, with the awareness that there may be side effects or that we may later discover that the medication has problems. It's not just psychiatry: look at Hormone Replacement Therapy and breast cancer, Vioxx and cardiac disease, Fosamax and osteonecrosis.
Rob, you've never given a child an antibiotic who maybe didn't have a bacterial infection? And what if that antibiotic (which might have been for an ear infection or a cough before a culture came back, or for a "presumed bacterial" infection, causes GI side effects, or a severe allergic reaction? I know, somehow psychiatry is different.
I have no doubt that we will look back one day and say "can you believe they did that back then.... lobotomies, insulin shock, leeches, surgery without anesthesia, thalidamide.
I continue to glad I'm not a child psychiatrist.
I guess I was under the mistaken impression that the performer of the lobotomies named his car that.
"Following his development of the icepick lobotomy, Freeman began traveling across the country visiting mental institutions in his personal van, which he called the "lobotomobile."[8"
Sorry Sara - I misunderstood!
Dinah - I agree about the potential harm of not treating in psychiatry - there are obvious reasons but many less obvious that impact quality of life, functioning, etc in more subtle ways. Outside of psychiatry, I cannot tell you how many CHILDREN have been dismissed with severe headaches because their mother must be nuts or they drink too many energy drinks. Sure, family situations and energy drinks and a whole host of other lifestyle issues can lead to a worsening of headaches and it is important to tackle these things, but to blow off seriously treating because of some of the reasons I've heard is absolutely absurd. If children get severe migraines, they can morph into chronic migraines by adulthood. If children are impaired in school because of severe headaches, they may decide against going to college. If they had aggressive treatment (even though the vast majority is off label and much of it has not yet been studied), then perhaps they'd have a shot at not ending up with lifelong severe headache issues.
In terms of adults - I've heard countless personal tales of people saying that Women Don't Get Cluster Headaches - this has been said by physicians so many times that on the cluster headache websites, we just abbreviate it to WDGCH... ;) When I first got them, I had already been suffering from New Daily Persistent Headache for almost 3 years. I was getting clusters every day at 5pm, 7pm, 9pm, 2am, 4am and they lasted 45-90 minutes. It was so awful to wake up in the throes of one that I'd stay up until the 4am one ended and then sleep for an hour or two before class. This was going on for at least a month or two when I saw my neurologist. I wasn't great at differentiating it from my regular NDPH in my description of it, but he blew me off, saying there was no reason to treat or abort these headaches. I was floored - absolutely devastated.  So I went back to school and kept up the pattern.
When I landed in the hospital over a month later, I described it again - he finally realized it might be cluster headache and had me try 15LPM of oxygen for about 15-20 min to abort - and voila - it helped! Then ramping up verapamil, frequently used for clusters, to high doses resulted in busting up the clockwork schedule. My story is more complicated than that, BUT - the point is, many people are harmed by not treating - plain and simple. Yes, there is overtreatment, but in some of these less common areas, undertreatment is much more of a problem.
I dunno, I think with things like depression the bigger problem is not lack of treatment. I think more often the problem is meds handed out too readily, but that's true of a lot of areas of medicine. I can have a bad day walk into a physician's office and come out with an antidepressant just by saying "I feel depressed." Not sure that's such a good thing.
Some of this is people looking for a quick fix to life stuff. I was not arguing that this is a universal truth. Of course sometimes meds are needed, but at this rate? I doubt it.
What we should probably focus on is the question of what, in our lifestyle and society, has made people so miserable? Because I think it's gotten worse and worse over time. People are overextended, exhausted, and the expectations keep getting higher.
I would venture a guess to say that people don't see psychiatrists (on their own - forget about the involuntary stuff for a minute) without feeling that something is wrong in the first place. I'm not even a fan of primary care docs treating migraines that require more than a monthly imitrex - and I also don't like the idea of them writing a script for an antidepressant unless they have a plan for how they are going to follow up, manage, etc or it's a specific circumstance, such as a divorce where the person hasn't been able to function, and then they can refer to a therapist.
People have choices - in the vast majority of cases, this is not forced upon them. Psychiatrists aren't just pushers - the more I listen, the more I hear of many of them that do therapy or treat in other ways besides just prescribing meds - and many of the ones I know well also believe that med use should be minimized and/or avoided if at all possible - and some of these are just finishing up training or recently did so.
All treatments have risks to some degree - I got avascular necrosis from repeated steroid doses to treat severe headaches. That sucks and resulted in another surgery (that has really pretty much fixed the problem!), but at the time, if somebody had told me there was a small risk of AVN, I would have taken the steroids anyway. Hindsight is always 20/20 when adverse events happen in those types of situations.
As one who obviously has been critical of psychiatry on this and other similar type blogs, the Walter Dully story has had nothing to do with my outrage. There are enough things going on currently in psychiatry to spark my anger.
By the way, during my time on withdrawal boards and other blogs that would be perceived as anti-psychiatry, I can't recall his story ever being mentioned. Again, people are too concerned with the present and how their lives are being effected.
I do agree with the previous commentators who feel that in many ways, things have not changed. Of course, lobotomies are no longer being performed.
But ECT is being done against people's will. Additionally, people continue to be treated with psych meds for life issues like grief and unemployment.
Someone I know who was the victim of spousal abuse was incredulously diagnosed with bipolar disorder. She was about as much BP as I am a millionaire.
At the same time, I do agree that psychiatry shouldn't be the only medical specialty singled out. Primary care doctors also wrongly prescribe alot of psych meds.
Additionally, many other drugs are way overprescribed that have dangerous side effects. Statins and the osteoporosis drugs are prime examples.
I do thank Dinah for posting this story. I was cringing big time when I even read snippets of this story so I won't be buying the book. But it is obviously a very important one.
Yes, yes, yes, and yes. All of these actions represented a violation of my oath to do no harm. What's your point?
I agree with you. I think that lobotomies are a straw man in the grand picture of what is at stake in contemporary psychiatric practice and ethics. However, I will say that Shrink Rap is truly unusual in medical "social media" in being willing to post articles that welcome open discussion of their own medical field's grim history on their blog.
It's not just psychiatry where we don't perfectly capture who should receive medication.
"Do no harm" may be a tough standard given the pressures and options we have today. If you send a kid out saying "it's likely a virus, and antibiotics have risks," and the child dies from their raging bacterial infection, then choosing not to treat was harmful. It's not that much different from choosing not to offer medications or therapy to someone who is suicidal and who then commits suicide.
The problem is that the Do No Harm dictate assumes that physicians have crystal balls.
Do no harm, is supposed to be a tough standard. Why should it be otherwise? Frankly, I'm astonished, Dinah, that you seem to suggest we abandon the standard. I sincerely hope that's not what you mean. And if if it's not, what do you mean?
Sideways, thank you.
Rob, no I'm not suggesting abandoning the standard, I'm just saying that the issues are different then when it appeared in the Hippocratic Oath. We now offer many prophylactic treatments, and we're not that clear for any individual that they are helpful---- how many men do you think have been rendered surgically impotent based on diagnoses of prostate cancer that never would have turned into a virulent illness? How many people get chemotherapy that makes them horribly ill who would have felt better and lived longer without treatment? It's a great goal, but medicine is not living up to it, and given that we study treatments on populations, I'm not sure it's attainable. The autism discussion aside, even immunizations will cause troublesome reactions in some children, and how could you have known that you would cause harm? Maybe a standard of Do No Purposeful Harm? Oh