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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 18 to 42 of 42. Go back in thread:
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.
Posted by rjlockhart37 on November 10, 2012, at 13:37:18
In reply to Re: playing chess with psychiatry, posted by linkadge on November 8, 2012, at 17:33:10
yea....benzos alter the GABA activity and comes to a point when their discontinued it will disrupt gaba function. What im implying in this whole thing is how to approcated doctors that are difficult. Not implying anything else about drugs and euphoric effects of them. I know vary well of my substance abuse that I have am prone to abuse, yet I personally disclosed my substance abuse freely...i havent hidden anything. And I guess the truth will set us free....only with consequeces from others.
thanks for the post...
r
Posted by rjlockhart37 on November 10, 2012, at 13:40:17
In reply to Re: playing chess with psychiatry, posted by sleepygirl2 on November 9, 2012, at 10:16:06
yesss...i know of my substance abuse history...but is always going to be brought up in every danm post I post? i mean ... god, all the stuff ive posted for benefit to others and all I get in response...is a old reminder of my history...? If I wanted to hear about my history I would post about it. I mean did you get anything out what I posted?
Posted by SLS on November 10, 2012, at 16:10:00
In reply to Re: playing chess with psychiatry » sleepygirl2, posted by rjlockhart37 on November 10, 2012, at 13:40:17
> yesss...i know of my substance abuse history...but is always going to be brought up in every danm post I post? i mean ... god, all the stuff ive posted for benefit to others and all I get in response...is a old reminder of my history...? If I wanted to hear about my history I would post about it. I mean did you get anything out what I posted?
You might acknowledge that you have a substance abuse history, but it might not hurt from time to time to hear from others that it could be getting in the way of your present.
- Scott
Posted by sleepygirl2 on November 10, 2012, at 16:55:58
In reply to Re: playing chess with psychiatry » sleepygirl2, posted by rjlockhart37 on November 10, 2012, at 13:40:17
How in the history is it?
I hear that you're frustrated.
I think you're in this corner because you've been your own worst enemy.
Posted by Phillipa on November 10, 2012, at 18:52:27
In reply to Re: playing chess with psychiatry » rjlockhart37, posted by sleepygirl2 on November 10, 2012, at 16:55:58
I've communicated with RJ's Mother via email and this is a huge part of the problem. Family. If RJ wishes to divulge his history he can it's not my right to do so. Phillipa
Posted by jane d on November 10, 2012, at 21:07:39
In reply to Re: playing chess with psychiatry » sleepygirl2, posted by Phillipa on November 10, 2012, at 18:52:27
> I've communicated with RJ's Mother via email and this is a huge part of the problem. Family. If RJ wishes to divulge his history he can it's not my right to do so. Phillipa
No it's not! You have no business posting here about anything you may have learned from either rj or his family since they were naive enough to trust you. I strongly suggest you contact dr bob and beg him to remove your post.
Posted by Phillipa on November 10, 2012, at 23:40:58
In reply to confidences » Phillipa, posted by jane d on November 10, 2012, at 21:07:39
Tomorrow if have time
Posted by jane d on November 11, 2012, at 1:08:43
In reply to Re: playing chess with psychiatry » sleepygirl2, posted by rjlockhart37 on November 10, 2012, at 13:40:17
> yesss...i know of my substance abuse history...but is always going to be brought up in every danm post I post? i mean ... god, all the stuff ive posted for benefit to others and all I get in response...is a old reminder of my history...? If I wanted to hear about my history I would post about it. I mean did you get anything out what I posted?
I think you brought it up in this thread. And I think you're reading into our responses (and probably your doctor's) a criticism that isn't always there. You have a bad reaction to stimulants that not everybody has. No moral judgment - just a bad reaction. If someone here said they'd had an allergic reaction whenever they used a med and then said that they wanted to use that med again you'd see just as many posts reminding them not to use it again. It's what people do when they care.
Posted by SLS on November 11, 2012, at 7:11:04
In reply to Re: playing chess with psychiatry » sleepygirl2, posted by rjlockhart37 on November 10, 2012, at 13:40:17
What are the remaining symptoms of your psychiatric condition(s) that you would like to see improved?
For now, I would refrain from exposing your brain to any psychotropic substances that are not part of your treatment regime.
- Scott
Posted by ShawnThomas on November 12, 2012, at 10:00:47
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 like a good debate as well. Sometimes I leave out details when writing, and it's always helpful to have others draw them out of me.
Nobody has comprehensive insight into what goes on in his or her brain, but that's just a fact of life. I think that the vast majority of psychiatric patients have sufficient self-insight to make informed decisions about their treatments. No matter how grounded we are in reality, we still must accept that we are unaware of much of what goes on in our brains and how various drugs can affect millions of cells in the brain.
I agree that many psychiatric medications are rather imperfect. I don't believe that everyone who takes psychiatric meds has complete faith in them; many people take them in spite of serious doubts. I admire the courage of many people who take psychiatric drugs; it can often be a rather scary proposition. There are a lot of heroes on this board, and I hope that some of them can learn to see themselves in that way.
Posted by rjlockhart37 on November 12, 2012, at 12:34:09
In reply to Re: playing chess with psychiatry » rjlockhart37, posted by SLS on November 10, 2012, at 16:10:00
hey scott...i know, its just vary annoying when people bring it up when its not being discussed. I mean I aknowedge all the way of it....it happened it it has a prodominate knowing that It may happen again, but what really makes me edge and irritated is that there are tons of posts here from the past of people expirimenting with all these drugs and they never got bad reviews for it. I appeared they where kinda celebrity that everone like to read. I've read people getting extra provgil, and getting some reviews and posting how they mixed it with dextroamphetamine. Its so ironic...
r
Posted by rjlockhart37 on November 12, 2012, at 12:45:26
In reply to Re: playing chess with psychiatry » rjlockhart37, posted by sleepygirl2 on November 10, 2012, at 16:55:58
my own enemy? im just trying to find solutions for this...all this sh*t people never read in my posts of things im stuggling, alot of other people here are some enemies and I have to address them, they use my name in deratory manners in other posts thinking i won't read them. I am frustrated....i mean that's pretty obvious, but im mapping and telling people of how to deal difficult doctors, get what im saying of playing chess.
I am in a corner, but im sure everyone uses what I write against me, it may of just been fine it I never mentioned substance abuse...but I choose to be open with it. Ever since that its got bad reviews, kinda like releasing info to the poperatzi....they let everyone know it, and write bad stuff in tabloids. And yes I have used meth....short periods of time for fun, but long periods of time it no...it messes with my mind and makes me do wierd things...
so....i hope i cleared some stuff. I really like the idea of you posting but seriously, i am always on the edge with arguing with people about this issue because they flat out think "rj just wants stimluats" i've read that so many times...i can get stimulants if want them. But I stay with my Nuvigil.
cheers...
r
Posted by rjlockhart37 on November 12, 2012, at 12:58:32
In reply to Re: playing chess with psychiatry » sleepygirl2, posted by Phillipa on November 10, 2012, at 18:52:27
hey phillipa....my mother...I hope your talking with the real her, there are other people that can imposter it. If you want my mothers email, facebook, ill send it. But I'm getting along well with her, have no fights, no bad stuff, i don''t know if you got info what happened in july, i was hanging out with some people that....they took and stripped everything I had, my phone, my credit card, my cat, about 600dolers in cash, all of this was associated with bad people,
my mom came to pick me up and she didnt show any resentment and was glad to have me back. I slept for 2 days after that.
seriously, this is like telling the press of whats the scoop and people use this stuff against me....when im just being honest, i could of kept this a secret but ... i just want to come out and let people know.
it ok if you talk to my mom, I just hope its not a imposter its ok, you show care about me and thats what makes me feel good.
im just going to have about people having a bad view of me, its really annying, its stupid of me in the first place of telling everyone my 360degree story of my life here.
thanks
r
Posted by rjlockhart37 on November 12, 2012, at 13:06:55
In reply to Re: playing chess with psychiatry » Phillipa, posted by rjlockhart37 on November 12, 2012, at 12:58:32
phiilpa, i really don't feel comfortable about talking to my family, i tell alot of things here so i can at least know someone hears something. But if this is going to make me to browsing people on google, im gonna have to find to get this stuff off here. Dr bob desoent listen to me anytime I contact him. Theirs a website that you can manually take posts off, but i think there a fee.
just try to keep it, here, i don't really mind if you know who my family is but discussing things here about me, try to keep it here. My family sometimes will read, and will think im a fool....and won't want me around them.
thanks...and thanks for posting really.
r
Posted by rjlockhart37 on November 12, 2012, at 13:08:32
In reply to Re: playing chess with psychiatry » rjlockhart37, posted by jane d on November 11, 2012, at 1:08:43
ahhh thanks jane d....its good to see a friend with no critism. :)
rj
Posted by SLS on November 12, 2012, at 14:31:21
In reply to Re: playing chess with psychiatry, posted by rjlockhart37 on November 12, 2012, at 12:34:09
Hi RJ.
I apologize for "piling on".
> hey scott...i know, its just vary annoying when people bring it up when its not being discussed. I mean I aknowedge all the way of it....it happened it it has a prodominate knowing that It may happen again, but what really makes me edge and irritated is that there are tons of posts here from the past of people expirimenting with all these drugs and they never got bad reviews for it. I appeared they where kinda celebrity that everone like to read. I've read people getting extra provgil, and getting some reviews and posting how they mixed it with dextroamphetamine. Its so ironic...
I see what you are saying.
I think most people who respond to your posts want to see you be healthy and happy. I do.
Would you describe your use of some drugs to be "recreational"? There is probably a fine line there. Self-medication with drugs that are considered to be recreational is still an attempt to treat pain and frustration. I don't judge you for your use of any drug. You are only human like me. However, I would stress again that I think your chances of improving your mental health would be increased by limiting your exposure to drugs to those you are being treated with by your doctor. That doesn't mean that you shouldn't participate in your own treatment, though. You should continue to educate yourself and try to work with your doctor in a cooperative manner.
As always, good luck.
- Scott
Posted by schleprock on November 12, 2012, at 16:54:59
In reply to playing chess with psychiatry, posted by rjlockhart37 on November 6, 2012, at 15:15:49
This is the end of the thread.
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