Psychiatry, is it science?

[Schneibster]

Actually, given that they believe a science-fiction story dreamed up by a pulp SF writer in the '40s is a religion, and given that that writer was smart enough to immunize his cult against the most likely challenge to it, i.e. psychiatry, I hardly think it is a coincidence. But maybe that's just me.

You really want to piss a $cientologist off, remind them that their cult was started on a bet. I'd say Ron Hubbard won the bet. I'm pretty disappointed he doubled down instead of admitting it in the end.

 

[ponderingturtle]

The fact also remains (at least in the US) that a psychologist cannot conduct a physical examination, or order tests; formerly, they also could not prescribe, because they did not have the doctor of medicine credentials to do so; I do not know if this is still the case. Psychologists, clinical or otherwise, engage in psychotherapy to the general (and perhaps complete) exclusion of other types of therapy such as drugs and surgical intervention, at least to the best of my knowledge.

And how many of the techniques used in therapy are backed by more than anecdotal evidence? There are many that are based entirely on anecdote and so someone who practices that is not practiceing science

 

[ponderingturtle]

That's an error. There was another post above that covers the distinction. They are parallel disciplines: psychiatry is a medical specialty, like pediatrics or oncology; psychology is a department in the faculty of arts, and only a few become therapists.

But we are looking at the point of view of the mental health industry. From this logic all mental health practitioners are practicing psychaitry at some level, just like nurses and EMT's practice medicine at some level.

So why does this make psychaitry more woo resistant than psychology? I have still not gotten an answer about that statement from anyone. Or a reason why from a mental health perspective they should be viewed at as highly seperated.

Does this mean that a phycologist who treats people is practiceing psychiatry then?

Depends on the jurisdiction and condition. I'd say: half-and-half. Keep in mind: in circumstances where adjunct therapy is required, this could be done by a clinical psychologist instead of the prescribing MD.

It would be difficult to use raw numbers to evaluate what proportion of psychiatrists would treat with med and/or adjunct CBT. The reason is that psychiatrists tend to specialize: eating, addiction, reproductive, mood, personality, positive-affect psychotics, negative-affect psychotics, pediatric, &c. Each condition has its own treatment guidelines, and for some conditions therapy is absolutely contraindicated. For others, it's mandatory. It would be inappropriate to say that a psychiatrist who does not treat violent psychotics with group therapy - when they're clearly not capable of participating - is exhibiting a "personal style". It could be an artefact of his speciality.

And how much of their thearapy is backed by solid research and thus does not fall into the Woo catagory?

 

[ponderingturtle]

Sorry, I'm not interested enough to read eight pages of $cientology ranting against psychiatry; I may have skipped a couple items here or there. I'm not really interested in that conversation, but in the one regarding the OP.

The thread seems to be about that, I don't remember any one arguing against medication, but against the mental heal industry for not being based on good evidence and resulting in convictions based on things people imagined in therapy sessions.

 

[ponderingturtle]

I can't counter this, but again all I was saying is that you can't hold psychiatry accountable for the foolishness of others. It is not a science, it is medicine.

So medicine is not a science and should not be dependant on evidence?

Which to the first point why I ask people what they have done to fight domestic violence and social injustice. You can't hold psychiatrists to some higher standard.

So the the industry that creates the problem is not responcible for the problem? Researchers who proposed recovered memories and supported them, and they are still out there, have no guilt in the lives the false ideas they are advanceing ruin?

But a few psychiatrists sued for bad practice is anecdotal, just like my sample of psychiatrists. In my experience psychiatrists are too busy to be very woo, those that have patients who can pay for talk therapy, I don't know.

I feel that there are greater ills in psychiatry than the woo, take the medical treatment of domestic violence, or the abusive manner of many psychiatrists, those would be greater concerns. Or the perscription of medication to children and young adults without requiring therapy.

The greatest ill of all is the lack of protocols for most GPs treating people with psychotropics.

So increaseing the effects of PTSD in victims from poorly designed thearapy is not a problem then. They are all related, they stem from a lack of evidence which is the fundamental bais of Woo.

 

[ponderingturtle]

Quite true, and I am not saying that there aren't bad psychiatrists out there, there sure are.

But the area of legal medical testimony is an even stranger area of behavior. Most 'expert' testimony comes from just a few experts and is more a matter of legal persuasion than science. Very few psychiatrists tetify at a trial.

I am saying that in terms of bad medicine there are some issues that come before the woo. And that there is lot mopre woo in the non-psychiatry aspect of mental health. Take 'christian counselors' for example, or ministry in gerenral.

If the bad medicine stems from unsupported beliefs is that not a good definition of Woo?

 

[Dancing David]

But we are looking at the point of view of the mental health industry. From this logic all mental health practitioners are practicing psychaitry at some level, just like nurses and EMT's practice medicine at some level.

Well that would be true in some settings more than others. In the EMt or nursing care setting there will be a supervising physician. And there is a strong medical bias and framework for the nurse and EMT. In social services there are many models of which the medical one is not always the strongest. A counselor may have very limited medical training and a non-medifcal model. Such as in the domestic violence field, in Illinois you only have to have a forty hour training to work at a shelter as a domestic violence counselor. they provide a lot of counseling most with little contact with psychiatry. The same is true of the substance abuse field.

So why does this make psychaitry more woo resistant than psychology? I have still not gotten an answer about that statement from anyone. Or a reason why from a mental health perspective they should be viewed at as highly seperated.

psychiatry currently is based upon the medical model.
Because not all counseling and therapy is provided in even a pseudo-medical setting?

Does this mean that a phycologist who treats people is practiceing psychiatry then?

No. it could in limited areas.

And how much of their thearapy is backed by solid research and thus does not fall into the Woo catagory?

It depends, to date only rational emotive therapy and cognitive behavioral have a strong research bias. Dialectic based therapy has some treatment data but not a whole lot.

For a recent example, EMDR (eye-movement desensitization) is very popular for PTSD treatment, proponents claim that they have a sciemtific basis, yet according to many the data is lacking. The proponents say it is effective, but they don't run controlled studies to demonstrate it's efficacy.

Another area is the one where some large studies have shown that the 'therapeutic benefit' is attained is 8-12 sessions, but many practtioners continue long term therapy.

Political whim and fashion also determine a lot of the funding and criteria, in the last ten years 'outcome based objectives' have become more common in the public sector.

 

[Dancing David]

So medicine is not a science and should not be dependant on evidence?

Well the practice of medicine is based upon science, but there is also the 'art' aspect where a practitioner makes educated guesses.

So the the industry that creates the problem is not responcible for the problem? Researchers who proposed recovered memories and supported them, and they are still out there, have no guilt in the lives the false ideas they are advanceing ruin?

I am not saying that at all, but they are not usualy researchers and it is an area where mopre regulation could benefit all. There is this thing called 'christian counseling' that i don't like.
Malpractice is malpractice.

So increaseing the effects of PTSD in victims from poorly designed thearapy is not a problem then. They are all related, they stem from a lack of evidence which is the fundamental bais of Woo.

I think you are reading more into what i say than i am, there should be evidence based practice, and there sometimes is. I agree that more regulation would be good.

I have never said that there is not bad practice. i have said that recovered memories were not a commonly accepted practice. But until they outlaw hypno-therapy some will persist in using it.

The same hold true of any servive field, auto-mechanics and the like. And conventional medicine. One of the reasons I think that medical malpratice is a problem, esp. in the having sex with your patients category, is that other doctors are reluctant to sanction themselves.

 

[Dancing David]

If the bad medicine stems from unsupported beliefs is that not a good definition of Woo?

That is not my contention at all, I am saying that to condemn psychiatry, it would be better to prove that it was a belief that was commonly held by psychiatrists and that it was not based upon science. And to condemn the mental health area would require an even broader area of proof.

I have not said that there are not bad practitioners, I have stated that to say that psychiatry is reposnible for the ills of RM would require a different standard of evidence.

Yes, woo is dangerous, and I have stated so.

My contention was more a sceptical request that you show that psychiatry in general was responsible for RM, but since we seem stuck in different definitions of psychiatry i am not sure we will reach accord.

I feel that there are much greater ills in psychiatry and the practice of medicine than RM. Such as the medical treatment of domestic violence and child abuse without a careful assesment, the over perscription of anxyiolitics and the exploitation of patients, especialy with questionable 'alternative treatments'. That does not say that RM is not a problem, especialy since there are still therapists who continue to develop it. Just as there are many sorts of therapists who are opposed to the medical model and psychiatry in particular. I find some of the lack of medical treatment for anorexia nervosa to be very disturbing, but there is a political element in that treatment sector which is opposed to the medical treatment of AN.

 

[ponderingturtle]

That is not my contention at all, I am saying that to condemn psychiatry, it would be better to prove that it was a belief that was commonly held by psychiatrists and that it was not based upon science. And to condemn the mental health area would require an even broader area of proof.

So wide spread practices based on unscientific beliefs is not enough to condem the mental health area. How much woo does there need to be?

Remember Scientologists run alot in these feilds, but how can you rule say Narc Anon to be Woo just because of that?

I have not said that there are not bad practitioners, I have stated that to say that psychiatry is reposnible for the ills of RM would require a different standard of evidence.

Yes, woo is dangerous, and I have stated so.

And there is little woo resistance built into so much of the mental health practiced in this country.

My contention was more a sceptical request that you show that psychiatry in general was responsible for RM, but since we seem stuck in different definitions of psychiatry i am not sure we will reach accord.

I feel that there are much greater ills in psychiatry and the practice of medicine than RM. Such as the medical treatment of domestic violence and child abuse without a careful assesment, the over perscription of anxyiolitics and the exploitation of patients, especialy with questionable 'alternative treatments'. That does not say that RM is not a problem, especialy since there are still therapists who continue to develop it. Just as there are many sorts of therapists who are opposed to the medical model and psychiatry in particular. I find some of the lack of medical treatment for anorexia nervosa to be very disturbing, but there is a political element in that treatment sector which is opposed to the medical treatment of AN.

I was never claiming RM was a major problem in the industry, just that it illustrates one of the great failings of the mental health industry in this country.

 

[Dancing David]

So wide spread practices based on unscientific beliefs is not enough to condem the mental health area. How much woo does there need to be?

Remember Scientologists run alot in these feilds, but how can you rule say Narc Anon to be Woo just because of that?

I wouldn't say that RM is a wide spread practice, but we differ. All substance abuse treatment programs have a 30% success rate. I don't know if that is good or bad. I prefer rational recovery and relapse prevention.

And there is little woo resistance built into so much of the mental health practiced in this country.

i would say that is true, but i don't know to what extent. i am a behavioral bent, so i am considered a sceptic by many.

I was never claiming RM was a major problem in the industry, just that it illustrates one of the great failings of the mental health industry in this country.

And I am not usre it was a widespread problem, I think people gettinh therapy for more than twelve sessions and a lack of goal specific practice is a greater problem. Then there is the wide array of unethical behaviors, including 'alternative treatment'.

 

[ponderingturtle]

And I am not usre it was a widespread problem, I think people gettinh therapy for more than twelve sessions and a lack of goal specific practice is a greater problem. Then there is the wide array of unethical behaviors, including 'alternative treatment'.

Well I guess it depends on how your rate, midlessly billing people for little or no benifit, vs harming them. ANd all I ment for RM to represent was an example or a woo belief

 

[pipelineaudio]

Scientologist are the only ones I know of, who would question the science of Psychiatry.
http://www.scientology-lies.com/faq/society/psychiatry.html

Nice try, but there are those who feel all religions are silly, not just scientology, but religious reverence given to shrinkery as well

 

[luchog]

Well the practice of medicine is based upon science, but there is also the 'art' aspect where a practitioner makes educated guesses.

It's still a science, not really an "art", but it's an imprecise one. There is much more normal variation to deal with in medicine than there is in, say, engineering.

But we are looking at the point of view of the mental health industry. From this logic all mental health practitioners are practicing psychaitry at some level, just like nurses and EMT's practice medicine at some level.

Agreed, but on a very very low, rudimentary level.

So why does this make psychaitry more woo resistant than psychology? I have still not gotten an answer about that statement from anyone. Or a reason why from a mental health perspective they should be viewed at as highly seperated.

Psychiatry is based on a physical etiology model, like the rest of the medical field; and thus is capable of more and simpler experimentation and falsifiability. Psychology doesn't have as concrete a basis, and is dealing with something that is still poorly understood and extremely imprecise; and falsifiability is much much more difficult.

Does this mean that a phycologist who treats people is practiceing psychiatry then?

No, the fundamental difference is the model they are based on. A psychiatrist who prescribes medication does so based on a medical/physical etiology model, with the drugs intended to correct or mitigate the physical/neurochemical disorder which causes the mental dysfunction, very likely on a permanent/chronic treatment basis. The psychologist, if they do prescribe medication (which IIRC they can't without actual medical training), would do so based on the behavioural/psychological etiology model, with the drugs intended to provide a temporary palliative while the behavioural issues were being addressed.

Examples of the differences:

A psychiatric treatment would cover disorders such as schizophrenia and bi-polar disorder, which are accepted as physical/neurochemical dysfunctions (and in the case of schizophrenia, potentially degenerative), although their actual etiology is still poorly understood. Drugs would be prescribed to make up for deficiencies/excesses or malfunctioning neurochemical mechanisms, or to allieviate symptoms caused by a degernative disorder. Since correction of the underlying physical dysfunctions is currently beyond our technology, medical treatment is generally assumed to be a more or less permanent necessity to ensure relatively normal functioning.

A psychological treatment would cover something like PTSD, a purely psychological reaction to severe trauma. It might include medications such as sedatives to control the extreme symptoms while the behavioural treatment addresses the causes of the disorder, with the goal of restoring normal functionality and dispensing with the drugs.

 

[ponderingturtle]

Agreed, but on a very very low, rudimentary level.

Psychiatry is based on a physical etiology model, like the rest of the medical field; and thus is capable of more and simpler experimentation and falsifiability. Psychology doesn't have as concrete a basis, and is dealing with something that is still poorly understood and extremely imprecise; and falsifiability is much much more difficult.

ANd we see yet still more definitions of of the two, and that psychaitrists can practice psycology makes it even more confusing.

No, the fundamental difference is the model they are based on. A psychiatrist who prescribes medication does so based on a medical/physical etiology model, with the drugs intended to correct or mitigate the physical/neurochemical disorder which causes the mental dysfunction, very likely on a permanent/chronic treatment basis. The psychologist, if they do prescribe medication (which IIRC they can't without actual medical training), would do so based on the behavioural/psychological etiology model, with the drugs intended to provide a temporary palliative while the behavioural issues were being addressed.

And how does this relate to the thearapy given by each? And what the hell do non doctorate level thearapists do, psychaitry or psychology?


They are not limiting their practices in such a manor as psychaitrists can often legaly practice psychology.

 

[luchog]

ANd we see yet still more definitions of of the two, and that psychaitrists can practice psycology makes it even more confusing.

No, merely clarification of the existing definition, since you seem to have difficulty grasping the difference.

And how does this relate to the thearapy given by each? And what the hell do non doctorate level thearapists do, psychaitry or psychology?

They practice what they were trained for. If they were adequately trained in Psychiatry, that is what they practice. If adequately trained in Clinical Psychology, then they practice that. If not adequately trained in either, then they practice "counselling", which incorporates a varying amount of Psychology, but which is generally based on a different model and set of practices, often religious in origin.

They are not limiting their practices in such a manor as psychaitrists can often legaly practice psychology.

No, you're conflating two distinct practices because of similarities between them. The models, and goals are substantially different, as has been shown repeatedly, even though some of the processes can be similar. Part of the diagnostic process is also determining whether a particular disorder is psychiatric (ie. medical etiology), or psychological (purely mental/behavioural etiology); and there is still some gray area between the two, which further research is gradually shrinking. However, it's quite clear that they are two entirely distinct and seperate entities. I get the impression that you're being deliberately obtuse on a lot of this. It's like you're claiming to be confused about the difference between cosmetic surgery and neurosurgery, because they both involve a few similarities in surgical practices and tools.

 

[ponderingturtle]

No, merely clarification of the existing definition, since you seem to have difficulty grasping the difference.

They practice what they were trained for. If they were adequately trained in Psychiatry, that is what they practice. If adequately trained in Clinical Psychology, then they practice that. If not adequately trained in either, then they practice "counselling", which incorporates a varying amount of Psychology, but which is generally based on a different model and set of practices, often religious in origin.

So how do you tell if the psychaitrist is practicing psychology or counselling? And how many psychologists in individual practice practice counselling?

No, you're conflating two distinct practices because of similarities between them. The models, and goals are substantially different, as has been shown repeatedly, even though some of the processes can be similar. Part of the diagnostic process is also determining whether a particular disorder is psychiatric (ie. medical etiology), or psychological (purely mental/behavioural etiology); and there is still some gray area between the two, which further research is gradually shrinking. However, it's quite clear that they are two entirely distinct and seperate entities. I get the impression that you're being deliberately obtuse on a lot of this. It's like you're claiming to be confused about the difference between cosmetic surgery and neurosurgery, because they both involve a few similarities in surgical practices and tools.

No, the problem is that neurosurgons do not generaly also practice cosmetic surgery, but psychaitrist can practice psychology and do so all the time. They are not clear cut becuase you can have one person who does all of them, couceling, psychology and psychiatry.

 

[Jeff Corey]

If you told any of the psychiatrists that I have worked with that they were practicing psychology, they would probably correct you and point out that the medical practice is called psychiatry.
Just because many of the treatments used by psychiatrists were developed by clinical psychologists doesn't make them psychologists.

 

[ponderingturtle]

If you told any of the psychiatrists that I have worked with that they were practicing psychology, they would probably correct you and point out that the medical practice is called psychiatry.
Just because many of the treatments used by psychiatrists were developed by clinical psychologists doesn't make them psychologists.

So in otherwords a particular treatment does not fit into Luchog's catagories then?

I am not trying to cause problems but there really seems to be multiple definitions of what is psychaitry and what is psychology, sure medication is clearly psychaitry and university psychology departments are clearly psychology, but treatments that are not medication based do not seem to fit cleanly into one or the other.

So why is it wrong to use psychaitry as a substitute for saying "the mental health professions"? As that neatly excludes research psychologists and includes everyone who treats patients?

 

[Jeff Corey]

So why is it wrong to use psychaitry as a substitute for saying "the mental health professions"? As that neatly excludes research psychologists and includes everyone who treats patients?

Because psychiatry is a medical subfield, psychiatrists are MDs., the others are not.
It's no big deal, but the distinction is stressed in chapter one of every intro psychology text.