Opinion Piece: Current Psychiatry and its Discontents

[Snow Leopard]

• Parkinson's -- due to too much (ahem) 'alone time', an accompanying perversion and lack of self-control implied

2015??! WTF?

 

[JaimeS]

2015??! WTF?

Didja see the date on the AIDS one?

I don't know enough of medicine's history to say for sure whether we are seeing a resurgence/renaissance of psychosomatic attributions, but it may be the case.

 

[arewenearlythereyet]

and look at this one on epilepsy

http://emedicine.medscape.com/article/1186336-overview

Role of the neurologist in the psychiatric management of patients with epilepsy
As neurologists, we tend to focus on seizure control, and psychiatric comorbidities are often underestimated. Recognizing psychiatric manifestations is an area that needs improvement. Once symptoms are identified, the following questions arise [2]:

• Are the symptoms related to the occurrence of seizures (preictal, ictal, postictal)?
• Are the symptoms related to AEDs?
• Is the onset of symptoms associated with the remission of seizures in patients who had previously failed to respond to AEDs?

Because of the phenomenology of epilepsy, the close association between epilepsy and psychiatry has a long history. The traditional approach to epilepsy care has been to focus on the seizures and their treatment. Concentrating only on the treatment of the seizures, which occupy only a small proportion of the patient's life, does not seem to address many of the issues that have an adverse impact on the quality of life of the patient with epilepsy.


Sackellares and Berent stated that comprehensive care of the epileptic patient requires "attention to the psychological and social consequences of epilepsy as well as to the control of seizures." [3]


Although undoubtedly important in the care of the patient with epilepsy, advances in neurologic diagnosis and treatment tended to obscure the behavioral manifestations of epilepsy until Gibbs drew attention to the high incidence of behavioral disorders in patients with temporal lobe epilepsy.


Neurologists it would seem are just as culpable of holding the door wide open for psychobabbling colleagues to prey on people with epilepsy as well.....as if the stigma of this wasn't bad enough!

Its progress from demon possession and burning for being a witch I suppose.

 

[KME]

• Parkinson's -- due to too much (ahem) 'alone time', an accompanying perversion and lack of self-control implied

J

I'm not a fan of psychologising illness at all. However, I think there may be a misunderstanding here with the Parkinson's example– some medications for Parkinson’s have a side effect for some patients that reduces their impulse control. So some patients with Parkinson’s that is being treated have problems with gambling, overeating, hypersexuality etc. These are very real and very debilitating symptoms for some people who are being treated for Parkinson’s, with horrible consequences for the person and their family and friends. They do not imply that Parkinson’s is psychosomatic at all; they are very unfortunate side effects of medications. The cause-effect relationship is known, and it is that the medications can cause a side effect of reduced impulse control in some patients, manifesting as hypersexuality in some, gambling in others, etc.


See here:

https://www.parkinsons.org.uk/information-and-support/impulsive-and-compulsive-behaviour


The link you provided specifies that hypersexuality can occur with treatment for PD: “Hypersexuality (HS) was one of the earliest examples of an impulse control disorder (ICD) or behavior to be associated with treatment for Parkinson's disease (PD)”. Further down they again specify hypersexuality as “a complication of treated PD”.


It is probable that Parkinson’s has been misunderstood as psychosomatic by some at some point, but the link provided is not saying this.

 

[JaimeS]

It is probable that Parkinson’s has been misunderstood as psychosomatic by some at some point, but the link provided is not saying this.

Agreed! Interesting.

I think we'd need to get a decent text on the history of psychologization to find information. Medicine doesn't like to admit to its mistakes.

 

[Large Donner]

Didja see the date on the AIDS one?

I don't know enough of medicine's history to say for sure whether we are seeing a resurgence/renaissance of psychosomatic attributions, but it may be the case.

I think we are definitely in an age of corporate diagnosis wherby growing brands and one sized fits all diagnosis benefits markets and governments. I have long thought that the evolution of the CFS brand is becoming less and less about marginalising ME (they seem to have succeeded at that decades ago) and more and more about encapturing as many illnesses under CFS type banners as possible, whether it be for the duration of that patients life or to minimize or stall insurance or disability payments.

This can easily happen by a combination of design and or default and once the meme is established there are just too many obstacles in the way of overturning it and too many benefits to the powerful not to maintain it.

This is also apparent in the new notions of pain clinics and how the word "rehabilitation" has now somehow transformed to mean cure right infront of our eyes.

People go through a "rehab" process after becoming permanently paralyzed from the waist down for example but it doesn't mean they are cured. Old people go through rehab checks to get them back into their own homes after being in hospital from a fall at home but it doesn't mean the numerous ailments that led to the fall no longer exist.

I know in the case of my grandma when she had her last fall in her house the "rehab" was just a process of tick boxes purely designed to prohibit the need for her to have full time care especially in a care home which would have cost four to five times more than just dumping her back in her flat. After "assessing " her by observing her putting a potato in the microwave and turning the kettle on for a cup of tea she was deemed rehabilitated.

She was capable of neither yet the tick box "rehabilitation" caused her to be denied extra help and no doubt went down somewhere as a successful cure for her last recorded medical episode. She then sat at home for the last few months of her life paying out of pocket for help alongside help from the family, barely able to draw a breath and in constant pain.

Most of medical science is now just a statistical exercise in my opinion.

 

[JaimeS]

the evolution of the CFS brand is becoming less and less about marginalising ME (they seem to have succeeded at that decades ago) and more and more about encapturing as many illnesses under CFS type banners as possible, whether it be for the duration of that patients life or to minimize or stall insurance or disability payments.

A quick look at how the definition of ME in the UK gets more and more inclusive with each decade and it becomes very tough to argue with this point of view.

She then sat at home for the last few months of her life paying out of pocket for help alongside help from the family, barely able to draw a breath and in constant pain.

That's terrible.

When it comes to medicine, I feel it's suffered more than many other professions (except, perhaps, for education) from becoming more and more automated. Physicians are harassed, with little time for patients, and have trouble navigating the more and more complex waters of health insurance, at least here in the US. The best ones I know are constantly doing things that are intended to trick the system: yank the right lever in the complicated machine to get the patient what they need. That requires cleverness, a rather devil-may-care attitude about said machine, and a determination to help, even when it gets tricky. Needless to say, a rare confluence of characteristics. Most people are just trying to make it through their day.

As a result, medicine is hurtling towards Big Data -- and by that I mean, your toilet will soon be analyzing your pee metabolites, a drop of your blood will soon be on a chip ready for analysis, and a machine will spit out what's wrong, or at least make some predictions for humans to interpret. Then we may actually get very good medical care, but we are here in the middle: the vast wasteland between honest, empathetic human care and total automation.

J

 

[Sean]

Sean said: ↑
It is not just the ME/CFS world they are savaging, we are being used a Trojan horse to impose this crap upon the whole of society.

That's an interesting statement. How so?

J

Pardon late response, been down for a couple of days.

If you follow the timeline of their publications from the late 1980s on, it broadly works outward from ME/CFS & FM, first to other 'unexplained' physical symptoms, then to other diseases, and finally on to the entire population. I am confident that when all the contemporary official records are eventually declassified, they will show the same basic pattern in their technical policy advice to governments.

Using us as guinea pigs is another way to look at it.

 

[Snow Leopard]

As a result, medicine is hurtling towards Big Data -- and by that I mean, your toilet will soon be analyzing your pee metabolites, a drop of your blood will soon be on a chip ready for analysis, and a machine will spit out what's wrong, or at least make some predictions for humans to interpret. Then we may actually get very good medical care, but we are here in the middle: the vast wasteland between honest, empathetic human care and total automation.

Big data in the near term is going to lead to even more sloppy decision making, with a lot of associations with poor specificity being made out to be a big deal by people who don't know any better (usually anyone who isn't a statistician).

 

[user9876]

Big data in the near term is going to lead to even more sloppy decision making, with a lot of associations with poor specificity being made out to be a big deal by people who don't know any better (usually anyone who isn't a statistician).

I don't think statisticians understand big data. Often different techniques are used that make processing very large data sets efficient. People deal with big data tend to like being called data scientists.

But the big thing won't be the big data but better and cheaper sensors. Like the one that Ron Davis has been talking about others talk about nano fingers for analyzing proteins. Because these are essentially chips the theory is they can be made relatively cheaply. There is also talk of micro-fluidics which concerns moving very small quantities of liquids (for example blood) onto the sensors for testing. Such data can then be combined with other sensors such as from wearables to monitor movement, heart rate etc. That may improve the state of knowledge simply by making it possible to make many more readings and do so over time.

 

[JaimeS]

But the big thing won't be the big data but better and cheaper sensors.

Agreed -- hence the toilet comment and the drop of blood comment. Soon it's gonna be common to hear people muttering about their metabolites who ain't us.

 

[boombachi]

Do s one know if there are recent examples of psychiatrists attacking a whole population of patients like this?

I can't imagine someone saying publicly such things about patients suffering from depression or anxiety.

Try googling borderline personality disorder to read the delights psychiatrists have written about them. If you ever get a chance to speak with someone with this diagnosis, ask them how they are treated by ANY medical staff or someone who has been to the emergency room for treatment for self harm.

I know i am a bit late responding to this but just had to point out there are other victims of this kind of attitude.

 

[Solstice]

Try googling borderline personality disorder to read the delights psychiatrists have written about them. If you ever get a chance to speak with someone with this diagnosis, ask them how they are treated by ANY medical staff or someone who has been to the emergency room for treatment for self harm.

I know i am a bit late responding to this but just had to point out there are other victims of this kind of attitude.

Not really surprising tbh. If people are gonna act bad against us, why wouldn't they act bad against others too. It's about picking easy victims more than anything I reckon. Borderline has serious stigma-issues aswell.