# How come psychiatrists are so fucking stupid?



## bearlybreathing (Aug 6, 2013)

Okay so I had an appointment yesterday with a new psychiatrist. My main diagnosis is schizoaffective, but I've been stable in that regard for a couple months now. She wrote "currently in acute episode" on the paper they give when you leave. I told her one of my meds was giving me really weird vivid dreams that wake me up and I don't sleep much because of it, and she said to call back if they get to the point I don't sleep well because of them--like that's what I just said was happening?
And about two months ago I was hospitalized for a psychotic episode, but the doctor there said it was depression when I was having literally no depression symptoms.
And a couple months before that I was hospitalized somewhere else for a mixed episode (manic and depressed at the same time) and they put me on meds that clearly made the mania worse (which was expected) and they had to give me lots of PRNs for that.
Over the years I've been through a lot of psychiatrists and none of them stood out to me as good at their job.


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## StinkyBambi (Jul 12, 2018)

theyre just in it for the money


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## Sour Roses (Dec 30, 2015)

Because they're not psychologists.

It's a crying shame that in this country, people the most in need of help are only seen by psychiatrists who's job is just to medicate and be done... while only the people who least need them can afford the real psychologists who can actually provide the counseling and coping therapies needed by those in greater distress. 

I've been in similar shoes to you in the past. Big Hugs! The only thing that worked for me was to depart from the absolutely useless psychiatrists and be done with their clueless experimenting on my body... they never did a damn thing that actually helped me, and in many incidents they instead sucked the hope of recovery & confidence in myself right out of me with their hamfistedness.

Then I spent a good long time in introspection and working with myself to find methods of coping that worked for me. Getting in a better environment also helped a ton too. Remove as much stress as you are capable of doing from your life, and ask people for help removing more. Challenge your perceptions with reality to help keep yourself from spinning out into delusions, and most of all be nice to yourself. 
You can be your best counselor if you find it in yourself to decide you deserve the nurture you would give someone else in your shoes. JMHO


ETA: The worst sin of psychiatry is that their biological models takes the mental component out of recovery. They handicap their patients and lock them into a cage made out of the belief that they are inherently flawed and aren't capable of getting better... except if some magical theoretical medicine can be found through trial & error, much trial and much error, all the better to line their pockets with, and nevermind the side effects and brain damage. 
Antipsychotics Cause Brain Damage


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## Charus (May 31, 2017)

Pretty much the same story here. I got the ADHD and OCD label slapped on me when I was a kid for irrelevant reasons and I am forced to go to a special education class and take their random shitty medicals because of that.

Honestly, if you wan't my opinion, personality disorders or mental disabilities are just a hoax made for untalented doctors to line up themselves some free cash money while ruining one's life in the process with their shitty treatments.


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## lokasenna (Apr 7, 2019)

Because if they had an ounce of critical thinking, they wouldn't have gone into the field in the first place. 

Careful with the meds, OP. They can really fuck with you long term, even after discontinuation, and it's all too easy to view med side effects as symptoms of mental illness.


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## bearlybreathing (Aug 6, 2013)

lokasenna said:


> Careful with the meds, OP. They can really fuck with you long term, even after discontinuation, and it's all too easy to view med side effects as symptoms of mental illness.


I'm trying to aim for a situation where I stay in touch with reality _juuuussst_ enough where I won't be in danger of myself or anyone else, and it seems so far that I need to be on some meds to achieve that. I really want my psychiatrist to realize she's overmedicating me so she can lower the doses and stop one, but apparently I'm "currently in an acute episode" so she can't do that. I realize my "mental illness symptoms" are partially side effects, but unfortunately it doesn't seem like my psychiatrist does.


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## Anunnaki Spirit (Mar 23, 2018)

A lot of them are morons being only book smart in a field that requires some level of emotional intelligence and empathy but as some have already said all they do is push meds.


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## angelfish (Feb 17, 2011)

Ehhhh there's some disparaging generalization going on in this thread. I understand that negative experiences with mental health professionals can be deeply personally discouraging and literally harmful, and it can be terrifying to consider when you're handing over (sometimes fairly involuntarily) something as important as your mental health to that person, but it's reality that they're just people at the end of the day... very trained people, but people nonetheless... and they're dealing with a lot of economic shit... more on that below... 



Sour Roses said:


> It's a crying shame that in this country, people the most in need of help are only seen by psychiatrists who's job is just to medicate and be done...


A clarification - medically, a psychiatrist's job _is_ supposed to involve "soft" skills, and their training does include some psychology, though not to the extent of a psychologist. American docs do their 4 years of med school which involve 2 years of rote book learning and 2 years of rotations where they do hands-on training in many subspecialties, then they do an additional residency (anywhere from ~1-9 years) in their specialty. Psychiatry residency is 4 years; depending on the program it may have less or more focus on talk therapy and counseling. Either way, psychiatrists must have extensive knowledge of disorders, symptoms, comorbidities, prognoses, and treatment. 

Almost all current, professional literature in both psychology and psychiatry indicates that the best treatment outcomes primarily come from _the combination of medicine *and* supportive psychotherapy/counseling._ In an ideal situation one would be seeing both professionals concurrently. Some individuals may get to a place where they are stabilized enough on their meds that a GP can monitor and they can just see their psychiatrist for a check-in every once in a while, or move to just psychotherapy. Others may be able to have a basic psychiatric med prescribed by their GP for a short period of time while they attend psychotherapy and never need to see a psychiatrist at all. 



> The worst sin of psychiatry is that their biological models takes the mental component out of recovery. They handicap their patients and lock them into a cage made out of the belief that they are inherently flawed and aren't capable of getting better... except if some magical theoretical medicine can be found through trial & error, much trial and much error, all the better to line their pockets with, and nevermind the side effects and brain damage.


This isn't accurate. Some will say there is "no recovery" from certain conditions, but medicine is a field of study and does change with time; it's a science and it should be understood that practitioners are working with the best information they have available based on empirical data. If all data amassed suggests that a condition does not change with time, then it's the practitioner's responsibility to share that. Docs take the Hippocratic oath, though. They swear to heal. It goes against the whole point of the profession itself to suggest they'd _want_ to keep people sick. I'm sure there are one or two bad apples out there, but on the whole, there's very, very, very little reward for a doctor who isn't interested in the welfare of their patients. The workload is heavy, the average school debt is enormous, and the monetary payoff isn't particularly good until quite a number of years into their career, if ever.

Speaking of: psychiatry isn't a money-maker; any med student who's ever google searched three or more specialties' salaries knows that... it's got a decent lifestyle but is one of the lowest-paid specialties... you're more likely to see the money-hunters in derm, plastics, ortho, rads... Now, if you want to talk big pharma on the other hand... _there's_ money... but that's not the psychiatrists, and most docs aren't thrilled by patients walking in and demanding meds they saw on TV...



bearlybreathing said:


> kay so I had an appointment yesterday with a new psychiatrist. My main diagnosis is schizoaffective, but I've been stable in that regard for a couple months now. She wrote "currently in acute episode" on the paper they give when you leave. I told her one of my meds was giving me really weird vivid dreams that wake me up and I don't sleep much because of it, and she said to call back if they get to the point I don't sleep well because of them--like that's what I just said was happening?
> And about two months ago I was hospitalized for a psychotic episode, but the doctor there said it was depression when I was having literally no depression symptoms.
> And a couple months before that I was hospitalized somewhere else for a mixed episode (manic and depressed at the same time) and they put me on meds that clearly made the mania worse (which was expected) and they had to give me lots of PRNs for that.
> Over the years I've been through a lot of psychiatrists and none of them stood out to me as good at their job.


First, I'm sorry. Second - I wish I had good advice for you in this situation but at least I can offer you the consideration that psychiatry is just difficult (it's the meeting place of mind and matter, after all, where brain and body very literally bidirectionally impact each other _constantly_) and it's made more difficult by asinine economic and political decisions that hamper psychiatrists. 

I don't know how many psychiatrists you've seen for years - maybe you've seen quite a number for a long period of time and they all seemed to suck too - but I just wanted to share that I've definitely heard psychiatrists in my family/friend circles talk about how crucial seeing someone a number of times can be to good diagnosis. I mean, realistically, the hospital's main job is simply to stabilize you - which is not to say they ever want to misdiagnose you, but in that setting an accurate diagnosis is less important than just getting you to a point where you're ok enough to function (out of curiosity, I googled "hospital diagnosis vs stabilization" and got this interesting article and statistics - _The most frequent diagnoses at the first admission were bipolar disorder (48.5%) and Major depressive disorder (18.8%). The most stable diagnosis was bipolar disorder (71% prospective consistency, 69.4% retrospective consistency). Schizoaffective disorder had the greatest diagnostic instability (28.5% prospective consistency, 16.6% retrospective consistency)_.).) And since a doctor never really knows if they're going to see you just once or many times, they sort of have a dual responsibility to play both the long and short games at an appointment... to try to help you as much as they can immediately but also to leave the door open for future discovery... And to figure out if you have an undiscovered comorbidity (or comorbidities) or environmental factor (factors) that is (are) impacting you. And eventually to figure out which and how much medication, none of which react the same way in each different person's body and brain, will help you the most. And most psychotropic medication takes a while to get up to a level for it to actually work... so sometimes it's hard to even tell when it has started working if it has started working... Plus finding one that is available and that your body can tolerate and that you and your insurance (or not) can realistically pay for. And to diagnose in a way that aligns with the DSM and insurance coding... Meanwhile taking good notes for future reference and managing their own workload... to me, at least, it sounds like a challenging profession...

Importantly too - besides just "some people suck, in _all_ professions", and the difficulty in the field itself... the problem in psychiatry, at least in the US, is in large part that money-driven forces, particularly insurance companies that determine what services they are going to pay for, and privatized healthcare companies that employ psychiatrists (especially in areas that have privatized healthcare - i.e. it's no longer a mainly government-funded service) are _businesses_ that try to push for efficiency and "results" - even though healthcare _can't be run like a business_ and mental wellbeing isn't linear and can't readily be measured on a simple scale. Combine that with what @Sour Roses said about the patients who really need the therapy being the least likely to receive it because they tend to be the most in financially distress and you have what amounts to a hot mess dysfunction in an otherwise needed and well-intended profession...


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## Mange (Jan 9, 2011)

They're making educated guesses thats all they can do.


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