Psychiatry and our society

[mlp]

My professional life as a psychiatrist has been spent gaining more and more respect for the power of psychiatry to heal people, while watching the profession itself become a shadow of itself, partly due to the ineffective, misguided leadership of the American Psychiatric Association and other bodies that we entrusted to deploy our resources to the public good.

Read more: http://www.foxnews.com/opinion/2012/07/25/colorado-shooting-reminder-that-psychiatry-not-gun-laws-needs-fixing/#ixzz21fAmN54q

This psychiatrist (and Fox News contributor) is arguing for compulsary mental health screening for students, among other things, and holding schools responsible if students go off the rails.

While some of his points (for instance, the gutted mental health care system) are well taken, IMO he displays an amazing naivite/lack of knowledge with respect to many of his points: for example, the difficulty of involuntarily committing someone, taken in conjunction with the limits placed on involuntary commitment - long enough to start them on med, but not long enough for the meds to begin to have a meaningful effect.

But the overriding problem with his entire argument, IMO, is his belief in the power and ability of psychiatry to heal, at least within the limits of what is currently known. It's difficult enough to effectuate even small beneficial changes when a person with a relatively *easy* disorder like depression is very motivated and has access to qualified professionals and appropriate meds. Dealing with more *severe* disorders, like schizophrenia, is all that much more difficult.

Your thoughts about mandatory mental health screenings, holding schools (and presumably employers, relatives, etc.) legally accountable, and the other recommendations made by this author?

 

[Forster]

Hmmmm, no. I can't imagine any psychiatrist being willing to give a clean bill of health and facing liability when they're wrong and someone goes off the rails.

I do think psychiatry can be helpful to those who recognize they have a problem and are motivated to help themselves. But forced, no.

 

[mlp]

Well, if a person underwent mandatory mental health screening, was found to be schizophrenic, refused treatment, and eventually went off to a McDonald's and killed seventy five people, if they wouldn't get to use insanity as a defense, on the grounds of refusing to be treated for it, I'd be for the mandatory screening bit, if not the forced treatment.

But how can you hold a person responsible for a decision to refuse treatment, if his condition wasn't such that he could make a rational decision about treatment?

 

[uno]

one of those slippery slopes.

I'd say use psychological instruments over psychiatry first and foremost.

it's a delicate balance between the rights of the citizens vs. the greater good of the society. i like to fence sit, esp. on this kind of thought.

 

[Freesia]

My experience of psychiatrists and psychologists have given me a complete lack of faith in them. I prefer counselors and therapists and even then you have to be careful.

 

[uno]

My experience of psychiatrists and psychologists have given me a complete lack of faith in them. I prefer counselors and therapists and even then you have to be careful.

i put them all in the same pot. i guess you could label me a counselor. egad.

 

[Freesia]

^ Im sure you are one of the good ones : ) .

 

[uno]

^ Im sure you are one of the good ones : ) .

Lol. i try. empathy and compassion, along with being honest and accountability go a long way.

 

[Freesia]

^ Yep those are all good qualities : ) .

 

[das_nut]

I don't think psychology is mature enough as a science to fix everything.

 

[K-II]

The only part I particularly agree with is the title, and even then, the way laws vary in the USA, some of them probably do need fixing.

 

[Moll Flanders]

I agree with him in that most people are very ignorant about mental health issues and I think it would benefit society in general if there was more awareness campaigns regarding MH. In the UK it is actually quite difficult to have someone involuntarily committed and rightfully so. Psychiatrists in the UK diagnose and prescribe meds but they don't actually give out therapy, well in my experience anyway. There is also a danger of being misdiagnosed by psychiatrists. I know two people who were mistakenly diagnosed as schizophrenic in the 1970's. There is a stigma with a lot of MH issues and some companies discriminate against hiring people with MH problems. Most mentally ill people are a danger to themselves rather than being dangerous towards other people.

 

[MrsSchu2u]

Here (and in other places I have worked) it is alarmingly EASY to commit someone for a 48 hour psych hold. It's an often abused system where the wrong people are far more frequently brought in than those who really might be a danger to themselves or others.

For the sake of full disclosure in this particular thread, I work in a mental health hospital. I'm a Psychiatric Social Worker. It is a broken system for sure, but there are a lot of good docs out there too.

 

[Moll Flanders]

Here (and in other places I have worked) it is alarmingly EASY to commit someone for a 48 hour psych hold. It's an often abused system where the wrong people are far more frequently brought in than those who really might be a danger to themselves or others.

That is very worrying.

 

[K-II]

I'm the only person in my immediate family who hasn't stayed in a mental hospital.

To be fair though, my parents met in one.

 

[MrsSchu2u]

That is very worrying.

I find it less worrisome than I do sad and frustrating.

 

[mlp]

Here (and in other places I have worked) it is alarmingly EASY to commit someone for a 48 hour psych hold. It's an often abused system where the wrong people are far more frequently brought in than those who really might be a danger to themselves or others.

For the sake of full disclosure in this particular thread, I work in a mental health hospital. I'm a Psychiatric Social Worker. It is a broken system for sure, but there are a lot of good docs out there too.

I agree there are good docs, good social workers, counselors, etc.

I just don't think that the field of psychiatry/psychology/counseling is at a point where it can reasonably meet people's expectations. People seem to assume that anything is curable, if sufficient effort is put forth and the right meds and counesling are provided. I just don't think the picture is that rosy, and it may never be.


The problem with 48 hour holds is that they may stop people in the short term from committing suicide or harming others, but it's not enough time for meds to kick in.

 

[uno]

.

I just don't think that the field of psychiatry/psychology/counseling is at a point where it can reasonably meet people's expectations. People seem to assume that anything is curable, if sufficient effort is put forth and the right meds and counesling are provided. I just don't think the picture is that rosy, and it may never be.

.

I doubt that it will ever be adequate for all of the complexities, irregularities and general fruitiness of the human mind and psyche.

 

[Moll Flanders]

Just to say I don't disagree that some patients need to be held involuntarily. During my therapy I met a man who managed to cut into part of his arm with a saw while he was heavily on drugs and I met a woman who poured boiling oil on her arm. Last year I used to visit a mental hospital for treatment and while I was walking through the grounds I would hear people screaming while they were dragged into the drying out/detox section and I can understand that certain people need immediate help.

 

[MrsSchu2u]

I agree there are good docs, good social workers, counselors, etc.

I just don't think that the field of psychiatry/psychology/counseling is at a point where it can reasonably meet people's expectations. People seem to assume that anything is curable, if sufficient effort is put forth and the right meds and counesling are provided. I just don't think the picture is that rosy, and it may never be.


The problem with 48 hour holds is that they may stop people in the short term from committing suicide or harming others, but it's not enough time for meds to kick in.

Anyone who believes that a mental health issue can be cured needs serious education. It just isn't. Period. It's a long term chronic condition and needs to be managed as such.

48 hours holds are often enough time to get through the immediate trigger and halt the impulsive suicide attempts. The vast majority of people who attempt suicide are acting on impulse. Not all, of course. Meds can be started and follow up can be scheduled. Again, not a great system, but given the state of health care, it's what we work with.