This is not intended to discourage people to seek help. If you need help, please be seen. Psychiatrists are not perfect but are preferable to not going out of fear of psychiatry or stigma or whatever. If you are suicidal or feel you might hurt someone call a hotline, call 911, go to an ER and scream until you are seen if needed. If you have been feeling down or have wide mood swings or hearing voices, don’t let anyone, including psychiatrists, get in your way of getting help.
There are few things more soul-crushing than being hurt by people with good intentions but are oblivious to the damage they cause. Of course, not all psychiatrists are bad at their job. Many of the good ones don’t seem to realize that they are causing hurt.
Psychiatry is a pseudo-science. The DSM is a monument to pseudo-science. It is a diagnostic manual, made up mostly out of thin air, in a group of committees. Things are added, removed, and merged in each new edition. Politics rules the DSM, not science. There are arbitrary definitions that cover many diagnoses that are not measurable or testable. Mental diagnoses magically become other diagnoses or disappear entirely. Many of these diagnoses have no proven cause and no proven treatment. Even a well-known diagnosis like major depression has no proven causes, so its treatment is not very focused.
Don’t be surprised that if someday, the cause of depression is found and that cause and effective treatment of depression is completely different from what they do today.
The typical approach to treating mental illness is to place you in one or more defined boxes from the DSM that most closely matches what you are telling them. That is another strike against psychiatry; there is little objectivity in the exams. They have an objective portion in each exam note but is based on what you tell them and what the examiner observes. In other words, it is the exact opposite of objective.
There is no test to confirm the diagnosis in most cases. If you go to a real MD for a physical issue, they might have an idea of what is wrong and order tests to confirm it before proceeding. Those tests will determine the treatment protocol, and it is effective in most cases.
With psychiatry, the best you will get is one or more multiple-choice tests, which are self-reporting and are “blunt little tools” to quote the eminent Dr. Hannibal Lecter.
Next, they come up with a treatment plan using a unique method not seen elsewhere in medicine.
I like to call it the throwing-crap-on-the-wall-and-see-what-sticks-and-ignore-the-mess-it-makes method. Each shrink has the go-to meds that they try first. Then they work down an arbitrary list of meds from the set of meds that are either approved for your issue or have some evidence that it works and is prescribed off-label. Make no mistake, the list is entirely arbitrary and not based on your unique circumstances. They will finally stop when something is found that has an acceptable benefit/drawback ratio for the patient. That ratio is often determined by the dart-thrower that calls themselves a doctor.
Off-label means that a medication is used for a condition that it is not approved. Amazingly, that is not illegal, and it is extremely common. In psychiatry, it is typically used as an adjunct to another medication. A common example is adding an antipsychotic to an antidepressant, even if the patient is not psychotic. It can not be overstated: antipsychotics have extremely harsh and potentially dangerous side effects.
Heaven help you if a single med failed to work. Now, you have to go through it again, with a new drug, while also taking the old one that didn’t work all that well. Polypharmacy is very common in psychiatry. If a drug isn’t working, find another to force the first one to behave itself. Patients with depression and anxiety might end up on 3-6 meds, sometimes more. More often than not, side-effects are dealt with by more drugs, which can cause more side effects.
It would be comical if the potential damage inflicted is not so terrible. The drug merry-go-round can be a severely painful process, both mentally and physically.
Making matters worse, it is a rare psychiatrist that looks for underlying causes.
Mental disorders can be caused by a variety of physical issues, and those issues are almost always ignored. I have had many shrinks in the past 21 years, and only one ran blood work, and that was last year. He kept screwing up the lab order, ordering tests that have no real meaning medically. My primary doctor had to take over to get the correct labs run. Laughably, he thought my low testosterone was the cause of my mental illness for 21 years. It was ridiculous and said as much. My primary doctor also thought his hypothesis was groundless. To her credit, she responded to him with more tact than I did.
Psychiatrists may have gone to medical school, but it is a joke to call them medical doctors. They don’t even perform therapy because an MS or Ph.D. in Psychology is cheaper than an MD. They hand out meds, track side effects, and not much else.
So how does one who truly needs help minimize the damage a shrink can cause? Simply put, education. Focusing on anything when your mind is not well is sometimes the hardest thing in the world to do, but educating yourself is your best chance at success. Just know that all the education in the world can only aid you: it is not a silver bullet.
Learn about meds, side-effect profiles, and how much better they performed in trials against placebo. A shocking amount of psych meds are marginally more effective than placebo. Learn about the various therapy techniques and figure out what you might respond to better. Although, the effectiveness of both pills and therapy will be unknown until you give it a go.
If you are at risk for diabetes, avoid meds that raise blood sugar. If you have cholesterol issues, avoid meds that raise cholesterol and triglycerides. Granted, that is removing many potential meds, but it is the sort of thing you need to do to minimize the pain. If you have no significant risk of other serious health problems, don’t go into treatment with a wide-open attitude. They can still cause serious issues, and getting off psych meds can be very painful. These are dangerous drugs that require caution and carefully noting any problems.
Going to a psychiatrist is a lot like going to the dentist. You aren’t happy to go and most likely won’t leave with a smile on your face. Yes, I have dental anxiety. Why do you ask? That in itself sets up a negative impression, even before you get there, which can color the session. This anxiety is an issue for the patient and something that shrinks don’t seem to understand. If your shrink acts all superior and is issuing edicts that you are expected to follow without question, the way to combat that is to bring yourself to their level.
To do that takes work and the luck of the draw. If your shrink isn’t listening to you and simply dictating, it is simpler to move on. Although, given a specific circumstance being dictated to might be the most useful course for a patient. Occasionally, we have no insight or perspective. Sometimes, a person might lose control of their reasoning faculties and need firm guidance. If you are lucid enough to do research, you are capable of being in control of your treatment. There is no one-size-fits-all answer in psychiatry. Sticking with an unreasonable shrink can cause unbelievable amounts of damage.
That might be the worst thing about this. Your bad doctor is another’s lifesaver. Like meds, you won’t know how a specific provider is for you until you see them. As much as you need to challenge your doctor, your doctor needs to challenge you. I am not advocating for an adversarial process, and your doctor will know more about psychiatry than you. However, you know more about your condition than anyone else in the world. No one seems to experience and deal with mental health problems in the same way. Your shrink can talk about it in general terms that may or may not apply to you until you let them know, with specificity, how your condition and meds affect your life. Open dialog between two people with the same goals is generally the better path.
The thing to remember is that you are in charge. Seeing a psychiatrist doesn’t remove your rights or ability to make decisions. Getting a person declared incompetent to manage their medical decisions is a legal process and has a high bar and is not invoked often. At least in the US.
Therapy has another factor to consider: the therapist. You need someone you can respect, trust, and who has your best interests at heart. You should find someone who is kind but firm. Someone who will push you out of your comfort zone, and be willing to confront you, and will be receptive to without causing you to shut down. They should also be your cheer section. That is a balancing act that may be tough to find, and it may take a while to find the perfect fit.
When therapy goes wrong, it can be devastating. I have physical and mental scars to attest to that. I had a therapist that was totally against me. I was so messed up when I started seeing her, and I couldn’t see how toxic she was. My ex-wife hated her and told me that she was against me. Every session was antagonistic, and any push-back got labeled as passive-aggressive. Any attempt at a social life was met with derision and mockery.
I met one of the best friends I have ever had during this time, and she did so much to help me, but my therapist said it was an unhealthy relationship, even though we were never more than friends. We got along well, helped each other through some issues, and had fun. That seems to have been a bad thing. During all this therapy, I not-at-all-surprisingly got worse and worse until I got committed for a week. That was the best week I had had in several years because it got me away from her. Not long after that, I ditched her, and I magically improved and did it very quickly. That was 1999, and I haven’t seen a therapist for more than one session since. I probably should go back to one since I am almost med-free but nowhere near free of symptoms. I still hear her voice prattling in my head after all these years, making it difficult to even think of having a social life.
So this was a lot of whining, but what can be done to improve things? As patients, there is little to do to change an established system that governs itself through non-scientific methods. All we can do is educate ourselves, be assertive, and don’t be afraid to fire your psychiatrist or therapist. The field itself needs to be more scientific and less political. There is some progress on that front. As science begins to understand mental issues, the petty political garbage will be pushed out. Studies are being done with therapy and fMRI’s to see what therapy is doing or not doing, to the brain, for example. The important thing to remember is that psychiatry is just slightly out of the dark ages.
