Submitted by Bruce Wilder, Nov 18, 2007 01:32

Part of the problem is the inadequate experience of those giving the diagnoses. To be a really competent practitioner, one would probably need to spend several years working in and around a state or federally run psychiatric institution. Why? Because that is where you would get experience working with the most difficult cases. The more difficult cases are the ones that teach you the most and expose you to the experiences you need in order to evaluate psychiatric illnesses.

The other difficulty is the fact that psychiatry is often simply educated labeling or name calling. From a strictly empirical perspective, it could be called explanatory fiction. For example, "Sarah is bi-polar." Why do you say so? "She's moody." Why do you say so? "She's bi-polar!" Over the years, the diagnostic manual, the DSM has improved in its listing criteria that can be observed and measured. The problem is that often no one of competence is identified to actually do those observations and measurements. Board Certified Behavior Analysts, for example, are people who are well qualified to do this or to teach others how to do this with competence. But it is rarely, if ever, done.

Then there are the money mongering drug companies. Sales professionals representing these companies make six figure incomes peddling these pills to any physician authorized to write prescriptions. Physicians also love drugs. Why? Research tells them that at least 30% of people who take pills will report they are better as a result, even if the pill was no more than actually a lump of sugar, or compressed marshmallow. It's called the placebo effect. Yet, someone who believes that drugs are helpful and needed will keep coming back for more, and be happy enough to pay for the monthly or quarterly or annual doctor bills. Also, prescribing a pill is tangible proof that the physician actually did something.

So what's the point? The point is that sometimes, in psychiatry as it is actually practiced, the cart leads the horse. First, we prescribe Risperdal for a hyperactive kid. Then, to justify it's use, we see if we can get the kid to admit they hear voices. If they admit this, we are home free because Risperdal is supposed to be an antipsychotic, even though what we hope it does is make the kid less aggressive or less hyper.

I suppose with as much as I've written, I still did not answer Mr. Shrader's concern very well. How do you know if your Doctor is good at what he's supposed to be good at. I guess I would say, you have to get your own DSM, use the internet, know a lot of professionals, get other resources and do your homework. In doing so, you will find a psychiatrist who is really good eventually. When you do, realize they are gold!

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