Monday, July 19, 2010

Psychiatry vs. medicine in seven steps

On a number of occasions, I have explained to people my personal understanding of the difference between psychiatry and other medical practice. I don't think anyone has ever said this particular explanation was inaccurate. Some people have seemed thoughtfully skeptical perhaps, but no one has ever said, no, you're misrepresenting it, or no, that's not true.

I'll try to concisely outline this explanation here, so anyone who reads it can think about it and tell me if, and how, it may be off the mark.

I think of this as a narrative sequence of interactions among a doctor, a patient, possible other people, and facts in a clinical setting.

In most medical practices and specialties it goes this way:

1. A person has some sort of pain, malfunction of the body, or other symptoms.
2. The person takes himself to a doctor and complains, asking for a solution.
3. Doctor listens, inspects the body, does any of various medical tests, verifies presence or absence of objective abnormalities.
4. Doctor evaluates the data and makes a diagnosis.
5. Doctor offers the patient a recommended treatment with full information regarding risks and benefits.
6. Informed patient accepts the treatment or goes elsewhere for another opinion.
7. Patient or third party pays doctor.

In psychiatry, by contrast, it goes like this:

1. A person behaves in ways upsetting to someone else.
2. Someone else who is upset with the person convinces him to go to a psychiatrist, or takes him to one like-it-or-not, and complains about the behavior, asking for a solution.
3. Psychiatrist listens, believes the complaints, briefly interviews the patient.
4. Psychiatrist prescribes treatment which he hopes might restrain the patient's unacceptable behavior about which someone else complains.
5. Psychiatrist looks in the DSM for a diagnosis to justify treatment.
6. Patient is convinced by various devices, or coerced, to accept treatment.
7. Patient or third party pays psychiatrist.

OK. It seems to me the most notable difference is the precisely reversed sequence of steps 4 and 5. (I wrote about this at least once before.) But the only step that is the same for regular medicine and psychiatry is number 7, somebody pays.

You, readers, please tell me what's wrong with this understanding.


  1. There's nothing wrong with what you say. In fact, I think you're being far too kind.

    I can't be as tidy and succinct as you, but I will say that I've found, among many things, is that psychiatry largely preys upon the poor who do not have access or the resources to seek out second opinions from a second doctor.

    Psychiatry is also the one medical profession that blames the patient whenever the patient can't get better or otherwise be controlled. Psychiatrists take absolutely no responsibility for their wild-assed claims and the messes they leave behind.

    And unlike regular doctors, there seems to be no standard of care in psychiatry. Each psychiatrist is the tinpot dictator of his own little personal realm. He can do or claim whatever he feels like claiming or doing. It's such an Alice in Wonderland quality.

    This is what makes psychiatrists so difficult to pursue in malpractice cases, I think. After all, as a lawyer, you're well aware that not following standards of care is a cornerstone in medical malpractice. But with psychiatry, standards of care simply don't seem to exist. They're whatever the shrink decrees them to be and his standards can't be second-guessed, even by his own colleagues who may privately feel that what he did was stupid and batsh*t insane. Psychiatry is such a wonderful profession for people who always want to be right.

  2. ANYBODY, or even trained ANIMALS, can practice psychiatry. No medicene whatsoever is involved. Sometimes for SHOW, a psychoquack might use a blood pressure cuff or tap someone's knee with a reflex hammer.

    Better yet, psychiatry, as it is ACTUALLY done, can be done via MACHINE. Yes, a vending machine. Put in a dollar and some wheels spin and RANDOMLY land on a DSM "diagnosis". Then a two cups drop down and one fills with water and the other with some pills.

    Illinois madhouses are FULL of criminal shitskins from India and Afghanistan and so forth who came to Illinois specifically to become wealthy working as psychoquacks and who have absolutely no training or education in medicine. They bring cracker jacks degrees they printed on their inkjet printer and then pay Illinois bureaucrats/ pols to rubber stamp their certification process. In the past, they have been BUSTED. GOOGLE IT!

    As Tom Szasz so well stated, there can be no suits for psychiatric malpractice because psychiatry IS malpractice. Imagine the dumbass suing in a court claiming a psychchoquack didn't properly hammer an icepick into his eyesocket (this practice won a Noble Prize in Medicine, after all).

    1. You are an ignorant idiot!
      Do not hate others that were able to achieve the education, that you clearly could not attain.

    2. Thank you for your wonderful comment, Amy. To which education are you referring? I'll try not to hate anyone.

    3. Oh, pardon me, now I see you were addressing Rodney. He's a lot more educated than you think, however.

  3. Randolph,

    I agree with the spirit and essence of what you say, but there are a few additional points I would like to make.

    Firstly, I believe that nowadays most of the people who consult psychiatrists do so off their own bat, and completely voluntarily. This is because either they want pharmaceutical products, or because they have bought the false advertising.

    Secondly a great deal (perhaps most) of mental health "treatment" is provided by GPs. They prescribe anti-depressants, anxiolytics, stimulants, etc., for various "diagnoses," which I would describe as problems of living.

    Your comments do indeed apply very accurately to "treatment" by involuntary commitment, which although involving the minority of people, is the more serious in terms of law and civil rights.

    Your observation concerning the reversal of treatment and diagnosis is particularly compelling. In real medicine, the diagnosis is vital. In psychiatry, it's an artifact to justify the drugs. In America, a practitioner is not permitted to prescribe a drug without specifying the illness that the drug is targeting. Without the "diagnoses," the entire industry collapses. The diagnostic system is a house of cards, and is at present under attack thanks to writings such as your own. I hope you will continue to write.

    Philip Hickey

    1. I might only respond that those who seem to consult psychiatrists "off their own bat" often know perfectly well that at the end of the day they might be compelled. No other medical specialty has such power, backed by the police. There is no "forensic cardiology". No statutes detail the processes for determining whether someone is "dangerous to self or others due to cancer". GPs never commit anyone, they call in psychiatrists to do that.

      My point is that once coercion is part of the continuum of specialty practice, it affects the considerations of every patient on some level. If psychiatry could not retain the facility of state police power, I think it would be unrecognizable, and it would wither away.

      Likewise, if involuntary commitment and the insanity defense were simply abolished, I would probably have no further interest against psychiatry.

      Thank you very much for your attention and your well-stated points.