Hello...

[psychiatry_sho]

Hi there..

I'm a first year SHO in psychiatry. I did a psychology degree halfway through my medical degree too (mainly neuro/cognitive stuff),and got interested that way. I'm joining this forum to try and learn more from the patients' side and hopefull implement ideas into my practice.

I have actually got my doubts about psychiatry, and wonder what the hell I'm doing sometimes, because mental illness is not very well understood. Although I think terms like "chemical cosh" or "chemical straitjacket" are sensationalised and miss the point, I do understand that the medications used for alleviating psychosis ("antipsychotics") are essentially tranquillisers.

I don't necessarily have a problem with doing that if they help the patient gain perspective and stability to the extent that they can engage psychologically with therapy , their community, and function better, moving towards a happier life. I do have a problem with the fact that they often cause TD and other side effects (diabetes etc) and blunt emotions. I am hopeful future research will produce less debilitating drugs.

That's just psychosis though of course. In my short time in psych I've also seen severely depressed people improve with the help of anti depressants, bipolar people get their lives back, and seen older people with alzheimers perk up on rivastigmine and donepezil. Social and psychological input are invaluable however - I think the medications at the moment are a good initial holding measure which allow people to regroup psychologically, ideally speaking.

I hope you don't all hate psychiatrists, we're not all greedy bastards, some of us have the best intentions.

We're not all monkeys conditioned to believe that we're treating primarily biological illnesses either. I read quite a lot of critical/anti-psychiatry stuff (bentall, moncrieff) etc - which is interesting. I was thinking of jacking in psych this year and retraining in obs and gynae or paediatrics etc, because I thought at least those are "real" or 'hard' sciences, with solid evidence bases. If I'm honest though , I do find mental illness more interesting. And also remember one thing - EVERYTHING is organic in a sense, thoughts, emotions, beliefs/delusions/ideas are all neurochemical in basis until there is any evidence or strong reason to believe in a soul,spirit etc.

So in that sense, there is a rational biological element to some aspects of mental illness, which is often triggered or unmasked by the traumas and trials of life which might be considered "precipitating" factors...psychological trauma will cause brain changes, which will then affect future brain function, and it's a vicious circle. Shrinks, psychologists, neurologists and patients/clients have to all work together to figure out the best interventions to reduce harmful patterns, in each individual. Psychiatry's not like the rest of medicine, where antibiotic X is effective against organism Y. Each person needs a bespoke care package in my opinion, it's a pity we only get to see people every few months for 20 mins or so and are expected to get a flavour of clinical progress from that. I think there's a lot to be sorted out in psychiatry, and like I said I'm here to learn and discuss things with an open mind.

Best wishes to all

 

[Lady Summer Isles]

Hi and welcome to the forum I hope that you will gain something from your time here. I'm not brilliant myself tonight as i'm getting voices but i was intrigued by your comment about psychological trauma causing brain changes, which will then affect future brain function. Could you explain more about this for me please. I do not have very good experience myself of most of the cmht and am in the process of trying to change psychiatrist which is proving to be a very difficult process. Don't wish to tar everyone with the same brush but do feel like withdrawing from the whole process. By way of balancing things I am married to a wonderfull ex cpn.
Very best wishes to you
Tannith

 

[SimonB]

Hi

Good to see a doc with more liberal medical views

Hopefully you'll have some interesting threads....

Simon

 

[Apotheosis]

So in that sense, there is a rational biological element to some aspects of mental illness, which is often triggered or unmasked by the traumas and trials of life which might be considered "precipitating" factors...psychological trauma will cause brain changes, which will then affect future brain function, and it's a vicious circle.

Hello, & welcome to the site.

I'm afraid that I am one of those that disagrees with orthodox psychiatry.

I don't deny the biological component to a MH condition; but what I do take issue with is the assumption & focus on that Biology being cause/& primary factor; & then the main treatments being aimed at that 'said' biology - i.e. Brain Altering Drugs.

As you say - we don't know cause; the workings of the brain are largely unknown. In my own 20 years of searching for answers; then I would see biological changes as mainly nuances or as effects.

Simply - I don't think that anyone does know the answers here; & that mental health difficulties; especially those that are more severe - e.g. Bi-polar & Schizophrenia - are still a mystery.

I personally take issue with the generally accepted model & practise of drugging as the primary treatment.

As you say "which is often triggered or unmasked by the traumas and trials of life which might be considered "precipitating" factors...psychological trauma will cause brain changes" -

That would logically mean that Biology is NOT primary cause.

If the main issues here are traumas & trails of life - then is it not logical & rational to try & help people better deal & cope with such traumas? Rationally; does incapacitating the brain with very powerful mind altering agents (as you say - sedatives) - then make people better able to deal & cope with life; & better able to resolve their main issues & difficulties?

For me, such actions have just made it harder to deal with things; & added more problems into my life - not alleviated them.

I don't want to moan, & go into a long monologue of my life. There were certain traumas & difficulties growing up, & very early on in my life. Yes, there were some bad choices as I grew older; & more trauma & difficult life circumstances. I went mad.

Having being treated with powerful drugs by psychiatry, & little else; I feel very damaged by what has been done to me. I can only speak for myself. I'm wholly dependant on a powerful 'major tranquilizer', & I have had little in the way of orthodox help to address any of; what I see, as the underlying causes.

I know that many people profess to being greatly helped by drugs. But I am not one of those people. I do feel that I would have been far better helped by genuine therapeutic intervention; depth psychology, & proper social support.

Over 10 years out of work, 12 years out of a relationship, living alone for over 8 years, & I feel that psychiatry is in large part to blame for my predicament - labelled, drugged, excluded & isolated, with little to nothing I can do about certain situations in my life to change things. No real support from services; denied psychological help (12 sessions with an NHS psychologist in 20 years), & now refused any more psychological help.

I do know that it is very unfashionable to speak out against psychiatry. But in my situation I wonder how others would feel about all this too?

I am not blaming you 'psychiatry_sho', & I no longer blame any individual in any of this, & I think it brave of you to post here. I just despair of certain things. All I can do, & the best that I can do is to accept certain things. There is NO real choice in certain things; & there never has been. It would appear that those at the more extreme end of the spectrum of 'severe mental difficulties' are the ones most likely to be thrown on the slag heap, abandoned, heavily drugged, & in reality; very little done to actually help them.

 

[Apotheosis]

I know that it is vague; but I do see the 'Spiritual' (Trans-personal, esoteric/ect whatever you wanna call it) as being a major factor in a lot of MH 'conditions'.

How do you prove such a thing? I have tried to present some kind of argument on this site. I don't think I've done too badly in doing that.

If such factors are at play here - then they will not be acknowledged or described by Bio-Medical psychiatry & a materialistic & reductionist paradigm.

The larger system (if it exists, as I think it does); cannot be described from the perspective of a 'sub set'.

 

[oneday]

Hi psychiatry_sho

Welcome. I'm pretty new here myself (end of January) - see 'introducing...'. Look forward to chatting and reading your postings. Check discussions e.g. under '2 pence worth', but also have some fun e.g. in the Chill-out Cafe etc!

Oneday

 

[psychiatry_sho]

Hi everyone thanks for the welcome,

Apotheosis, I do get you, hence my comment

We're not all monkeys conditioned to believe that we're treating primarily biological illnesses either

.

When I attend teaching/lectures on my study days I do meet a lot of psychiatry trainees and even consultants who really push the idea that there are "genes" for schizophrenia etc and get all excited about equivocal functional MRI data etc, and lose track of the psychology and sociology. I do believe however there is genetic/biological propensity to react emotionally to circumstances differently to the majority, which manifests itself sometimes as psychosis, depression, mania etc.

That's a minority though remember, most aren't that reductionist. I think mental health is a bit like a political spectrum - extreme biological reductionists on the right if you like, and anti-psychiatrists/clinical psychologists on the left? I'd like to think I'm slightly left of centre.
If there was better access to CBT and intensive psychological input, I would be the first to champion that cause before medicating - I'd personally much rather rest,recover and rehabilitate without antipsychotics if it was me personally in that situation. On the other hand - were florid delusions and paranoia to persist, I'd bite the bullet and swallow the pill I guess. A close family member of mine also had a psychotic episode (drug induced I think) in the mid 90s. Took amisulpiride for a couple of years, now off it and works as a doctor (psychiatrist too in fact).

We're just at a very early stage of things in psychiatry. Over reductionism is not very helpful but quite interesting -even spirituality, religion etc could essentially be reduced to biological theories, but that's a matter for a separate discussion! As an agnostic (born to Muslim parents though) I'd have to sit on the fence there a bit. Anyway I have to get going but will post more in other areas.

 

[Apotheosis]

'psychiatry_sho' -

I do understand where you are coming from - But it doesn't change the accepted practises & assumed beliefs. If you experience a severe end of the MH spectrum - you will be locked up & drugged up; & little to anything else done. There may be some appeasement, or a nod in the direction of 'environmental' influences; & alternative perspectives; but that's all it is 'a nod'. The overridding assumption is that these conditions are biologically based, & treated accordingly. From my experience, understanding & perspective - that is wrong; very very wrong IMO.

I understand the materialistic, scientific reductionist perspective; believe me I do. But here is where we find the fundamental disagreement & opposite of paradigms. In general the consensus & conformity view is that no such thing exists outside of physical reality & with what can be measured & quantified. There are of course those few that are approaching things from an entirely different perspective.

I think that it becomes very much a case of simply agreeing to disagree.

 

[Yute]

Hi Psych. Sho,

I'm glad to see someone in your profession taking an interest from this angle. I agree that we all need to work together to find solutions. Could you look at my intro and tell me if there's a name for my problem? It's titled 'hello, is anyone like me?'. Ty for your interest. I'm really desparate to start living again.

Yute

 

[Twylight]

Hello and Welcome
I'm pleased you have the best intentions

but I feel until Psychiatrists lobby drug companies to improve medications - there's little hope for us

It has improved, but i'm sure they can do better...

 

[rasselas]

Hi there..

I'm a first year SHO in psychiatry.

Ay up, lad.

I have actually got my doubts about psychiatry [...]because mental illness is not very well understood. Although I think terms like "chemical cosh" or "chemical straitjacket" are sensationalised and miss the point, I do understand that the medications used for alleviating psychosis ("antipsychotics") are essentially tranquillisers.

But why so casually dismiss the violence of them? Are you aware they are often used for punishment, especially in the prison system? They have a utility for punishment because they can knock a person out, fast. They can make it unbearable to be in your own skin. And they can keep you down, well down, to the point where even a gradual crawl would feel like unattainable effort. Let alone speaking or, God forbid, thinking.

I will have to fish out the reference for this... there was a study, a controlled study. A small number of psychiatrists took 'anti-psychotic' drugs voluntarily, and were then monitored as they went to work. Most of them were unable to perform their duties, to concentrate, to settle (this was one low dose!). Many had to return home and took a few days off from work. You may know that an 'anti-psychotic' affects the same changes in the brain whether the person who takes it has psychosis or not?

It's good (if you are what you claim to be) that you wish to get a service user's perspective. Getting your head around the agressivity of the drugs would be helpful to you, I reckon.

 

[intelgal]

Hi and to the forum. Some very interesting points of view .. keep posting intelgal!

 

[*Sapphire*]

Hi and , I hope you find it of some use to you being here!

 

[emski]

Hello psychiatry_sho

I am both a service user and a student nurse. The first psychiatrist I met when I was 16 was an uncaring bully. Since then I have been seen by and worked with some truly wonderful SHOs and psychiatrists, mentla health nurses, therapists and support workers, and some equally useless ones with no social skills. This goes throughout healthcare and goes for any other profession, which is more about the people less about the discipline. I don't like having to take medication any more than they next guy, but they have their advantages/disadvantages and I have found a combination that currently works for me. For me personally, my bipolar disorder is akin a mental diabetes - I take medication to keep my mood stable like a person with diabetes would take insulin/metformin etc to regulate blood sugar. But that's just how I think it is for me.

I worked with one SHO who seems along the same ways of thinking as you. You're very right, there is an awful lot to be sorted out in psychiatry, just as there is in other areas. But psychiatry is not going to lie down and go away, nor do I think it should, and I'm optimisitic that there is a lot of new thought and a lot of new people starting in the field that are going to make a difference and have best intentions of psychiatry for people, not just for the science, the status or the money.

So best of luck and nice to read your post

 

[Watercolours]

I'm just going to say hello for now... so hello!