Psychiatry – the medical speciality that combines empathy and science

Jonathan Edwards said:
And how do you empathise with someone about their irrational illness beliefs - do you have them too?
Click to expand...

Adopting a view of the illness as primarily a problem of irrational beliefs will diminish empathy.

Psychiatry seems to have a preference to view illnesses in this way and unsurprisingly has an empathy problem. I say preference because the etiology is unclear and different interpretations are possible.

It would better and in my opinion more accurate (in many cases) to view distress, depressive mood, and anxiety as ordinary reaction to adverse economic and social conditions and disability. In other cases like schizophrenia and inflammatory illness the problem is purely biological. Empathizing is suddenly easier: life has dealt patients bad cards and they are overwhelmed and need a helping hand.
 
Last edited:
Jonathan Edwards said:
Are you sure you are not being too charitable @Lucibee? What horrifies me about psychotherapy is that to a first approximation we do not even know if it ever does more good than harm.
Click to expand...
Psychotherapy is not a monolithic entity, CBT is a mechanistic fraud imo, and therapists who just listen to their patients for years on end are useless and wasting time. There are many other types of therapy that are different and have real research behind them. I wish i had the mental fortitude to provide references.
 
Last edited:
Jonathan Edwards said:
Are you sure you are not being too charitable @Lucibee? What horrifies me about psychotherapy is that to a first approximation we do not even know if it ever does more good than harm. My limited experience of sitting in on three therapists' sessions is that they either were useless or harmful. I have good evidence of harm in another case (the break up of a family based directly on ideas put in the patient's mind by the therapist).
Click to expand...

Oh, probably. But that's just the way I am!

If the aim is to feel better about things, then a good therapist can be useful - although probably no more than talking to a good friend would be. Sometimes there are things you want to talk about that you wouldn't want to discuss with your friends though.

I've certainly experienced harm in therapy. My first experience of therapy did enormous damage to my relationship with my mum. However, most of my experiences have been fairly neutral, the only harm being done to my pocket. The worst was with an NHS therapist who had previously worked for the local fatigue and pain management service. As you can imagine, that did not go so well! I didn't take kindly to being told that my scientific views were a prejudice.

If your aim is to achieve a certain level of calm through meditation, say, then that takes practice. For example, a freediver will need to use similar techniques to slow heart-rate and oxygen consumption to a level that allows them to do what they do, but that takes a lot of practice, and they're not fighting against an abnormal reaction or a disease process. Maybe something similar might be useful when we better understand what is going on in ME, but we are nowhere near that yet. [Just to clarify, I'm talking about methods to cope with pain etc - symptom management - not that it might be possible to reverse things as BPS proponents seem to think - and it's not appropriate for everyone]
 
Last edited:
Jonathan Edwards said:
Are you sure you are not being too charitable @Lucibee? What horrifies me about psychotherapy is that to a first approximation we do not even know if it ever does more good than harm. My limited experience of sitting in on three therapists' sessions is that they either were useless or harmful. I have good evidence of harm in another case (the break up of a family based directly on ideas put in the patient's mind by the therapist).

For the martial arts expert at least we have an objective outcome - the opponent on the mat - and convincing evidence of causation. With psychotherapy it is often very unclear which of all sorts of outcomes is most important and rarely clear that any improvement was actually caused by the therapy. For the great majority of psychotherapists I suspect there is no solid evidence available to them throughout their careers as to whether they are doing things right or wrong or getting better at it. It could well be that trainee therapists make people happier than old hacks - I suspect nobody knows.

In short, nobody knows anything much.

The audit on the FINE trial brings this out. The 'supervisors' assume that they know how to do the therapy and that the nurses are making beginners mistakes. But nobody has shown this therapy works in any circumstances so how can the supervisors know?
Click to expand...
The blind leading the blind, but convinced they have 20:20 vision.
 
No @Andy I went in for taekwando and boxing for a time before I became ill (I was interested in aikido but I think our local studio was really pricey!). I'd have pretty much the same criticism for the taekwando I did. Little practical focus - you get good at choreographed forms and bashing pads, not fighting in a dangerous situation via truly antagonistic sparring. It was more performance art than anything. (Sure maybe other studios focus on intensive sparring, but it's still a very incomplete style)

That's not to say I wouldn't apply anything I learned from there if pressed, but if a situation really broke down, I wouldn't trust it for a second to be terribly effective, and I would not have trusted the training of the blackbelts or instructors in such a situation either despite their undeniably masterful skill. Not to say it doesn't give you a leg up - you might well even score a brutal KO - but it's hardly decisive.

I realize taekwando and aikido are not very similar. My understanding of aikido: throws, wrist/shoulder locks, grappling, leverage the opponent's energy, emphasis (almost all?) on defense and trying to spare the attacker from harm. I don't have experience with it but there is enough publicly disseminated material for a curious person to go on to form a reasonable opinion. It's certainly not fake. Some of the techniques could be pulled off in the right situation. I acknowledge being several degrees too flip in how I referred to it.

But the point is that a large part of the appeal of these traditional martial arts is that they project an aura of containing master secrets that will make practitioners brutally (or at least highly) effective at unarmed combat/self-defense or whatever - often after years of practice (and paying dues). That's just not realistic for aikido or taekwando. If a person's goal is expressly to become the best 'fighter' or most effective at self defense, tradition, ritual, and aesthetics become fluff and other routs which drop these will be vastly more efficient and effective. If someone likes the history, ritual, and aesthetics with their exercise and maybe wants a few techniques they might pull off (maybe to supplement other self-defense expertise), traditional martial arts is a winner and you can sign me up for a bit of that, too. Aikido in particular has a laudable goal of not harming interlocutors which rightly appeals to a lot of decent people much more than MMA's bloody canvas.

Heck. I'd love to go back to a boxing or taekwando studio just to punch pads. It's one of the most fun and satisfying things I've ever done in my life regardless of how 'applicable' it was.
 
andypants said:
My friends who studied psychiatry fall into one of two categories: Those who have trouble getting a grasp on life and think psychiatry will help them (and others) correct this, and those who think they have really figured life out and just need a diploma that will allow them to use all this wisdom to ‘help people’.
Click to expand...

exactly... they can (subjectively) label everyone around them as faulty, thereby anointing themselves as superior & perfect. I knew someone socially who is a therapist and she "diagnosed" everyone around her all the time (presumably) to cope w her own insecurities... the meanest, most toxic person I've ever met..
 
It's pinatas time again set to the soundtrack of the ohh no no no cat
Can someone pull up those gifs plse
 
nonstopflu said:
exactly... they can (subjectively) label everyone around them as faulty, thereby anointing themselves as superior & perfect. I knew someone socially who is a therapist and she "diagnosed" everyone around her all the time (presumably) to cope w her own insecurities... the meanest, most toxic person I've ever met..
Click to expand...

BTW - this 2013 letter from the (now former) NIMH director thomas insell is remarkably sensible for a shrink! too bad he left.

"But it is critical to realize that we cannot succeed if we use DSM categories as the “gold standard.”2 The diagnostic system has to be based on the emerging research data, not on the current symptom-based categories. Imagine deciding that EKGs were not useful because many patients with chest pain did not have EKG changes. That is what we have been doing for decades when we reject a biomarker because it does not detect a DSM category. We need to begin collecting the genetic, imaging, physiologic, and cognitive data to see how all the data – not just the symptoms – cluster and how these clusters relate to treatment response."

https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml
 
nonstopflu said:
BTW - this 2013 letter from the (now former) NIMH director thomas insell is remarkably sensible for a shrink! too bad he left.

"But it is critical to realize that we cannot succeed if we use DSM categories as the “gold standard.”2 The diagnostic system has to be based on the emerging research data, not on the current symptom-based categories. Imagine deciding that EKGs were not useful because many patients with chest pain did not have EKG changes. That is what we have been doing for decades when we reject a biomarker because it does not detect a DSM category. We need to begin collecting the genetic, imaging, physiologic, and cognitive data to see how all the data – not just the symptoms – cluster and how these clusters relate to treatment response."

https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml
Click to expand...
The blind leading the blind...
 
"Empathy" and "Science"

came into federal immigration custody in January 2016. He was transferred to Shiloh RTC in June of 2016 where he remained until December 2016.

During his time at Shiloh RTC, was placed on numerous psychotropic medications including Duloxetrine, Clonazepam, Olanzapine, Geodon, Latuda, Divalproex, and Haloperidol. Attachment 9.

This combination of drugs includes four different classes of medication, the majority of which, four of the six, are antipsychotics with very limited FDA-approved uses in children and adolescents. The use of multiple antipsychotic medications at the same time is inconsistent with medical guidelines. Moreover, the use of Clonezepam (trade name Klonipin) indicates that the other drug combination may have caused significant adverse effects – such as akathisia, a severe movement disorder. ORR Records indicate that, at times, was simultaneously placed on six psychotropic drugs, plus two additional drugs “as needed.” Attachment 9.

In addition to the regular psychotropic medications he was placed on, was forcibly medicated on several occasions at Shiloh RTC, as well. Plaintiffs’ review of file revealed nothing to indicate that either or any family members provided consent for any of these medications.

An independent psychologist who evaluated concluded that the multiple diagnoses was assigned while at Shiloh RTC were not justified based on his behavior and clinical presentation. For example, was diagnosed with Psychotic Disorder when he displayed none of the typical features of a psychotic disorder, but instead presented with autoimmune encephalitis and pneumonia.

During his time at Shiloh RTC, the Shiloh psychologist identified multiple diagnoses, including Psychotic Disorder, Obsessive Compulsive Disorder and Bipolar Disorder assigned to that were inconsistent with his behavior. These diagnoses resulted in the prescription of inappropriate medications that had adverse side effects, including weight gain of almost 100 pounds.

After arrived at Yolo County Juvenile Detention Facility, the Yolo psychologist recommended that he taper off of his medications.
Click to expand...
(emphasis added)

UNITED STATES DISTRICT COURT

CENTRAL DISTRICT OF CALIFORNIA - WESTERN DIVISION

Jenny Lisette Flores, et al.,

Plaintiffs,
v.
Jefferson B. Sessions, Attorney General,
et al.,
Defendants.

Case No. CV 85-4544-DMG (AGRx)
EXHIBITS IN SUPPORT OF MOTION TO
ENFORCE SETTLEMENT (VOL. 2: EXS.
21-30, PAGES 109-73, REDACTED
EXHIBITS ONLY)



https://www.documentcloud.org/documents/4525292-420-2-Exhibit-Vol-2-Exs-21-30-Pages-109-73.html
 
Fun as all this psychiatry bashing may be, I do think it’s a subject that warrants further investigation and study.

Unfortunately, like much of the well conducted scientific research into ME/CFS, there hasn’t been enough of it.

It would be lovely if they consistently held themselves to high standards of scientific rigour and proof.

...sorry, here my thoughts evolve: when/why/how did psychiatry become separate from neurology??
I can see why you might want a gastro-neurological combined field etc sometimes but what reason did we have to split the mind from the brain in a medical (as opposed to faith or religious) context?

Rambling again, darn. Stopping.
 
I think its historical. So historically, "nerve" diseases were things like Parkinson's disease (early 1800s), and hemiplegia from strokes. So things that looked sort of "physical". Things that didn't have any physically detectable signs were "madness".

I think it just went on from there, with neurology accounting for an increasingly larger share of the terrain as they discovered neurological bases for things like dementia (like Alzheimers), epilepsy, etc.
 
You must log in or register to reply here.
Back
Top Bottom