I was interviewed today on the Facebook page for a movie called "Medicating Normal" about the current problematic state of psychiatry - such things as malignant polypharmacy, the over-diagnosis of bipolar disorder and other b.s. diagnoses, doctors spending too little time with patients for a good evaluation, and such.
It can be seen at:
https://www.facebook.com/watch/live/?ref=watch_permalink&v=1479833659217305
As mentioned in my post of January 31, there are many studies showing a correlation between Adverse Childhood Experiences (ACE's) and a wide variety of psychiatric and physical conditions. This is probably also true of the effects on offspring of certain parental behavior problems.
Correlation does not mean causation. Answering the question of whether two characteristics that correlate are also involved in a causative relationship depends on a number of factors. How strong is the correlation? A weak correlation can be a statistical fluke, If there is a lot of natural variation in the characteristics being discussed, the found relationship may just be a coincidence.
Are there other variables that are not
controlled for that create the correlation?
In order to verify any relationship seemingly uncovered in any given
study, repeated experiments that lead to the same result become necessary. And even
if causation is involved, we may not know which variable was the causative
factor and which the result.
The metrics I tend to use also include
my answers to the following questions: If A and B are indeed causally related,
what else would I have to believe? Can I think of a third, uncontrolled-for
variable that could account for both A and B? Can I come up with any logical and
known facts or data that might be the explanation for an apparent causative
relationship, or does it seem inexplicable or even off the wall?
Last, is this result consistent with what I have seen clinically in my 40 plus years as a psychiatrist, or does it fly in the face of it? Now here it is possible that I might be looking at only confirmatory evidence of my opinions and discounting disconfirming evidence (confirmation bias), although I like to think I have at least a modicum of objectivity.
So I also ask other psychiatrists
and therapists if they’ve seen the same things I have in their clinical
experience. When I do that, I have to take into account that I asked my patients a lot of
questions that most therapists never even think about asking – for example, “What
does your mother-in-law think about this problem your daughter is having?” So
they might or might not be able to give me any relevant information.
Many studies showing the same thing
makes for a stronger case for causation. When it comes to ACE’s and later illnesses, both psychological and physical, they
usually pass most if not all of the tests above with flying colors. And they keep
on coming in. Here’s some recent additions:
Children who experience adversity ― including serious family illness or death, poverty,
neglect, or dysfunctional and stressful family relationships ― are at increased risk of developing cardiovascular
disease (CVD) in early adulthood, a large Danish study of patients aged 16 – 38
has found. Compared to young adults who experienced little adversity in
childhood, peers who experienced high levels of childhood adversity had about a
60% higher risk of developing CVD, the researchers found.
Bengtsson
J. et al. “Childhood
adversity and cardiovascular disease in early adulthood: a Danish cohort study.”
Eur Heart J. 2023 Feb 14;44(7).
In this study of more than 15,000 adolescents, higher levels of adolescent-reported
parental warmth, parent-adolescent communication, time together, academic
expectations, relationship and communication satisfaction, and maternal
inductive discipline were all associated with favorable outcomes in young
adulthood.
Participants rated their depression,
stress, optimism, nicotine dependence, substance abuse symptoms (alcohol,
cannabis, or other drugs), unintended pregnancy, romantic relationship quality,
physical violence, and alcohol-related injury.
This was done while controlling
for age, biological sex, race and ethnicity, parental educational level, family
structure, and child maltreatment experiences.
The serenity prayer:
God grant me the serenity to accept the things
I cannot change, the courage to change the things I can, and the wisdom to know the
difference.
When I read psychotherapy journals and posts on psychotherapy list-serves, it often sounds to me like the field has lost its collective mind. Some authors seem to think that every behavioral syndrome results entirely from some deficiency within a person, rather than being mostly a reaction to their social environment (the fundamental attribution error). If their patients are upset or anxious, they ask them things such as what is wrong with your thoughts or why don’t you know how to calm yourself down (cognitive behaviorists). Or what might be their deep-seated desires that they won’t face (psychodynamic therapists).
(To be clear I’m not talking about major psychiatric disorders that are most likely real brain diseases such as schizophrenia).
While these types of questions can be helpful for people who are not very disturbed about their lives and relationships, sometimes their use has been comical. As a psychiatrist named Jim Dillon put it:
“As a psychiatrist, I
cringe upon hearing recommendations for psychotherapeutic methods employed to
resolve ongoing social conflicts. It is like suggesting labor unions obtain
group counseling when the threat of a strike is the only strategy that will improve
their economic circumstances.”
Or teaching clients “mindfulness” when they are being invalidated,
criticized or abused by their family and spouses - instead of helping them learn how to put a stop
to the dysfunctional interactions.
As
I described in a previous post, more systemic or social types of therapy that involve family members
(family systems therapy), while still out there and being employed by masters’
level therapists, have fallen out of favor with psychologists. And they were
never taught to psychiatry trainees at all (except in a residency program that
I ran). This has occurred because of a number of social issues. Examples: Feminists thought
systems people were blaming just women, who are still the primary caretakers for
children; some folks believed that there were people using the “abuse excuse” for criminal behavior
and to avoid taking any personal responsibility for their problems; unscrupulous therapists were uncovering “false memories” of abuse through
suggestions to the highly suggestible, as well as through hypnosis.
That
last one also points to another issue that shows the field’s current state is
more political than scientific. Just
because some of the ideas therapists' used for problematic behavior were being misused in some contexts does not
automatically make them invalid. Furthermore, if some of aspects of complex
theories are wrong, that hardly means that all of them are wrong.
These phony arguments are also used to further the financial interests of pharmaceutical companies, who want to sell more pills. If everything is a disease, drugs should be all you need. They are also used by the medical insurance companies. These insurers refuse to pay for any longer-term psychotherapy treatments in order to better cash in. They only cover symptomatic treatment. Bogus “medical necessity” criteria are used to drastically cut down the number of sessions therapists can administer. In other words, the current models help the greedy. The federal parity law that says psychiatric disorders must be paid for by insurers just like physical disorders has been a complete joke.
Science
has clearly shown beyond a reasonable doubt that the structure of the “plastic”
human brain is in part shaped by interpersonal interactions. Most
of what we do in social situations is learned (or intuited as I believe some are), and is then done automatically in response to environmental clues. The brain has about
6 Billion neurons with up to a thousand connections each, and the circuits
change in response to what is learned. And learning also includes how to best react
to literally thousands of environmental factors operating at different times,
strengths and combinations.
An article published by Harvard
University Center for the Developing Child says that 700 new connections per second are made in the brains of newborns
within the context of care-giving relationships
Another recent study showed that small differences in a mom's
behavior early on in interactions with infants may possibly show up in child's epigenome
(epigenetics is the study of how genes are turned off and on in response to
such things as social interactions).
It is time for therapists to learn, not how to change their clients’ “internal” family system (another recent therapy fad), but how to help them react better to their external one.
Michael Shermer is the man behind Skeptic and the Skeptic Society. The group talks about all the crazy stuff people believe in and promotes science and
critical thinking. This book was originally published in 1997 and a new edition
came out in 2002. As someone who thinks that there are a lot of crazy ideas in
the mental health fields, I wanted to see if Shermer had any ideas about the nature of weird
beliefs that I had not already come across.
The book looks at some commonly seen unscientific ideas including abduction by aliens, recovered memories,
anti-evolution notions, and Holocaust denial. It tears apart the tricks that
leading “thinkers” in these movements use whenever they are seen in the media.
Shermer has debated many of them, and seems somewhat surprised by how likeable
and intelligent these people can be even when they are pushing very hateful
myths.
Their methods include focusing solely on
opponents’ weak points while avoiding saying anything definitive about their
own position. They use quotations by reasonable experts but use them out of
context. They take honest debates about one aspect of some phenomenon within a
field to dispute the entire field. They focus on what is not known while
ignoring things that are, and they emphasize data that does not fit the
prevailing wisdom while discounting data that does.
One of their tactics I am familiar
with is the use of the fallacy that if scientists were wrong about one part of
a complicated theory like evolution, then the whole theory must be wrong. This
reminds me of attacks on psychoanalysis. Just because Freud was wrong about the
pervasiveness of the Oedipus Complex or penis envy does not mean he was wrong
about the existence of intrapsychic conflicts and defense mechanisms.
All-or-none thinking is a hallmark of groupthink.
Another tactic is one which I have
written about. It occurs when a theory has been misused for foul purposes by a
political or social group. If fact, any idea
can be misused like that. Such misuse does not negate the validity of the
theory. The big one for me is rejection by a majority of evolutionary
biologists of the concept of kin selection because it might be used to justify
social Darwinism. One of the people that is responsible for this turn of events
is noted evolutionary biologist Stephen Jay Gould, who is someone frequently
quoted in a positive manner by Shermer throughout the book.
And speaking of groupthink, that is
something the author alludes to somewhat briefly but does not seem to completely
understand. In fact, groupthink maintenance is the best answer to the question
posed in the book’s title in a lot of cases. I recall when it hit me that oft-used
logical fallacies like begging the question and non sequiturs were not just random
weaknesses in critical thinking but had a purpose: enforcing group norms, which
are often, in turn, enforced by the use of illogical thoughts. In other words,
they have a biological purpose.
Instead, Shermer focuses on somewhat
more selfish reasons for why folks push a weird point of view. The thoughts are
comforting (like believing in a specific type of afterlife), or the idea helps
advance some political agenda like racist policies, or to sell books and
become famous. He also discusses our ubiquitous tendency to look for data that fits our
beliefs while discounting data that does not (confirmation bias). People are
very good at “seeing what they are looking for.” People of high intelligence
may even be better at that than those lower on that Totem Pole because they can devise
reasonable-sounding justifications for their beliefs.
Another issue I had is that the author seems to think that in many of these cases the people who spout nonsense really believe what they are saying, rather than saying them because of an ulterior motive of some sort. He opines, for example, that some of these people believe in, say, alien abduction because they also mistakenly believed that hypnagogic or hypnopompic hallucinations they experienced in which they saw an alien in their room. These hallucinations are actually a normal phenomenon that occasionally occur as people are drifting off to sleep or awakening from a deep sleep. Most of them only last a couple of minutes and, despite what the author says, feel somewhat dreamlike when the person comes to – at least those I’ve experienced did.
To think that very smart people who don’t know about this phenomenon wouldn’t
question their own sanity rather than believe that what they saw was real seems
to me to be a bit of a stretch. As he points out, a lot of these people are
quite bright, so they have to know that a lot of what they are advancing is
b.s.
Despite these limitations, the book
is a fun and interesting read. The history of fad-like belief systems is informative.
He has a lot of amusing stories about arguing about these nutty ideas with their champions
on talk shows like Phil Donahue.
A new article in a nursing journal discusses
the experience of Swedish families of people with members who have borderline personality disorder (BPD), and who have access to
something they call “Brief Admission” to the hospital because of recent
self-injurious behavior (SIB). In their study, 12 patients, whose age range is
not specified in the article, have picked out one of their family-of-origin relatives
or spouses for the researchers to interview. The relative is then interviewed
by phone by two of the authors and asked to describe their experiences as the
parents or spouse of someone with disorder. The two authors basically coordinate with
each other so they are basically covering the same types of questions.
The authors mention almost in passing that the
interviewers had to remind the relatives repeatedly not to focus their
discussion on the patient, but rather talk about their own experiences. Not
only that, but they also make the claim that “the burden experienced by
families of someone diagnosed with BPD involves greater suffering than those
with other mental disorders."
Now of course, if a loved one is acting in ways
like SIB that reminds everyone that suicide is an issue, they are going to
worry more about that person than they may have before. But how are we to know whether
the obsession with the patient that is described by the family members over and
over again was not what triggered the self-injurious behavior in the first
place? After all, some people with BPD hide the self injury from their families
(or at least the families are ignoring the evidence for it), while these
research subjects obviously did not.
What distinguishes one from the other? Well, in
my clinical experience, there are two reasons for this. When SIB is hidden,
it’s sole purpose is to stop the panic attacks that occur when a patient feels
helpless to alleviate a family problem. When it is not, the behavior does that
and also feeds into the parent’s
preoccupation with the patient’s mental health.
Of course, the parents will all claim that it was the patient’s behavior that created their preoccupation. This is the basic reasoning espoused by two support groups for parents of offspring that have BPD (TARA4BPD and NEA-BPD). They say such parents are sick and tired of being blamed by the psychiatric profession for their child’s condition.
As my
readers know, I agree that blaming parents is counterproductive because it
sidetracks any and all attempts at actually solving problems that are shared by
all members of the family and which were caused by events that took place over at least
three generations.
So how do we know which came first: the
parents’ preoccupation with the patient, or the patient’s self injurious
behavior? A true chicken-and-egg type question. My readers already know my
answer: the parents’ anxious and guilty preoccupation comes first, which then
leads to their child developing the role of spoiler
designed to somewhat control both the guilt and anger they see in their
parents. The family members then all continue to simultaneously feed into and
make worse one another’s problem behavior, especially over the long run.
The parents’ overblown preoccupation, albeit after the SIB has started, can be seen in comments the authors make throughout the study, starting with the above-mentioned statement comparing it to the parents of people with other psychiatric disorders.
Other examples: the family
members’ fear about the children makes “it difficult for them to prioritize
their own well being.” The family members have “a hard time allowing themselves
to have fun” – due to their feelings of “guilt and shame,” – not fear for their child’s life.
“Constantly prioritizing their loved one and ignoring their own well being meant that many of the families
suffered from their own mental illness and fatigue diagnoses…” “In this study,
feelings of helplessness and anger
and a constant need to monitoring their loved ones...”
It seems doubtful that the interviewers asked
certain questions about the parent’s pre-occupation having perhaps pre-existed
before their child’s SIB began. At least in their article, there is no mention
by the authors about the possibility that this was the case, despite their
making the following points: “…children can see if someone is unwell and can
withdraw and try to make themselves invisible” (that’s only one of many other
possible “helpful” responses). “When a parent suffers from mental illness, the
children can become carriers of their anxiety.” “Children of parents with
mental illness can take a great responsibility for their ill parents.” “…the
families and their loved ones’ lived experiences are considered to be linked
and interaction with each other.”
The other big problem with this study was that this was a highly biased set of subjects. As mentioned, the SIB of the subjects was known to their families. Also, recall that the patients had to pick a relative for the authors to interview, and the relative had to agree to it. Parents that were sexually or physically abusive would probably not be suggested by the patients, who often go to great lengths to hide the family’s secrets because of dire consequences.
They know what will happen if they spill
the beans. In the family, such revelations are responded to with denial, or
alternatively, with an accusation that the patient was at fault for, say, being
molested because of being seductive. Usually, everyone in the family including
the victim just pretends it never happened – as illustrated by mothers who had
been sexually abused by their father letting that man baby sit their own small
children when rest of the family suggests it.
And even if the subjects picked the abusive
parent, and the abusive parent agreed to be interviewed, it would be highly
unlikely that such abuse would be divulged. After all, if it were indulged, the
interviewers might have to turn them in!
In my
last post, I mentioned that the American Psychiatric Association rejected the
diagnosis of Developmental Trauma Disorder in 2011, and refused to acknowledge
that “…childhood adverse experiences lead to substantial developmental
disruptions” and added that this idea is “more clinical intuition than
research-based fact.”
In fact, there have been numerous studies showing a correlation between ACEs and a wide variety of clinical conditions. Below are brief descriptions of the results of four studies, recently published, addressing this contention. One is a review and meta-analysis, which is a research process used to systematically synthesize or merge the findings of, in this case, 39 (!) single, independent studies, using statistical methods to calculate an overall or 'absolute' effect.
Of course, the studies do only show correlations, which
means that they do not “prove” that ACE’s actually cause psychiatric
disorders or even symptoms. But the correlations are as good as any in the
psychiatric research literature, which is pretty much minimal in findings that prove actual causation for almost every psychiatric disorder.
Adverse Childhood Experiences
Among Adults With Eating Disorders: Comparison To A Nationally Representative
Sample And Identification Of Trauma
The primary objectives of the current study were: (1) to examine
and compare ACEs between two samples: treatment-seeking adults, and a
nationally representative sample of adults, (2) to characterize ACEs items and
total scores across demographic and diagnostic information in adults seeking
treatment for an ED, (3) to statistically classify ACEs profiles using latent
class analysis, and (4) to examine associations between ACEs profiles and
diagnosis. Results: Patients with EDs had significantly higher ACEs
scores than the nationally representative sample. Within patients with EDs, four latent
classes of ACEs item endorsement were identified. Patients with other specified
feeding or eating disorder (OSFED) and binge eating disorder (BED) were more
likely to fall into the "Household ACEs" and "Abuse ACEs" groups,
respectively, compared to anorexia nervosa-restricting subtype (AN-R).
Conclusion: Patients with EDs reported more ACEs than the nationally
representative sample, across all ED diagnoses.
“Adverse childhood experiences among adults
with eating disorders: comparison to a nationally representative sample and
identification of trauma profiles.” Rienecke,
Johnson et.al. Journal of Eating Disorders , volume 10,
Article number: 72 (2022).
Considerable Mental Health Burden Associated
With Childhood Trauma
Trauma is associated with
increased odds of anxiety disorders and any psychiatric disorder at age 6 years.
There is a considerable mental health burden in association with childhood
trauma.
“The association between childhood trauma and psychiatric disorders in low-income and middle-income Countries." Alckmin-Carvalho et. al., The Lancet Psychiatry, Oct. 31, 2022.
Association of Neural Connectome With Early Experiences of Abuse in Adults
In this
cohort study of 768 participants, individuals with abuse experienced during
childhood (but not adolescence) demonstrated an altered connectome [connections between brain neurons] of greater
functional connectivity [changes in usual and not pathological connections in various brain areas] associated with somatomotor and dorsal-ventral
attention brain networks, irrespective of current diagnosis or symptom state.
"Association of Neural Connectome With Early Experiences of Abuse in Adults." Korgaonkar et. al., JAMA Network Open. 2023;6.
A Systematic Review and Meta-Analysis of the Relationship Between Childhood Adversity and Adult Psychiatric Disorder.
A review and analysis of 39 different studies suggests that childhood and adolescence is an important time for risk for later mental illness, and an important period in which to focus intervention strategies for those known to have been exposed to adversity, particularly multiple adversities. There was some evidence of a dose-response relationship with those exposed to multiple forms of maltreatment having more two and a half times odds of developing a mental disorder.
“A revised and extended systematic review and meta-analysis of the relationship between childhood adversity and adult psychiatric disorder [Review]." McKay et. al., Journal of Psychiatric Research, 156 (2022).
As I stated in my Review of
Nadine Harris’s The
Deepest Well, every mental health
professional should know that adverse (traumatic) childhood experiences (ACE’s)
- especially with parents who are abusive, neglectful, are perpetrators or
victims of domestic violence, have multiple partners, or have substance abuse
issues - are a major risk factor for children developing many different
psychiatric disorders, as well as being a risk factor for a variety of physical
illnesses. Yet therapists and psychiatrists often ignore this issue in favor of
theories about some sort of genetically-caused, pre-existing brain disorder.
In this fascinating book, the author also makes the case for the importance of ACE’s, especially in the case of pediatric psychiatric conditions, by examining the physiological effects of trauma on brain development. There is an extensive literature on this, although most of it neglects the fact that a continued relationship with an abusive or formerly abusive parent is usually continuing in some form throughout much of these patients’ adult life.
In any event, the author points out that organized psychiatry in 2011 refused
to acknowledge that “…childhood adverse experiences lead to substantial
developmental disruptions” and added that the idea that it is is “more clinical intuition
than research-based fact.” They then added, “There is no known evidence of
developmental disruptions that were preceded in time in a causal fashion by any
type of trauma syndrome.” (From the American Psychiatric Association rejection
of a Developmental Trauma Disorder diagnosis, as quoted in the book).
That last part
is misleading if not an outright lie. We don’t have high caliber causal evidence
on the causes of just about any diagnosis in the
DSM. Van Der Kolk has a list of references from an extensive literature on the
enduring negative effects of early maltreatment. ACE’s are a major contributor
to a variety of psychiatric symptoms
that are part and parcel of the genesis of many different psychiatric
disorders. Especially the childhood ones like ADHD, conduct disorder, and
oppositional defiant disorder, as well as many of the mood and anxiety disorders.
This blindness by the psychiatric community has led to what is called “malignant polypharmacy” – the tendency of some psychiatrists and psychiatric nurse practitioners to confuse symptoms that appear in different forms within a variety of different psychiatric diagnosis as instead being co-morbid (co-occurring) conditions. When I was in practice, I would find new patients who were on several different psych medications – sometimes including both uppers and downers simultaneously – because new drugs were added whenever the practitioner noticed additional, seemingly untreated symptoms.
Clinicians had misinterpreted these symptoms as
being due to their being indicative of other psychiatric disorders
that were not being addressed by the existing drug regimen. As the author
points out, what was really not being addressed is the underlying issue – the
history of abuse.
As mentioned, and as with the Deepest Well, this book unfortunately ignores the question of whether brain changes caused by ACE’s are at least partially reversible - were it not for continuing reinforcement of the trauma throughout the lives of the subjects of this literature. This question lurks in many of the book’s case examples and within the literature that the author quotes.
For example, he talks about a case where a woman continued to blame
herself for her father molesting her despite her rational mind knowing full
well that this was nonsense. He describes traumatized firefighters who were “desperately
trying to protect the system.” As part of a suggestion for criteria for a proposed
diagnosis of developmental trauma disorder, he included, “Intense preoccupation with the safety of the
caretaker or other loved ones.” He even describes himself as mistakenly
thinking that his own parents no longer had a major influence on him!
In the numerous,
highly interesting case examples, Van Der Kolk omits mention of whether or not the
patient still maintained contact with abusive parents. The closest he comes is
a statement on page 210 about a perpetrator "hopefully" not still being around
to hurt a traumatized individual.
Nonetheless,
this well-written and almost entertaining book is a good introduction to the
consequences of ACE’s on psychological and brain development, as well as
introducing some possible therapeutic ways to treat traumatized patients. Van
der Kolk is a master story teller.
There has been a lot of
news recently about the significant increase lately in the number of drug
overdoses resulting in fatalities. Most of these overdoses are labeled “accidental,”
and surely many of them are. Of course, if drugs have been secretly laced by dealers with something
dangerous like fentanyl, and the addict is unaware of that, the overdose can
indeed be accidental. Although not necessarily
even in that case, because news about the fact that dealers are lacing other
drugs with this one has been widely reported in the press, and many addicts
know other addicts.
I suspect that a considerable portion of
these “accidental” overdoses are actually suicides, either through specific
intent at that particular moment, or through strong chronic suicidal intent
leading to carelessness that will certainly cause death, but at some
unpredictable time.
There is no way to know for certain, obviously,
but I would like to discuss the deaths of two celebrities to illustrate my
thesis here: actor Phillip Seymour Hoffman and Americana singer-songwriter
Townes van Zant.
Van Zandt wrote numerous songs, such as
"Pancho and Lefty", "For the Sake of the Song", "Tecumseh Valley",
"Rex's Blues", and "To Live Is to Fly", that are widely
considered masterpieces of American songwriting.
Van Zandt died on New Year's Day 1997
from cardiac arrythmia caused by health problems stemming from years
of substance abuse. In 1994, he was admitted to the hospital
to detox, when a doctor told Jeanene Van Zandt that trying to detox Townes
again could potentially kill him. He grew increasingly frail during the
mid-1990s, with friends noting that he seemed to have "withered.”
The evidence for my viewpoint comes in the
shape of the lyrics of a song he wrote called “Waiting Around to Die.” I
suspect that this is exactly what he was doing.
The lyrics:
Now I'm
out of prison
I got me a friend at last
He don't drink or steal or cheat or lie
His name's Codine
He's the nicest thing I've seen
Together we're gonna wait around and die
Together we're gonna wait around and die
If a mental health
provider has you on a whole lot of different psych meds on the basis of a
cursory diagnostic interview without much follow up and almost no attention to
what is going on in your life currently, it is time to see somebody else.
In the July issue of Clinical Psychiatry News, Nicolas Badre and David Lehman discuss what is known as “malignant polypharmacy” – the tendency of some psychiatrists and psychiatric nurse practitioners to confuse symptoms that appear in different forms with a variety of different psychiatric diagnosis.
They then make multiple diagnoses – many of which are not really separate
conditions co-occurring with a primary diagnoses – and prescribe a variety of
medications. Many of these are not only not indicated but may interfere
with each other or produce unnecessary side effects. This diagnostic and
treatment stew also creates a great deal of confusion for the patient about
exactly what they are being treated for.
An example they give
is a patient who comes to a new doc having been diagnosed with bipolar II (a b.s.
diagnosis to begin with), high anxiety, split personality, post-traumatic
stress, insomnia, attention deficit and depression.” The medication list of
such a patient may include a stimulant and
a tranquilizer (uppers and downers and bears, oh my!), a mood stabilizer, two
antidepressants, and a low dose antipsychotic!
Overprescribing of dangerous meds is another problem. The Wall Street Journal exposed abuse of Adderall prescriptions by telehealth organizations. One story (8/19/22) was about a man with substance abuse who was given an Adderall prescription after a “30 minute consult” with a Nurse Practitioner who’s specialty was family medicine with no psych training.
Reports show the company sometimes prescribed after just a 10
min consults, giving 90 day scripts with limited or no follow up. The NP was
making 20k per month. Patients were charged $79 to subscribe. Some of these “providers”
were given $10 per script per month with some having over 2,000 of them filled
per month.
In adolescents, overprescribing has become pandemic. The New York Times (8/27/22) reported on the common medical practice of “the simultaneous use of multiple heavy-duty psychiatric” medications among adolescents. “Such medications are too readily doled out, often as an easy alternative to therapy that families cannot afford or find, or aren’t interested in.”
The medicines, “generally intended for
short-term use, are sometimes prescribed for years, even though they can have
severe side effects,” and a number of psychiatric medications “commonly
prescribed to adolescents are not approved for people under 18.”
While of course, as the authors of the Clinical Psych article point out, there is in psychiatry a high rate of co-occurring conditions, a lack of treatment specificity, and poor understanding of causes. However, a complete work up includes the doctor looking at all of the patients’ symptoms, biological factors, psychological factors, and social factors, as well as the course of the patient’s illness.
Are the symptoms present all the time, or do
they come and go depending on environmental factors? If the latter, what
factors are we speaking of? Does one diagnosis preclude another, like bipolar
and unipolar depression? Is there a family history of certain disorders?
Did your clinician even
ask about any of this? Like I said, if not, time to find a new one.
YouTube web address: https://www.youtube.com/watch?v=SBiI7uJqnHc&t=2s
