My main issue is that the quality of inpatient psychiatric care is often degrading. I do understand that you guys have a job to do… however when it comes to disposition, I wish that more weight was given to what inpatient treatment is going to change…. after all its expensive, you have essentially no rights, and you said it yourself you kind of have to “lie” to leave I believe you called it minimizing?
I also think that the artificial environment of a psych ward can heighten animosity and resentment in some patients. I also know that there is little evidence that an inpatient stay is effective for treating suicidal thoughts…. I do wish that more psychiatrists would listen to psych rights activists instead of being dismissed.
As a former foster kid, CPS, troubled teen industry, facility survivor the conditions in those places was often worse than the situations we came from. The prison like atmosphere and lack of bodily autonomy was confusing. You say that you like to act like a kid and ask “questions” as to why people are guarded and from lived experience, people are guarded because they feel “damned” if they do and “damned” if they don’t…..
It can be just as scary and confusing for patients to try and “work” with you when the outcome is being detained….
With the rise of authoritarianism, especially during the trump administration, I am concerned that psychiatry will be used more like a weapon to label anyone that disagrees as “disordered”
I know there aren’t always easy answers. I also acknowledge that truly some people are violent and out of control…. however its somewhat disheartening that not more attention is paid to the “agents of the state” who wield a lot of power to make decisions that rob people of freedom especially when institutions are often just jails by another name.
UHS and Acadia are both under investigation for holding patients until insurance runs out…. There is a lot of moral ambiguity in psychiatry than say other fields of Medicine. I just hope that the weight of involuntary treatment is truly considered…… Other than “containment” I don’t quite understand how those places are supposed to help people.
"My main issue is that the quality of inpatient psychiatric care is often degrading." I entirely agree.
"I do wish that more psychiatrists would listen to psych rights activists instead of being dismissed." I think the problem is that psychiatrists aren't the ones who have much say in the solution. When I worked as inpatient (in residency, also somewhat involuntarily heh), there was nothing I could do to change the larger system.
Will circle back around and write a longer reply when I have more time.
Midge, did he ever circle back to you and write a longer reply, perhaps in a direct message to you? I think these people are being too overly defensive. I have never had a single like or reply either on my comment here, even though my Substack is pretty detailed about who I am and what I do and what I don’t want to put up with anymore as far as victim labelling syndrome goes. Hope you like my new disorder that I have just invented there. Readers - you know that there is an issue with the classification system and the way we react to severe mental illness. There is nothing shocking in Midge’s comments and likes or mine on my blog that you deserve to be protected from. You are going to meet us someday, (in the widest sense of the word), so there is nothing shocking about reading our comments here. There is no logic in hiding from us during your training either, since we are the people you are determined to treat whether we like it or not. We don’t have anything to hide, so why should you? Come out into the light where we can see you!
I’m someone who, like Midge above, is an advocate for better quality care and outcomes and I’m someone who managed to avoid psychiatric hospital and a potentially stigmatising diagnostic label out of sheer luck. I’m not seeking to dismiss your own feeling of powerlessness about the system that you were part of during your residency, but if you aren’t empowered by the system you found around you, then how can real change ever come about? The problem, as I see it, is circular. A person, for whatever reason, begins to lose executive control of their own mind. People around react with excessive force, reinforcing the terror that the sufferer is in. People jump to the conclusion that the person is about to do them harm. The person is preemptively incarcerated and tranquillised “just in case” they are a danger to the public. For the unwell person, rejection is reinforced by being assigned to a stigmatised out group. The person stabilises on medication, is discharged, and left to rebuild their life afterwards, with some outpatient care if they are lucky. No one ever establishes whether the person was ever a danger, since they are now gone from the sphere of the inpatient psychiatrist. This reinforces the mutual “us and them” view survivors and psychiatrists have of each other, rather than seeing each other as human beings who they can connect with and learn from. How do we make things better?
My main issue is that the quality of inpatient psychiatric care is often degrading. I do understand that you guys have a job to do… however when it comes to disposition, I wish that more weight was given to what inpatient treatment is going to change…. after all its expensive, you have essentially no rights, and you said it yourself you kind of have to “lie” to leave I believe you called it minimizing?
I also think that the artificial environment of a psych ward can heighten animosity and resentment in some patients. I also know that there is little evidence that an inpatient stay is effective for treating suicidal thoughts…. I do wish that more psychiatrists would listen to psych rights activists instead of being dismissed.
As a former foster kid, CPS, troubled teen industry, facility survivor the conditions in those places was often worse than the situations we came from. The prison like atmosphere and lack of bodily autonomy was confusing. You say that you like to act like a kid and ask “questions” as to why people are guarded and from lived experience, people are guarded because they feel “damned” if they do and “damned” if they don’t…..
It can be just as scary and confusing for patients to try and “work” with you when the outcome is being detained….
With the rise of authoritarianism, especially during the trump administration, I am concerned that psychiatry will be used more like a weapon to label anyone that disagrees as “disordered”
I know there aren’t always easy answers. I also acknowledge that truly some people are violent and out of control…. however its somewhat disheartening that not more attention is paid to the “agents of the state” who wield a lot of power to make decisions that rob people of freedom especially when institutions are often just jails by another name.
UHS and Acadia are both under investigation for holding patients until insurance runs out…. There is a lot of moral ambiguity in psychiatry than say other fields of Medicine. I just hope that the weight of involuntary treatment is truly considered…… Other than “containment” I don’t quite understand how those places are supposed to help people.
Thanks for the thoughtful reply.
"My main issue is that the quality of inpatient psychiatric care is often degrading." I entirely agree.
"I do wish that more psychiatrists would listen to psych rights activists instead of being dismissed." I think the problem is that psychiatrists aren't the ones who have much say in the solution. When I worked as inpatient (in residency, also somewhat involuntarily heh), there was nothing I could do to change the larger system.
Will circle back around and write a longer reply when I have more time.
This popped up today https://www.livemint.com/news/us-news/minnesota-senate-republicans-bill-proposes-adding-trump-derangement-syndrome-to-mental-illness-definiti/amp-11742049348473.html
Midge, did he ever circle back to you and write a longer reply, perhaps in a direct message to you? I think these people are being too overly defensive. I have never had a single like or reply either on my comment here, even though my Substack is pretty detailed about who I am and what I do and what I don’t want to put up with anymore as far as victim labelling syndrome goes. Hope you like my new disorder that I have just invented there. Readers - you know that there is an issue with the classification system and the way we react to severe mental illness. There is nothing shocking in Midge’s comments and likes or mine on my blog that you deserve to be protected from. You are going to meet us someday, (in the widest sense of the word), so there is nothing shocking about reading our comments here. There is no logic in hiding from us during your training either, since we are the people you are determined to treat whether we like it or not. We don’t have anything to hide, so why should you? Come out into the light where we can see you!
Hi Doc. perhaps when you get a chance I would love to hear your thoughts on this? I know that Dr. Awais Aftab as some very interesting views as well.
Happy Friday.
Bring out the bodies, please 🙏
I’m someone who, like Midge above, is an advocate for better quality care and outcomes and I’m someone who managed to avoid psychiatric hospital and a potentially stigmatising diagnostic label out of sheer luck. I’m not seeking to dismiss your own feeling of powerlessness about the system that you were part of during your residency, but if you aren’t empowered by the system you found around you, then how can real change ever come about? The problem, as I see it, is circular. A person, for whatever reason, begins to lose executive control of their own mind. People around react with excessive force, reinforcing the terror that the sufferer is in. People jump to the conclusion that the person is about to do them harm. The person is preemptively incarcerated and tranquillised “just in case” they are a danger to the public. For the unwell person, rejection is reinforced by being assigned to a stigmatised out group. The person stabilises on medication, is discharged, and left to rebuild their life afterwards, with some outpatient care if they are lucky. No one ever establishes whether the person was ever a danger, since they are now gone from the sphere of the inpatient psychiatrist. This reinforces the mutual “us and them” view survivors and psychiatrists have of each other, rather than seeing each other as human beings who they can connect with and learn from. How do we make things better?