Post by Admin on May 6, 2023 18:38:29 GMT
Drowned by doubts. Why am I thinking of leaving psychiatry?
By E. Baden and Editorial Mad in (S)pain -June 29, 2021
madinspain-org.translate.goog/ahogado-por-las-dudas-por-que-estoy-pensando-en-dejar-la-psiquiatria/?_x_tr_sl=auto&_x_tr_tl=en&_x_tr_hl=en&_x_tr_pto=wapp
I am a recent career psychiatrist who has been practicing adult psychiatry in outpatient care within a hospital mental health system in the United States for five years. I decided to go into psychiatry because listening to people is what I like the most. I am endlessly curious and interested in the human experience. A relative of mine had schizophrenia, was rejected by his family, and my heart went out to him and others struggling with similar experiences. I thought that, being a sensitive, non-judgmental and open-minded young man, this was the ideal career for me.
I started questioning psychiatry in my third year of residency. I read an article about delayed dysphoria or chronic depression caused by antidepressants, and intuitively it made sense. It made sense that keeping people on these drugs indefinitely can cause the person's system to counteract the drug. I did a presentation on the effects on the renal system of long-term lithium use that terrified me. I was saddened to learn that many people will live with permanent kidney damage after decades of taking the drug. I also began to understand the risks of antipsychotics and watched their use grow in ways that again horrified me. I saw these very strong, high-risk drugs being used for everything from insomnia to anxiety to behavior control.
In the meantime, I turned to psychotherapy, which gave me hope that kept me going. It's still a pleasure to practice. However, no one is interested in hiring a psychiatrist to offer psychotherapy. I work in an underserved area and as a concession they allow me to practice it a bit as an inducement to stay. I have come to the conclusion that the jobs are interesting above all because of the amount of money they generate, which translates into seeing more patients than can be attended with a certain quality.
After five years as a caring psychiatrist, I have seriously considered leaving this field. It makes me very sad, since I love the practice of psychiatry in its most genuine sense. A practice in which I take into account the multiple factors that influence the emotional state of the patient and prescribe very little medication. I am an extremely critical psychiatrist, but I believe that mental illnesses, although rare, do exist and that drugs used selectively, prudently, and for the shortest possible time are beneficial. Yet 90% of the people who come into my practice do not have a mental illness. They have emotional and psychological experiences of suffering. I estimate that 80% of these experiences are due to relationship trauma, both current (abusive or unsatisfactory relationships) and past (traumas caused by the people who cared for them). These are very serious problems; however, they are not medical problems and should not be medicalized.
However, patients come to me demanding that I diagnose a psychiatric disorder and sometimes they get very angry and offended when I don't. A good many tell me that they have "chronic depression and anxiety," which they believe is due to a disturbance in brain chemistry, and that they need lifelong medication. These patients have no other way to explain their suffering than through words like depression and anxiety.. It is very sad to see so many people suffering from such a deep disconnect with themselves due to the spread of a false story. I imagine they grew up with a caregiver who told them there was something wrong with them when they experienced a negative emotion—probably due to the caregiver's emotional incompetence—and now the medical system re-traumatizes them with the same abuse.
Patients are even more demanding with psychiatric medication and see me as someone who hands out prescriptions without talking. In fact, I have had patients tell me not to ask them about the factors contributing to their discomfort, as that was not my role, and that I only have to ask them about their symptoms.
Faced with these issues, something that has greatly disappointed me is the attitude of my colleagues. Psychologists and some psychotherapists, whom I expected to be allies, have been the complete opposite. I hoped that these professionals would not advise medication and promote emotional recovery. Instead, most of my referrals come from psychologists, who misdiagnose patients with myriad serious disorders, including ADHD and bipolar disorder.
Just the other day, a therapist referred me to a young woman who was diagnosed with Bipolar Disorder for having repeated bouts of racing thoughts and overwhelming feelings. The patient was a young perfectionist obsessed with the diagnosis, and she hoped that a mood stabilizer would transform her into an idealized version of herself. I suggested that she did not have bipolar disorder or another mental illness and that infrequent or difficult emotional experiences were normal. I encouraged her to accept herself and explore contextual elements and ways to deal with her racing thoughts.
However, it was not satisfactory to him, and he told me that he did not agree and that he would seek a second opinion. Most disturbingly, I detailed the adverse health effects of "mood stabilizers" to him, but he was unfazed, despite being asked by a therapist to "apply" a mood stabilizer to a patient. due to his frequent visits to the emergency room for anxiety. This patient was not only not bipolar but, in my opinion, she also did not have a mental illness. In my experience, many therapists when they are not effective are guided by her ego, and tend to interpret their own lack of effectiveness as the need to medicate the patient. Something that is even more crazy and totally frustrating, since these therapists are not involved in the problems of psychiatry,
Primary care physicians are usually very nice people, but because of their mental training (or lack thereof), they prescribe psychiatric drugs lightly and inappropriately. In my experience, professional nurses are especially dangerous in this regard, especially when it comes to prescribing stimulant drugs. They often send me messages complaining that a patient is not "getting better" and that I am not prescribing properly. These patients often have abusive relationships but refuse to leave them. I do not want to be part of the numbness of their original anguish, which challenges them to abandon the abuser.
Medicine in general is creating a lot of disease through overdiagnosis and overtreatment. No wonder Emergency Units and Psychiatric Hospitals are overwhelmed: we are creating “treatment resistant” patients at an accelerated rate because they are not mentally ill.
Since there is no one in my field with whom I can talk about my feelings, I feel completely alone. When I started sharing these concerns at my residence, I was met with strange looks. Sometimes I write about these topics on a psychiatrist forum. Some participants support me, but most tell me that I should just get over it, shut up, stop making drama, open my own private practice, etc. None of these suggestions will change our field or the damage done to society. On the contrary, if someone comments on the amount of money that can be made by treating as many patients as possible, people support them, and no one is surprised by this unethical practice.
Therefore I am trying to find a way out. I will miss my patients very much. Some listen to me and decrease or stop medication and explore the path to emotional health and self-acceptance. Practicing psychiatry in a healthy environment, in which I have enough time for each patient and without pressure to prescribe would be the ideal scenario, but unfortunately it is not the standard of care. I have read the stories of the patients on Mad in America, and I am so sorry for the mistreatment and abuse they have suffered. I deal with cases like those described quite frequently. Sometimes I can help, but other times it's too late.
When I entered psychiatry, as an innocent 25-year-old novice, I had no idea what I was about to discover. If I had known then what I know now, I would not have chosen this field. At the same time, I have learned a lot about myself and other people and have generally become a more conscientious and whole person. I have become more understanding and accepting of my feelings and emotions and have learned to embrace, rather than reject, my emotional self. Along the way I have helped some, but the dynamics of psychiatry are very strong and I feel that I am drowning trying to swim against the current. I'm not sure what the future holds, but until then I need to keep working, which is why I'm not attaching my full name to this article, I'd be fired for sure. Nevertheless,
Article translated by Mikel Valverde and originally published in Mad in America on May 14, 2021
By E. Baden and Editorial Mad in (S)pain -June 29, 2021
madinspain-org.translate.goog/ahogado-por-las-dudas-por-que-estoy-pensando-en-dejar-la-psiquiatria/?_x_tr_sl=auto&_x_tr_tl=en&_x_tr_hl=en&_x_tr_pto=wapp
I am a recent career psychiatrist who has been practicing adult psychiatry in outpatient care within a hospital mental health system in the United States for five years. I decided to go into psychiatry because listening to people is what I like the most. I am endlessly curious and interested in the human experience. A relative of mine had schizophrenia, was rejected by his family, and my heart went out to him and others struggling with similar experiences. I thought that, being a sensitive, non-judgmental and open-minded young man, this was the ideal career for me.
I started questioning psychiatry in my third year of residency. I read an article about delayed dysphoria or chronic depression caused by antidepressants, and intuitively it made sense. It made sense that keeping people on these drugs indefinitely can cause the person's system to counteract the drug. I did a presentation on the effects on the renal system of long-term lithium use that terrified me. I was saddened to learn that many people will live with permanent kidney damage after decades of taking the drug. I also began to understand the risks of antipsychotics and watched their use grow in ways that again horrified me. I saw these very strong, high-risk drugs being used for everything from insomnia to anxiety to behavior control.
In the meantime, I turned to psychotherapy, which gave me hope that kept me going. It's still a pleasure to practice. However, no one is interested in hiring a psychiatrist to offer psychotherapy. I work in an underserved area and as a concession they allow me to practice it a bit as an inducement to stay. I have come to the conclusion that the jobs are interesting above all because of the amount of money they generate, which translates into seeing more patients than can be attended with a certain quality.
After five years as a caring psychiatrist, I have seriously considered leaving this field. It makes me very sad, since I love the practice of psychiatry in its most genuine sense. A practice in which I take into account the multiple factors that influence the emotional state of the patient and prescribe very little medication. I am an extremely critical psychiatrist, but I believe that mental illnesses, although rare, do exist and that drugs used selectively, prudently, and for the shortest possible time are beneficial. Yet 90% of the people who come into my practice do not have a mental illness. They have emotional and psychological experiences of suffering. I estimate that 80% of these experiences are due to relationship trauma, both current (abusive or unsatisfactory relationships) and past (traumas caused by the people who cared for them). These are very serious problems; however, they are not medical problems and should not be medicalized.
However, patients come to me demanding that I diagnose a psychiatric disorder and sometimes they get very angry and offended when I don't. A good many tell me that they have "chronic depression and anxiety," which they believe is due to a disturbance in brain chemistry, and that they need lifelong medication. These patients have no other way to explain their suffering than through words like depression and anxiety.. It is very sad to see so many people suffering from such a deep disconnect with themselves due to the spread of a false story. I imagine they grew up with a caregiver who told them there was something wrong with them when they experienced a negative emotion—probably due to the caregiver's emotional incompetence—and now the medical system re-traumatizes them with the same abuse.
Patients are even more demanding with psychiatric medication and see me as someone who hands out prescriptions without talking. In fact, I have had patients tell me not to ask them about the factors contributing to their discomfort, as that was not my role, and that I only have to ask them about their symptoms.
Faced with these issues, something that has greatly disappointed me is the attitude of my colleagues. Psychologists and some psychotherapists, whom I expected to be allies, have been the complete opposite. I hoped that these professionals would not advise medication and promote emotional recovery. Instead, most of my referrals come from psychologists, who misdiagnose patients with myriad serious disorders, including ADHD and bipolar disorder.
Just the other day, a therapist referred me to a young woman who was diagnosed with Bipolar Disorder for having repeated bouts of racing thoughts and overwhelming feelings. The patient was a young perfectionist obsessed with the diagnosis, and she hoped that a mood stabilizer would transform her into an idealized version of herself. I suggested that she did not have bipolar disorder or another mental illness and that infrequent or difficult emotional experiences were normal. I encouraged her to accept herself and explore contextual elements and ways to deal with her racing thoughts.
However, it was not satisfactory to him, and he told me that he did not agree and that he would seek a second opinion. Most disturbingly, I detailed the adverse health effects of "mood stabilizers" to him, but he was unfazed, despite being asked by a therapist to "apply" a mood stabilizer to a patient. due to his frequent visits to the emergency room for anxiety. This patient was not only not bipolar but, in my opinion, she also did not have a mental illness. In my experience, many therapists when they are not effective are guided by her ego, and tend to interpret their own lack of effectiveness as the need to medicate the patient. Something that is even more crazy and totally frustrating, since these therapists are not involved in the problems of psychiatry,
Primary care physicians are usually very nice people, but because of their mental training (or lack thereof), they prescribe psychiatric drugs lightly and inappropriately. In my experience, professional nurses are especially dangerous in this regard, especially when it comes to prescribing stimulant drugs. They often send me messages complaining that a patient is not "getting better" and that I am not prescribing properly. These patients often have abusive relationships but refuse to leave them. I do not want to be part of the numbness of their original anguish, which challenges them to abandon the abuser.
Medicine in general is creating a lot of disease through overdiagnosis and overtreatment. No wonder Emergency Units and Psychiatric Hospitals are overwhelmed: we are creating “treatment resistant” patients at an accelerated rate because they are not mentally ill.
Since there is no one in my field with whom I can talk about my feelings, I feel completely alone. When I started sharing these concerns at my residence, I was met with strange looks. Sometimes I write about these topics on a psychiatrist forum. Some participants support me, but most tell me that I should just get over it, shut up, stop making drama, open my own private practice, etc. None of these suggestions will change our field or the damage done to society. On the contrary, if someone comments on the amount of money that can be made by treating as many patients as possible, people support them, and no one is surprised by this unethical practice.
Therefore I am trying to find a way out. I will miss my patients very much. Some listen to me and decrease or stop medication and explore the path to emotional health and self-acceptance. Practicing psychiatry in a healthy environment, in which I have enough time for each patient and without pressure to prescribe would be the ideal scenario, but unfortunately it is not the standard of care. I have read the stories of the patients on Mad in America, and I am so sorry for the mistreatment and abuse they have suffered. I deal with cases like those described quite frequently. Sometimes I can help, but other times it's too late.
When I entered psychiatry, as an innocent 25-year-old novice, I had no idea what I was about to discover. If I had known then what I know now, I would not have chosen this field. At the same time, I have learned a lot about myself and other people and have generally become a more conscientious and whole person. I have become more understanding and accepting of my feelings and emotions and have learned to embrace, rather than reject, my emotional self. Along the way I have helped some, but the dynamics of psychiatry are very strong and I feel that I am drowning trying to swim against the current. I'm not sure what the future holds, but until then I need to keep working, which is why I'm not attaching my full name to this article, I'd be fired for sure. Nevertheless,
Article translated by Mikel Valverde and originally published in Mad in America on May 14, 2021