eager to use their rx pad. Like anything else, doctors are responding to a need that developed. For me, it would be more worthwhile to discuss how and why that need (real or perceived) developed.

 

To use a metaphor, consider a city with an arsonist on the loose, who has been torching so many buildings that the fire department is having a hard time keeping up. In this discussion, its like we're demonizing the fire department for having a response time that's a couple minutes too long, while ignoring the fact that the police department isn't prioritizing catching the arsonist, or that the buildings weren't built to adequate fire resistant standards to begin with. Sure, the fire department has an obligation to perform at high standard, but if the root of the problem was identified and solved, the fire department wouldn't be stretched so thin.

 

Not a perfect analogy, but I hope it helps clarify my point. In my opinion, the medical community may not be collectively be making the best choices all of the time in regards to psychiatric/psychological care for today's youth, but if the root of the problem were identified and addressed, maybe the doctors would not be so pressured to come up with a solution to a problem that isn't necessary theirs to begin with.

 

 

[vol_scouter]

Scoutfish,

 

You have brought up some good points. One's background will certainly influence the way that they view others. It is not alway possible to predict the effect. For example, someone who grew up in a very structured family may view that as good (agreeing with their upbringing) or bad (feeling that the structure was a bad thing). Physicians are instructed to not allow their backgrounds to influence them but that is clearly impossible.

 

Determining normal and abnormal behavior is done with studies and then by vote of a committee. In general, a study determines the prevalence (how often it occurs in a defined population) of a particular condition. If the prevalence is less than 4%, it is considered abnormal. However, before being declared abnormal, it goes through committees who vote on what are the signs (physician discovered evidence based upon examination), symptoms (patient supplied information), and laboratory/radiologic findings that together constitute the disease. Then the committee votes based on the whole package of information. It can be a cut and dried process or very contentious. In the case of homosexuality where according the CDC less than 2% of the population is a long term homosexual. Thus, in a statistical sense, homosexuality is abnormal but a vote in the 50's or 60's changed it from abnormal to normal. So the method is complex and not entirely scientific because it deals with behavior that is difficult to define and multi-factorial.

 

So what constitutes ADD and ADHD is determined the same way. Once a patient has a given diagnosis, there are accepted treatment options which the physician should choose to avoid liability issues. If a physician does not follow those guidelines, then they are not following the 'standard of care' which opens them up to lawsuit. So even if a physician does not believe that a child is best served by amphetamines, they can violate the standard of care. Before outright condemnation of such a system, it does prevent physicians from straying too far from proven therapies. On the other hand, it somewhat removes the physician's judgment. This is a complicated system and difficult to describe accurately.