![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 51 to 75 of 75. Go back in thread:
Posted by Quintal on December 3, 2006, at 16:22:49
In reply to Re: Illness increases vulnerability to the irratio » blueberry, posted by Squiggles on December 3, 2006, at 15:38:21
>The treatment of mental illness is
>demanding and chronic. If I had my
>way I would apply Dr. Fuller Torrey's
>ideas of insitutions. However, we now
>have so many people and so many with
>depression, that it may end up being
>worse.>I suppose he believes in democracy. But I don't -- not in medicine.
> In cases of crisis people may need more. And
> when I mention Torrey, I do not do so to
> provoke but to point out that psychiatric
> care is deteriorating in proportion to the
> growing number of people with depression,
> the lack of an adequate number of physicians,
> the complexity of drug care, and the fall out
> of all that-- mentally ill people on the
> streets, in jails, in abandoned shelters,
> and without recourse to internet help.
>
> SquigglesSo, for those of us who are not actively psychotic and do have access to inetrent resources, may I again ask what freedoms we would have (if any) to request specific medicines or experiment with approaches outside psychiatry under your/Dr. Torrey's proposed dictatorship? Do you have a manifesto or anything we could examine?
I share your concerns for the vulnerable people who slip through the net of our current mental health services entirely, but my concern is for the majority of people posting here who do not fall in to that category and who's basic freedom would *seem* to be severely restricted by the ideas you have proposed.
Q
Posted by bassman on December 3, 2006, at 16:36:06
In reply to Re: Illness increases vulnerability to the irratio » linkadge, posted by Squiggles on December 3, 2006, at 9:24:39
My experience is that the sicker I am, the more I fear medications. When I'm doing better, I just have the attitude, "well, let's try the med for the prescribed period and see what happens. I can always stop (and have)". I've noticed this tendency in others so much that I have an expression-"the sicker you are, the more avoidant you are to medication". I don't know why; it just seems empirically true. In a perfect world, we could simply go to our wildly competent doc and be put on a path that would lead to success. In the real world, there is such a high percentage of docs that aren't able to help people (for a variety of reasons, including lack of ability) that it would seem foolish to me to allow oneself to be put in the hands of ANY doctor without doing your own research. You'd probably do your own research and get a second opinion if a mechanic told you you needed a new $3500 transmision for your car-and therefore not just trust his opinion alone. Isn't your mental health more important than a new transmission?
Posted by blueberry on December 3, 2006, at 16:37:07
In reply to Re: Illness increases vulnerability to the irratio » blueberry, posted by Squiggles on December 3, 2006, at 15:38:21
> >
> > Personally I think the best of both worlds exists right here at psychobabble.
> >
> That's a considerate post Blueberry.
> Psychobabble is unique in exchaning
> information and asking about meds, when
> you are well enough to do so.
>
> In cases of crisis people may need more.**I've been in crisis and needed more. I had to spend a week in the hospital. Sadly they let me out even **more depressed than I went in.
> And when I mention Torrey, I do not do so to
> provoke but to point out that psychiatric
> care is deteriorating in proportion to the
> growing number of people with depression,
> the lack of an adequate number of physicians,
> the complexity of drug care, and the fall out
> of all that-- mentally ill people on the
> streets, in jails, in abandoned shelters,
> and without recourse to internet help.
>
> Squiggles
>
>**Good point about the internet. I depend on it for heavy research at pubmed, rxlist and pbabble. When a doctor writes a prescription, I guarantee you I know a lot more about that drug than he/she does. Without the internet, I would be screwed.
Posted by Squiggles on December 3, 2006, at 16:40:46
In reply to Re: Illness increases vulnerability to the irratio » Squiggles, posted by Quintal on December 3, 2006, at 16:22:49
> So, for those of us who are not actively psychotic and do have access to inetrent resources, may I again ask what freedoms we would have (if any) to request specific medicines or experiment with approaches outside psychiatry under your/Dr. Torrey's proposed dictatorship? Do you have a manifesto or anything we could examine?You have all the freedom you want. But
freedom without knowledge is an adolescent's
dream.
>
> I share your concerns for the vulnerable people who slip through the net of our current mental health services entirely, but my concern is for the majority of people posting here who do not fall in to that category and who's basic freedom would *seem* to be severely restricted by the ideas you have proposed.Some people here have died it seems from
accidents or suicide. For most, if you
can type legibly and make sense on the computer,
you need not worry about severe psychosis.It's funny how someone with apendicitis is
rushed to the hospital and loses his freedom
under anaesthesia, but the freedom of someone who is ready to jump off a bridge or drown their children, is considered inalienable, by the
anti-psychiatrists. I think it reveals a hidden
antipathy, perhaps even fear for the mentally ill.
But they are just as treatable as if they would have heart disease-- the mental illness originating or affecting the brain.Squiggles
Posted by Squiggles on December 3, 2006, at 16:54:41
In reply to Re: Illness increases vulnerability to the irratio, posted by bassman on December 3, 2006, at 16:36:06
bassman,
I've found exactly the same reaction;
the sicker i am, the more afraid i am
of treatment and medication. My guess
is that it is natural to assume the
medication, especially when high, is
causing you the distress. But you may
be very wrong. Experience has helped me
but it's a painful way to do it through
research on the net; witness my last
attempt to concoct OJ, salt, and sugar
to get the lithium down-- yeah, it did
but the lithium should have been up. I
was just to sick to read the research
correctly.Squiggles
Posted by Quintal on December 3, 2006, at 17:24:03
In reply to Re: Illness increases vulnerability to the irratio » Quintal, posted by Squiggles on December 3, 2006, at 16:40:46
>You have all the freedom you want. But
freedom without knowledge is an adolescent's
dream.Yes, I have most of the freedoms I want right now, but it seems many would be curbed or outright prohibited under a mental health system guided by the ideas Dr. Torrey, of which you seemed very supportive. That is my objection.
I have considerably deeper and broader knowledge of psychoactive substances than all bar one psychiatrist that has tried to treat me. That's not arrogance, it's an unfortunate fact. I refer to my earlier post: http://www.dr-bob.org/babble/20061129/msgs/709925.html
>Some people here have died it seems from
accidents or suicide. For most, if you
can type legibly and make sense on the computer,
you need not worry about severe psychosisI'm not sure what you mean there. Some people who have psychotic disorders are very articulate and artistically talented.
>It's funny how someone with appendicitis is
rushed to the hospital and loses his freedom
under anaesthesiaThat's a different set of circumstances entirely and not particularly relevant to psychiatry. If the patient is conscious they are invariably asked to sign their consent to surgery. If they happen to fall unconscious it is assumed they would prefer to have an appendectomy, as is a doctor's duty under the Hippocratic oath to preserve life I believe?
>but the freedom of someone who is ready to jump off a bridge or drown their children, is considered inalienable, by the
anti-psychiatrists.No it isn't. The freedom of people to go about their daily lives in safety is the inalieble right. If a person for any reason - terrorism, activism, insanity - tries to jeopardise that right they should be restrained against their will if necessary. The fear I think for the anti-psychiatrists is vulnerable people being incarcerated against their will for indefinite periods of time and forced to take powerful drugs with dangerous side effects. It's something I think we should all fear here lest it happen to us, and it saddens me to hear a fellow bipolar advocating a regime where that type of abuse could flourish. The book "Repossessing Ernestine" comes to mind when I think of this subject.
>I think it reveals a hidden
antipathy, perhaps even fear for the mentally ill.Perhaps with good reason? I refer to my earlier post: http://www.dr-bob.org/babble/20061129/msgs/709986.html
>But they are just as treatable as if they would have heart disease-- the mental illness originating or affecting the brain
That isn't true for some people - the ones who are considered treatment resistant. I'm not convinced all psychiatric problems are entirely due to brain dysfunction.
Q
Posted by Squiggles on December 3, 2006, at 17:45:29
In reply to Re: Illness increases vulnerability to the irratio » Squiggles, posted by Quintal on December 3, 2006, at 17:24:03
>
> Yes, I have most of the freedoms I want right now, but it seems many would be curbed or outright prohibited under a mental health system guided by the ideas Dr. Torrey, of which you seemed very supportive. That is my objection.I think that since the sixties, the idealistic
push for deinstitutionalization of asylums has
saved the government a lot of money, and left
many mentally ill people out on the street, or
in situations where they have acted beyond their ability for self-protection and self-interest; sometimes even committing crimes without intent.You may be imagining that I am proposing asylums of the Victorian Era or even the 50s where in poor public environments, patients were treated without respect of rights and dignity. I am not proposing a return to that. I am suggesting that clinics (apart from public health) specifically for mental illness or social discord be open. And yes, I think that is necessary not only because hospitals cannot handle the surge of patients now, but because there IS a stigma against the mentally, and NO you cannot get over it with the good will posters of various government associations. You have a society to deal with that is much larger, and not part of the inner circle of academic psychiatry.
>
> I have considerably deeper and broader knowledge of psychoactive substances than all bar one psychiatrist that has tried to treat me. That's not arrogance, it's an unfortunate fact. I refer to my earlier post: http://www.dr-bob.org/babble/20061129/msgs/709925.
htmlI do too, but I would rather not speak of it.
>
> >Some people here have died it seems from
> accidents or suicide. For most, if you
> can type legibly and make sense on the computer,
> you need not worry about severe psychosis
>
> I'm not sure what you mean there. Some people who have psychotic disorders are very articulate and artistically talented.I mean that for most who are not seriously disable d by a mental crisis, the internet is accessible and makes sense. If as you say you have experienced more serious states, you will surely understand that research on the net is definitely a challenge, at least until the crisis is over.
>
> >It's funny how someone with appendicitis is
> rushed to the hospital and loses his freedom
> under anaesthesia
>
> That's a different set of circumstances entirely and not particularly relevant to psychiatry. If the patient is conscious they are invariably asked to sign their consent to surgery. If they happen to fall unconscious it is assumed they would prefer to have an appendectomy, as is a doctor's duty under the Hippocratic oath to preserve life I believe?
>
> >but the freedom of someone who is ready to jump off a bridge or drown their children, is considered inalienable, by the
> anti-psychiatrists.
>
> No it isn't. The freedom of people to go about their daily lives in safety is the inalieble right. If a person for any reason - terrorism, activism, insanity - tries to jeopardise that right they should be restrained against their will if necessary. The fear I think for the anti-psychiatrists is vulnerable people being incarcerated against their will for indefinite periods of time and forced to take powerful drugs with dangerous side effects. It's something I think we should all fear here lest it happen to us, and it saddens me to hear a fellow bipolar advocating a regime where that type of abuse could flourish. The book "Repossessing Ernestine" comes to mind when I think of this subject.Well, you may be right there. But there are many incidents where one cannot predict how a person who is depressed will respond if he or she is not observed by a doctor.
>
> >I think it reveals a hidden
> antipathy, perhaps even fear for the mentally ill.
>
> Perhaps with good reason? I refer to my earlier post: http://www.dr-bob.org/babble/20061129/msgs/709986.html
>
> >But they are just as treatable as if they would have heart disease-- the mental illness originating or affecting the brain
>
> That isn't true for some people - the ones who are considered treatment resistant. I'm not convinced all psychiatric problems are entirely due to brain dysfunction.Ah - there's the rub. I think mental health as well as mental illness depend on brain function.
To call it a dysfunction is a value judgement-- but that is what our culture is-- a set of judgements; it is conceivable to have a society of schizophrenics and call it a kind of Dystopia.Squiggles
>
> Q
Posted by Quintal on December 3, 2006, at 18:17:26
In reply to Re: Illness increases vulnerability to the irratio » Quintal, posted by Squiggles on December 3, 2006, at 17:45:29
> I think that since the sixties, the idealistic
> push for deinstitutionalization of asylums has
> saved the government a lot of money, and left
> many mentally ill people out on the street, or
> in situations where they have acted beyond their ability for self-protection and self-interest; sometimes even committing crimes without intent.I agree.
> You may be imagining that I am proposing asylums of the Victorian Era or even the 50s where in poor public environments, patients were treated without respect of rights and dignity. I am not proposing a return to that. I am suggesting that clinics (apart from public health) specifically for mental illness or social discord be open. And yes, I think that is necessary not only because hospitals cannot handle the surge of patients now, but because there IS a stigma against the mentally, and NO you cannot get over it with the good will posters of various government associations. You have a society to deal with that is much larger, and not part of the inner circle of academic psychiatry.
Yes, I was imagining a system similar to the 1950s asylums. When you quote Dr.Torrey's idea of institutions in the same thread as declaring your opposition to democracy in medicine I hope you see how misunderstandings like this arise? Thanks for clarifying. I believe the institutions of the 1950s were supposed to uphold the patient's rights though, and the word given to the Victorian institutions - asylum - meaning refuge from persecution - implies they were founded on similar intentions. Abuse flourished in them, as it seems to whenever people are given total command over another's freedom. How do you propose this would not happen again if you deny some democratic rights to inpatients? I think that is the major bugbear about returning to approach for myself and many other people who are opposed to it.
Q
Posted by madeline on December 3, 2006, at 18:17:45
In reply to Illness increases vulnerability to the irrational, posted by Squiggles on December 3, 2006, at 9:10:42
When a physician prescribes you a drug, they are playing the odds. When you take a drug, you are playing the odds.
It's a numbers game. What number you ask?
That number is a statistical value called a p value. You can think of it as a value that describes how certain a researcher is that a certain result did not happen by chance. When p-values are less than 5%, then that is considered a "statistically significant" and - here is the kicker - VALID effect.
Clinical trials are DESIGNED based on that number and it depends on three primary things: how many people were enrolled in the trial, how big the effect size is and how variable the effect is.
So does a drug work? It depends on the p-value. It may only work in 30% of patients, but if that is enough to satisfy a p-value of only 5% chance of error, then that drug officially "works", gets prescribed and we are all on our merry way.
If a drug offers a 3% improvement in 98% of patients tested, and that is enough to satisfy the p value of 5%, then here we are again on our merry way.
If a drug causes kidney value in 3% of patients, but that isn't enough to be satitistically significant, then guess what? That drug gets officially labeled as "not causing kidney failure", when in fact, it DOES in 3% of patients.
So when you take a drug you play the percentages. Am I going to be in the 3% that gets kidney failure? Am I going to be in the 30% that works? We can NEVER say ANYTHING about the safety and efficacy of any drug in an individual, we can only play the odds based on the statistics.
And as we all know, there are lies, damn lies and statistics. Right?
So, what does all this mean to the discussion here? Just because a drug has been through the rigors of biomedicine, it doesn't mean it will work for you or not kill you, it just means the odds say yes or no.
Given that, I think it is wise to always look at alternative treatments even though they may be kooky sounding or just plain weird. I mean fish oil? Come on, who would have thought it? Well, it works in some people.
And where I think people get into trouble is when they look only to exclusively one type of therapy be it herbal or biomedical and proclaim it to be the "truth". It's not, there is no truth, only the numbers.
Maddie
Posted by linkadge on December 3, 2006, at 18:47:24
In reply to Re: Illness increases vulnerability to the irratio » linkadge, posted by Klavot on December 3, 2006, at 15:37:06
I'd start here:
http://www.modern-psychiatry.com/st__john's_wort.htm
Note: The guy who runs the modern psychiatry website is actually pro-psychiatry, as you will note he offers full review of conventional drugs too.
Note: Many of the studies included severe depression where patients were *not* excluded because of suicidiality.
Here are more:
http://www.qualitycounts.com/fpstjohns.html
And, again, note the inclusion of studies with severely depressed patients.
Linkadge
Posted by linkadge on December 3, 2006, at 18:58:39
In reply to Re: Illness increases vulnerability to the irratio » Quintal, posted by Squiggles on December 3, 2006, at 16:40:46
People have the right to choose no treatment.
John Nash for example, only used antipsychotics for a few years, maybe only 2 or 3. In an interview he admitted to being concerned about the long term dammage the drug might cause. He said he didn't think the drugs were safe.
He's a smart guy, who was suffering severe psychosis, but he was allowed to make his own decisision which ultimately got him better.
Linkadge
Posted by linkadge on December 3, 2006, at 19:21:00
In reply to There really aren't even opinions, just statistics » Squiggles, posted by madeline on December 3, 2006, at 18:17:45
Thats a very fair assessment.
I think it is necessary for anyone undergoing such treatmetents to constantly reevaluate the safety and usefullness of a particular treatment.
Perhaps there is a tendancy to think that drugs are evil when a person is sick. On the other hand, there is the tendancy to think that drugs are gifts from God when a person is well.
My mother still thinks that TCA's were a gift from God dispite the fact that they sent her into a psychotic manic episode that lasted months. Yeah...thats the way God works.
I guess my main point is that the truth about a drug is completely independant of both ones state of mind, and how the drug makes one feel.
The drug could be helping your mental condition, but still be doing very bad things to the body.
But when you're well, I suppose the tendancy is to dismiss those possabilities.
Linkadge
Posted by Squiggles on December 3, 2006, at 19:26:30
In reply to There really aren't even opinions, just statistics » Squiggles, posted by madeline on December 3, 2006, at 18:17:45
I'm so glad to learn there's method
to this madness. But you know,
*ars brevis, vita longa*. :-)Squiggles
Posted by Squiggles on December 3, 2006, at 19:31:33
In reply to Re: Illness increases vulnerability to the irratio, posted by linkadge on December 3, 2006, at 18:58:39
>
>
> People have the right to choose no treatment.
>
> John Nash for example, only used antipsychotics for a few years, maybe only 2 or 3. In an interview he admitted to being concerned about the long term dammage the drug might cause. He said he didn't think the drugs were safe.
>
> He's a smart guy, who was suffering severe psychosis, but he was allowed to make his own decisision which ultimately got him better.
>
> Linkadge
>
>
He was also married to a wealthy wife, who
took care of him and insisted that he
be given minimum meds and no ECT to preserve
his beautiful mind. He spent many years at
a swanky sanitorium where his celebrity status
provided a priviledged status.Squiggles
Posted by Phillipa on December 3, 2006, at 19:45:21
In reply to Re: Illness increases vulnerability to the irratio » linkadge, posted by Squiggles on December 3, 2006, at 13:14:01
Digoxin is a plant. Love Phillipa. And there is an MD here who is using the natural approach am on his waiting list.
Posted by madeline on December 3, 2006, at 19:46:09
In reply to Re: Illness increases vulnerability to the irratio » linkadge, posted by Squiggles on December 3, 2006, at 19:31:33
and I heard she left him in real life.
Don't know if that is true or not, but if it is, I liked the movie version much better ;)
Posted by Phillipa on December 3, 2006, at 19:50:18
In reply to Re: Illness increases vulnerability to the irratio » linkadge, posted by Squiggles on December 3, 2006, at 13:47:27
From what I was told psychiatrists have the highest suicide rates one I know used carbon monoxide as he was drunk and left his car running in the garage. Love Phillipa
Posted by Squiggles on December 3, 2006, at 20:24:49
In reply to Re: There really aren't even opinions, just statistics, posted by linkadge on December 3, 2006, at 19:21:00
...
> But when you're well, I suppose the tendancy is to dismiss those possabilities....
It is a sad state of affairs that psychiatric
drugs are for the most part full of side effects
ranging from very unpleasant to downright dangerous. That's the way it is; the alternative is almost always much worse.Squiggles
>
>
> Linkadge
>
Posted by Quintal on December 3, 2006, at 20:59:21
In reply to Re: There really aren't even opinions, just statis » linkadge, posted by Squiggles on December 3, 2006, at 20:24:49
>It is a sad state of affairs that psychiatric
>drugs are for the most part full of side effects
>ranging from very unpleasant to downright dangerous. That's the way it is; the alternative is almost always much worse.Now, now Squiggles do behave........... I sense a bit of provocation in that last post.
The main problem I've had with alternative is the remedies being too weak to be effective. Some certainly do have severe side effects - such as the Ayahuasca I'm planning to take, but that in my experience is quite unusual compared to synthetic pharms.
Q
Posted by notfred on December 3, 2006, at 21:00:59
In reply to Re: There really aren't even opinions, just statis » linkadge, posted by Squiggles on December 3, 2006, at 20:24:49
> It is a sad state of affairs that psychiatric
> drugs are for the most part full of side effects
> ranging from very unpleasant to downright dangerous. That's the way it is; the alternative is almost always much worse.
>
Not for all of us. About the worst side effect I had was massive sweating from Tofrinil and still it was a very effective AD. I could not continue as I was risking electrolite problems loosing that much fluid. Anything else has been manageable. I do realize some are not so lucky. Still I think it is important to not generalize.
Posted by sdb on December 3, 2006, at 22:18:52
In reply to Re: Illness increases vulnerability to the irratio, posted by linkadge on December 3, 2006, at 13:23:50
> And what of the high rate of suicide among psychiatrists ?
>
> LinkadgeFrom where do you have that data?
kind regards
sdb
Posted by Dr. Bob on December 4, 2006, at 2:44:46
In reply to Re: Illness increases vulnerability to the irratio » Quintal, posted by Squiggles on December 3, 2006, at 14:38:32
> So this is about forcing your own opinion on the rest of the group?
>
> Quintal> I would say you are rather impolite with me and presumptuous about my values.
>
> SquigglesPlease don't post anything that could lead others to feel accused or put down.
But please don't take this personally, either, this doesn't mean I don't like you or think you're bad people.
If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please first see the FAQ:
http://www.dr-bob.org/babble/faq.html#civil
http://www.dr-bob.org/babble/faq.html#enforceFollow-ups regarding these issues should be redirected to Psycho-Babble Administration. They, as well as replies to the above posts, should of course themselves be civil.
Thanks,
Bob
Posted by Dr. Bob on December 4, 2006, at 2:44:53
In reply to Re: Illness increases vulnerability to the irratio » Squiggles, posted by Quintal on December 3, 2006, at 18:17:26
> > I think that since the sixties, the idealistic push for deinstitutionalization of asylums has saved the government a lot of money, and left many mentally ill people out on the street, or in situations where they have acted beyond their ability for self-protection and self-interest; sometimes even committing crimes without intent.
>
> I agree.Sorry to interrupt, but I'd like to redirect follow-ups regarding deinstitutionalization to Psycho-Babble Politics. Here's a link:
http://www.dr-bob.org/babble/poli/20061123/msgs/710200.html
Thanks,
Bob
Posted by linkadge on December 4, 2006, at 15:01:02
In reply to Re: Illness increases vulnerability to the irratio » linkadge, posted by Squiggles on December 3, 2006, at 19:31:33
>He was also married to a wealthy wife, who
>took care of him and insisted that he
>be given minimum meds and no ECT to preserve
>his beautiful mind. He spent many years at
>a swanky sanitorium where his celebrity status
>provided a priviledged status.Neverthe less, it is an example of an alternative choice working.
Linkadge
Posted by Dr. Bob on December 7, 2006, at 22:10:10
In reply to Re: Illness increases vulnerability to the irratio, posted by sdb on December 3, 2006, at 22:18:52
> > And what of the high rate of suicide among psychiatrists ?
Sorry to interrupt again, but I'd also like to redirect follow-ups regarding the rate of suicide among psychiatrists to Psycho-Social Babble. Here's a link:
http://www.dr-bob.org/babble/social/20061123/msgs/711312.html
Thanks,
Bob
This is the end of the thread.
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