Hi all, I am working as a psychiatrist. I am happy to answer any questions you may have about the field. Offcourse, I will not be providing any management / treatment of illness as I do not think it is appropriate unless I have assessed a person myself.
For a good online self help resource, people can use MoodGym website.
[AMA] I Am a Shrink (Psychiatrist), Ask Me Anything
DiLs on 13/11/2020 - 22:02
Last edited 15/11/2020 - 08:36
Last edited 15/11/2020 - 08:36
closed Comments
You mean like the Chief in One Flew Over the Cuckoos Nest? He chose to remain silent presumably, but must have been diagnosed with something.
I cant believe you answered the question I put to the OP. No, I dont mean like Chief Broom, the chief was probably sane when he went into hospital and is not the sort of person I meant.
Believe it.
I think these things are very rare now since the improvement in diagnosis of mental illness. I think what you are mentioning is something shown in the movie K-Pax.
Even though, these things are uncommon now, there are still some patients who make you question whether it is mental illness or normal realm of reality or cultural aspects etc. The important thing in those cases is to take a proper history, conduct a mental state examination, get collateral information from family and checking with people from same culture.
e.g. Religious beliefs. It's not a delusion if it's a mass delusion, amirite?
Its not a delusion if it can be explained from religious, cultural or social perspective.
@DiLs: Does that mean that as long as someone else close to your patient believes in the same paranormal phenomena, that it's not considered to be a delusion? Where do you personally draw the line?
If a psychiatrist may have made a mistake, but they seem to be acting kinda shifty when they realise the mistake, who should you report it to? I don't have a psychiatrist but I wonder in general how accountable they really are when at the end of the day it's just them and the patient and there's no other record of what's been going on than their own. Suppose they neglect to write something important you've been telling them and they are tempted to deny that you ever told them about it in the first place if it comes up for something important later. What organisation or whatever compels a psychiatrist to do the right thing when they find themselves in a situation where doing the wrong thing might boost or save their careers? There's ethics and all that, but at the end of the day who steps in and makes sure it's actually all happening as it should have when it all falls apart? If you're a surgeon or a radiographer or many other jobs there's a solid record of everything you do, images, charts from machines, maybe dozens of other staff signing off on their own interactions with the one patient over the weeks they are in hospital. If you're a psychiatrist it's just you and your own record, seems very unlikely that 100% of psychiatrist can be trusted to do everything right 100% of the time. Or that one would be eager to own up to their own mistake, especially if it was a big one that was years in the making. I feel like any sane psychiatrist, if their job or reputation was potentially on the line, would just deny everything and instruct their insurer to make the problem disappear.
Good question.
There are numerous check and balances for psychiatrists as well. As other health professionals, they are also bound by Code of Ethics and are governed by Australian Health Practitioners Regulation Agency (AHPRA). Anyone can report a health professional to AHPRA if any of the following occurs:
are practising with an impairment, and
place the public at substantial risk of harm. are practising while intoxicated by alcohol or drugs, and
place the public at substantial risk of harm. are significantly departing from professional standards, and
place the public at substantial risk of harm. have engaged in, are engaging in or might engage in sexual misconduct connected to their pract
Other options depend upon your state e.g. in NSW there is Health Care Complaint Commissions (HCCC). In QLD, there is a Health Ombudsman.
Do you ever miss doing acute medicine and if so do you miss it a lot/frequently?
Are you satisfied in your specialty choice and do you have any regrets?
If you could do it all again would you still do psychiatry?Not really, I do not miss. I am happy with psychiatry. I dont have regrets.
I saw in one of your other responses that you're a public hospital staffie. Are you fully public or do you also do some private work? Why or why not?
Are you inpatient or community? CL? Can you paint a picture of your average day? How would you describe your stress level and the pace of the work?
If you're inpatient - how do you feel when your admitted inpatients deteriorate from a physical health perspective? Do you institute some basic medical management or leave it up to the medics?
I am actually applying for the the graduate med course for 2022 with the intention of specialising in psychiatrity eventually. I haven't looked too much into what happens after completing the medical degree so are you able to shed some light on that part of the journey? Also any tips for surviving 4 years of medical school? Thanks
Check this link to know everything about the specialization program
https://www.ranzcp.org/pre-fellowship/about-the-training-pro…As doctors, we do have personality traits of obsessiveness perfectionism and neuroticism. Just try to take it easy and dont stress too much and you will be fine.
Thanks!
Happy to answer any further questions if you have
@DiLs: I had a look at the link and wanted to ask, during the 60 months of the psychiatrity speclization, would I be paid or would I be considered an intern and not be paid? Similarly with the Med degree when you do rotation, is that paid as well?
Thanks
@Staff: You will not be paid during med school rotations - the current 2020 final year students (in NSW, possibly also in VIC) have been lucky to be the first ever med students to get paid, but I wouldn't expect it to last as it is mostly a covid initiative.
What is your opinion about Donald Trumps tendencies and what mental illness / personality disorders do you suspect he has according to the DSM V ? Eg. Cluster B PD’s
Just wanting to see if you have similar views of what myself and my sons psychatrist has about trump and his tendencies
The Goldwater rule is Section 7 in the American Psychiatric Association's (APA) Principles of Medical Ethics,[1] which states that it is unethical for psychiatrists to give a professional opinion about public figures whom they have not examined in person, and from whom they have not obtained consent to discuss their mental health in public statements.
How about a personal opinion, rather than a professional one. You're allowed to have those right?
I would hunch towards narcistic personality disorder
@DiLs: That's fair and quite reasonable. Although sometimes I ponder whether he is just "playing to the crowd" and demonstrates more antisocial or even psychopathic characteristics, given his apparent lack of concern for the welfare of others and his preselection for functional aggression (if not actual violence committed by him personally).
Do you have any thoughts on that? Much harder to offer comment on antisocial PD or psychopathy without interviewing him (and having him not lie) so I understand if you're agnostic on that one.
@ozbjunkie: Lack of concerns about others can also be a component of narcistic personality disorder. I think antisocial PD is harsh.
@DiLs: Thanks for the input. My personal, and probably far less informed personal opinion is:
He seems to have the egocentrism of NPD and APD, and the antagonism present on each disorder, by his disinhibition, risk taking and disregard for the welfare of otherd (not wearing a mask in a mask factory, for example, taking a victory lap while still infected with covid, would be another, encouraging or praising violence against protesters and holding in door maskless rallies might be more examples).
@DiLs: I've noticed you've mispelled narcissistic and other words, which makes me think you are not Australian. Is that the case? If so, have you completed the Specialist Pathway?
@this is us: Does you writing mispelled makes you non Australian? I couldn't find this word in dictionary.
@DiLs: You got me there. I am not Australian, but I am familiar with the Specialist Pathway. I am not asking to offend or minimise what you are saying here. However, it caught my attention that you wrote narcissistic a few times, always misSpelled, and that you used American spelling for a few words. Therefore, I was wondering if you finished your training in Australia or overseas, and how difficult it was for you to achieve medical registration and specialist recognition in Australia as an IMG. That was going to be my question as I've been in this process myself.
Moreover, I wouldn't expect an Australian psychiatrist to call himself/herself a shrink, which is often considered derogatory. To be honest, I have never heard/seen the word shrink used in this context, in Australia.
@this is us: I am not Australian if that means born in Australia but I became a specialist here going through the whole training. Once you get into system it's not difficult if you are reasonably good. I did not go through specialist pathway.
Out of interest you may like to know, Jeffrey Lieberman (ex president of American Psychiatric Association possibly the most well reputed Psychiatrist Association in the world) in 2018 in a NY opinion piece suggested that Trump likely has incipent dementia.
https://www.nytimes.com/2018/01/12/opinion/trump-mentally-il…@DiLs: That does indeed interest me. Certainly a reasonable explanation of his apparent stupidity in some interviews. Alternative explanations include general low IQ, willful ignorance, feigned ignorance, but dementia is certainly up there.
Edit: Maybe I'm not understanding the subtext of that article, but it doesn't make what I would call an implicit suggestion of dementia, let alone and explicit one. Sure, the word appears, but the article claims than any opinion without systematic observation is essentially invalid.
@DiLs: Read the article you linked a couple of times … does not sound like he was suggesting dementia.
He mentioned:
It’s entirely possible that he simply has certain personal qualities we don’t find ideal in a leader, like being a narcissistic bully who lacks basic civility and common courtesies. …
This seems more consistent with observables, and with what people who knew him said about him, e.g., Tony Schwartz (who co-authored The Art of the Deal with him), and his niece, psychologist Mary Trump (who wrote the book about him - Too Much and Never Enough), and others.
@bluesky: Apologies, this is the link to the correct article which he wrote.
https://www.vice.com/en/article/wjjv3x/trumps-brain-and-the-…@DiLs: Thanks, the article gives interesting insights into the possibility of incipient dementia, while both may co-occur.
@bluesky: Many 'leaders' have the same qualities: Musk, Jobs (even worse), etc. It's just the leader of the free world is 1,000, 000,000% more visible than CEOs who have PR departments, lawsuits and advertising budgets, etc to stop bad stories being reported on.
Trump certainly doesn't have low iq.@Other: Corporate leaders’ behaviour impact only their companies and their stakeholders. A sitting president, on the other hand, holds so much power that his decisions/actions have a wide-ranging impact on the entire nation, and even the world. It is thus befitting that there are a lot more scrutiny and public interest in the president’s conduct.
He has the entire White House staff at his disposal, ranging from press secretaries to counsellors – to act as his mouthpiece, handle damage control, etc. It was due to public interest, that the media uncovered some of the negative stories that he wants to stay hidden (e.g., his tax returns).
Fair enough .
That’s why I like discussing things with my sons psychiatrist only if and when he makes a comment about such people and to confirm my knowledge and understanding about Cluster B tendencies Which I can relate back to me and my teenage children own personal experiences in the past .
Which is the root cause as to why my son is seeing as psychatrist in the first place .
Hello thank you for offering your knowledge upon this site.
I my readings, I have come across the topic they term "Serpentine Energies". This is viewed graphically as upon the serpent entwined orphic egg, and in fact physically in the form of the makarah (serpent stair rails) found upon many Hindu, and Aztec temples.In describing Serpentine Energies, they break it down to: Physical, Mental, Emotional and, Sexual.
Could you please briefly explain the definitions/differences between Mental, and Emotional.
CheersMedical doctors usually do not believe in these things. A person practicing or specializing in these things may be more able to answer appropriately.
While paying lip service to the differing skills of a psychologist and psychiatrist, does your training basically teach you that psychiatrists at "better" in some way than psychologists? Psychology training carries an undercurrent of "psychologists are better than psychiatrists".
What are your thoughts on the idea that lots of pharmacotherapy is like playing bucket chemistry with someone else's brain?
How comfortable are you with the idea that in psychiatry (as with some other pharmacological treatments) drugs appear efficacious and are used without a clear understanding of mechanisms of action? Not meant to be a loaded question. I can see good points for multiple stances here.
Finally, how much does training involve distinguishing between suppression of general mental functioning, against treating symptoms, against treating the underlying disorder?
I think there is a hidden message that psychiatrists are better as they are also medical doctors. I personally respect the knowledge, skills and experiences of other members of the multidisciplinary team. Yes, we may not know the exact mechanism of action of some of the treatments but that does not mean they are any less effective. Real life experiences and researches have proven that most of them are efficacious. Electroconvulsive therapy (ECT) probably one of the most useful treatment in psychiatry is one such example.
Really good answers, very straightforward, thank you.
Yes I think psychiatrists training in medicine provides something clearly superior to the training in psychology, but psychology's emphasis on theory bashing and scientific methodology might be useful for creating conceptualisation a of illness and wellness. I find it regretful that psychiatrists are mischaracterised as "people throwing drugs at a problem" and psychologists get characterised as "psychiatrists without any medical training or rights to prescribe drugs".
Meanwhile, while I think both types of professionals can help, although there is a more than a healthy amount of charlatanism in each discipline. Papers on trying to measure first episode psychosis in babies, and the trend of increasing prevalence of ADHD increasing so fast that if projections matching recent data are maintained, in the near future 100% of people will have ADHD, these things come to mind, but there are many many other examples.
Thanks for your time.
I work in the mental health field with many experiencing severe financial hardship. For those that are not under the public health system, I am finding it harder as the years go by to find a psychiatrist that will bulk bill. I only know of 2 on the Gold Coast at the moment. Psychiatrists appear to be very well paid and always wonder why more don’t offer bulk billing for at least a small percentage of their case load. Are you able to she’s any light on this?
I'd imagine it has something to do with "what the market will bear" combined with "costs of training, length of training, delay in earnings" but I'm in for the answer to this one as well.
This is indeed a challenging situation. I can not comment on personal decisions by psychiatrists but on the other hand you can think that it takes a lot of time and energy for psychiatrists to assess and manage a patient. A usual psychiatric appointment in private field go for about 45+ minutes for initial consult and 30+ minutes for a review consult. They also have to pay for the office fee, keeping administrative staff, paying for indemnity insurance etc and so much more.
One option you may like to explore is getting your patients assessed by TelePsychiatry. One option is to get the patient assessed by a psychiatrist with initial consult and then the psychiatrist gives a detailed report to the referring GP with a comprehensive management plan. These assessments are bulk billed and a competent GP can then keep managing the patient.Is a TelePsychiatry consult cheaper than a regular consult?
In some cases e.g. having 1-2 appointments with a psychiatrist who then give a detailed management plan to your GP
Use of title Dr is absolutely correct for psychiatrists. You have to pass the medical school to get a primary medical qualification i.e MBBS or MD. Only then you can enter into the psychiatrist training of further five years. Also, one of the main assessments of becoming a psychiatrist through The Royal Australian and New Zealand College of Psychiatrists is research.
What was your unique research paper & how many words did you have to write?
I got it published and had 5000 words. To remain annoymous, I will not be sharing what was it about.
@Boogerman: Pseudoscience sure, and that's true of psychology and counselling too. And economics. And most other social sciences.
But it's true in much of the humanities.
And "not good science" is also part of the hard sciences too, given that partaking in "good science" often requires much iteration. Some of which takes otherwise hardworking and honest researchers practicing science in a way which is later determined to be misleading.
But sounds like you have a chip on your shoulder about something here. Care to share why that is?
@ozbjunkie: It’s simple really - it boils down to the less educated diminishing the value of the more educated to resolve their own cognitive dissonance after ‘looking in the educational mirror’
They lack the knowledge, often wilfully, of what is required to obtain a certain level of education. And so they approach life with a mentality of “Everyone has a mouth, everyone has an opinion, everyone can voice that opinion so as to be heard”, meaning that we all have the same levels of critical thinking ability.
That’s not true@Boogerman: We don't all have the same critical thinking ability, that seems true for me.
As for the more or less formally educated having preconceived ideas about the abilities of the other group, I find that also true, but regrettable.
I would hope that people are judged by the content of their speech, rather than the previous attainment or non-attainment of some degree or certificate.
I also try to remember that even when someone I find to be not particularly intelligent is communicating an idea in a way that seems particularly clumsy, there is still some interesting information in there, if I am willing to look with the patience to find it.
There is merit in what others think and feel, regardless of whether they have degrees, and other people will frequently overestimate or underestimate themselves. I believe it is a virtue to not try to estimate other people, but to attempt to engage with them constructively.
I sometimes fail at this.
By the way, I've met some utter morons with PhDs. It is not the valid marker of critical thinking you seem to suggest.
@Boogerman: simple to see that if you never had experience dealing with patients with mental illness- it affects their lives, everyone around them. in truth psychiatrists have probably the most profound and beneficial impact on a patient's life than any of the specialties
@funnysht: I suggest researching the more recent history of psychiatry & how, from memory, less than 10% practice ‘talking therapy’. The suggestion being that prescribing medication is more financially lucrative, as more patients can be processed per hour. That’s not to say medication doesn’t have a purpose. When diagnosed comprehensively, the patient can have life changing benefits from appropriate medication. However, considering time spent getting ‘amongst the weeds’ of ones life I would argue the psychologist has the more profound effect than the psychiatrist
@Boogerman: i think given your previous remarks 'physicians either general or specialist do not deserve the title of doctor' i think you have something against the medical professional, inferiority complex etc. Anyway
@funnysht: Yes I do. The title of ‘doctor’ overstates their educational level & by extrapolation their level of critical thinking.
It’s sad how many GPs are ignorant of medical ailments & the scientific method. For me GPs are just prescription writers & specialist referral service. Most of the time I tell them what to do@Boogerman: Why dont you become a doctor and set a benchmark so we can all know how a doctor should be and who we have to look up to. It's very easy to shoot in the dark rather than yourself showing this is how it is done.
@Boogerman: Sorry 'Doc' but you're delusional mate. Get off that high horse and maybe you'll understand that satisfaction and meaning in life isn't derived from people grovelling at your feet.
@Boogerman: My favourite part of all of this is how long it takes to become a qualified Psychiatrist/GP and how long it takes to get a PhD.
The minimum time to become a GP is;
5 years full time assuming you go straight from highschool (7 if you do undergrad then PG)
1 year internship
3 year fellowship
9 years total (minimum at full time)Psychiatrist
5 years full time assuming you go straight from highschool (7 if you do undergrad then PG)
1 year internship
5 year fellowship
11 years total (minimum at full time)PhD
3 year undergrad
2 year masters
4 year PhD
9 years total (minimum at full time) to get Doctorate in PhilosophyIn addition something being Pseudo scientific is not necessarily a bad thing, it merely means the subject is incompatible with scientific method, for example Archeology and Philosophy are Pseudoscience's.
What you are propagating is academic elitism and honestly an embarrassment to others in the academic community. Even attempting to call Psychiatrists and General Practitioners less educated then a standard PhD Holder.
@Bjingo: Length of time is irrelevant, it’s the complexity
PhDs also do further training post completion
They could, say 15 years or so later, become a Professor@Boogerman: Time and complexity undoubtable correspond, to write it off as irrelevant then go to use it as a measure in the same sentence is really just puzzling. The whole reason PhDs take so long is because you first have to learn the fundamentals and then you apply it to the field you wish to study. Which is the same as Medicine, do the base degree then specialise into your desired field.
Both individuals require an immense amount of knowledge on their field get to where they are and in both there are those who are better and worse but to outright say "It diminishes the value of true research & most importantly the pinnacles of critical thinking." is preposterous, at its core a physicians job is just critical thinking, someone comes to you with an issue they do not know how to fix, you apply your abundance of knowledge to identify the problem and give the optimal solution, if you cant you refer to someone who has spent more time studying that area.
What "training" is there post PhD? and more importantly you don't have to do more training, work or research to maintain your Doctorate making your comment completely off topic.
To worship the theoretical over practical as if it somehow makes it more prestigious is just damaging to academia as a whole. The whole reason Physicians got called Doctor is because of the wealth of knowledge they have on their field.
Personally I think it would be better as an honorary title given to those of a certain standard, rather than those who went through the specific procedure and paid money.
@Bjingo: In the most basic of terms there is no practice (what GPs & psychiatrists do) without research (what biologists do). That is, research precedes practice
Additionally, what you call problem solving, I call box ticking
You may like to go through this website to know what it takes to become a psychiatrist. You would realize it is not just a simple thing.
https://www.ranzcp.org/pre-fellowship/about-the-training-pro…
I'm currently working as a psychologist in schools but looking at pursuing medicine in the future. I've always been interested in psychiatry but also the dual training pathway in paediatrics and child and adolescent psychiatry.
- Do you know any colleagues who have completed or are undertaking the dual training pathway? What are your thoughts about the dual training pathway? Would you and/or your colleageus recommend it?
- How difficult is to secure a place in the psychiatry training program? Would previous experience/training in psychology help or do you need mental health experience when practising as an intern? Would you recommend applying during PGY1 or PGY2?
Thanks for your time!
Yes, I know colleagues who are doing dual training. Basically, the pedatric and child / adolescent psychiatry is a single pathway not two. You will need to get a primary medical qualification e.g. MBBS, MD before you can enter training. You will also need general registration with AHPRA to enter into psychiatry training.
Thanks!
Do you think it's worth pursuing the dual training program or better to pursue child and adolescent psychiatry? I'm mindful that applying for the dual pathway requires completion of the BPT and some advanced training which is very competitive. However there might be a greater scope of practice and knowledge.
There is someone who, when they aren't managing their illness well, they start seeing events from a completely different perspective. Like literally forgetting entire series of events (even major events) and adding onto events with things that never happened. Even years later, the person still recalls what they thought happened as the 'truth'.
I've always been curious - do you ever how work out this is happening? As the person becomes 100% adamant things that didn't happen actually happened, so when they come into the practice, a completely different version of major events and triggers is being said.
This person has actually been told to approach us about some of the non-events on occasion by their psychologists and psychiatrists (and we've learned the hard way to just nod and say nothing because it's a lose-lose situation…). So I'm not sure if the psychologists/psychiatrists are using the technique as part of a different treatment approach or are actually believing it?
You do not necessarily have to agree with everything the person believes. It is important that psychiatrists, while supporting the clinical interests of the patient, maintain a position of neutrality in the consulting room – no matter what personal views they may have formed. This is no different from the stance which psychiatrists must take on many other matters raised by patients. It is not, generally, the clinical role of the psychiatrist to advocate for the patient ‘as victim’ – but, where necessary and possible, to support a process whereby the patient comes to feel able to deal with the experience of having recovered a hitherto forgotten aspect of their history in any way which they themselves deem appropriate.
In my experience with some family members and friends, I do not see that neutrality you speak of. I see 2 different scenarios.
Scenario 1: patients make some accusations against their psychiatrist. These are dismissed on the basis that patient has mental illness and what they’re saying isn’t true.
How is it possible to ensure that when a patient’s complaint is legitimate it is taken seriously?Scenario 2: patients make some accusations against family members. Patient’s version is accepted as the complete truth and family members who were once accepted as support people and advocates are now completely excluded. Psychiatrist’s attitude towards family members changes completely.
(Years later the patient’s view is that psychiatrist and psychologist got in their head and encouraged the beliefs they held, that were not true, which subsequently led to them viewing family relationships in a negative way)
How is it helpful to the patient to support beliefs which lead to family breakdown when those beliefs are not true? How do you decide whether to encourage a patient to view a relationship as supportive or toxic?That is where collateral information comes in handy and you do not always have to maintain neutrality. If you think patient beliefs are wrong and harmful you tell them it's not actually happening and you disagree with their idea. You tell them it's a false belief and the harms involved.
As a long time member of the busted in the head club, who is going to see a psych at the end of this month to have my meds fiddled with:
- What is the current preferred treatment protocol for bipolar type I?
- What is the current status of ketamine as a treatment?
- What is the current status of LSD, DMT, psilocybin, MDMA, etc.as treatments?
- What is the latest thinking on the inflammatory model of psychiatric illness?
- What is the efficacy of vagus nerve stimulation?
- What are your thoughts on the replication crisis in science? This is of particular interest to me having been on several drugs (and having paid for them) that have later been found to have been no more effective than placebo.
Fantastic Qs!
- Different patients respond to different treatments. In additition, the impact of side effects and tolerability are also important. But generally lithium is a very useful medication for bipolar 1. Interestingly, lithium is Australia's greatest contribution to psychiatry. It's anti manic properties were discovered by John Cade, an Australian war veteran and psychiatrist.
- There is a lack of robust evidence to prove the efficacy (especially long term) of ketamine in depression. Most of the use is experimental and research based. Recently FDA has approved a nasal spray in America for use under specialised condtions and requirements. There is also a tremendous abuse potential.
- There is limited but emerging evidence that psychedelic therapies may have therapeutic benefits in the treatment of a range of mental illnesses.
Psychedelic substances are illicit substances and cannot be prescribed or administered outside of properly approved research trials. Current research confirms the presence of psychological support as an essential component of the psychedelic treatment model. This requires trials to be carefully designed and led by researchers with appropriate psychiatric and psychotherapy training. - One of the explanatory model of mental illness is that inflamation causes mental illness.
- It is efficacious in treatment resistant depression but availability is very difficult and rare. Not a treatment used in real life.
- As we continue to learn more, evidence may change. I think it is not just for psychiatry but for many other things. The best thing to do is only going on treatments which have robust evidence to back them up.
Lithium is old news to me, and unfortunately ineffective the last time I used it.
If a treatment exists then I can get my hands on it one way or another. You just need to be motivated about these things. Besides, vagus nerve stimulation is pretty basic medically, the harder stuff is finding someone that is willing to put electrodes in your brain.
Evidence doesn't change, and that's the root of the replication crisis. If the same experiment cannot be replicated then your experiment is dodgy. Maybe it's fraud, maybe it's error, maybe it's something else - the point is that the assumption that your medication works is wrong.
I believe the VNS works. For a real eye opener, check vids on youtube (a bit full on) of people who have them and show you how they use them. I would have to say there is a lot of real boots on the ground evidence to suggest it works well for people who really aren't helped by much else.
Re Ketamine you might be interested in looking at this clinical trial for major depression, currently underway at sites across Australia. I don’t think they’ve published anything yet, but it’s certainly interesting https://www.australianclinicaltrials.gov.au/anzctr/trial/ACT…
Each medical treatment is customised to the patient. Each is not 100% efficacious. The fact that you don't mention PBS heavily subsides the psyc medications and furthemore medicare subsidises clinic appointment does not do much justice to how good we have it in australia compared to other countries
This is the starving Africans argument. It's never worked for me. Your objective suffering is trivially comparable but your subjective suffering is a completely different story. I look and sound normal whilst I've endured levels of suffering that would have killed others. I may be ill but I'm also tough.
I have had the best treatment in the Southern Hemisphere, and certainly world class treatment. My current psychologist is an associate professor at USyd, my previous was a professor at Western Syd and criminologist that consults for the government in the justice system now that she's semi-retired. I've been seen by two world class psychiatrists, both professors, both researchers. I've had the best, and it's often not enough. I'm old enough that my treatment commenced prior to medicare subsidies, so I've had to pay lots of money. Plenty of my medications have either been scribed years before they made it onto PBS, or never did.
If I could buy my way out of this situation I'd have done it years ago. Money isn't the problem here. The problem is simple: there's no cure and barely any treatment for what I have. I'm just unlucky in that.
How do you deal psychologically and personally with the:
1. Traumatic events that patients describe to you that have happened in their lives?
2. Potential feelings of anger or disgust with patients who disclose terrible, unethical or violent things like crimes that they’ve done, and continue to treat them objectively?
Thanks for offering to answer our questions tooInteresting question. This does impact you emotionally especially early in the career but slowly you get to use to these and able to reduce the emotional impact on yourself. Another helpful thing is to discuss these issues with colleagues.
As someone who's going through the pathway that's leading to psychologist, you have my respects, especially during the COVID time.
Just wanted to say that.Many thanks and extremely grateful.
Is there any actual positive evidence for psychogenic illness?
I don't mean "we couldn't detect this on MRI/etc so it must be mental", not "God of the Gaps for medicine" stuff where you can't find a matching physical disease so make up an imaginary explanation to have an explanation rather than admit "we don't know yet/I'm not good enough to figure this out/etc", tangible objective proof it is a psychogenic condition rather than just past the abilities of medical science at the moment.
Every psychologist or psychiatrist I've asked have given "God of the Gaps" type answers and can't seem to comprehend their error, "we can't find any physical pathology, ergo it is mental" which is a total logic fail and doesn't acknowledge science hasn't solved everything yet. I'm sure 100yrs ago they thought science was pretty close to nailing everything too, kinda like nuclear fusion being perpetually 30yrs away.
We all are together in our pursuit of answers and knowledge. Yes, there are still unanswered questions about many things. That being said there is a lot of evidence from clinical perspective that people respond differently to stress. These may include physical health symptoms e.g. conversion disorder.
What are your thoughts on Jordan Peterson and his book Twelve Rules For Life? Do you think his ideas are useful?
Some of them are
Should I have a shrink gf when they know all I want is to get into their pant?
Have you ever encountered a patient that made you question the whole medical paradigm surrounding psychiatric diagnosis and treatment?
I mean like a patient who was diagnosed with a mental illness that prevented them functioning within the norms of society who was expressing things that could be perceived as genius or told you things that indicated they were functioning at a higher intellectual level than normal.
What I’m getting at is, do you think that some people diagnosed and medicated by psychiatrists are actually higher functioning beings and our society’s inability to comprehend that and our inability to tolerate individual uniqueness dictates we turn them into chemical zombies?