Psychiatry, is it science?

[ponderingturtle]

For you, maybe.

ANd others here, or was telling a psychaitrist that they are practicing psycology not going to generaly be something that they will take issue with?

All psychiatrists are doctors, by definition.

When I complete my MA in psych and pass the professional exams, I will hopefully be doing therapy with families coping with a member who is from a different culture. This could include transcultural adoptions, mental, or physical disabilities.

There are many opportunities for sub-doctoral psychologists, inside and outside the role of therapist.

But that does not do anything about actualy scietific basis of the practices.

They need to do additional clinical work and pass additional exams before being licensed to conduct therapy. At least, this is the case in Canada. MDs who do both Psychiatry and psychology are rare, and often have a psych undergrad.

Ok that is something that I think is different in the US, and leads to one of the problems we are having.

 

[blutoski]

So the idea is that thearapy and treatment, asside from medication, exist outside psychology and psychaitry? So you can not say if a therapy is psychiatric or psychological?

That sounds basically right. The distinction is more about whether the patient is diagnosed in the DSM-IV - that's psychiatry's penumbra of care.

 

[blutoski]

But that does not do anything about actualy scietific basis of the practices.

That wasn't your question. You asked: what do non-doctor therapists do?

Ok that is something that I think is different in the US, and leads to one of the problems we are having.

I doubt it. The problem looks like malpractice, which by definition happens outside of standard practice. There are psychiatrists in Canada who have woo ideas. It happens in any profession, so I'm unsure why the focus on just this one.

As an example, the other day, a mechanic in our province did a crappy job on a bus' steering maintenance, and children died. I wouldn't say that it's time to abandon 'mechanics' as a profession. Just an argument for identifying and weeding out the hacks.

It's true that these past-life-regression cases are sad examples of quackery ruining innocent lives, but there are about 30 million patients in the system in north america, and we can count these exceptions on one hand. The lesson is that the profession needs to defend its right to self-regulate by active monitoring.

The College is acutely aware of its position of public trust, and does not want it squandered by a few quacks. Likewise, the APA (CPA, here in Canada).

 

[blutoski]

That is because the treatment offered by people lower than doctors are heavily legally restricted. As an EMT there are lots of things I am required and required not to do and say. I don't see these requirements that are written by many doctors having a correlary in mental health at all.

And what I have gotten from Dave is that you can't say if any treatment is psychatric or psychological with the exception of medication. So treatment is divorced from theory and discovery then?

No, the reason is that different conditions can use the same therapy. So: a therapy can be beneficial for both psychiatric and psychological conditions. Also: sometimes, a patient has both problems. ie: they have schizophrenia, and it makes them socially isolated and depressed. It is good for the patient to receive combinatorial therapy to address the whole patient, rather than artificially disengage the treatment into twice the visits with twice the number of professionals.

Is talk thearapy everyones bastard stepchild?

By 'talk therapy,' do you mean psychoanalysis, then, yes: I could count on one hand the number of people in Canada that are practicing Freudians/Jungians. I would say that in the US, this may number in the hundreds at worst. I have only met one ever, an MA(psych), and she's about seventy years old now (specializes in addiction). I heard there was one in Halifax, but my wife says this woman does ordinary CBT. They are a dying breed.

If by 'talk therapy,' you mean CBT or group therapy, then no: these are considered legitemate therapeutic techniques by both psychiatrists and other therapists.

So thought field intergration and other energy psychologies are backed by strong research now.

They aren't. But then again: they aren't psychiatry, either. That was your question: how much of psychiatry was research-based. I would say that here in 2007, pretty much all.

As I said: each diagnosis (or sometimes a cluster of similar diagnoses) in the DSM-IV have a standard treatment. A sort of 'best practice'. These are published and occasionally updated. Typically, you get them as enclosures in your JAMA or JAPA or CMAJ. Treatments not in this standard can happen, but if nobody complains, they don't get disciplined, and that's where these problems came from.

 

[blutoski]

But it does say something about the quality of the data, that you can find so many compeating mutualy antagonistic idiologies running around. I think that his is part of what makes mental health have so little resistance to woo ideas.

I have mixed feelings about that statement. Again: why pick on just one field of medicine? We don't know how SSRIs work - there are competing theories about mechanism of action. ECT was brought up earlier: we don't know how that works, either. But we *do* know from studies that they work. Consequently, it's just like any other field in medicine: data trumps theory, when available.

I get the impression that you're saying that psychiatry has little or no data available, so it's all practice-by-hypothesis, but I disagree. Quantitatively, there are probably very few practitioners whom I would call 'psychologists' or 'psychiatrists' operating this way. You will, however, find a disproportionate number of therapists whose educations are centered in other professions doing this. I would direct your concern to their respective bodies (social work, nursing, education...).

 

[Ben Tilly]

Ben Tilly: HI and welcome to the discussion.

I prefer to think of science as the practice and use of the scientific method.

Would you care then to give a definition of the scientific method? Before doing so you may wish to re-read http://wwwcdf.pd.infn.it/~loreti/science.html to see some of the complexities that the scientific method poses in practice, and how easy it is to think you're following the scientific method when in fact you're doing something else.

Cheers,
Ben

 

[blutoski]

I spent a few minutes looking for policy statements from professional organizations such as the APA, AMA, &c - hopefully early in the schmozzle - and found a good site that had alreay done this for their own purposes: the Ontario Consultants on Religous Tolerance.

• pre-1996
• post-1996

So, basically, any psychiatrist practicing recovered memory therapy in the early 1990s should have known that the consensus of the profession was that this was considered quackery.