Best blog reads

[cinephile]

Just had an idea: let's start a list of our favorite posts in the psych blogosphere in 2011.

 

This was a great year for psych blogging (perhaps a watershed one), so choosing is difficult. Here's a few of my faves:

 

-"The Psychiatric Industrial Complex": Mickey really ties it all together with this one. He breathlessly rips gallon-sized holes in the new medical PR/pseudoscience throw-up like translational science and regulatory science. You really do come away with a sense of foreboding for 2012. Bravo Mickey!

 

-"Prove that You Need Me" -- My god, the balls on this guy! Steve Balt is rapidly becoming my new favorite psychiatrist. He regularly says what many psychiatrists are no doubt thinking but daren't say. Case in point is this post, in which he says, among other things, "we in psychiatry provide a lot of 'care' that might be considered unnecessary and, in the long run, wasteful and inefficient." And what about this gem: "Furthermore, because many of us are loath to send a patient home empty-handed -— and ill-prepared to do anything other than diagnose or prescribe -— we give a medication which we think might 'work.' (And if it does, we see it as affirmation of our diagnosis, but that's material for another post.)"

 

Those two statements right there are enough to catapult Balt to the vanguard of progressive-minded psychiatrists. But the entire post has even more to offer. Read on!

 

-"We're Doctors. We Prescribe. That's What We Do." Another haymaker to the jaw bone of modern medicine, courtesy of Steve Balt. This post covers a lot of ground, and Balt's opening two paragraphs sum it up in which he talks about how modern medicine has devolved into the "a pill for every ill" brain-drain. In fact, he even says that the relentlessly reductive cycle of taking labs and then prescribing a pill has brought medicine to a point where a "computer could do it almost as well."

 

I think Balt is on to something there. I've noticed a general trend in the last decade where the unholy union between corruption and technology is essentially removing all the art and humanity from any profession and forming it into something machine-like to ease the inevitable transition from humans doing jobs to computers doing jobs (or outsourced labor doing jobs). Hell, some hospitals are currently using teleradiology where an American patient's X-rays are being emailed to a radiologist in India to be read! And of course the next step is to have computer software replace a doctor's physical examination. I'm sure it will be a stealthy introduction, but it will happen (gradually). Perhaps those on Medicare/Medicaid will be forced to accept a "virtual" doctor's visit because that's all the beyond-bankrupt government health care programs can "afford." Eventually I think all of us will have to pay extra if we want to see a real doctor for a physical. We may then face a shortage of doctors worse than we do now because so few will want to subject themselves to the gauntlet of med school once they realize their curriculum is largely just pork on the hoof that they'll never use since their profession has become so automated and dumbed down.

 

I guess I'll sum it up by echoing internet critic Piero Scaruffi's theory that society isn't making robots/computers more human, but humans more like robots/computers. Sad.

 

-"Plausible Deniability" A most fascinating and revealing post in which family psychiatrist David Allen puts up his dukes and challenges psychiatric pharmawhore =&term=william+glazer"]William Glazer about how pharmaceutical companies use the concept of "plausible deniability" to their advantage when marketing new drugs. It also brought to my attention a tantalizing concept that I (nor Allen) can prove, but is absolutely credible: drug companies suddenly become more than willing to be transparent about all the dangers and inefficacy of their meds once they are rapidly approaching off-patent status. In fact, they relish this opportunity to trash their once-wonder drugs, as they can use it to demonstrate how much more superior their new drugs are in contrast to their older drugs which are coincidentally (hee hee!) going off patent and won't generate much profit for them anymore.

[compsports]

Cine,

 

You're going to think I am the grinch for disagreeing with you but here goes:

 

I had a favorable opinion of Steve Balt until I saw the blog entry on the Soulful Sepelcher blog:

 

http://bipolarsoupkitchen-stephany.blogspot.com/2011/12/transparency-truth-part-2-psychiatric.html

 

"In my opinion, there needs to be a correction on the Psychiatric Times article, stating Balt is a psychiatrist, when in fact it should say 'resident', because patients and readers deserve the truth,honesty and transparency.

 

As for the transparency and full disclosure on Balt's blog--that is ultimately up to him as to how he portrays himself to his readers and commenters."

 

Frankly, it bothers me greatly that he says nothing on his blog about being a resident vs. a psychiatrist. I have a problem with that big time.

 

Also, in thinking about his columns, yeah, they sound great. But he is beginning to sound alot like Daniel Carlat. He badmouths psychiatry but wants to keep drinking the koolaide.

 

At least with David Allen, while I disagree with him on many things, he doesn't seem to come across as wanting to have it both ways. I am not sure what the difference is.

 

Maybe I am cranky due to lack of sleep and just need to hear a different perspective, I don't know.

 

Totally agree about Mickey Nardo. He is the best.

 

CS

[Barbarannamated]

Interesting point • it's hard to distinguish if Steve knew he would be listed that way or Psych Times made the error • I've not noticed any MDs listed as Board Eligible (or PGY 4) for purposes like that

I'd heard of Steve before but didn't know his psych history • to Me that is a very important factor beyond being boarded • I believe that mental health practitioners should be required to do time as an anonymous inpatient (not identified as a psych/therapist/etc) • I haven't worked out the details of their treatment plan yet

 

Q: Does anyone know who his wife is a pharma rep for

I'd love to chat with her

[Altostrata]

cs, Steve Balt wrote a long response to that on soulfulsepulcher, it's on that site. He says Psych Times made the error.

 

It's not even an error. In the real world, the distinction between a psychiatry resident and a psychiatrist is non-existent. Psychiatry residents routinely call themselves psychiatrists.

 

In my opinion, Stephanie has been very unfair to Steve Balt. She started trashing him on Twitter on his wedding day, for marrying a drug rep, and spewed a lot of other dirt about him at the same time. I don't believe Balt had a duty to disclose his partner's profession to his "public" in advance of the wedding -- at the time he was obviously thinking of things other than his blog readers!

 

(People tend to marry people they meet professionally. If doctors were forbidden to marry drug reps, they'd be even more solitary and cranky.)

 

Balt has been patiently and diplomatically responding to all her accusations, which, IMO, have gotten quite intrusive and excessive. Almost stalker-like.

 

I wish she would turn her laser beam on, say, Stephen Stahl, instead. Relentlessly trashing an ally doesn't make any sense to me.

[cinephile]

This is absolutely fascinating, everyone.

 

I did not know that Balt was still a resident, and did not know his entire story about how he had to temporarily quit his medical training because of his psychiatric issues. I have just finished reading his email to Stephany and I must say I respect the man even more now.

 

Why?

 

For the simple fact that he has BEEN there. HOW MANY times have we wished that a psychiatrist has been on the other side of the fence? That is, as a patient? How much damage could have been avoided if psychiatrists could have experienced what we've experienced FIRST? Balt's experience on psych meds and as a patient of psychiatry is the closest thing to a psychiatrist momentarily switching mind/body with their patient to truly see where they are coming from. And surprise, surprise, he's agreeing with us whole-heartedly about how toxic and abusive psychiatry is, and just how ripe to corruption it is.

 

I honestly don't think Steve is wanting it both ways at all. I think Steve is actually one of the most honest people in the psych blogosphere because he truly is -- as his blog subtitle suggests -- "thought broadcasting" his thoughts straight from his head to you the reader. There is no filter, there is no cover-your-ass tactics here. He just puts it all out there and thinks out loud. His posts are almost thought experiments in the philosophical sense.

 

Because of this, his posts may seem like he wants it both ways, but I think he's just wrestling with himself and trying to figure out what is good and bad about psychiatry (and, along the way, what is good and bad about himself). In fact, he's doing what we want psychiatry as a whole to do so badly: to do some serious soul-searching before starting out in a new direction. This thinking is muddy, non-linear, and sometimes infuriating for us to read. But that's the nature of this thorny beast that is psychiatry. It's a dirty job wrestling with this stuff, but someone's got to do it. And Balt's as good as they come, in my opinion.

 

As regards to Stephany: I see so clearly what her thought process is and I totally understand it as I see some of myself in it. Her daughter was so horrifically "treated" by psychiatry that she became determined -- no, obsessed -- with getting the truth out about psychiatry. But this is the danger we must always be aware of: somewhere, sometime, she became anti-psychiatry and her crusade consumed her. I will say this over and over and over again: our cause should not be anti-psychiatry, but anti-corruption and anti-bad science. If you forget that and let your emotions (no matter how valid those emotions are) cloud your judgment and your view of the entire situation, your efforts will be vastly less effective to bring about the change you so desperately want. It saddens me to read Alto's report of Stephany harrassing Steve during his wedding day because it's just such a wasteful, misguided gesture. But again, it is very human and I have felt similar rages before. We all have.

 

Remember this simple fact: just because something we read/hear makes us feel good, doesn't make it true. If we blindly follow people who just tell us what we want to hear all the time, watch out! Just look at what a mess politicians have gotten us into from telling us what we want to hear! Case in point: as much as I love Mickey, I know some of what he says will turn out not to be true in the long run. It has to be, because no one is 100% right all the time. But does that make him a bad person or less useful to our cause? Of course not.

 

To conclude, everyone should read Balt's interview with William Heisel before passing judgment on him. It's a fascinating, almost shockingly honest interview. I gasped a few times. I don't even know if I could be that honest, and I pride myself on not bullshitting myself. Clearly Balt has more self-knowledge than any of the overly-credentialed KOLs, that's for sure. I especially loved this bit where he talks about the subconscious motivation for his shoplifting:

 

I had been struggling through medical school and residency and had seen very poor practices on the part of some of my classmates and peers. They would skip classes, complain about the workload and just generally cut corners, sometimes impacting patient care. Here I was trying to stay above it all and doing quite well, even with the pressures the board was putting on me, but I was getting no positive recognition, other than from patients. That lack of positive feedback really took a toll on me, and, in some bizarre way, being able to get something for nothing was appealing

-This quote is filled to the brim with revelations. For one, Balt is absolutely not joking when he talks about how sub-par med school students can be. This is a much-needed reveal on a little-known topic, and it proves how doctors (or doctors-to-be) are just as human as anyone else. I saw this first-hand in my nursing program and especially in the prerequisite courses, where cheating was rampant. My friend also said that the students in his program who got the cushiest jobs were the ones who, as Balt said, cut corners. They also shamelessly kissed ass and brown-nosed their teachers and preceptors. For both my friend, myself, and Steve (that is, people of morals), it was amazingly demoralizing and I can totally understand how it could be so shocking to Steve that the real world doesn't always reward good people for doing good things (and in fact neglects them) that they "act out" this pain through shoplifting or other impulsive, self-destructive behaviors.

 

Also, the issue of "positive feedback" and acknowledgement is a huge one, and one that is also grievously overlooked in this society. I think it was in a book by Jon Kabat-Zinn where he said that people don't so much want to conquer and rule, but just to have their presence felt and acknowledged. That is why I think bullying is so devastating: one's core presence is not just not being acknowledged, but it's being REJECTED (violently) from seemingly everybody. And I think what Balt was experiencing in med school was a kind of indirect bullying. Or at least he was more sensitive to feeling neglected and he felt bullied and took it more personally than others.

 

With all this being said, it is still entirely possible I could be wrong about Balt. He has yet to fully prove himself as he is just starting out in his career. But the kid's got promise, and I can't say that for any other young psychiatrist...

 

*PS: It is deliciously ironic that Balt married a pharma rep! I love it!

[compsports]

Hi Cine,

 

You're right, Balt is going through a process in coming to terms with psychiatry and I guess we need to be patient.

 

But if he is serious about becoming a new type of psychiatrist, then questions need to be asked of him to such as what percentage of his current outpatients are on meds. What is the breakdown of their diagnosis?

 

I would also love to know how he would handle someone like me who has sleep issues, If I showed up at his office, would he just automatically assume that my insomnia is due to depression or would he ask enough questions to suggest that I get tested for apnea as I will be doing this week?

 

I know being antipsychiatry isn't a useful position. But it is totally understandable in light of all the horrific abuses that show no sign of abating.

 

If it is determined I have sleep apnea, I will post in the rant section about why I am having a hard time not being antipsychiatry. When the sleep medicine doctor said she strongly suspected I had it, some obvious issues came up. But I don't want to jump the gun.

 

Speaking of David Allen, he was the only psychiatrist who posted publicly about the psych med abuses in the foster care system. Everyone else was totally silent.

 

Back to Steve Balt - I do applaud his honesty. But I guess because of my own personal situation that I am at the point where I need to see some proof that you really mean what you say. A perfect example is when Mickey wrote about seeing a teenage patient and referring him and his mother for counseling. No meds were prescribed.

[Altostrata]

I agree with you, cine.

 

I sympathize very much with Stephany. I appreciate her relentless focus on the antipsychotic beat.

 

But -- sometimes when people are hurt, they turn around and victimize others. (And Stephany spends way too much time on Twitter, IMHO, which gives one a false sense of power leading to snarkiness.)

 

If you can't abuse your friends, who the heck can you abuse?

 

As for how Balt treats patients, he's blogged about it. Being a resident and under supervision by a bureaucracy, he's somewhat constrained by the system. (He says at the Medicaid clinic, patients who want to go off drugs are being referred to him.)

 

I really respect Balt for putting his opinions out there on the blog, although they're somewhat more oblique and diplomatic than I would like. He isn't tenured like David Allen, or distinguished and retired like Mickey. He takes a risk with his career by being publicly skeptical about his field.

 

(As you may recall, in 1999 David Healy lost a good job in Toronto because in a lecture, he suggested Prozac might have serious adverse effects.)

 

Balt reads this site and has recommended it to other doctors as a way to understand patients. Isn't this what we want? If doctors listened to us and took us seriously, wouldn't that go a long way towards ending this pharmapsychiatry horror?

 

He's trying to figure out what kind of practice he wants to have when he's independent. It looks like he's leaning toward a patient- rather than drug-centered approach. Let's reinforce this decision as much as possible.

 

I caution everyone not to be harder on our friends than we are on authorities who are much more extensively clueless. You don't have to trust them completely but at least treat them respectfully and encourage them in the right direction.

 

We're not going to find absolute orthodoxy in anyone. None of our heroes are spotless.

[Barbarannamated]

Still laughing at Alto's comment above about docs marrying drug reps

[compsports]

Barb,

 

I apologize if I said anything offensive.

 

I agree that we need to be patient with Steve and that he is still limited in what he can say due to being under supervision. But in thinking about the psychiatry profession as a whole, I am not sure he is going to be able to practice the way he wants to, especially if he is starting out and has loans to pay off. That is just reality.

 

But maybe we can help him find the right role.

 

You're right, no one is 100% consistent in their views, including people on this board.

 

CS

[Barbarannamated]

Barb,

 

I apologize if I said anything offensive.

CS

 

CS~

Not at all offensive ~you got me thinking about how Residents do identify themselves and I've only heard them in conversation say Psych Resident or Fellow or Attending but that's within the academic setting •

I agree that Steve is facing an uphill battle

Psychiatrists originally did analysis as the mainstay of their treatment but I'm not even sure they are required to be trained in psychoanalysis any longer since meds have taken over and there are so many other more qualified therapists

I went to a psychiatrist over the summer who charged $300/hr for CBT and didn't take insurance • I didn't click with him but also couldn't pay that rate to an MD for therapy

BTW ~his card said "I don't like to prescribe meds but I will if I have to"

[Altostrata]

Actually, here in the San Francisco Bay Area alternative or holistic psychiatrists do quite well.

 

If Steve Balt offers slow tapering, he could fill up his appointment book on that alone.

 

The psychiatrists who claim they're forced to prescribe drugs to keep their practices going simply lack imagination, or guts, or something.

[Barbarannamated]

I agree Alto and that's great that theyre doing well in the Bay Area ~ Ive had a tough month but want to get on track finding docs in SoCal who know how to taper appropriately and to differentiate wd from relapse •

I really have difficulty accepting that SS/NRIs are ever appropriate now that I've seen the data with open eyes and know the harm that they do ~the ultimate 'gateway drug'

The risk:benefit ratio is clearly not favorable

[Barbarannamated]

There's also the issue that psychiatrists ~ in general ~ are the last professionals I would go to for therapy

Q: Are they still required to undergo psychoanalysis as part of medical training ~my guess is no ~ not aware that PA is used at all anymore with the push by insurance for brief„cost-effective therapy like CBT/DBT

 

Definitely not the specialty to go into right now unless doing UNmedicating as you mentioned

 

Depresion hurts ~psychiatry hurts more

[Altostrata]

I agree, I think medical school is exactly the wrong way to train practitioners to be sensitive to others' emotions, and psychiatry adds another layer of callousness on top of that. Psychiatrists for the most part are the very last people I would tell my troubles to.

 

Barb, you had some excellent suggestions for blog reading in another topic. What are your favorites for this topic?

[Barbarannamated]

Beyond Meds is beyond exceptional Gianna puts words to feelings that I have difficulty explaining ~ almost every entry is an 'AHA -- that's what I've been feeling but couldn't explain even to myself' -- I'd have to look thru to pick my favorites

 

I don't get other blogs regularly even though I've signed up ~not sure why

 

I'll think on this and get back ~

[Barbarannamated]

Check out Christophet Bollyn blog

 

I hadn't run across him until yyesterday but alot of good info

On SSRIs and cortisol/steroids

[Altostrata]

Barb, usually someone who rants about Zionism and Jewish plots is up to no good.

[Barbarannamated]

His information on Prozac and 'antidepressants' is excellent regardless of his political orientation ~

[Altostrata]

Yep, he's a conspiracy theorist. Sometimes people who are extremely distasteful do hold views with which we can agree.

 

However, I'm going to have to ask you not to link to his blog on this site, and I'd appreciate dropping discussion of his work as well.

[Barbarannamated]

Alto and all~

My sincere apologies for linking to any conspiracy theories/blogs ~

I read only a few entries about pharma but was unaware of his general views and political extremism •

My bad ~please understand no offense meant and im not a supporter of this person

Actually I have a hard time with any Conspiracy Theorists

Barb

[Altostrata]

No prob, Barb!

[Altostrata]

Gary Greenberg http://www.garygreenbergonline.com/