How bad doctors hide in psychiatry (and why psych is beautiful?)

[@thebeatles9]

"We are not an algorithmic field, and our organ of focus is poorly understood: our empathy is our stethoscope."

[@colehatton3073]

In that scope, friends and family are as qualified.

[@clairbear1234]

@@colehatton3073seriously

[@alejandrolopez1868]

​@@colehatton3073 sure but your society does not have that support role lol so you have to pay to have a therapist, counselor or even psychiatrist.

[@cheerry7]

who said this quote?

[@boldlyjoey]

I’ve had some really awful, traumatizing experiences with psychiatrists, and your content is healing. I hope there are more folks like you making this specialty a better place.

[@itspresro]

There are, I have so many classmates that I look up to and learn from. I hope the next generation will really change things

[@atesah]

I’ve been in and out of psych wards the consistently the last 5 years and I’m not joking when I say some Psychiatrists are sociopathic and enjoy wielding their massive power over very vulnerable people. What I would’ve given to have a psychiatrist with an outlook like this guy

[@Here4TheHeckOfIt]

​​@@itspresroI studied psychology and some of my classmates made me realize that not everyone is in it for the right reasons ☹️ Also, burn out is real and I believe it can affect a therapist's outlook on their work.

[@Here4TheHeckOfIt]

​@@atesah I'm sorry you experienced this 😢 There are definitely people who should never be in the field, Not everyone is capable of working with people experiencing the worst moments of their lives. I hope you managed to find someone helpful to you.

[@atesah]

@@Here4TheHeckOfIt I appreciate your kind words ❤️ my current psychiatrist is much better but sooooo much trauma has been endured during my in patient experiences and it’s so hard to hold these people accountable. They can write up notes and spin their narrative to protect themselves if they get investigated for bad behaviour. They can weaponise psychiatric jargon and gaslight you with it, they can hold an involuntary admission over your head if you “step out of line” and do something horrible like advocate for yourself and refuse to participate in a very new and potentially dangerous treatment. Some of the most disgusting people I’ve come across are psychiatrists and psych nurses. The culture of psych wards is dehumanising to in-patients. I don’t have much hope for that to change but at least this guy and a few others coming in to the profession have awareness and empathy, it will make a big difference to those in their care

[@greenasaruby]

Damn. Even your cough is accurate. Glad to be a part of a bigger wave of mental health practitioners that are just starting out with a refreshed perspective on the field!

[@thebeatles9]

Hear hear~!

[@safaasgari3115]

Phychiatry is scam never talks about protracted whitrawal ,Akhatisia,anhedonia, DPDR. Funked all of you.

[@safaasgari3115]

I'm dying every day. I was on many drugs for my OCD and then they misdiagnosed me with bipolar put me on many other drugs my life is over. It's been six months. I am off my meds, but it's like nightmare😢 Akhatisia,anhedonia, cognitive impairment, insomnia, DPDR, racing thoughts, and severe mood swings،Hyper sensitive nervous system. Hyper salivation,horrofic nightmare. I'm getting worse every day. I can't take it anymore 😢😢 I really want to live, but I can't take it anymore. I am so close to suside everyday.

[@phillyarchdad]

I have been suffering through an epic series of dreadful, and ineffective, psychiatric treatments for my severely depressed son. The utter lack of personalized, or even competent care (looking at you Johns Hopkins and UPenn) is mind blowing. He is finally connected with a seemingly caring and very well informed clinician, but we still have to prompt him go get meds refilled, beg for help in finding supportive outpatient services and which lab service our insurance will pay for. And all of this is out-of-network, private pay at rates of ~$750-$800/ hour. God help the psych patient who doesn’t have an outside advocate to manage their care and a family member with deep pockets.

[@Here4TheHeckOfIt]

Your son is lucky to have you. Everything you said is true. The healthcare system routinely lets people down everyday. It's particularly bad these days.

[@rcoppy]

I was severely depressed from late teens into early 20s, as was one of my siblings, and medical ketamine was arguably the biggest game changer for both of us. Good luck to your son!! It gets better 🙏

[@miloradvlaovic]

And now imagine just how bad the field of clinical psycholigy is too, considering all the therapists getting to syphoon all the money out of patients like your son - whoo need actual care, and not useless hustle culture tips and tricks 😡😡😡

[@lilp5197]

I'm sorry you've been put through the ringer with our broken medical system. please take this advice or leave it; I know you didn't ask for any, but this is the void of the internet, for Pete's sake! for treatment resistant depression, it may be worth exploring treatments off the beaten path like ECT (electroconvulsive therapy), psychedelic clinics (small, controlled doses of psilocybin, ketamine, etc.), or even hypnosis (seems kooky to some, but can truly be effective in some cases). These are out of the realm of "typical" mental health practitioners, but can have really impressive results in some patients (especially unusual or treatment resistant cases). I'm sure you've at least heard of these things, and maybe even tried them, but I thought I'd mention them on the off chance you haven't. I am not yet a qualified source of medical advice, so please take this with a grain of salt and ultimately listen to the advice of a physician. -- a med student who holds mental health and neurobiology dear to my heart. I hope your son finds the healing he needs. xx

[@marinmazer]

That's a cool concept. It's scary to think we have to be both the CT scanner, the radiologist finding the condition, and the Physician treating it, but seeing it as an opportunity to rise up to the challenge for our patients is more comforting. Thanks

[@itspresro]

It’s a ton of pressure, and it’s a great honor

[@jx14aby]

Psychiatrists and psychologists never inquire of their male patients if they were circumcised. This is malpractice. Childhood trauma causes every mental illness in the DSM V.

[@colehatton3073]

It's fake

[@carriehazel77]

​@@colehatton3073shut up dude

[@gnatdagnat]

It's a construct like everything else ​@@colehatton3073

[@nathanbarnes3969]

I have had 4 different diagnoses from 4 different psychiatrist’s, the first 3 were all incorrect, the 4th finally the correct one. But each time I described exactly the same symptoms, the same things going on in my head, each psychiatrist interpreted what I said differently, each one building on all the info from the previous assessments and treatments. Getting the right treatment for you can be a very long process in psychiatry

[@aydenr5467]

It sounds like only 1 doctor listened to you. Which is the major issues I've identified when working alongside this field. There's so much already wrong with Psychiatry as a profession, it is made doubly worse by the individuals practicing not even being decent humans at times.

[@ninjai5527]

psychiatry is based on very little objective data, that's why most other medical fields call it a pseudoscience, but that is because the mind is mysterious and everyone's mind is unique (using the word mind because brain = neurology, mind=psych). unfortunately until we develop tools for understanding the mind, we can only really base therapy off of subjective data such as what a patient tells us through surveys, questionnaires, etc. in many cases it's a guessing game of trying what works and what doesn't, some treatments work for some and dont for others

[@src3360]

Theres no sticker on you that says what mental illness you suffer from. Many times its diagnosis by elimination.

[@TheParadiseParadox]

How do you know that the fourth one was correct?

[@nathanbarnes3969]

@@TheParadiseParadox J guess you’re right, it could be incorrect still, but my symptoms are now severe and noticeable enough and they all fall within the classic symptom list for this illness so I’m hopefully they finally got it right

[@aidancurran4399]

These 2-3min monologues are as in sightful as the skits are entertaining. You're the man

[@alexisnelson9295]

When I was in long term psychiatric treatment every time I had a visit with the psychiatrist he would barely ask me questions and would just up my dosages for everything lol. This was in a utah RTC so the therapists did all the diagnosing and the psychiatrists just prescribed the mx. Everyone in that facility was basically on the same medications even though we were all there for very different reasons, it definitely is very easy to be a bad doctor in psychiatry lol.

[@itspresro]

A story we all know too well. I’m sorry you dealt with that

[@alexisnelson9295]

@@itspresro it makes me happy to see a psychiatrist who really is taking their craft seriously. i’ve been dipping my toes into the medical field as an MA/XRT to see if i want to get an MD and it honestly is crazy to see the amount of doctors who just genuinely don’t seem to give a shit, not just in psychiatry. keep doing what you’re doing you seem like you’re doing a great job 👍.

[@abbythomet]

Wow. I’ve never heard it explained like that but that’s an amazing analogy! As someone who not only struggles with mental health but is also in healthcare, I’ve really struggled with this concept. Especially from the perspective of the patient and how to address this with providers. I’m about to graduate pharmacy school, so I feel like I’m educated enough on the topic to know that my provider isn’t as “sensitive” as I would like, and that some of the things I say are glossed over/ignored. I don’t want to look like I’m questioning their judgment/qualifications, self diagnosing or looking for more meds to take, but their lack of “sensitivity”/“specificity” directly affects my care I also feel like many providers in psychiatry just don’t care enough. They just add another pill to solve the problem without even blinking. From the pharmacy perspective, I can’t tell you how many times I’ve seen patients medication regimens grossly mismanaged by providers who don’t know enough or don’t care enough.

[@ummmmmmmmmmmnmmmm]

It's good to see someone passionate about psychiatry. I got diagnosed with adhd over videocall because of covid and I just didn't get any support needs met or anything. There's really no system in place for psychiatric care in Ireland and from my experience with doctors and therapists, a lot of them don't even think things like ADHD and Autism are real. I just wanted to get assessed by a professional but every "professional" I encountered treated me like I was some idiot that self-diagnosed myself on TikTok. They kept asking me where I found out about ADHD and if I found out about it on TikTok. Like, if I thought I had the ability to self-diagnose, I wouldn't be here sitting in front of you asking to see a psychiatrist who can assess me. After getting a diagnosis in writing, doctors still dismissed it. They really view psychiatric illnesses as if they're some American thing that doesn't belong in Ireland. It's really weird that people allow their national identity to affect their perception of reality like that.

[@M_SC]

It’s totally normal for it to be culturally dependent like that. It has never not been like that. You are blind to your own bias. And I’m not saying your situation is fine, just that you’re taking a very dunning-Kruger position at the end of your paragraph. Hope you get what you need and want

[@SeanConnery-j7b]

As someone who was severely harmed by psychiatrists, all I can say is please please please read Dr. Peter Breggin's books. He's excellent. If every psych practiced like him, so many patients would be spared from terrible iatrogenic harm.

[@greg9069]

The fact they’re so against things like ritalin or adderall, but will not think twice about prescribing loads of psych meds that cause severe dependence and severely downplay the side effects. Evil.

[@zanfear]

Don't lump all of them into your subjective experiences.

[@G8tr1522]

​@@zanfear don't act like you understand the suffering of those with ADHD

[@zanfear]

@@G8tr1522 I have it myself, chump.

[@bharatnyr]

As a psychiatry resident i totally agree with everything you’ve said in the video and this very subjective nature of diagnosis and treatment in psychiatry is what annoys me on some days and makes me feel proud about myself on others. I totally felt you when you said psychiatry is the best place where a lot of bad medicine can hide. Especially in country like india where the amount of money you make as a psychiatrist is directly proportional to the number of patients you see on a daily basis there is a lot of bad medicine hiding in plain sight.

[@carlosgardellamerino9589]

Thank you for tryng hard to be good! OCD sufferer here, and psychologist and psychiatrist had been a literal life saver

[@thebeatles9]

im 35 YO premed and what you are saying is what I've been experiencing the last 10 years of trying to be a psychiatrist but everyone in my life pushing me away from it. My only regret is I only have ~40 years left to give to medicine (maybe 20 good years as an attending) and this pursuit of healing and reform

[@seeker296]

Fuck man that hit me hard. As a young student, I often get upset with the pacing and forget how short life is. I want to help as many as I can, and I've only got so much time to do it...

[@thebeatles9]

@@seeker296 it's noble, but your best is enough. you can't kill yourself over this. it's a hard pill to swallow, but being good enough is its own form of perfection.

[@Letstalk-zx7jx]

​@@seeker296I'm 32 and haven't even started college yet, so don't feel too bad

[@Emily-hd9sm]

Really glad to know there are people who view medicine the way you do. Sometimes it's easy to just see the people who want easy gratification - diagnose a common problem, do the right procedure, and everyone walks away happy and you get applauded as such a great doctor. It's nice to know there are people who see more challenging patients as an opportunity to be a great doctor and not just a problem to be passed along.

[@jeff-hc8ux]

These more serious videos remind me of vlogbrothers. I can't get enough of them and hope you enjoy making them.

[@padda_seun]

You're doing important work, bro 🫡❤️

[@samb8519]

Preston thank you for these beautiful words! I‘ve started to work in oncology realizing pretty fast I actually do wanna specialize in psych which I‘ve always known. And I always used to say: while in IM or surgery you need a pathologist to tell you what your patient has in psych you are the pathologist and the clinician. You are basically all in one which is unique. However, as you‘ve said, many bad physicians are hiding in this specialty…

[@whitecow9866]

This form of short talks are as good as the skits. Please make more of these

[@joeaabye9311]

M3 rotating through psych right now, you changed my perspective on how I approach this specialty in less than 3 mins. Really refreshing to see someone talk about their field with so much passion amongst all the burnout. Keep crushing it 🤙🏻

[@The_Life]

As long as y'all know you're not perfect and that's ok. You and other mental health professionals are so amazing!

[@frigginfrigg8699]

You are beyond refreshing. I love your videos

[@georgemataele9271]

I love this. Ive been in mental health for the past 10* years and I’ve recently got a calling to psychiatry. Even after my MSW in 2016 I look forward to the specialty nuance you speak of. I appreciate you and I love this content

[@DarthJarJar10]

This video is so important. My older psychiatrist sibling not only wouldn't let me choose my own psychiatrist, but after taking part in some very classic emotional abuse, they responded to my shouting at them by lying to that psychiatrist without notifying me that they will contact them nor my consent to speak with the treating psychiatrist. Magically, beds in a psych ward were reserved for me and I was commanded to admit myself. I refused because the reasons provided - that according to them I was burnt out and/or not "meeting responsibilities to our (surgeon) father" - made zero sense. When I met with the psychiatrist, she heard my side of the story then outlined the lies the psychiatrist sibking told her. She then recalled that my family was very controlling and demanded why I hadn't yet emigrated to create distance from them as she had instructed me to in our first consultation. I re-explained why and also added that I wanted to see a different psychiatrist but the psychiatrist sibling wouldn't let me choose... Neither the sibling nor the psychiatrist would explain who reserved the bed. As I was leaving the psychiatrist's office, she questioned whether my family knows that I'm gay. I corrected her and said, "I'm not gay. I'm bisexual. And no, they don't know..." She would not discuss why she asked. My father is an immigrant one to the country where I was born. Our descendant country is very anti-queer people - notably even putting queer people to death... Not only did this surgeon father lie about his knowledge and involvement of these events... When I confronted him telephonically he began to scream and shout that I've "grown aloof over the last few years" and "live my life like I'm by myself"... He made offensive comparisons to other deceased gay family members who got involved eith criminals, drug abuse, and even HIV (NONE OF WHICH IS DIRECTLY APPLICABLE TO ME) - the guy used his esteemed snd extensive medical acumen to overdose and off himself. Which obviously has me believing that the psychiatrist breached confidence or allowed that to happen. I got myself a new psychiatrist and about a year later, a new psychologist. The psychiatrists and the initial psychologist did not agree that admission was necessary. The current psychiatrist initially diagnosed me with "mild borderline personality disorder" - but that seems not to matter to the psychiatrists. Even when I do my own research and explain that the quiet/discouraged subtyped fit me perfectly. Subsequent to all of this, I wondered whether I did not have ADHD and not only was this correct, the Concerta fixed all my issues. I had to write off these crazy famiky members and then eventually stop taking the Concerta, though, because between the first write-off event and the second - which both occurred beforr the ADHD diagnosis was confirmed by the current psychiatrist, there was a massive family trauma which occurred. And I had to stop taking the Concerta, despite its efficacy, because it was found that I actually have epilepsy.

[@ollieq3150]

Thank you for your thoughtfulness, and your enthusiasm. Keep fighting the good fight. Cheers

[@Hgtp2_Hat]

Really like your video. I’m psychiatrist in uk. One of my biggest frustrations is how certain some of my colleagues are that a patient has x diagnosis rather than y diagnosis. Based on what? So much is subjective. Diagnostic constructs changing constantly. Words to describe symptoms are poorly defined, often meaningless. One person might say anxiety, another restlessness, another irritable…all describing the same negative emotion but might lead to different diagnosis (eg anxiety, adhd or depression). I wish psychiatrists and other mental health professionals would be honest & real, it’s best to have a list of possibilities, that way you have best chance of finding effective treatment. Thanks so much for posting, it’s refreshing to hear someone being real.

[@vicky__p]

Your funny stuff is great! This stuff is ABSOLUTE GOLD. Thank you.

[@alteredegoz]

Man you’re a thinker and all that you say is so true. Thank you for sharing. You are a health professional of quality

[@Nightsmaiden]

Having known *four* people who had neurological disorders of varying rarity misdiagnosed as bipolar and treated with medications that made them massively worse, that cough really hits home.

[@DiamondKingVideos]

Wow this was incredible. Well said, Preston

[@precious14stones]

This talk was so refreshing, loving the moustache ❤

[@jeffmrn]

Thanks for this thoughtful piece. You've articulated something important, I hope you keep providing videos like this.

[@Auric-BraiNerd]

My favorite medical content these days. Keep them coming.

[@samyukthaprabhu982]

LOVE the consistent uploads nowww :))

[@bones3764]

I really like your analogy of being an instrument. I work as a mental health clinician in an acute community setting, and your description is perfect.

[@crislockhart8188]

I'm a graduated Med student who's preparing the way to specialize, and Psychiatry has always been the #1 for me... This video really helped, actually, because I sometimes have doubts about my future, but I still think it's so beautiful... Hopefully I can become a good doctor someday, thank you for this

[@Ethanvaladez637]

You already are very talented, now flourish with gained, and imbued passion and hard-work!🎉

[@brianhigdon9773]

It seems you're well on your way to being an excellent psychiatrist. We need more of you!

[@music4meh]

Another beautiful thing about psychiatry, is someone having a breakthrough. Recently, skimming over the specifics of the situation, I heard of someone to whom this has been and would be and will be a great obstacle, say ''What I have been doing has not worked, so I might as well try something else.'' Them having that epiphany, not fooling themselves that they may revert into old ways OR obsessively pursue that denial of who they previously were, is such a beautiful thing. Having sentences such as ''what gave you the right to do that'' become ''what is it within me, that gave me the right to do that'', and then have people admit what they did was wrong or questionable, then have them not only accept they made a mistake, confront how they did it, and almost alienate themselves from the person they were, as they would never wish to behave, let alone behave, in that certain way, is beautiful. Having people not only distance themselves from certain outwards behaviour, but also recognizing the inwards behaviour and mental processes that allowed them to do certain things that were damaging, but also articulate what it is they did and how it was wrong, is beautiful. But having a person who is quite lost acknowledge they are, acknowledge they need help, acknowledge that their behaviour has not gotten them what they expected it to yield, AND that what they hoped for it to yield may itself be questionable, is beautiful. Sure, it may be temporary, and many may revert in their old ways and worse, but a breakthrough isn't supposed to be that. A breakthrough is supposed to be a break from that. Seeing someone actually overcome their struggles through their own efforts is so precious. In reality, it takes a lot of ''breakthroughs'', relapses, and it's only throughout months or even years we actually see progress, but having a person say ''what I have been doing hasn't worked, so I want something different'' is so great.

[@jeremiahbaker6396]

This is a interesting perspective sir. All the best!

[@richiecook2305]

The world needs more psych docs like you, keep it up!! 👊

[@SamAndAdamsFishroom]

You are a great teacher, and have the gift of summarizing otherwise complex concepts succinctly, and placing it in an easily understandable package. Your students and junior residents will be lucky to have you as a mentor.

[@monkiram]

I'm a psych PGY2, and I've also been saying that psych is the easiest specialty to be a bad clinician and also the easiest specialty to be an unethical doctor, because our population is vulnerable and it always our word against theirs. This has been making me feel kind of jaded about the specialty as a whole lately because I practice somewhere that attracts particularly bad psychiatrists given that nobody good wants to work here. I hadn't considered that it's a specialty where it's difficult to be a good doctor. Thank you for the small dose of inspiration haha

[@hailmademodeG]

Beautiful and also the most challenging part of psych. Such an incredibly complex, terrifying, and rewarding field.

[@SunSunSunn]

u make me wanna go into pysch bro, love your content.

[@pothospathos]

I finally found the most amazing psychiatrist about 2 years ago and she truly changed my life. I owe my life to her literally and figuratively. I can't adequately express the gratitude I feel for having found her. She diagnosed me with ADD in adulthood that went undetected during my childhood and adolescence; I learned this is more common in females too. True ADD is crippling and I often wonder how I ever functioned on any level before intervention. Its unfortunate it wasn't picked up early on because looking back its so clear. Sometimes it makes me sad wondering who I could've been and what I could've accomplished. But anyway, I hope it brings you some comfort hearing about another great provider that exists in your field. Based on all of your insight and expression, I have no doubt you'll make a profound impact on your patients

[@rutka_uliana_tarashkievich]

Last psychiatrist I went to caused me to have a suicidal breakdown. Everyone I've ever been to turned out to be a disappointment, prescribing meds, that never worked. I truly hope you succeed in this very field, but I don't trust psychiatry anymore. Self med turned out to help me more than any doctor. I'm a transfem pharmacist, diagnosed with autism and it showed for my whole life. I don't want to see any psychiatrist ever again. My anaesthesiologist is a far better help for me

[@thebeatles9]

You should write a book. So much of the perception of psychiatry is still stuck in the medical model with paternalistic "experts".

[@davidjha]

Curious if you’ve seen that old study (1960’s maybe?) where grad students were told to try and get committed to a mental institution, and then once they were there they couldn’t get out because their claims of being part of a research project were dismissed by staff as paranoia?

[@Aunruh557]

Oh my gosh this sounds like such a nightmare! How did they end up getting out eventually??

[@RR-kz4hq]

Yes god. My first psychiatrist really fucjed me up. Medicated me for bipolar when im clearly a victim of child abuse.

[@heyna1185]

I can tell by your attitude that you‘re a great doctor! I am very Lucky that the first psychiatrist I ever went to was a great one too. I have so many bad experiences with doctors and in my experience it‘s often the ones in fields that are a bit more “empirical“ that are lacking humility and empathy. But that could just be a bias based on my own personal experience.

[@annew1912]

"calling clubs spades for two decades" cut me deep, as I was misdiagnosed for 12 years

[@cheetahgoldenfire]

This!! I've been thinking about it and preaching it for a long time.

[@NatureHeadSupreme]

You can see and hear the passion. Good for you.

[@walters8748]

This was a beautiful written & spoken

[@Kimchiibreath]

There are *SO* many bad doctors hiding in psych especially ones that serve low-income / public healthcare for like Medi-cal / Medicaid patients. Which is ironic because I assume these doctors started out wanting to help low income patients but became so jaded and burnt out by the system that they totally lose their empathy. Which is also really dangerous because like you said, misdiagnosis becomes the norm. I have so many horror stories as a patient and a worker. * edit * : however I am optimistic for the next wave of doctors (and other healthcare workers) to create changes

[@maggie6152]

Yeah. I have a rare physical illness so I've had a lot of doctors wreck me because they didn't listen to me, but psychiatry and psychology have been BY FAR the most damaging field to me, preventing my healing (severe CPTSD, depression, anxiety). Your field is completely upside-down and backwards in almost every way, but there are nuggets of very good information hidden deep inside that elephant turd. Psychology as a whole needs to be completely reorganized. Also subscribed.

[@ihab2002ahmad]

This reminds me of the critique of medicine but especially psychiatry that is at the heart of The Yellow Wallpaper. Just watched crash course analysis of that book and its so telling that a psychiatrist would more or less have a similar critique.

[@psychegoddessoflight9358]

Very few people would likely believe me, but I experienced an inpatient clinician whom I'd gently confronted for having fabricated visits in my chart (claimed daily sessions but only saw her 2x/wk). I'd been a clinician myself, and documented everything, realizing the extraordinarily poor quality of care. She looked me dead in the eyes and said, "But you're *_delusional,_* arent you? No one will believe you." She could document any damn "truth" about me she so desired, and how could I disprove her narratives? Same hospital: the psych MD told me, in reference to the genetic neurotransmitter function test I'd had my psychiatrist send, "I have no intention of reading that," and consequently administered meds i was deathly allergic to. I had zero recourse, and if it weren't for a compassionate judge who chose to independently research some of my claims (r/t paradoxical reactions) and determined I just might be telling the truth against corrupt practitioners...i shudder to think. Minus my credentials, I would have been royally screwed. A LOT of egregious malfeasance occurs in psych wards, bc twisted psyches who seek minimal accountability + maximum power over "inferior" others are drawn to the profession just as much as empathetic individuals. And they're usually skilled at hiding their true colors from colleagues. I had met a woman whose father was head psychiatrist at an esteemed hospital; he performed experimental ECT procedures on her throughout childhood (along with s*xual abuse) 💔. No one believed her; he held ALL the power in multiple dynamics. Monsters live among us. Stay smart, stay safe. 🕊️🤍

[@dansaintamour]

Deliberate practice examines the disparity between effective professionals and less effective professionals. In mental health, the chasm is wide and the reasons are intangible.

[@icesparklefrost7511]

it's sad to hear that people in the specialty sometimes take advantage of the beauties of psychiatry. As someone hoping to become a doctor and most likely become a psychiatrist, I aspire to take part in the beauties of psychiatry and do my best to help patients with empathy and skill used properly

[@APCxcheesypuffs]

Mental Health-NP colleague at a local FQHC prescribed Bupropion SR 100mg QD for GAD patient I knew😮‍💨🤦🏻

[@Chimpy_Mc_Gibbon]

This is how I practice with psychiatry as a GP. I also agree that it's the hardest medical specialty to do well. But I'm trying too improve.

[@aff77141]

This is exactly the mindset. Too many people in psyche treat the human mind like it's something with consistents and definites, when it simply isn't. There's probability and patterns, but no two person is going to behave the same just because your book said so, that's not what it's for

[@RR-kz4hq]

Thank you fir doing this. I have only ever had a good psychologist. Never a good psychiatrist.

[@HaemDream]

Completely agree. I’ve often thought the same of geriatric medicine (not sure if it’s as prominent a specialty in the US as it is in the U.K.) - there are no guidelines or RCTs that can tell you exactly how to manage this highly comorbid 80 year olds fifteen different medical problems, 3 of which are now decompensating, in the optimal manner. So the management plan is entirely subjective and in the hands of the treating doctor. The result is that a lot of bad medicine can hide in geris, but equally some of the best and most pragmatic medicine I’ve seen has been by geratologists. There’s a lot more satisfaction in knowing your unique treatment plan has helped the patient (vs seeing predictable improvements after just following the same algorithm you know any other doctor would’ve done).

[@starrystarrynight52]

I feel like the psychiatrist I just had misdiagnosed me with bipolar 2. He seemed so bent on rushing to a diagnoses that I didn't get to other things I wanted to discuss. I started with my anxiety. But I felt he was guiding toward a certain diagnoses. He also prescribed a med that lowers the threshold for seizures and even more so with age (I am 52 and epileptic). I have none of the symptoms of bipolar, aside not from sleeping well and racing thoughts. I don't have mood swings, I don't have a reckless bone in my body, I don't take unnecessary risks. I''m not irritable. I do get more hyper from time to time though, but I have also been diagnosed with adhd and anxiety many years ago. And sometimes I feel anxiety keeps me awake, make me restless, etc... I called the office back and said I don't feel comfortable taking the meds and that I think I was misdiagnosed. He got very angry with meand focused on my sleep problems, saying it's not normal, (true I sleep badly) But he also said that "in his notes I said I was irritable sometimes". He asked me this question several times on the initial call (Which I emphatically stated over and over I am not irritable or even deal with anger on a regular basis. It takes a lot to get me angry. And told me need to go somewhere else. I did agree with him on that.

[@wren5291]

Damn! You could not have been more succinct and accurate in your explanation within 02:44 seconds😮. Please be my psychiatrist/therapist😆🙏🏽. It begs a great question though; how does one remove personal biases and yet still remain human with a view to helping a patient? Great vid!🖖🏽✌🏽🙏🏽.

[@itspresro]

First, you will never remove personal biases. So it’s just important to be cognizant about how they will affect you. And you can use your humanity to guide the questions you ask the patient to uncover things about themselves. If I have a very similar experience with a patient, I may not share it but it will guide how I investigate their thoughts

[@wren5291]

@@itspresro Yes. Using the word 'remove' was a bad choice of word on my part. What I meant was compartmentalisation with a view to giving the most accurate and beneficial info in order to help someone. I'm not a psychiatrist, psychologist, or therapist. As a member of the British public I have found it so daunting trying to find a psychiatrist/therapist who has the self awareness, and humanity, to give good insight and guidance without 'muddying the water' so to speak. I find Americans to be much more open and broad minded, and therefore less rigid in the field of mental health.

[@Ninsidhe]

I finally found someone I could work with, my clinical psychologist- long experience has made me fully aware of how bad psychiatrists as a group are and I won’t go there ever again. Fortunately DID is not medicatable so they weren’t interested, but I’ve had to ditch my DID therapist (professor) because he is into electroshock therapy for a number of things and that immediately was a huge red flag for me. Nope, no, nooooooo thanks, zero trust now, I’m much better off with how I’m approaching my own mental health care these days. 😊

[@DrZombieDeadpool]

This is exactly why we have so many PMHNPs

[@aazhie]

My friend was diagnosed with depression when she actually had bipolar disorder for a decade. The therapist I saw for gender.Desperate, I said I had a lot of anxiety but didn't diagnose me with AD.H.D. I ended up asking a new therapist years later and he loosely confirmed that I had some pretty damning symptoms

[@LeninMcDonalds]

Absolutely. That mustache though ❤

[@christaing1201]

HELLO, aspiring med student for psychiatry. I hear SPECTs are really efficient in diagnosing and providing treatment medications for specific mental disorders like differing depressive disorders. there’s a TED talk on this. 10/10 would recommend

[@OrpheoCT]

"There's no guideline that you can follow". Scary

[@MichaelJones-rg3hv]

Psychiatry seems like one of the few fields left that are still as much an art as it is a science. The art seems like it has been removed from many others, mostly for the better, but I can't help but feel like some good things are lost in that trade too.

[@Roadkiller85]

Used to work in psych, switched to surgical pathology. Worst case scenario for me in psych was a patient committing suicide after having talked to them or during hospitalization. Then I was told that a good and solid documentation was key for not getting into jail, aka a very subjective and focal (timewise) impression, you were practically invincible legal-wise. As a pathologist I am way more anxious considering my diagnoses, since almost everything is pretty "objective" or overseen by academic specialized pathologists in lawsuits, you are at their mercy.

[@Laotzu.Goldbug]

Dr House is my favorite psychiatrist

[@user-xy4ff5yp7b]

Yeah. You bring your own self much more to the interaction than in other specialties.

[@GuacASMR]

Currently between dermatology and psych and this might’ve done it for me

[@celestekalil517]

That first sentence. Most psychiatrists I've been too were not very good or understanding.

[@atheistbewildered2987]

There are objective measures that are not used. One is neuropsychological testing - psychometric testing. This testing shows the neurologic underpinnings

[@alvodin6197]

No, it doesn't. They are no objective measures for differentiating a healthy brain, without mentally illness, to a brain with mental illness, wether it be scans, blood tests, or your psychometrics jargon. Do some actual research and not look for sources that make claims without scientific research backing it up. Psychiatry has been debunked for over 70 years, but because of it status and power, it still remains as oppressive as always.

[@NuvosNexus]

Really well put! I have a question, if psych is subjective, then how can doctors ensure patients get the best treatment they need? An example that comes to my mind is if a patient is incredibly rude/mean/nasty or physically violent, whether they are out of their mind or not, how can you as the doctor ensure you won't treat them more poorly based on how they have treated you? I know professionalism and all that, but being treated poorly by another human still affects you. At the end of the day, we are all just humans trying to help one another. Maybe the answer is maintaining a mindset of complete compassion and empathy? Just curious of your thoughts.

[@Axqu7227]

As someone in their 30s who’s been seeing mental health professionals since I was a small child, it’s gotten to the point where I will categorically refuse to see any mental health specialist with MD or PhD at the end of their name. If I need a counselor, I look specifically for a LCSW or equivalent, but may very cautiously accept a PsyD if they’re extremely kind. If I need a psychiatrist, I look for a DO, but I generally prefer to go through my PCP for that. Turns out most of y’all can’t detect autism in women especially when comorbid with severe PTSD.

[@itspresro]

Seems like you filter out for providers who reinforce your ideas about what you have

[@redhotkido]

You HAVE to shop around people Do not blindly trust em. If you feel something wierd find someone else and so on

[@itspresro]

Unfortunately this is something you should do

[@GerardoGutierrezGonzalez]

I'm both, amazed and terrified

[@bini8393]

One of my family member was deppressed for over a decade to the point where they started hearing voices and having psychotic episodes, the psychiatrist said it was a common effect of someone being deppressed so they gave her medicine, and the medicine did help; we would go to him talk about progress every month. But after a couple of months he said that since she still isnt healed and hears voices, she is schizophrenic and will not recover because the medicine should've stopped the voices, so we need to stop the medication and try something else. I told him if this isnt from depression and is schizofernic then why did your previous medicine help, yes she isnt healed but shes improved a lot. And then he said...oh if thats the case then she should keep taking it. I just found it weird how if i hadnt mentioned that then he wouldve completely changed the medications and diagnosis, like shouldnt that have already been considered, the fact that my relative is improving. She might've been in a completly hopeless stage now if I hadn't mentioned that small detail that he should have been aware of since he is monitoring her progress. Anyways my family member doesnt hear voices anymore and isnt even depressed these days, but definitely made me wary of psychiatrist.

[@violinstudy]

Is this why my psychiatrist asked me what drug I wanted a prescription for? I ended up leaving with no prescription and gave up on getting better because I needed help and I didn't feel qualified to choose my own medication.

[@alexobrien4466]

Thank you.

[@leafcutter-id5zq]

I agree with everything you said, except on one point. CT scans detect a much more objective kind of disease than psychiatrists do. Cancer, infections, injuries, etc are all easily defined physical circumstances. Psychiatric diagnoses are much more invented categories. Otherwise, this is amazing! I’ve had disappointing experiences with psychiatrists and I’m glad the field is changing. Thanks.

[@RR-kz4hq]

My psych np put me on latuda and didnt titrate me on and i got akathesia and she just told me to take ativan 3 times a day. The saddest part is i still have her as my provider because i know how easy it is to manipulate a bad psych

[@ainelloydiaz7320]

Totally agreed.

[@kaiscote]

Too accurate 😭

[@Dr.tariqazzam]

My biggest problem with outher fields of medicine is that everything is outlined in a guideline, governed by nano variations in lab values or blood tests or other parameters. And that makes me feel like a robot, even though it's probably best for patient's benefit to eliminate human error and make doctors follow strict guidelines, it just goes against my whole autonomy and existence. I like the side of psych which hasn't yet been heavily imprisoned in strict and harsh guidelines.

[@Gracie-gf7lo]

You can do brain scans for neurodivergance and some types of depression

[@mindango4092]

As a current IM resident who was strongly considering psych, what you mention is exactly why I didn't choose to go into it. There is too much uncertainty, ambiguity and too little objective data. I can't handle that much uncertainty when diagnosing and treating patients. Do you think neurology and psychiatry will eventually be understood well enough to be the same field or will there always be things that we do not know the pathophysiology for?

[@itspresro]

There will always be things that we don’t know the pathophysiology for. I do see psych having a more diagnostic approach soon with advancements in MRI and eeg to detect changes consistent with certain established disorders (ADHD, PTSD,BPD) I’m hopeful that in 20 years we can do rapid FMRIs and eval the pattern with the radiologists and say this is consistent with chronic trauma: consider BPD or PTSD but cannot rule out GAD

[@itspresro]

One of the hallmarks of psychiatry applicants is a high tolerance for uncertainty

[@swissarmyknight4306]

I had a VA psychiatrist put me on anti-psychotic medication when I wasn't psychotic (did nothing but make me sleep all day and get uncomfortably fat, no detected organ damage) and a VA psychologist at the same time gaslighting me that I "just didn't want to take care of myself" when I told her I was having problems with executive functioning (she had no answer as to why I would ask for help if I didn't want help). I went around the VA and got diagnosed by a neuropsych on my own dime, with friggin ADHD in addition to PTSD (which explains the executive functioning problems). I'm on ADHD medication now and doing a lot better. The VA's treatment plan was to administer poison and gaslighting me into a suicide attempt. Its like they were trying to do as much physical and psychological damage as possible. Psych is a mess and so is the VA.

[@90klh]

My psychiatrist couldnt see past my oldest, most dealt with issue, addiction - I'm having panic attacks every . Fuggin. Day. I'm just one big red flag to them, and having to treat panic attacks on my own, seems worse than idk, like 5 lorazepam tablets a month, but wtf do I know

[@colehatton3073]

This is the worst part of psychiatry, no offense. In no other science do we go, "You know, man, what makes it beautiful is your ability to just artfully interpret. No data necessary, just like...do they feel like they have cancer? Simply beautiful."

[@itspresro]

Objective assessment of a mental status is not artful or whimsical musings it still requires skill and significant levels of verbal reasoning. It’s beautiful because it requires that kind of skill in the physical exam. It’s like practicing with a stethoscope listening for a murmur but you don’t have an echo to back you up. You have to be really good with your stethoscope

[@possiblypoet]

“I need to increase my sensitivity to every disease that I can” - this feels like it’s beggin to be taken over by AI