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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 42. This is the beginning of the thread.
Posted by rjlockhart37 on November 6, 2012, at 15:15:49
like i've said before in comments to posts...im going to eleborate on this. Some people can go to a doctor, and get meds easy...and totally be fine. Personally using my situation, my doctor is a addiction specialist....that means she avoids benzos, stimulants, etc....also because of my past in a file. So....ended up like this is pretty s h i t y, i can't go to another doctor because someone I live with is always on me....if I do something agaist what they don't agree with im out of the house. So, doing this realize that you have to think like your/a doctor thinks, how they view you, their opinion on medications, and basically what they study. If you can learn, and get clues....it will be alot easier to move around. Kinda get clues from observing, and talking, and info comes out. Then after you know what options they are prone to use....you can start playing chess, but don't take ths a something that is wrong. It's just advice....and if its taken wrong, beleive me im no scholar....just only have opinions.
r
Posted by ShawnThomas on November 6, 2012, at 16:43:53
In reply to playing chess with psychiatry, posted by rjlockhart37 on November 6, 2012, at 15:15:49
Well I am a scholar, but this discussion does not revolve around scholarly facts; it revolves around your perceptions of what is best for you. That said, I will share my opinions on the matter.
Anyone who has the ability to educate themselves should absolutely try to seek an improved understanding of his or her unique mental condition and any relevant medications. Ultimately, we all have our own unique blend of mental "disorder." Diagnoses should help to provide treatment suggestions rather than serving to define who we are as human beings. Because of your uniqueness, a psychiatrist cannot apply some mathematical formula to solve all your problems. If you see a doctor regularly, I definitely believe that developing a relationship based on mutual understand will greatly benefit you. In my opinion, a useful approach is to demonstrate a deep respect for your doctor while simultaneously being assertive about describing what you seek to get out of the relationship. You should view yourself as a courageous hero who is ultimately the key person in charge of figuring out how to be content with life. The games of chess and life are often most enjoyable if you don't take them too seriously; oftentimes, I have created more problems than were necessary simply by taking my existing problems too seriously. I think that life is often much easier when one has a sense of playfulness and an acceptance of the purposelessness that pervades so much of life. I was once told by a wise man that I should spend less time thinking about my problems and more time simply acting in the moment. Sometimes problems can seem to be overwhelming, but there are always healthy ways to cope. If you develop a good relationship with your doctor, then it should be easy to openly explore ways that can help you to cope with problems more effectively.
In my opinion, the best approach to the relationship with your doctor is to avoid becoming too attached to any certain goal. You should certainly try to seek outcomes that you feel will benefit you, but you should not feel that you or the doctor is to blame if desired changes are not occurring. Your emphasis should be on developing an improved understanding of the relationship's ability to provide benefits rather than focusing on specific things that must occur for you to be satisfied. I know lots of people who have sought a certain thing from a psychiatrist and got it; however, they made little progress because they were not able to empower themselves to change their ways of thinking about life in a manner that did not depend on having to achieve specific goals in order to feel well about life. If you find that you cannot spend what you feel is a sufficient amount of time talking to your psychiatrist, I think that talking to a therapist or at least close friends can be very beneficial. Many therapists can provide deep insights into how to best deal with psychiatrists, especially if they are close colleagues.
I have often suggested to friends that they print out abstracts and articles from peer-reviewed medical journals in order to help to influence their doctors' perceptions about treatment decisions. I think that it is important to understand, however, that a doctor may have read contradictory reports or experienced contradictory examples in the past. I also believe that patients should seek to understand the sensitivities and potential insecurities of their doctors in order to build a relationship based on mutual trust. Many times, the delivery of your point-of-view can be more effective if you are both respectful and well-informed.
Posted by phillipa on November 6, 2012, at 17:53:20
In reply to Re: playing chess with psychiatry, posted by ShawnThomas on November 6, 2012, at 16:43:53
Shawn surprised to see you here on babble. Seems that also knowing too much about meds and side effects is detrimental at times. I see an addictions pdoc also. He is letting me continue what I'm on even though it doesn't work. Seems the trend with him is to eliminate meds. And surely not increase them. Phillipa
Posted by gardenergirl on November 6, 2012, at 18:25:12
In reply to Re: playing chess with psychiatry » ShawnThomas, posted by phillipa on November 6, 2012, at 17:53:20
Why in the world would you stay on something that doesn't work? I'm confused.
Posted by ShawnThomas on November 6, 2012, at 19:02:58
In reply to Re: playing chess with psychiatry » ShawnThomas, posted by phillipa on November 6, 2012, at 17:53:20
> "Shawn surprised to see you here on babble. Seems that also knowing too much about meds and side effects is detrimental at times. I see an addictions pdoc also. He is letting me continue what I'm on even though it doesn't work. Seems the trend with him is to eliminate meds. And surely not increase them." Phillipa
Hi Phillipa, I hope that you are doing well. I really should spend more time here given my extensive educational background. I have learned how to successfully deal with cyclothymia without the use of medications other than occasional herbal supplements, which has given me less of an incentive to study psychiatry. Given how much I've learned since first visiting this forum and helping friends with their problems, I really should spend more time here offering advice to others.
I can see what you mean about knowing too much about side-effects. A phenomenon called the nocebo effect can occur in some people; it's the opposite of the placebo effect and leads to negative effects because of negative expectations. Personally, I tend to assume that I will not get side effects from any medication but try to be aware of any that do occur.
If a treatment is effective and does not yield unacceptable side-effects, there often is no reason to overanalyze just how it works. I think that education can help people to make better decisions about which drugs to take in general, but it is also true that some people lack the necessary educational background to make sense of more technical information about drugs. Some people may also lack insight into their conditions, which makes it much more difficult to self-educate. In the end, it's up to the individual to decide how much self-education is ideal for enhancing the relationship with a doctor.
Posted by rjlockhart37 on November 6, 2012, at 20:47:50
In reply to Re: playing chess with psychiatry » ShawnThomas, posted by phillipa on November 6, 2012, at 17:53:20
phillipa addiction docs are .... there hard to work with but it depends on how their approched...one time my doc said i look good with the meds I was on and didnt change them, you know what I did was checked into a psych ward in fort worth, for 2 reasons...one the meds where not working and my doctor was being stubborn, also because I thought the devil was trying to possess my body, which I still to this day don't know why.
After that...she realized that I have some conditions that she didnt even aknowedged in the session previous to this. You have to make them realize there is a problem that needs to be taken care of...some people will just go in and say simple problems, no sense of urgency and some doctors view that patients look fine, and will not do anything, exactly what happened with mine in 2010. I don't know what benzos could be switched or dosage increase....you have to think what their thinking on the medications and how they view treatment... getting them to rationalize, like get a clue that they need to increase or switch. Say your having anxiety over and over again that is impairing your daily functions. That should start it off, elaborate.
Keep me updated:)
r
Posted by rjlockhart37 on November 6, 2012, at 20:57:13
In reply to Re: playing chess with psychiatry, posted by ShawnThomas on November 6, 2012, at 16:43:53
hey shawn
i came across something that said don't get to attached to a goal....yes yes yes...i've tried to urge my current doctor of situations about ADD treatment and she refused due to my past. So...for a long time she just talked with me session after session and said there's nothing that needs to be done about meds...i finally had enough of the bullcrap and checked myself in to a psych hospital, but also the main thing I thought i was being possessed by the devil because I felt numb....i later realized it was dissociation caused by anxiety and delusional beliefs trying to explain the anxiety.
but yes progress, relationship with a doctor...if you know them its easier to know them ...have heart to heart and understand things. My worst fear is seeing a psych doctor a state hospital, pale face and souless eyes....its like they only treat the symptoms and not improve the quality of life....i feel bad for people who have to stay in wards for the rest of their life due to mental illness.
thanks!! your post is intresting to read seriously...
r
Posted by phillipa on November 6, 2012, at 22:13:48
In reply to Re: playing chess with psychiatry » phillipa, posted by gardenergirl on November 6, 2012, at 18:25:12
Don't be confused. Two choices of docs one the addictions & one forensics. This doc is old also my age. So he knows all the latest stuff. He believes that the less meds the better. Since nothing but benzos ever worked for me. And it's over 40 years on low doses just stick with what I'm on. Feels it's an unconventional combo the luvox & 2.5mg of lexapro,.5 xanax & 7.5mg valium. Not much choice when it's public docs. Or one of the two who take medicaire & United Healthcare. Plus doctors are now on an anti-med champaign here unless you are bipolar or schizophrenic. It's back to cope the best you can. So I do. Phillipa
Posted by SLS on November 7, 2012, at 5:54:51
In reply to Re: playing chess with psychiatry » phillipa, posted by ShawnThomas on November 6, 2012, at 19:02:58
Hi Shawn.
> I have learned how to successfully deal with cyclothymia without the use of medications other than occasional herbal supplements, which has given me less of an incentive to study psychiatry.
Why has your personal experience reduced your incentive to study psychiatry? What are the aspects of psychiatry that you would like to see changed?
What substances are you currently taking to treat your cyclothymia?
Thanks.
- Scott
Posted by Phil on November 7, 2012, at 11:26:48
In reply to Re: playing chess with psychiatry » phillipa, posted by ShawnThomas on November 6, 2012, at 19:02:58
I really should spend more time here given my extensive educational background.
________________
Should we get Bing to translate your post's so dumb people know what you're saying?
Posted by linkadge on November 7, 2012, at 20:06:00
In reply to playing chess with psychiatry, posted by rjlockhart37 on November 6, 2012, at 15:15:49
You don't need benzos and stimulants to get (be) well.
Linkadge
Posted by Phillipa on November 7, 2012, at 20:36:59
In reply to Re: playing chess with psychiatry, posted by linkadge on November 7, 2012, at 20:06:00
Link what are your suggestions in all sincerity? Phillipa
Posted by rjlockhart37 on November 7, 2012, at 22:35:33
In reply to Re: playing chess with psychiatry, posted by linkadge on November 7, 2012, at 20:06:00
hey link....my implication was not directly to point them out..its just starting to how observe the doctor and know what there thinking, why I'm doing this.... my doctor for period of 4 months would say I need no change to my meds and kept writing the same stuff I was on that was S H I T medication...besides prozac, and i finally had enough of her over ego speculations. I went to a psych hosptial both for that the thing that really made to step on the peddle to go was i've had the figure of the devil in my head and was trying to possess my body, i got all these wierd thoughts of doing crazy stuff....its too much wack to explain.
But back to my point, my doctor found out that I had went on when I was I was released and discharged, she got the papers of what happened. And then she said...rj you could of gotten a appointment with me...you see its like a trap to pay money and she sits there and doesnt do maintaince....its corrupt and still to this day. So...I gotta think corrupt to understand what their of treatment is...So the reason I wrote this is to deal with difficult doctors. Link...i know you probaly know, and still think in my mind I need stimulants, the only thing that has been prescibed so far is Nuvigil which ... is good for stying awake, and keeping me alert.
So....would I like to have what I want? yes...but the stuff that's happening right now...its not going to happen for a long time...i already know that, and have tried everytime I have force myself to do my own personal research...really its hard, ill think about something, go smoke, and then totally forget what I was doing. It's like breaking your leg in a rehab and you've had a past with heroine abuse, they won't give you anything...the best is suboxne. When I was in rehab....alot of herione addicts where on suboxyne[mispelled] and they still said they felt like sh*t. So in my case ... Nuvigil is similar. I hope you get what im saying...because I already know i'm an addict....and i am prone to abuse. Its just the other mental stuff that started this that are really being a problem, manic, fear filled, im afraid because of all my failures that are repeated when I do things, like work, go out with people.....the best awnser of how I am is written here on babble. So...yea
thanks...:)
r
Posted by linkadge on November 8, 2012, at 17:33:10
In reply to Re: playing chess with psychiatry » linkadge, posted by rjlockhart37 on November 7, 2012, at 22:35:33
>kept writing the same stuff I was on that was S H I T medication
Most / all medictions are sh*t medications and the so called 'good ones' (stimulants, opioids, benzos) just mess you up more longer term. The grass is always greener on the other side.
Posted by herpills on November 8, 2012, at 23:30:19
In reply to playing chess with psychiatry, posted by rjlockhart37 on November 6, 2012, at 15:15:49
As long as you keep going to a doctor that you HATE, you will probably NEVER get better. Time for a new doc...
Posted by sleepygirl2 on November 9, 2012, at 10:16:06
In reply to Re: playing chess with psychiatry » ShawnThomas, posted by Phil on November 7, 2012, at 11:26:48
Hey,
I noticed that too. :-)What I kinda thought was interesting is that the poster seems to say that since we don't have the knowledge, presumably, that a dr has, we are limited in our ability to make informed decisions.
Also, that a lack of insight might prevent us to make proper decisions about medication.
I guess... But doesn't it all seem terribly paternalistic?
As in, yes, "grand and benevolent master... Dispense at thy will, we naively accept thy pharmaceutical offerings..."I gotta say though, rjlockhart, it has been my impression that your substance abuse issues are pretty damn primary, and that's going to be your undoing.
Stimulants and.... I feel like you've mentioned crystal meth??? Am I not remembering correctly?
That'll get you good and psychotic.
Posted by SLS on November 9, 2012, at 13:00:17
In reply to Re: playing chess with psychiatry, posted by sleepygirl2 on November 9, 2012, at 10:16:06
> I gotta say though, rjlockhart, it has been my impression that your substance abuse issues are pretty damn primary, and that's going to be your undoing.
rjlockhart37:
I am not a professional, but I react the same way when I read your posts.
1. What are the symptoms of your conditions?
2. What are the diagnoses that your doctors have attached to these symptoms?
3. What drugs or substances have you had the most success with for treating your conditions?
- Scott
Posted by ShawnThomas on November 9, 2012, at 15:32:30
In reply to Re: playing chess with psychiatry, posted by sleepygirl2 on November 9, 2012, at 10:16:06
> What I kinda thought was interesting is that the poster seems to say that since we don't have the knowledge, presumably, that a dr has, we are limited in our ability to make informed decisions.
> Also, that a lack of insight might prevent us to make proper decisions about medication.
> I guess... But doesn't it all seem terribly paternalistic?
> As in, yes, "grand and benevolent master... Dispense at thy will, we naively accept thy pharmaceutical offerings..."I was trying to be very careful with my language. When I mentioned that *some* people have less insight into their conditions, I was definitely not speaking for everyone. I was thinking of a small subset of cases such as severe schizophrenia, which is often characterized by a lack of insight into one's condition. In a vast number of cases, I believe that clients have much more insight into their conditions than psychiatrists do, and many clients are better informed about some medications than their psychiatrists or family physicians. I think it would be a stretch, however, to suggest that anyone has "perfect" insight into his or her psychological condition. We are all in some sense limited when it comes to understanding the immense complexity of our brains and the full effects that medications can have on our unique selves.
I do have concerns that many sources of psychiatric drug information on the Internet, in some journal articles, and in many textbooks are based on questionable premises and shoddy evidence. There is a real challenge for any of us to understand exactly how many medications affect the brain and whether they are appropriate treatments for certain conditions. I do believe that both doctors and clients are often limited when it comes to making the most informed decisions possible about medications, but this is a result of psychiatry being a field in its infancy rather than a result of people being uneducated or unintelligent. In the end, everyone has to simply try to do the best they can with the limited information that is available.
I think that the vast majority of people who see psychiatrists are capable of educating themselves about medications. This is why I said that the individual has the responsibility for deciding how much self-education is ideal. If someone feels like they are unable to comprehend drug information, they will likely need to rely more on their doctor, family, and/or friends for most of their information. I also think that family and friends can sometimes play an important role in helping people to make better choices about medications.
My view of psychiatry (as well as a variety of other fields such as psychology, theoretical physics, and cosmology) is characterized by a large degree of skepticism. I certainly do not have a paternalistic view of psychiatry. I believe that anyone who has the ability ought to make an effort to learn about any medications that a doctor prescribes, and this is especially true with regards to psychiatric drugs. In many cases, I believe that people should strongly question the pharmaceutical suggestions made by psychiatrists and family physicians. The decision to take a psychiatric drug is a serious matter and should not be taken lightly.
Posted by ShawnThomas on November 9, 2012, at 16:22:35
In reply to Re: playing chess with psychiatry » ShawnThomas, posted by SLS on November 7, 2012, at 5:54:51
> Why has your personal experience reduced your incentive to study psychiatry? What are the aspects of psychiatry that you would like to see changed?
>
> What substances are you currently taking to treat your cyclothymia?
>
> Thanks.
>
> - ScottI would like to see a decreased use of SSRIs in psychiatry. There are obviously a lot of cases where SSRIs are effective treatments, but we lack sufficient tests to identify the subset of people who will benefit from these drugs and to identify people who will experience unacceptable side-effects. I am also alarmed by the number of children who are prescribed psychiatric drugs. We need better ways to figure out which children truly need medication and which do not. I am concerned that many psychiatrists are not spending enough time with their clients. I also think that we need a better understanding of how infectious diseases and substances in the environment such as organophosphates can potentially lead to psychatric disorders. My biggest wish is that pharmaceutical companies will be able to speed up the development of more effective medications with fewer side-effects for conditions such as depression, bipolar disorder, schizophrenia, panic disorder, and OCD.
I think that I found less of an incentive to study psychiatry for a period of time because I gained a better understanding of myself and needed to round myself out more in other areas. I have come to see cyclothymia as a condition that has a lot of benefits in spite of the sometimes less comfortable aspects of it. I also have a strong interest in educating myself about a wide range of topics, and focusing solely on psychiatry for year after year would limit my ability to gain a fuller understanding of life. I am still interested in helping others to understand psychiatric medications, but it was necessary for me to step back for a while to better appreciate the "big picture." I have been thinking about what sorts of opinions and information are truly important to share with others. I've come to better understand what really matters in life, and it definitely seems to me that educating others about psychiatry will play a bigger role in my life in the coming years than it has in the recent past.
I think that the best treatments for my cyclothymia have been gaining an improved understanding of myself and growing more mature. There really are not any good medications for cyclothymia (at least in my case), so I really limit the substances I take to mild herbs that provide a calming effect. I drink chamomile tea because of its relaxing effects and occasionally take valerian to help me sleep. I've also taken l-theanine, passionflower extract, and kava extract in the past but haven't recently ordered any of those. I think that exercise, a proper diet, avoiding substances like alcohol and stimulants, relaxation techniques, introspection, self-education, writing in a journal, getting sufficient sleep, and maintaining a healthy attitude toward life can all be very helpful self-treatments for cyclothymia. I get mild atypical depression from time to time as part of my cyclothymia, which I find is only troublesome when it comes to interpersonal rejection sensitivity. As I've grown older and more self-aware, rejection sensitivity is much less of a problem for me, and developing a better attitude seems like a better approach to that problem than taking a medication. My most difficult symptom can be occasional irritability, which is why I have grown fond of chamomile and other mild anti-anxiety herbs.
Posted by Phillipa on November 9, 2012, at 18:14:05
In reply to Re: playing chess with psychiatry » SLS, posted by ShawnThomas on November 9, 2012, at 16:22:35
Makes sense to me as docs have done this to me. Thanks Shawn. Phillipa
http://www.nytimes.com/2012/08/12/opinion/sunday/beware-the-nocebo-effect.html?_r=0
Posted by ShawnThomas on November 9, 2012, at 18:46:26
In reply to Re: nocebo effect, posted by Phillipa on November 9, 2012, at 18:14:05
> Makes sense to me as docs have done this to me. Thanks Shawn. Phillipa
>
> http://www.nytimes.com/2012/08/12/opinion/sunday/beware-the-nocebo-effect.html?_r=0You're welcome; that's an interesting article. I'm sorry to hear that you have had trouble with the nocebo effect in the past.
I think that it's important to realize that the prescribing information for many drugs includes a list of side-effects ranked by the percentage of patients who experienced each effect. This information will typically show that the vast majority of patients do not experience each side-effect that is associated with a drug. If more than 9/10 people do not experience a side-effect (which is usually the case), the expectation should ideally be that the effect is possible but not very likely. Hopefully, future generations of psychiatric medications will have fewer side-effects so there will be less to potentially worry about.
Posted by Phillipa on November 9, 2012, at 20:53:19
In reply to Re: nocebo effect » Phillipa, posted by ShawnThomas on November 9, 2012, at 18:46:26
Shawn not only nocebo effect but docs that increase doses much too fast so anxiety kicks into full gear. I had this happen with cymbalta no problem at one time tolerating 60mg with low dose benzo. Moved up here and the doc wanted me to take 30mg week one, 60mg week two, 90mg week three, and 120mg week four. At the time was new drug and the manufacturer only advised up to 60mg. I said this to the doc who replied "I don't care I have better results with this dose". Immediately so terrified I only took it for a few days couldn't tolerate the anxiety. Caused by feeling I was taking something that could hurt me. Phillipa
Posted by sleepygirl2 on November 10, 2012, at 0:49:28
In reply to Re: playing chess with psychiatry » sleepygirl2, posted by ShawnThomas on November 9, 2012, at 15:32:30
I didn't really think you had a paternalistic view, but you did raise some interesting points. I was inserting a little sarcasm, perhaps aimed at my experience with mental health care (not just my own). Maybe I like a good debate.
I think it takes a tremendous amount of faith (in something so imperfect) to take psych meds. I like my Pdoc, everything is ultimately my decision, and I trust that he's applying his knowledge toward increasing my quality of life.
The idea, that I can lack some insight, seems so strange to me, but I have to think it is true, even though I'm pretty grounded in reality.
Posted by SLS on November 10, 2012, at 6:41:52
In reply to Re: playing chess with psychiatry » ShawnThomas, posted by sleepygirl2 on November 10, 2012, at 0:49:28
> I didn't really think you had a paternalistic view, but you did raise some interesting points. I was inserting a little sarcasm, perhaps aimed at my experience with mental health care (not just my own). Maybe I like a good debate.
> I think it takes a tremendous amount of faith (in something so imperfect) to take psych meds. I like my Pdoc, everything is ultimately my decision, and I trust that he's applying his knowledge toward increasing my quality of life.
> The idea, that I can lack some insight, seems so strange to me, but I have to think it is true, even though I'm pretty grounded in reality.
I guess one can make the argument that anyone who is mentally ill experiences an alteration in cognition that affects their perception, insight, and judgment. How, then, would one go about making treatment decisions for himself?
- Scott
Posted by sleepygirl2 on November 10, 2012, at 11:24:51
In reply to Re: playing chess with psychiatry » sleepygirl2, posted by SLS on November 10, 2012, at 6:41:52
Right. I think it depends on the diagnosis and symptoms.
What's the term?
http://en.m.wikipedia.org/wiki/AnosognosiaBut then there's plain old denial. My therapist has sometimes commented on whether I had one or two feet in the river (that's de Nile). I don't usually agree.
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