The Mystique of Medicine

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I wish I could get my mind around the mystique of the medical profession, psychiatry specifically, and how the significance has been buried in hype.  Psychiatry is now “in vogue,” the latest panacea for individual and collective woes.  I see that in the professional literature, where the “opiate crisis” has brought psychiatrists to the forefront of bids for federal funding.  Psychiatrists are lobbying Congress for the expansion of telemedicine, because there are not enough shrinks to meet demand.  We have psychiatrists pushing for “evidence based medicine” and “collaborative care,” and for new drugs to treat diverse symptoms, like tardive dyskinesia.  We’re seeking new treatments, such as transcranial magnetic stimulation and vagal nerve stimulation to alleviate symptoms.

 

With all this expertise and innovation, we have yet to offer cures—or hope for cures--for any psychiatric problem.  Instead, we have invented new mental disorders, such as adult Attention Deficit Hyperactivity Disorder (Adult ADHD), which now justifies lifelong prescriptions for amphetamines, highly controlled substances. 

 

Nor do we consider the systemic causes of the mental illnesses.  The psychiatric community consoles itself with partially effective treatments for problems like Post Traumatic Stress Disorder (PTSD), but there is never a whisper that we could prevent a great deal of PTSD by stopping US aggression and wars around the world. 

 

In many ways, the medical profession functions like a secret society, with insider knowledge gained through the rigors of medical school and residency.  In this context hazing is the norm, not the exception, and those who survive the trials join the ranks of abusers and feel justified in passing on the whip-based approach to “the healing arts.”  In short, doctors are driven, and they drive others.  This is believed to be a sign of strength.  It is also a cause of burnout, job dissatisfaction, and physician suicide.

 

Psychiatry, more than any other medical specialty, has historically attempted to blend art and science to heal the mind.  For me, it offered hope of setting people free of limiting beliefs and expanding their minds to new levels of awareness.  It turns out this was a naïve fantasy, because that’s not how it works in practice.

 

The “art” of healing has given way to the “science” of healing, in a mechanized, piecemeal, statistically analyzed way, to the detriment of doctors and the patients they treat.  Both doctors and the public seem caught in the illusion that medicine can do more than it can do.  When the patient is dissatisfied, blame falls on the doctor.  I wonder, though, if both have been hypnotized by unrealistic expectations, intensified by all the hype generated by advertising, insurance, government, and the magical belief that doctors possess some mystical knowledge known only to the select few.

 

I don’t think so, and anyone who does is bound to be disappointed.  Medical school reveals not how much but how little we know about the human body, its intricate homeostasis, and its natural inclination toward health.  Left alone, the body wants to be healthy.

 

The concept of healing the mind presumes there is something wrong with it, a belief reinforced by history and religion.  Father of psychiatry, Sigmund Freud, postulated a semi-demonic “id” that vied with the controlling “superego” in symbolic good-versus-evil fashion reminiscent of God and the Devil in monotheistic tradition.

 

Under this scenario, the “mind” can never be healed, but the presumed relevance of psychiatry lies in its ability to control the mind through drugs and therapy.  Thus painful emotions become pathologized and diagnosed by subjective criteria that psychiatrists pretend are “scientific.”  The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the result.

 

A common stereotype about doctors is that they are money-driven, but I suspect they are driven more by a desire to be helpful.  Yes, the money is nice, but by itself, it does not provide the fulfillment that satisfying work does.  And, in recent years, the desire to be helpful has translated into a tendency to overprescribe pills and surgery.  This is especially true in psychiatry, where success in alleviating suffering is hard to measure.

 

I wonder if the tendency to over-prescribe is a reaction to a deep sense of helplessness in the face of so much suffering.  Do doctors and the public have unrealistic expectations for what the medical profession can do?  Would it be appropriate to re-assess the paradigms we use to define mental or physical suffering in the context of society as a whole?  Is it the individual’s problem or society’s problem that there is so much dis-ease and pain, or is it a combination of both?  Shouldn’t psychiatrists and other physicians ask themselves and the public what, exactly, they are attempting to treat?

 

Oriental philosophy recognizes a spiritual component in all suffering, but we have ignored spiritual contributors in Western, allopathic medicine.  The Oriental concept of life force, or “qi,” that arises from within and maintains life, including quality of life, presumes that problems begin at a spiritual level, then become progressively “dense,” through mental and emotional levels, until they eventually reach physical manifestation.  Under this paradigm, uncomfortable emotions motivate change of attitude, belief, or action, in order to regain balance. 

 

The Western “quick-fix” approach to pain, through pills or surgery, attempts to by-pass this internal signal system.  Not surprisingly, the treatments often fall short of promises and expectations, while the problems themselves go unresolved.

 

It is said by some, including me, that all healing comes from within.  Doctors or others may assist, but the patient’s belief and desire for healing are paramount.  By putting responsibility for health outside ourselves, are we sabotaging our body’s natural self-correcting abilities?

 

It seems to me that psychiatrists would inspire more confidence by admitting they don’t have magic bullets and maybe never will.  In most cases, the best we can offer is a compassionate  “There, there,” and be a source of comfort and a touchstone for those who minds are bedeviling them.

Comments

Jeffry Gilbert Added Nov 2, 2017 - 10:59pm
the magical belief that doctors possess some mystical knowledge known only to the select few.
 
Grandfather always warned us the most important thing to remember about doctors is they're just practicing. 
Michael B. Added Nov 2, 2017 - 11:12pm
I worked at a law office that specialized in medical malpractice defense. Moral of the story - Doctors are people too.
 
I once dated a woman with a Master's Degree in Psychology, who wanted to get into Marriage and Family Counseling. Moral of the story - If you've never been married, don't have kids, and are a raging whore, you really shouldn't be a Marriage and Family Counselor.
 
She subscribed to "Therapist" magazine, but I saw "The rapist". Spaces truly make a difference! By the way, unlike most crazy chicks...she was VERY bad in bed.
 
Someone described a psychiatrist as "a cult leader in a two-person cult." Sounds about right.
Tubularsock Added Nov 3, 2017 - 2:37am
Katharine, great post. Tubularsock agrees with much of what you have pointed out here.
 
Tubularsock is a big believer in working everything from within out rather than the other way around.
 
Doctors are like car mechanics and they are extremely good at most “mechanical” aspects of the body. They can repair and replace rather well.
 
But what is very important is that YOU look into your problem first because YOU probably know much more than the doctor does about YOU. That is not to say that doctors don’t know stuff but they base much of their diagnosis on comparison and trends and are often incorrect.
 
Tubularsock would venture to say from my own experience that illness comes from two sources, emotional disconnect from the self AND a lost connection from soul energy.
 
Tubularsock seldom goes to doctors and if the proper occasion occurs Tubularsock would go to one but it is rare.

Stress is a major cause of illness. Illness is a simply “cry for help” that you hadn’t heeded. And if an authority figure tells you YOU MUST REST then you do. And you can tell your boss that THE DOCTOR SAID I MUST REST!
 
But YOU KNOW BEST!
 
Take that power back.
 
Tubularsock could go on but one has to work this out themselves and some psychiatric help may be helpful to many BUT YOU need to find someone that will work for YOU and YOU need to understand that YOU are the seer!
 
The problem arises with many when you give YOUR OWN POWER away to a so called authority figure.
 
Doctors can assist YOU but YOU are the final arbitrator of YOU.
 
Use your knowledge well ....... the force IS you!
Neil Lock Added Nov 3, 2017 - 5:22am
Nicely said, Katharine.
wsucram15 Added Nov 3, 2017 - 6:31am
Great article.  Its also starting to scare me that I agree more and more with Jeffry or at least his Dad.  Wow.
You know since I was 14 and diagnosed with Epilepsy, I have seen enormous leaps in medicine.  In many ways but most noticeably to me in neurology and psychiatry,  (believe me they have a correlation).  I have seen the changes in the horrific treatments of the disabled from when I was a kid to now.  HUGE DIFFERENCE.
I have seen the difference in lets say the treatment of depression or severe mental illnesses from then to now, knowing what  actually happened to my mother and how it was treated over years.   That was many doctors over many years "practicing" until one almost killed her.  After that, I found 1 person I trusted with Mom and she was the most profound diagnostic and treatment person in the psychiatric area I ever met, dealing with severe illnesses of the mind and neurological damage.  I wrote a thesis on her and the work in the clinic at JHU where she worked.   I not only got an A on the paper and the semester in the class, but the Professor kept a copy of the paper for the research that went into it and the rarity of the subject matter. 
 
I dont have much faith in doctors that are not my own. I am extremely selective, I will research and select a doctor before I ever go into that persons office.   I will know that person as a medical professional well.  I have to be able to trust my doctors, discuss my treatments with them and when I feel something is wrong..know they will hear me.    I have had my two major doctors for 25 years (my PCP) and 28 years (my neurologist).   I went to a well known psychologist with my son, his father, my daughter, my mother..etc, for a very long time, it helped some.  But the only therapy I have ever seen work, is gestalt therapy, therapeutic journaling, DBT and mindfulness.  Its not required for all people but mindfulness should be practiced by everyone.   Im not saying there are not reasons to medicate, but I dont think you can put pills in your body and not expect long term problems from that...you have to learn to counter balance the functions of the brain.   Having the "right" doctors helps A LOT.
 
Katharine..good article.
 
George N Romey Added Nov 3, 2017 - 7:34am
Katharine our increasingly dysfunctional lifestyles and mainstream economy is causing people to become physically and mentally sick. Doctors overrun with patients and controlled by the medical complex are taking the easiest road-Pharma. We are not solving the root of the problem.
wsucram15 Added Nov 3, 2017 - 7:48am
Katharine..I guess my point was if you go to the doctors expecting a cure all, thats what you will get.  If you go to a GOOD doctor and want to work for good health, thats what you will get instead.   At least thats my experience..too many people expect the first example.
Dino Manalis Added Nov 3, 2017 - 8:47am
We need many more doctors; pharmacists; and nurses to treat us!  Primary care should be available in nurse-led clinics; pharmacies; and other stores.
Even A Broken Clock Added Nov 3, 2017 - 10:39am
Katharine - very thoughtful and good article. One thing you mentioned was transcranial magnetic stimulation. That technique will be undergoing much more rigorous testing as it does appear to have a very beneficial effect on removing the urge to do drugs. I've seen several stories in Science about this, but no reports yet representing completed testing.
 
Of course, you can't get a patent on a magnet, which is why if the treatment does become recognized, look for pharmaceutical firms to object to it since they can't make money on it.
Even A Broken Clock Added Nov 3, 2017 - 10:39am
By the way, what type of organisms are in your avatar?
Katharine Otto Added Nov 3, 2017 - 11:00am
Thanks for reading and for the supportive comments, folks.
Jeffry,
You're right.  Every situation is new, so much of treatment is trial and error.  Cost, time pressure, and unrealistic expectations by all parties, including payers, distort the picture.  Also, the trend in medicine is not to set people free but to bind them in a perpetual state of dependency.  This attitude is reflected in the belief that health care insurance is necessary and now mandatory.
 
Michael B.,
Unfortunately, many therapists need their clients more than clients need them.  They bind them in a state of co-dependency that can be frightening.  On the other hand, you don't have to be psychotic to treat schizophrenics, although it might help.  A little of what we call "magical thinking" keeps the mind and imagination flexible.
 
Katharine Otto Added Nov 3, 2017 - 11:17am
Tubularsock,
I wish everyone, including doctors, had your understanding.  The body is infinitely more complex than a car, yet doctors often do perform like technicians rather than healers.  This trend has only gotten worse with the growth of the "health care industry" which profits by churning patients as quickly as possible through a variety of cost-intensive tests, procedures, pharmaceuticals, and other interventions.
 
You make a good point in saying people should look inside themselves for answers.  Patients are notoriously poor at recognizing and describing their own symptoms.  A little introspection can help anyone communicate better with professionals.  I believe the best doctors are good listeners who know how to ask the right questions.  That so many patients and doctors are frustrated by time constraints is a symptom of our overburdened system that profits from perverse rewards.
 
Katharine Otto Added Nov 3, 2017 - 11:18am
Neil,
Thank you.  It's only the tip of the iceberg, but I didn't want to throw too much into one article.  
Ian Thorpe Added Nov 3, 2017 - 11:21am
Hi Katherine, Ah psychiatry and its evil twin psychology. How the pharmaceutical manufacturers love them. Apparently I have ODD (oppositional defiant disorder) a fairly new but quite popular mental health problem. The symptoms? I think for myself, regularly question those who believe they exercise some kind of authority, I habitually decline to follow the crowd. I'm told that even at my advanced age if I accepted treatment (drugs) I would as a result experience enhanced quality of life and fit into society more easily.
Well I've known I'm odd since my teen years, I am happy, fit into society in the way I wish too and have never felt that not conforming held me back in any way.
We all need to keep our BBF (built in bovine feculence) detectors well maintained so we can be sure of picking up the early warning signals of  bullshit from doctors, salesmen, car mechanics, financial services brokers, politicians etc
Katharine Otto Added Nov 3, 2017 - 11:44am
Jeanne,
Thanks for your story.  Your experience has given you insight few people have.  Neurology and psychiatry are definitely connected, and I'm an advocate for re-combining the two.  Freud was a neurologist, after all, and the brain extends throughout the body via the nervous system.
 
When you say you have seen a huge difference over the years, I guess you mean treatment has improved?  Certainly there has been greater acceptance of mental illness, to the point where it is almost a source of pride for some people.  I claim we have a crazy-making system, so the increase in mental illness, including substance abuse, is not surprising.
 
You're lucky to have good long-term doctors.  The therapeutic relationship is a valuable and under-appreciated component of the dynamic.  This is being systemically and intentionally (?) undermined by insurance and government, with their networks and other methods of controlling access and making "providers" interchangeable.
 
I agree with you about treatments that work.  My journal is and always has been my best therapist.  In fact, I still believe that the primary purpose of therapy is to help patients find the words for their feelings.  Verbalizing feelings is a way to make them conscious and to get them working for you rather than against you.  I like gestalt, too, especially for interpreting dreams.
 
"Mindfulness" or "be here now," has been praised by mystics and gurus since time immemorial, and I agree it is key to deepening appreciation for life.  After all, the moment is all we can be sure of.
Katharine Otto Added Nov 3, 2017 - 12:07pm
George,
I agree with you about a lot of the problems, but they are so interconnected that it's hard to isolate a single cause.  In fact, one of the things I like about Oriental medicine is that it is pattern-based.  In the West, we tend to think in terms of cause and effect, but are there ever single causes or single effects?  
 
We do seem to place undue emphasis on money and social status in our culture, but maybe this belies an internal fear of inadequacy?  Pressure to perform, to "make time count" comes from inside and outside.  I'm having to learn to relax without feeling guilty, but I've found it saves lots of money, and I probably get just as much accomplished as before.  
 
Of course money pressure and time pressure are connected, so cultivating "mindfulness" or the ability to let go of the fear and worry could be quite therapeutic.  The "health care industry" is caught up in the twin pressures so is not a good example of healthy living.
Katharine Otto Added Nov 3, 2017 - 12:10pm
Dino,
We need more people taking responsibility for their own health.  The biggest problem with the system, as I see it, is that too many people are passive recipients of "health care" without understanding or desiring to understand how they can help themselves feel better.
Katharine Otto Added Nov 3, 2017 - 12:32pm
Clock,
Use of magnetism for healing is in its infancy.  We have MRI for diagnostic purposes, and there are active proponents of "magnet therapy" loosely affiliated with those who believe in crystals and other alternative techniques.  I believe all could be useful, but it seems results are subtle and unreliable.
 
While the transcranial magnetic stimulation idea is intellectually intriguing, I don't see it being practical in the immediate future.  I'm generally suspicious of high-tech solutions to widespread problems, because of their limited availability.  These treatments are generally only available in university or urban settings, for a select few, and they are only treatments, not cures.  Their overhead-to-improvement ratio leaves a lot to be desired.
 
Substance abuse is a highly complex problem that is built into our society.  I could write a book about all the perverse incentives leading people into addiction and keeping them there, but it would be a commentary on society as a whole, and not specifically on the individuals who succumb.
 
Katharine Otto Added Nov 3, 2017 - 12:36pm
Clock,
The "organisms" in my avatar are my own chromosomes in one of my cells.  As an exercise in medical school, we dropped cells scraped from the inside of our cheeks onto slides for staining and photographing.  We had to stand on chairs and drop the samples from as high as possible to get adequate spreads.  
George N Romey Added Nov 3, 2017 - 12:41pm
Katharine starting in the 1970s business schools began to teach the sole motto that managers was to maximize shareholder value (profits), period.  The treatment of employees and the communities in which companies operated no longer mattered.  The economic emphasis of the Treasury and Federal Reserve went from full employment to controlling inflation, even if the latter meant scores of unemployed people.  The lessons of the 1930s were waning quick as Baby Boomers that only knew great economic times took over the reins.
 
Of course we now have significant unemployment and underemployment and no inflation because of inability to raise prices.  Look at retail.
 
So now people are expendable to profits.  Or people must stay on the treadmill to remain employed which means longer hours and more day to day stress. Who sees and experiences the aftermath?  Health care professional whether in private practice or social services.  However, they too are pressed for profits and time and in the case of the latter lack of funding.  So off to "meds" it goes. 
wsucram15 Added Nov 3, 2017 - 2:06pm
Katharine;
I  am not sure how lucky I am, but I am blessed.  I was born with a disability and made the best of it.  In 2000, my mother tried to kill herself..somehow causing a stroke. (well I know what she did-but no reason to educate)... YES MEDICINE  HAS MADE HUGE IMPROVEMENTS. 
I remember when the first CAT scan came out, it was at Cleveland Clinic (at least in Midwest) and I had my scan done.  They knew nothing then and I was misdiagnosed.   They have learned so much about the brain since that time, leaps and bounds, and still only know a portion of the functionality.  Phenomenal organ..in every way. Now I am near JHU and have much better access to care.
 
With my mother, I spent three years fighting doctors and learning what was wrong with her, her lifelong battle (I never knew anything about) with a serious personality disorder and her eventual recovery from all of that only to lose the use of her legs.    It was a difficult road for her  and I give her a great deal of credit.   I was not happy for me..but for her when she was no longer suffering.  She was VERY intelligent and the slow loss of cognitive function and memory was hard for her.
Good care and the RIGHT doctors for you are critical.  She didnt get much decent MD care that last year, except for the hospice nurses who were exceptional.
 
Different approaches work for me, I dont like regular treatments.  They dont usually work on me or FOR me..so I work on a good bit of self improvement.  Mindfulness and meditation are my favorites.
Along with (if needed) acupuncture for any pain or out of sorts feelings. I swear by it.   
I dont care for prescriptions and prefer home made remedies or something holistic if I can.
 
Michael B. Added Nov 3, 2017 - 11:12pm
Katharine, thank you for your honest, accurate, and hilarious reply! I agree, it certainly "takes one to know one", lol. About two weeks before we split up for good, the would-be therapist insisted that I attend a session with her own therapist, as "you have been a frequent topic lately." Without going into the details, her intention was for her and her therapist to kind of "gang up" on me, but it completely backfired on her. My soon-to-be ex-girlfriend actually scooted her chair back about 3 or 4 feet as her therapist and I ganged up on HER! I cannot recall ending a romantic relationship on a more satisfying note, lol.
Katharine Otto Added Nov 4, 2017 - 1:36pm
Ian,
Yours is a good example of my point.  Diagnoses like Oppositional Defiant Disorder tells me more about our anal-retentive, repressive society than about the person so diagnosed.  Under this system, individuality and challenges to authority are seen as pathological.  
 
Ideally, psychiatry would support individualistic thinking.  Squelching creativity rather than seeking to direct it makes for a boring world.  
Katharine Otto Added Nov 4, 2017 - 1:46pm
George,
That's why the "health care industry" has become so profitable and is growing.  Managers in the "health care industry" are also overly concerned with profits, so staff dissatisfaction in the hospitals I've worked in is high and affects patient care.
 
What's the answer?  Work less, earn less, spend less, and pay less in taxes?  How much money is enough?  It's another blog topic, but I suspect the retail markets are glutted with too much stuff, people are maxed out on credit and don't have space to put more junk. 
 
Maybe it's a good thing that the economy is slowing down.  Learning to appreciate and make better use of what we already have could bring an enhanced sense of prosperity, even if the bank accounts don't reflect it.
Katharine Otto Added Nov 4, 2017 - 1:57pm
Jeanne,
Thanks for your insights about how medicine has made huge improvements.  I tend to lose sight of that.  Would you say those improvements are tapering off?  
 
Interesting that acupuncture has helped you.  I'm fascinated by it and actually did a published study in residency on ear acupuncture for cocaine abuse. Also, one full-body acupuncture treatment completely cured low back pain I had at that time.
 
There's a lot of evidence that acupuncture works, especially for pain and for substance abuse, two problems now in the national spotlight.  But do you see anyone in the allopathic field promoting it?  No.  If medicine is to make further advances, I believe it needs to make a serious commitment to investigating some of these Oriental (and other) non-allopathic disciplines.
 
 
Katharine Otto Added Nov 4, 2017 - 2:06pm
Michael B.,
Unfortunately, that two-against-one strategy is used too often, both in therapy and in real life.  I noticed it particularly in adolescent and child therapy, when the parent wanted me to side with him/her against the "bad" child.  When you see parents acting like that, it's understandable that the child would have problems.  It's also very hard to show the parents what they are doing without alienating them.
 
Another instance is when divorcing or dysfunctional parents try to get children to take sides, playing the loyalty card.  Or the bribing card, or try to get the child to spy on the other parent and report back.  The children get good at playing parents against each other, too.  That pattern is pervasive in the culture and in history.  "Divide and conquer."
 
Henry Ortiz Added Nov 4, 2017 - 9:13pm
Katherine, are you a physician?
Katharine Otto Added Nov 5, 2017 - 10:27am
Henry,
Yes.  I thought it was obvious from my writing and the slant.  Articles like this one are an attempt to de-mystify medicine and make the concepts more accessible to regular people.  There's so much hocus-pocus involved, and such a disconnect between doctors and the public that nobody really benefits.
Henry Ortiz Added Nov 5, 2017 - 6:25pm
I am a physician as well, I agree that there are some points need to be addressed to clarify our rol in medicine.
 
I would say that specifically talking about this article, you are doing more mystifying that de-mystifying.
 
you are more focusing in a “psychological” view, which is a kind of  abstract way to approach medicine and the art of healing.
Katharine Otto Added Nov 5, 2017 - 7:59pm
Henry,
I'm happy for feedback but don't understand what you are saying.  How does it mystify?  The article is meant as an introduction to the idea that there is a disconnect between what's expected and what is practically achievable with medicine.  Isn't the "art of medicine" (as opposed to the "science" of medicine) abstract and hard to define?  Isn't the "psychological view" appropriate for attempting to explain people's (and MD's themselves) attitudes and beliefs about medicine?  
 
Out of curiosity, what kind of physician are you?
Ari Silverstein Added Nov 6, 2017 - 1:45pm
I wonder where Autumn digs up all you anti-American losers.  Every major military campaign America has involved itself in, was with the support of the most of the developed free world.  With a name like Katharine Otto, my money is you reside in one of those countries, so before blaming America for war related PTSD, I suggest looking in the mirror. 
 
How many people do you think suffered from PTSDs following 9/11?  Allow me, a lot more than the total quantity of military personnel who suffer from them right now.  Just think of all the PTSDs we could have prevented if our military took a more proactive role and killed bin Laden before 9/11. 
Katharine Otto Added Nov 6, 2017 - 7:06pm
Ari,
If the US took better care of its veterans, I might be more forgiving.  However, it virtually abandons its vets as soon as they have served their purpose.  And most of the vets I worked with said they wanted to support the troops (then in Iraq), but they thought the war was wrong.  They felt that way about Vietnam, too. 
 
By the way, there was an Esquire interview with the guy who killed Bin Laden.  He's having trouble getting military benefits because he left early.
 
I am a pacifist, without party affiliation.  If being a pacifist makes me an "anti-American loser," so be it.  I didn't blame America for war-related PTSD, although the US is decidedly the most militaristic empire in the history of the world.  I blame war for war-related PTSD.
Tubularsock Added Nov 6, 2017 - 8:55pm
Ari, oh gosh ...... Tubularsock guesses you missed the memo!
 
9/11 was BLOWBACK from exactly what you are suggesting!
 
Get a grip on reality ........ the aggression of the U.S. has caused more damage than it has ever solved.
Henry Ortiz Added Nov 7, 2017 - 2:32am
Katherine, it is true that all pathologies are part somatic and part psychological, and that is the art of medicine, to recognize how much is each of them, and then comes the science of medicine to treat the pathology, either somatic or psychological, or both.
 
There are some physicians who are pure science, those are the ones who deshumaniza what really is medicine. As you may have experienced, there is something that you feel will lead you to the appropriate diagnosis, that is the art. There is, as well the way you approach your patient, that also is the art. Then comes the science, to grab all your data, , get some test and get the diagnosis.
Katharine Otto Added Nov 11, 2017 - 7:14am
Henry,
Interesting distinction.  What bugs me is that diagnosis is not an exact science, especially in psychiatry, but also in other ailments, like the autoimmune diseases.  Many are diagnoses by exclusion.
 
Also, treatment is not purely scientific, but empirical.  I believe an over-reliance on "science" leads to over-testing and over-treatment, as well as excessive costs, because of the illusion that medicine and science can do more than they are able to do.
Bill H. Added Nov 12, 2017 - 12:54pm
 
My wife has been battling ME/CFS (Chronic Fatigue Syndrome) for over 6 years. It had been misdiagnosed by several doctors as other diseases such as a thyroid condition, Lyme disease, and hypoglycemia early on, and she has been prescribed everything from antibiotics to antidepressants with no success. Surprisingly the best results so far has been with a treatment that includes acupuncture and a 1/2 dose of Lorazepam daily (go figure?). This disease has just recently been recognized and is still held as "non-existent" by many medical insurance providers.
Katharine Otto Added Nov 16, 2017 - 10:33am
Bill H.,
CFS is another diagnosis of exclusion, which is why your wife has had trouble getting diagnosed.  Thanks for the tip that acupuncture helps.  I'm not surprised, since acupuncture is pattern-based.  Its main claim is that it enhances quality of life, and can do so in many conditions. 
 
CFS, to me, is probably a reaction to many stressors, including environmental and food toxins, as well as things like noise pollution.  Lorazepam is an anti-anxiety agent, sedative, and muscle relaxant.  If it helps, it suggests your wife lets stuff get to her too much.  Does she do things like yoga or meditation?  They may also help.
PaganTeaPartier Added Nov 17, 2017 - 1:07pm
While there may be physiologically based mental illnesses, and there may be a physical component to many others, the mental health industry seems to have forgotten, or just conveniently failed to acknowledge, that it has the inherent limitation of only being able to achieve the patient's own goals.
 
If all that the patient REALLY wants is a diagnosis to act as a shield against criticism, then once they get handed what they perceive as an excuse they will stop trying.
 
If what they want is to get the legal system off their back, they will do JUST enough to get themselves in the clear, then stop trying.
 
This fundamental principle applies even in cases of serious dysfunctions. Medication can assist those trapped in a delusional state, but they must still make the choice for themselves to return to the reality, which was so painful that they escaped from it in the first place.
 
Throw ideological bias into the mix and the situation becomes exponentially more distorted. "Gay Conversion Therapy" is one of the best example of this.
 
Those ideologically opposed start out from the belief that the only real problem is social judgement, thus they take positions which deny the observable fact that human sexuality is fluid, and constantly evolving over a person's lifetime.
 
Whereas those ideologically in favor want to believe that it is a condition which can be cured. Thus they overlook that social pressure, moral dictates, and internal denial, could never hope to be enough; and that the ONLY cases which can be pointed to as successful, are those in which the recipient started out already wanting something different FOR THEMSELVES.
 
The concerns of those who wish to prohibit it for minors, and those opposed to such efforts, fixate on their ideological presumptions, and ignore the special considerations which must be taken into account when providing ANY kind of mental healthcare for minors.
 
Pills and therapy will never mold your child into being what you want them to be, mental healthcare can only ever help them to be themselves. It is irresponsible for providers to fail to make it explicitly clear to parents seeking help for their child, that their legal rights can't change the limitations of the mental health profession.
 
As legal guardians they might have the authority to direct treatment, but the interests of the parents and the interests of the patient are not the same thing. Likewise the provider's inability to invoke privilege in regard to parents of minor patients, doesn't change how critical confidentiality is. Insisting on their right to know what their child has been saying, can destroy the trust which is essential for a productive therapeutic relationship, thus making it impossible for them to actually help anymore.
 
And don't even get me started on the effect that insurance companies and institutionalized practices have, on obscuring and impeding the reality that a patient can't get help from any therapist, but needs the RIGHT therapist in order for an effective relationship to be forged.
 
I'm not suggesting that your observations aren't valid, I'm simply saying that the full scope of the real problems are even more broad, pervasive, and fundamental than any one perspective can account for.
Katharine Otto Added Nov 19, 2017 - 12:06pm
PaganTeaPartier,
Thanks for your thoughtful reply.  You cover a lot of territory, so it's a little hard to reply appropriately.  It seems you are basically agreeing with me.  The issues of health and illness are so complex that it's hard to address any part of it without challenging paradigms most people take for granted. 
 
The interconnections and symbiosis between personal health and social health, for instance, go far deeper than most people, including doctors, realize.  Doctors as a group are caught up in some unhealthy notions, according to me, and one of them, perpetrated by the "health care industry, seeks to profit by keeping people sick and dependent.  Doctors need to be needed, unfortunately, and overhead, insurance, and government foster this dependency. 
 
Or, especially in psychiatry, doctors are complicit in making people sick and dependent by creating "diagnoses" (aka "labels") for them.  Psychiatrists don't get paid for "no diagnosis," something that should scare people away from visiting one.   
 
I could go on, but suffice to say I try to keep my articles short and focused but have not finished writing about this subject.  
PaganTeaPartier Added Nov 20, 2017 - 2:36am
I did cover a lot of ground, but it was different manifestations of how mental healthcare is limited to only being able to assist the patient in achieving their own true goals, and not whatever goals other people think that they SHOULD have.
 
But you are also correct that, "I can only help you if you truly want it for yourself," isn't going to be a very effective sales pitch.
Katharine Otto Added Nov 20, 2017 - 8:45pm
PaganTeaPartier,
Western medicine is not marketed toward the patient who wants to help himself.  The subtle message is that healing comes from outside, in the form of pills, doctors, treatments.  This is reinforced by everything from advertising to public service messages, to the insurance industry.  The unspoken message is the patient can't trust his own body and mind to maintain homeostasis.
 
Worse, patients are treated like irresponsible children when it comes to medications and billing.  Many don't know what medicines they are on or why, and they don't care.  They trust doctors too much, and with insurance, they are oblivious to cost.  To suggest that a patient is ultimately responsible for his own body is heresy to some, but it is truth and respects that person's adulthood.

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