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Psychiatry: A specialty relegated to the basement

From Tuesday's Globe and Mail

Mental health patients and the medical professionals who treat them face discrimination every day ...Read the full article

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  1. Jung Frau from Switzerland writes: You're taking the easy way out Your patients will make your life hell Your patients will make you depressed What a waste of talent! This is not a one way street. As a parent of a son who has spent the past six years with psychiatrists on both sides of the Atlantic, I feel qualified to say that many (not all) of his psychiatrists have made our life hell and most (not all) of them have made us depressed. Why? Because unlike an oncologist, for example, who can remove a tumour to the everlasting gratitude of both patient and family, psychiatrists have a knack for keeping their clients patients. They have abandoned psychotherapy (empathy and understanding) and the 50 minute hour in favour of 'high tech' brain imaging and prescription drugs. We spent the first half of my son's treatment arguing with his psychiatrists about the efficacy of the drug treatments. Antipsychotic dedications have been acknowledged as ineffective in most patients (National Institute of Mental Health funded study in 2005), produce tardif dyskinesia and type II diabetes with long term use, yet still psychiatrists push these ineffective and dangerous drugs on their patients. Why? The prevailing attitude is 'I am the psychiatrist and I know what is right for you.' Our attempts to suggest to them to try other interventions was met with stony resistance. Few psychiatrists that I have met actually seem to be on the side of their patients. Most doctors have a God complex but psychiatry in particular is a dangerous to exercise it. Despite all this, I believe psychiatry is a needed, but if only it were practiced with imagination, care and empathy.
  2. june Conway Beeby from Kingston, Canada writes: How revealing.

    Families have already experienced the disrespect and lack of services for their ill relatives. We know that neurology and psychiatry need a closer collaboration to treat diseases like schizophrenia, manic depression and other serious mental illnesses.

    We desperately need a political leader like Person, who successfully led the country to medicare, to ensure our country understands and responds to the suffering of the mentally ill and legislate the care they deserve..
  3. Syed Mohammad Husain from Mississauga, Canada writes: Psychiatry is a little different from other medical practice and should remain as such since a pill isn't a cure like in the latter, in fact there is no magic cure.
    This fundamental difference has to be accepted at all levels amongst different schools of thought practicing psychiatry.
    Sometime back I read in a book written by an eminent doctor in this field that John Hopkins University has discontinued psychotherapy curricuum for young entrants as it is time consuming and not that profitable for the industry.
    I believe talk therapy is the crux in the healing process since as this article highlights, it is a very lonely situation to be in if one is caught up there..
  4. CD W from Canada writes: I was sitting in court and watching the most preemininant psychiatrist in calgary testify for a bi polar in a family matrimonial dispute. He assured the court under oath that she would never have a relapse. The judge gave the child back to the whack job, and a week later the mother while trying to fly to Toronto to pick up the child, assaulted 3 waitresses, and 3 police officers in the calgary airport. She is now on the no fly list, and the little girl's life was saved. The psychiatrist has faced nothing, no discipline, no civil damages. This is why we think little of them. The change the world for those of us who are okay by sending back to us, those who would hurt or kill us. Thanks
  5. Rob Swanson from Edmonton, Canada writes: Thank you to the Globe for keeping this series front and centre.

    So much pain, and so little understanding.

    Keep it up, it just might be helping.
  6. Jennifer Forbes from Ottawa, Canada writes: My heart goes out to Ms. Misurelli and I wish her well in her recovery. Moreover, I'd like to thank everyone who chooses a career in mental health in order to help improve the lives of those affected. Thank you!
  7. it's a fact from Canada writes:
  8. Brian Barry from sudbury,on., Canada writes: 'Regulated to the basement'... Literally... I would visit my Mom in the basement of the hospital in Mississauga in the '80's, after one of 4 suicide attempts.

    I was 15 yrs. old at the time. The dysfunction continued for years and years. I just want to get THIS off my chest... In all the years, my moms psychiatrist never once called ME into the office to ask ME what was going on in our home to help her understand my Mom better.

  9. annick aubert from toronto, Canada writes: And there also is a pecking order in that basement.
    Schizophrenia is in the sub-basement.
  10. annick aubert from toronto, Canada writes: There is a pecking order in that basement too, please note that schizophrenia is in the sub-basement. Were you aware that some psychiatrists do not take sz.patients.. How often do schizophrenia patients see their psychiatrist ? compared to patients with other mental illnesses ?
  11. Canadian Woman from Canada writes: I find it incredibly telling that there is not a single comment on this article at 11 am (CST), when general articles almost always have many comments by this time of day. Is this another indication of the lack of interest & the 'irrelevance' with which mental health is perceived in this country? I am a nurse and have seen all of the things described in this article many many times over. The lack of services, lack of funding, the ridiculous wait-lists, the discrimination against these patients - both re their psychiatric treatment & also re their physical problems - is rampant throughout Canada's health care system. Our society compounds these problems. I heartily applaud the G&M for this Mental Health Series of articles, and I thank the author of this particular one for doing an excellent job! Every Canadian has a responsibility to try to help to overcome, personally & societally, the ignorance, discrimination & biases regarding mental illness, as well as the lack of funds & services available. Remember, it can happen to any one of you or a loved one. No one is immune. And no one should have insult added to injury by being treated without respect, understanding or care.
  12. Yukon Maverick from Whitehorse, Canada writes: What a depressing state of affairs! Even more so, when you consider that the economic calamity that is still unfolding will surely lead to the need for more mental health services and providers.

    What hope is there for reducing the stigma against mental illness amongst the general public when the very people who are supposed to know something about it - doctors - are unable to take a more enlightened view? Definitely not very 'God-like.'
  13. Richard Dougherty from Spruce Grove, Canada writes: That psychiatry is a pseudoscience (and therefore held in such low regard by other doctors and the public) can be easily proven. There are no reliable objective laboratory tests (pap smear, blood test, brain scan, x-ray, urinalysis) to prove what many people are misled by the profession to believe - that they have a 'chemical imbalance,' some sort of 'genetic abnormality' or other 'physical abnormality.' Therefore, conventional medical treatment (which almost always involves psychotropic drugs) is not only useless but downright harmful...especially when prescribed to children and adolescents whose brains and other body parts are still in development. Fortunately, there are now a growing number of medical doctors and other experts who think outside the box who are having success with drug-free alternatives to conventional drug therapy.

  14. Benjamin Frankling from Canada writes: The worse stigmatizers are the politicians. Mention mental illness to them and they either smirk or look at you as though you might be crazy. I brought up the issue once and I had one politician asking me why I brought up the issue. He said that in all the years he had been in politics nobody ever discussed mental illness and he wasn't about to start meddling in it. Another politicians asked me if 'crazy people' vote. Other than you guys and this series of articles, no one ever speaks out for mentally ill people. Actually, they might as well be buried for all the attention they get. I hope these articles are not a one shot deal.
  15. Alan Blanes from Kelowna, Canada writes: Psychiatry would raise its prestige greatly if it was willing to look at PTSD from the perspective of eradicating structural unfairness. I cite the Special that National Geographic showed on PBS earlier this Fall on the physical affects of stress and disempowerment in primates, that results in abdominal obesity, diabetes and numerous other degenerative conditions. The conclusion was that living under unfair conditions is very damaging to those who are oppressed.

    Psychiatry has been extremely averse to dealing with this systemic cause of pathology. In cases such as destruction of democratic rights of people in special needs housing - caused by collusion between corrupt group home operators and police, [citation LERB Judgement 038-99; Alberta Law Enforcement Review Board] psychiatrists wilfull blindness and automatic resort to prescribing drugs for depressive anxiety - rather than acting to defend the principles of a democratic society - has resulted in fearful patients who are having to put up with their rights being trampled in the interests of corporations that benefit from overmedication and passive warehoused patients.

    I would like to see real action to awaken the capacities of psychiatrists to participate in creating full citizenship for those who have been marginalized by the above kinds of short sighted and irresponsible reflexes into pharmacology and ego maniacal roles for therapists. When psychotherapy joins the cause of affirming democratic culture, their standing will be affirmed as responsible practitioners. For further discussion of this subject, participate in 'citizensforpeacefulcommunities@yahoogroups.com' or visit the list serve that has been moderated by Rob Wipond as a followup to the Madness, Citizenship and Social Justice conference held at Simon Fraser University in June/2008.
  16. Katie T from Canada writes: CD W: 'Whack job'? Nice. After an article addressing the stigma still attached to mental illness, how kind of you to demonstrate that prejudice in practice.
  17. c. f. from not specified, Canada writes: Mental Health is a huge subject, and it is has been sorely underfunded and stigamatized for years in Canada -- and the USA. Our entire health care system is now under pressure, and the diseases of the body that are curable are pushing out the 'incurables' from the hospital to the community. Lets have the elderly ''age in place'', and the mentally ill be at home with their families, and the cancer patient die in their own bed. Well these initiatives can sound great, but not when you don't finance them sufficiently. Not when there is a shortage of nurses and doctors. What if the family can't take care of their dying, ill, elderly, mentally ill, family member?? What then? We pay a large tax bill so that we have a system of compassionate care for all the weak and ill. We can't let that go down the tubes. Why aren't the ridiculously premature infants (less than a half a pound who will drain health care forever) kept in the basement? Why cant' the mentally ill have the new nursery space with the outside playground space for fresh air? Not only have medical schools pooh poohed psychiatry, but nursing schools in Ontario are making psych nursing an optional rotation, not a mandatory one like obstetrics, and pediatrics which a person might choose never to do either. What does that convey to tomorrow's nurses? Mental Health isn't really a specialty - it's ooie. Step Up Canada. Mental Health Issues are here, and we need to take care of them!
  18. james castle from Canada writes: Psychiatry isn't called a 'soft science' because it's easy but rather because it's not very scientific. The entire discipline is based almost exclusively on inductive instead of deductive reasoning. There is no doubt that the brain is hard to understand but the fact that we don't yet understand it doesn't suddenly value psychiatry into the realm of science. For years and years and years homosexuality was labeled a disease. Suddenly (around the time it became more socially acceptable) it wasn't. What scientific discovery led to this new status? None. It was simply no longer acceptable to identify homosexuality as a disease. Any 'science' that is that succeptable to political and social whims simply isn't a sciene.

    Not to say psychiatrists aren't wonderful people. Most of them do very hard work and work with what they have. Unfortunately what they have is a very imperfect understanding of what's happening in most cases.

    Calling psychiatry a 'soft science' should not detract at all from the work psychiatrists do. It's simply stating a fact about the world.
  19. Benjamin Frankling from Canada writes: The mentally ill people might as well be buried for all the attention they get. Ask a politician what has he done lately for mentally ill people and he'll say, 'Who?' They don't even want to hear the term. I had one telling me that in all his years in politics no one ever brought up the issue. The Globe and Mail should be commanded for this series of articles. However, I hope this is not just a one shot deal.
  20. Old blue from Canada writes: I'm not a G&M fan ....but this is a superb article.
    Psychiatry, radiology and pathology definitely don't get the respect that they deserve.
  21. Brenda Mathieson from Canada writes: Thank you so much to the Globe and Mail for profiling a subject long in need of discussion in a public forum. My family spent years attempting to get treatment for a mentally ill loved one who was too ill to consent to treatment. Fortunately for us, after 17 years of chronic illness, our family member was finally hospitalized and has been a fully functioning person for the last 12 years on proper medication. I believe we have a happier ending than most. Our laws put obstacles in the way for patients who are too ill to consent to treatment; meanwhile families break up, friends disappear - unable to understand why the family would 'allow' their loved one to go untreated; finances collapse; stress and related-health problems affect the rest of the family. Once the families break up, many of the mentally ill end up on the street with no one to care for them. Of course, then the crime rates and drug/alcohol problems climb. The Globe and Mail has brought forward this subject and generated a mountain of interesting feedback and material from all kinds of sources. Even more amazing, instead of letting the subject drop off the radar after a few headlines, has continued to profile the subject. Patients, family members, and medical communities have been brought together, online and in print, to discuss the matter from all sides. Please continue to profile this subject front and centre. I believe that the changes that need to be made to the medical system, to the mental health laws and public awareness and empathy are only going to happen with continued openess and public discussion. To all the various people who have shared their stories, you are a courageous lot.
  22. Olivia Beck from Canada writes: I cannot heal until I am given the opportunity to do so. I cannot heal until I have a place in my community.

    Help me heal. Help me belong.

    I belong.

    We all belong.
  23. Patricia Forsdyke from Kingston, Canada writes: Yes there is stigma and all that goes with it – discrimination and name calling etc. – but stigma will not go away by just talking about it. While there are so many people wandering our streets without treatment it will persist. Diabetic patients were once stigmatized. Before insulin was available it often meant a sure death, and death was a taboo subject.

    A good way to move beyond second class citizenship (both for psychiatrists and their patients) is to get the medical profession to speak of schizophrenia, bipolar, etc. as physical illnesses. It is time to debunk the legacies of Freud, Szasz and Laing, and place these illnesses firmly back into medicine. The very good psychiatrists are up-to-date. They are, or should be, medical experts. Other areas of medicine have had some monstrous quacks throughout the centuries.

    In the meantime those who are seriously mentally ill deserve access to the best treatments currently available. New knowledge about the brain may eventually be the ultimate help and it may ultimately embarrass those who presently hold false views. I do hope the emergency doctor who so abused his diabetic schizophrenia patient gets his just desert.
  24. sam themacman from waterloo, Canada writes: My wife works for CMHA as a crisis worker. She is a certified RNA that worked for years in the Psych ward of one of our local hospitals. She would confirm a lot that is in this article. It is not just the psychiatrists, but all people who work with the mentally ill, including RNs, RNAs, Social Workers, Psychologists, as well as the supporting agencies and the patient's families. The stigma is huge, even among the professionals.

    During cut backs in Ontario, and lay offs, the hospitals reassigned nurses to the Psych department who had ZERO training in psychiatry! That alone was incomprehensible. Eventually my wife could not hack the institutional side of things any longer, and found a new role within the CMHA as a crisis and addiction worker. It is a community based system of care where many agencies help one another. She finds her work much more fulfilling and better than what she endured all those years in the hospital institutional system.

    Great article. Thank you.
  25. Kyle Burns from Canada writes: While there may still be some stigma for those of us who work in psychiatry it really doesn't compare to what our patients experience. I will admit that people are sometimes careful about what they say at dinner parties but I am invariably treated with respect and decency. I only wish that were the case for my patients. I do believe there is more understanding about mental illness and the stigma around it is improving. Nevertheless we still have a long way to go as CD W has demonstrated nicely.
  26. kristy williams from Halifax, Canada writes: An interesting and telling article, however I think we need to carefully consider the language we associated with mental health issues. For example, in the paragraphs following the quote 'Your whole being no longer matters, or what other illness you have, those things fade away, you become the illness.', the potentially discriminating label 'mentally ill people' was used multiple times. Calling unique and diverse individuals mentally ill reduces their identify to their illness- we don't refer to people with cancer as 'cancerous people'. Perhaps terms like people who have experienced mental illness would be a more just and respectful way to describe individuals (which may be any one of use at some point in our lives) who experience such an illness.

    At the same time, kudos for the Globe for highlighting such a neglected aspect of our national health.
  27. Jung Frau from Switzerland writes: Patricia Forsdyck, you say 'it is time to debunk the legacies of Freud, Szasz and Laing, and place these illnesses firmly back into medicine.' I say that a large part of why patients remain patients today is because psychiatry has turned its back on people like Szasz and Laing. They, and psychiatrists like Loren Mosher, have a lot of relevant things to say. What they say is often painful, but true. Psychiatry and drug manufacturers have made it easy for people to think the cause of their problems is a biochemical imbalance, when in fact, their biochemical imbalance may be a result of their own thought processes.
  28. Patricia Forsdyke from Kingston, Canada writes: Brenda Mathieson speaks of her loved one who went without medical treatment for years because mental health legislation failed to meet his needs. This is all too common a problem. Yes, people are more than their illness, but being trapped inside an untreated serious mental illness diminishes the person's real personality. I was the President of the Schizophrenia Society in Kingston for many years. I now see people who eventually became stabilized after years of untreated illness. ( I also have met many who died because of lack of treatment.) I meet many who have now been rescued from their tortured lives. Two in particular, who had paranoid delusions of terrible nature, reponded well to treatment ... to my great surprise. Their delusions were very entrenched and it seemed that they were unlikely to function well again. Now they are both helping their lovely elderly parents. One remained in hospital for at least a year before the illness was tamed. He was untreated for over a decade before medical intervention. This very educated man spoke beautifully at his father's funeral. He actually drives his mother to church and other appointments. Another has a mother who is almost blind and she cares for her. This particular person had easily the worst paranoid symptoms that I have ever encountered (I was a trained psychiatric nurse in my youth!). She was without treatment for at least six years. When the suitable neuroleptic was found, she needed absolutely no further support. She had her life back, with her wry sense of humour and never has needed support from a mental health agency. I bump into her in town and she asked asks why nobody had committed her to treatment earlier.
  29. Patricia Forsdyke from Kingston, Canada writes: Jung Frau from Switzerland appears to put great faith in two very misguided psychaitrists R.D Laing and Thomas Szasz. The former claimed that people were mad because the world made them so and the second believed that there was no such thing as mental illness. I bought Szasz very expensive book 'The Myth of Mental Illness' in the sixties. At the time I was taken in by the works of Freud and the like. Fortunately more experienced professionals knew better. Laing and Szasz were invited here to Queens University. Laing filled one of the largest lecture theatres and performed abysmally. He was either very high or very drunk. Szasz was invited by the medical students. He continued to dogmatically spout that mental illness was a myth. I challenged him in a packed auditorium. He responded by playing word games. He fooled quite a few. A twin whose brother had Schizophrenia and was extremely ill at the time, also challenged Szasz. Szasz was absolutely ruthless and devoid of compassion in response. Someone subsequently sent me a nursing magazine which reported that the wife of a psychiatrist attempted to challenge Szasz in court. Apparently the doctor had been influenced by Szasz to go off his bi-polar medication and had committed suicide. It was reported that the matter was settled out of court. Laing son may also have committed suicide. I do not hold a brief for the pharmaceuticals, but like insulin , antipsychotic medications usually work. Psychotherapy can be a useful adjunct treatment but it is important to make the person sane first.
  30. Jung Frau from Switzerland writes: Re Szasz and Laing: I clearly wouldn't want these two guys as my best friends, but that doesn't mean that what they say isn't relevant. I pick and choose what I think is relevant for healing and discard the rest. There is a nugget of truth in most controversial ideas. We reject them at our own expense.
  31. K B from to, Canada writes: AS A FOREIGN TRAINED OR EDUCATED PROFESSIONAL YOU ARE PERMITTED TO WORK WITH THE CRIMINALLY INSANE. You should not be permitted to be a in a position of trust with any other citizen including those with medical psychiatric issues. It is a myth that people who have medical psychiatric problems are thrown to the basement. We care for our citizens and demand the best care possible at any age. We will not tolerate abuse from any one. Foreign trained or educated professionals in positions of trust within the medical field create, condone,support and inflict an abusive, intolerant, and dominating environment for people who are ill.

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