Parity of esteem within the biopsychosocial model: is psychiatry still a psychological profession?

[rvallee]

So we literally can't even get their attention? How disappointing...

I was told that not doing harm was kinda important in medicine... especially that helping a few is not a valid excuse for harming others. Which is clearly happening here, because the system of healthcare is fully self-contained. When those within the system know of harm and do nothing, there is no plan B, nothing else that can undo the harm.

Tolerating harm is the same as doing harm when you are part of regulated system. I'm sorry but I find that this is "not my problem" attitude is just as much part of the problem as the ideologues pushing this. Injustice happens just as much when good people refuse to end it as when bad people choose to force it onto others.

Of course we never get anywhere if harms are tolerated that easily. That's what makes the banality of evil so potent, so... bureaucratic.

 

[rvallee]

article in Guardian from 2016
Therapy wars: the revenge of Freud



https://www.theguardian.com/science...evenge-of-freud-cognitive-behavioural-therapy

Good example of two wrongs being added up to make a right. Neither are any good, the problem is clearly with how things are evaluated, that they can find that something useless is "superior" to another useless thing, and back again. Without ever thinking that there's anything wrong with using methodologies that produce absurd results all the time, easily gamed and exploited.

We know this kind of methodology, where judgment is everything, is not reliable. The entire history of science is all about proving this simple fact: bias will ruin all results. It's all hype and marketing. Even worse than in the damn marketing industry, because appeal to authority is constantly used and abused out of self-interest, then enforced with the power of the law.

 

[Arnie Pye]

I think there is a major confusion in many people's minds. Psychiatry will continue to be an essential discipline and probably grow. Its proper role is to deal with biological illness that primarily presents as disordered thinking.

How many people with a psychiatric diagnosis on their GP records have actually ever been seen by a psychiatrist? I would guess very few of them. I don't think the stigma surrounding mental health problems is actually completely the result of the actions of psychiatrists. It is also the actions of other doctors who use it when convenient that is a large part of the problem.

I suspect GPs diagnose depression and anxiety multiple times a day because prescriptions for anti-depressants are cheap and they can't do anything about "shit life syndrome". And so many people in pain are assumed to be drug-seekers just on the basis of how the GP feels about a patient.

Gynaecologists diagnose Primary Dysmennorhea when they don't want to actually investigate thoroughly and think the woman is a hysterical, attention-seeking, drug-seeker. And they seem to think that with practically every woman they meet.

I've even had my suspected Eustachian Tube Dysfunction dismissed as being a mental illness by a doctor in the audiology department of my local hospital.

Doctors from every discipline use mental health as a weapon to dismiss people they don't want to help and/or don't believe. If someone is told they are "depressed" or they are "anxious" they know that they are most likely going to be out the door in the next 30 seconds or so and they won't be getting any useful help.

 

[Hubris]

Doctors from every discipline use mental health as a weapon to dismiss people they don't want to help and/or don't believe

Yes, that's the point. Even if you have a psychologist or psychiatrist certify that your illness isn't mental (even more than one), they will say that they suck and you need to find a better one.

This is straight corruption in medicine, there is no way around it. If the system wasn't rotten to the core, this ping pong that doctors play where non psych sends you to psych and psych sends you to non psych wouldn't be possible.

 

[ToneAl]

While we are talking about this, I want to ask you something.

As you have implied in your post, the most capable, science oriented psychiatrists do not think ME or fatigue is a mental illness. This is obvious, otherwise we would have phase 3 trials with psych drugs all over the place. The only psychs that think of ME as a mental illness are the low quality ones, who have no concept of science and are happy to prescribe things like hypnosis that have no evidence behind them.

Despite psych illness not having organ specific problems, or even Neuro issues, there is still a large effort to study the neuroscience there and try to apply cutting edge treatments (like for example the brain implants they use in treatment resistant depression, OCD, etc).

So my question is this:

There is this misconception among non psych doctors that fatigue (if you don't have obvious biological abnormalities) is a mental illness and it's treated effectively with psychotherapy. This belief is encouraged and propagated by both the low quality psychs I mentioned, and the ignorance of non psych doctors about mental illness. Why do the serious psychiatrists not speak up against this? Why have they abandoned us, knowing that nobody will help us? Ok, we are not mentally ill so our illness is not part of their expertise but since everybody else mistakenly thinks we actually do have a mental illness, and get referred to psychs all the time, don't they at least a moral and ethical obligation to set the record straight, or at least make a statement?

There are some
Dr Allen Francis the Psychiatrist who worked on the DSM is often on twitter pointing out Inconsistencies and other mistakes other doctors make about psychiatry.

 

[Ash]

That’s right.
And I’ve seen there are lots of decent psychiatrists pointing this out in stronger terms.
But I think they are hugely outnumbered by the ones who go along to get along. And some who don’t have much respect for others in general or their patients in particular.

 

[bobbler]

I feel like we need an open/repeatedly findable thread (as it will take a while to build up thoughts) to focus on working up how to tackle and unbundle the switch and bait issues of the 'biopsychosocial' or psychosomatic or 'behavioural psychology' (which is what I think is really what it is about) cabal and manifestos. In order to unbundle the ambiguity deliberately caused by their adopting and co-opting this term inaccurately to hide behind. And also to begin specifying the harms caused by it, how, how it is immoral and yes... difficult to do, but I think we need to psychoanalyse the different 'players' in the chain who perpetuate this being used (there are the 'pushers' who would be 'NUrse Kratchet' anyway and then just created a manifesto to convince themselves, then there is the chosen ignorants who shouldn't be sucking up the behavioural but do and close their ears to anything different from pwme and so on).

Re this article: In this case what I find fascinating is how in the world of psychiatry they've detailed above the 'component parts' they try and claim are somehow all there in the bio-psycho-social they've warped to completely different things to even what those in medicine or psychology would expect.

To them (and maybe psychiatry - I don't know) the 'bio' is the psychiatric drugs - which we must remember tend to be tested by inferential trials (because the brain has certainly historically been harder to actually test on live people for various reasons) - that seems to be it. Not even the oft-cited idea of genetics e.g. I assume for things like Schizophrenia vs the 'psychological' or social (which in my mind I think of the situational and how that impacts on someone - which would/could be seen as 'environment' and known as 'trigger'). Nevermind comorbid physical conditions and interaction of physical and biological environment on the condition itself etc.

To me it feels there is disingenuous use of references to back up what they are trying to argue:

The psychological and social contributions to the biopsychosocial model of psychiatry have been downgraded and are now in danger of being lost in favour of a solely ‘bio’ model. These concerns are shared in many areas of the psychiatric and mental health community, including suicide prevention.Reference Bolton3–Reference Tripathi, Das and Kar5

I say this because the latest talk I've seen of suicide prevention has for example been refreshingly seeing e.g. organisations like Mind actually acknowledging and focusing on the 'situational' being highly prevelant and needing to be tackled in these situations - and that the current UK model missing that completely. The cause of that is certainly not due to 'more psychoanalysis' or more 'CBT of the 'how can you sort your own problems' type' being lacking.

This overly biological vision of psychiatry ignores the pioneering part that psychiatrists have played in the development of psychological interventions and evidence-based treatment modalities such as cognitive therapy,Reference Beck6 developed by Aaron Beck; transference-focused psychotherapy,Reference Clarkin, Yeomans and Kernberg7 developed by Otto Kernberg; mentalisation-based treatment,Reference Bateman and Fonagy8 developed by Anthony Bateman; and psychodynamic interpersonal therapy,Reference Barkham, Guthrie, Hardy and Margison9 developed by Bob Hobson.

Of course here they are arguign that the logo of the Royal COllege of Pyschiatry is using 'bio-leaning' images, when I suspect it is merely an attempt to 'seem scientific/science-based' as a perception they want others to have, when actually that would be defined by not having crap unscientific methodology - whichever side of the coin you are coming from. It's a whinge about identity marketing and their place in the logo and the funding I assume. There is little depth even with this about how said symbols relate to anything real in the profession.

Weirdly some of the points they argue for are correct: tick-box culture meaning no context looked at whatsoever, generic assessments pushing down transdiagnostic streams, revolving door when tey treat someone's acute symptoms to get them out of the door (or because someone realises they need to get out of the door) but nothing else - their claim is of it meaning 'firefighting' but I'd argue it is just not really treating if you aren't being required to diagnose properly and id the cause and ergo the actual codnition (which could be situational entirely) and they've caused their own issues by not wanting to do real self-effacing science about whether what they do 'works' as long as they get them out of the door it can't be a con/mirage and so on in order for them to reassess their diagnostics and profession.

I find it offensive that anyone, nevermind a profession claiming 'psych' label patients 'complex' when often this is what has been brought to said people's own door, and is made worse by bad treatment making their situation not only more complex but them fighting epistemological issues (red herrings so their word isn't heard when they look to get diagnosed properly in future). And ironically that latter part contributes and is caused by the fear of the staff of that last sentence in the prior para - don't want to be honest with themselves where they got it wrong and things don't work because they don't really diagnose specifically enough anymore.

To then straw man a big old whinge with what is behind it psychological and biological damage caused by a profession twisting and refusing to accurately acknowledge the impact of the social or more accuraely situational - and I suspect responsibility issues to always be behind anyone who can't see or acknowledge accurately these aspects - as if the answer is more labelling which causes a worse situation on that.... well. I should be allowed to say the words of how apalling that is but daren't.

What these people really want becomes clear at the 'what we want' section towards the second half. More medics to be co-opted into psychotherapy training so whether they go onto psychiatry or don't then I guess that gives them a niche idea of what 'psychology' really is they maintain for the rest of their career. I'm sure there are some good training programmes or those who are good 'despite' based on hearing of some good and critical thinking psychiatrists but the following fills me with horror.